Glaucoma treatments: drugs, laser treatment and surgical procedures. What they are, when they are used and how to ensure maximum effectiveness

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A lecture by the IMO’s glaucoma specialist, Dr Elena Arrondo, on administering topical glaucoma medication, when to use laser treatment or different types of surgery and how the different techniques must suit each patient to ensure the best results.

How should treatment with drugs be administered to ensure effectiveness?

It is very important to strictly follow the ophthalmologist’s recommendations on when to take the drug and how to administer it:

  1. Wash your hands
  2. Shake the bottle well, especially if the drug is in suspension form
  3. Hold the bottle upside down so that the drop falls into position
  4. Hold the bottle as close to your eye as possible, without touching it
  5. Pull down your lower eyelid and apply the drop to your eye
  6. Press the corner of your eye or close your eyes
  7. Wait at least 5 minutes before applying the next drop. Otherwise, the effect will be lost.

Why is laser treatment not used in all glaucoma cases?

YAG laser iridotomy is used to prevent acute angle-closure glaucoma, and argon laser trabeculoplasty is a treatment for open-angle glaucoma if eye drops do not work or cause allergies. The problem with laser treatment is that it is only effective in some patients, and for a limited time of two to three years, after which time many patients also need surgery.

When is glaucoma surgery performed?

It is performed when eye drops and laser treatment have not been sufficiently effective in reducing intraocular pressure. The surgical procedure involves a new opening being made to allow aqueous humour outflow from the eye. This type of surgery is performed on an outpatient basis in an operating theatre and only the eye is anaesthetised

What types of surgery are performed to treat glaucoma?

"As some surgical treatments work better than others depending on the type of glaucoma, it is important to closely monitor each patient and choose the best option for that patient", Dr. Arrondo - IMO Barcelona

There are different types of operations depending on the case and type of patient. As some surgical treatments work better than others depending on the type of glaucoma, it is important to closely monitor each patient and choose the best option for that patient. Some patients react differently depending on their healing capacity. Influencing factors include whether the patient has previously suffered from an eye disorder or has undergone surgery in the past. In the most complex cases, over time, it is usual for patients to have to undergo second or third operations.

Trabeculectomy is the classic surgical procedure for glaucoma and still the number one choice for many ophthalmologists today. It does, however, have a certain risk of complication compared to deep non-penetrating sclerectomy, which is more comfortable for the patient as the postoperative period is easier and recovery faster. Trabeculectomy involves removing part of the eye’s tissue to create a new channel to drain the aqueous humour, while sclerectomy creates a very thin membrane that enables the aqueous humour to drain away in a more controlled manner and with fewer complications.

For patients with closed angles who suffer from cataracts and glaucoma, cataract and glaucoma surgery can be performed at the same time to preclude the need for the patient to go into theatre twice. In patients with diabetes or neovascular glaucoma, for which surgery has a very poor prognosis, the implantation of drainage valves is usually the best option. These valves consist of a silicone tube that connects the interior and exterior of the eye, enabling the aqueous humour to drain away. It is only used in severe cases in which previous interventions have not worked or, for example, the patient has already had a retinal detachment. In these cases, the valves provide better results than conventional surgery because the structures of the eye are already extensively damaged. In cases where vision is very low and the aim is to primarily reduce discomfort and intraocular pressure, without any hope of improving vision, diode laser treatment is often used. It is also used in cases where the conjunctiva or another part of the eye is highly deteriorated and no other treatment is possible.

Do any of these treatments cure glaucoma?

Glaucoma cannot be cured, but early detection and monitoring of suitable treatment can help preserve vision. Lowering intraocular pressure in the early stages of the disease is key. If left untreated or not properly treated, glaucoma can result in blindness.

Are certain people more prone to suffering from glaucoma?

People who have direct family members who suffer from the disorder have a higher risk of being predisposed to it, as have black people over the age of 40, the over 60s, people with high IOP, sufferers of retinal disorders such as high myopia and retinal detachment and those with transplanted corneas.

Is it possible to find out my particular risk of developing the disease?

Some genetic disorders that cause a predisposition to the development of glaucoma have been identified. IMO’s Genetics Department performs genetic testing of blood samples to detect for any of these genetic abnormalities and facilitate early detection of glaucoma and preventative treatment.

What can I do to preserve my vision?

The key to glaucoma is prevention: go to an ophthalmologist before the age of 40 to check for glaucoma and ocular hypertension, and strictly follow any recommendations if you are undergoing treatment.

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