Treatment options for Glaucoma

In any case of glaucoma, ophthalmologists are not able to "cure” its etiologic cause, as an antibiotic kills bacteria. In some patients, medication and/or surgery effectively halts glaucoma’s advance. More often, physicians treat the disease and slow the progression of optic-nerve damage and visual-field loss.

Several treatment options exist to alleviate eye fluid pressure. Different medications, administered as eye drops, can reduce the eye’s production of fluid or improve fluid outflow by inhibiting enzymes, targeting the eye’s light-absorbing receptors, or other means. Prostaglandins, one class of medications, are a common first treatment. Medications can be tailored to patients’ wishes in consideration of potential side effects. (Every medication has potential side effects.) Most patients can be treated with medications, although many will require more than one medication to achieve the desired decrease in eye pressure.

For patients whose conditions don’t respond to medication, ophthalmologists can perform outpatient laser procedures or other surgery to treat the condition. Surgery is recommended as a first course of treatment for some patients, particularly in closed-angle cases.
Surgery can improve access to the trabecular meshwork (peripheral iridotomy or iridoplasty) or to improve its function (laser trabeculoplasty). An alternate procedure is a trabeculectomy, in which an incision is made on the iris, akin to letting wind out of a sail, which can open the angle. In some cases, a glaucoma drainage device, consisting of a plastic tube that drains eye fluid to the back of the eye, must be implanted to lower eye pressure. Often cataracts occur in people who have glaucoma, and these can be removed surgically, if appropriate.

In patients with closed-angle glaucoma, physicians can more readily aim at glaucoma’s mechanism. For these patients, and particularly in acute cases, laser surgery often has lasting benefits. However, most patients still can develop chronic closed-angle glaucoma. Continued monitoring can help ensure that the eye pressure is not becoming elevated. Some patients might need medication to augment surgery and afford them the best maintenance of sight.

The majority of glaucoma cases are open-angle, whose cause is still under investigation. Among open-angle patients, results of laser surgery such as trabeculoplasty can vary and usually are not permanent. About 60 percent of those patients who have laser surgery get about two years of beneficial effect, with about 10 percent per year losing benefit after that. Subsequent repeated laser procedures generally have less or no benefit for patients with open-angle glaucoma.

As of March 2008, the National Eye Institute (NEI) supported 244 glaucoma studies at a cost of approximately $60 million. Among therapies being developed, neuroprotection is seen as an area of potential benefit to glaucoma patients. NEI-supported investigators recently used gene transfer therapy in model rodents to provide a continual supply of an essential neurotrophic factor to the optic nerve, and reported significant improvement in the survival of retinal ganglion cells, which make up the optic nerve. However it may take years or even decades before such advances can be brought to bear on human glaucoma.