How your glaucoma is treated will depend on your specific type of glaucoma, the severity of your disease and how well it responds to treatment.
Glaucoma damage is permanent—it cannot be reversed. But medicine and surgery help to stop further damage. To treat glaucoma, your ophthalmologist may use one or more of the following treatments.
Medicated eye drops are the most common way to treat glaucoma. These medications lower your eye pressure in one of two ways — either by reducing the amount of fluid created in the eye or by helping this fluid flow out of the eye through the drainage angle.
These eyedrops must be taken every day. Just like any other medication, it is important to take your eyedrops regularly as prescribed by your ophthalmologist.
Once you are taking medications for glaucoma, your ophthalmologist will want to see you regularly. You can expect to visit your ophthalmologist about every 3–6 months. However, this can vary depending on your treatment needs.
If you have any questions about your eyes or your treatment, talk to your ophthalmologist.
Possible Glaucoma Medication Side-effects
Glaucoma medications can help you keep your vision, but they may also produce side effects. Some eye drops may cause:
- a stinging or itching sensation;
- red eyes or red skin around the eyes;
- changes in your pulse and heartbeat;
- changes in your energy level;
- changes in breathing (especially if you have;
- asthma or breathing problems);
- dry mouth;
- blurred vision;
- eyelash growth; or,
- changes in your eye color, the skin around your eyes or eyelid appearance.
Never change or stop taking your medications without talking with your doctor. If you are about to run out of your medication, ask your doctor if you should have it refilled.
If you have glaucoma, it is important to tell your ophthalmologist about your other medical conditions and all other medications you currently take. Bring a list of your medications with you to your eye appointment. Also tell your primary care doctor and any other doctors caring for you what glaucoma medication you take.
In some patients with glaucoma, surgery is recommended. Glaucoma surgery improves the flow of fluid out of the eye, resulting in lower eye pressure.
A surgery called laser trabeculoplasty is often used to treat open-angle glaucoma. There are two types of trabeculoplasty surgery: argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT).
During ALT surgery, a laser makes tiny, evenly spaced burns in the trabecular meshwork. The laser does not create new drainage holes, but rather stimulates the drain to work better.
SLT uses a newer, lower-energy laser which only treats specific cells in the drainage angle. SLT and ALT are equally good at lowering eye pressure.
Even if laser trabeculoplasty is successful, most patients continue taking glaucoma medications after surgery. For many, this surgery is not a permanent solution. Nearly half of the people who receive this surgery develop increased eye pressure again within five years. Many people who have had a successful laser trabeculoplasty will need more treatment in the future. This treatment may be another laser, more medication or surgery.
Laser trabeculoplasty can also be used as a first line of treatment for patients who are unwilling or unable to use glaucoma eye drops.
Laser iridotomy is recommended for treating people with closed-angle glaucoma and those with very narrow drainage angles. A laser creates a small hole about the size of a pinhead through the iris to improve the flow of aqueous fluid to the drainage angle.
When laser iridotomy is unable to stop an acute closed-angle glaucoma attack, or is not possible for other reasons, a peripheral iridectomy may be performed. This is performed in an operating room. A small piece of the iris is removed, giving the aqueous fluid access to the drainage angle again. Because most cases of closed-angle glaucoma can be treated with glaucoma medications and laser iridotomy, peripheral iridectomy is rarely necessary.
In trabeculectomy, a small flap is made in the sclera (the outer white coating of your eye). A filtration bleb, or reservoir, is created under the conjunctiva — the thin, filmy membrane that covers the white part of your eye. Once created, the bleb looks like a bump or blister on the white part of the eye above the iris, but the upper eyelid usually covers it. The aqueous humor can now drain through the flap made in the sclera and collect in the bleb, where the fluid will be absorbed into blood vessels around the eye.
Eye pressure is effectively controlled in three out of four people who have trabeculectomy. Although regular follow-up visits with your doctor are still necessary, many patients no longer need to use eye drops. If the new drainage channel closes or too much fluid begins to drain from the eye, additional surgery may be needed.
Aqueous shunt surgery
If trabeculectomy cannot be performed, aqueous shunt surgery is usually successful in lowering eye pressure.
An aqueous shunt, or glaucoma drainage device, is a small plastic tube or valve connected to a reservoir (a roundish or oval plate). The plate is placed on the outside of the eye beneath the conjunctiva (the thin membrane that covers the inside of your eyelids and the white part of your eye). The tube is placed into the eye through a tiny incision and allows aqueous humor to flow through the tube to the plate. The fluid is then absorbed into the blood vessels. When healed, the reservoir is not easily seen unless you look downward and lift your eyelid.
Important things to remember about glaucoma treatment
There are a number of ways to treat glaucoma. While some people may experience side effects from glaucoma medications or glaucoma surgery, the risks of side effects should always be balanced with the greater risk of leaving glaucoma untreated and losing vision.
If you have glaucoma, preserving your vision requires strong teamwork between you and your doctor. Your doctor can prescribe treatment, but it’s important to do your part by following your treatment plan closely. Be sure to take your medications as prescribed and see your ophthalmologist regularly.
Does marijuana help treat glaucoma?
The main objective in treating glaucoma is to lower intraocular pressure (or "IOP") in the eye. A lower IOP can reduce damage to the optic nerve and save your remaining vision. Marijuana has been proven to lower IOP but only for a short period of time and at considerable risk to your overall health.
When marijuana is smoked or when the active ingredient is ingested in some other manner, the pressure-lowering effect within the eye can last from 3 to 4 hours. This period of time is too short, as glaucoma needs to be treated 24 hours a day. Additional drawbacks include the impaired functioning that results from smoking marijuana and the potential harmful effects of prolonged use.
The Academy does not recommend marijuana as a treatment for glaucoma. Considering the more effective treatments available to patients—from prescription medication to surgical procedures—the risks and side-effects of marijuana treatment far outweigh its modest short-term benefits, which do not properly control IOP.
Additional resources for glaucoma information
American Academy of Ophthalmology Preferred Practice Pattern: Primary Open-Angle Glaucoma Suspect (Oct 2013)
American Academy of Ophthalmology Preferred Practice Pattern: Primary Open-Angle Glaucoma (Oct 2013)
American Academy of Ophthalmology Preferred Practice Pattern: Primary Angle Closure (Oct 2013)