How is glaucoma
treated in the UK
At the hospital appointment, as part of your assessment, the ophthalmologist will examine the front of your eye. As sometimes a build-up of fluid is the cause of high pressure in your eye, they will assess how well that fluid can drain from your eye. They will also look for debris which might block the drainage, and will measure the pressure inside your eye using a small probe which painlessly rests on the surface if your eye. What’s more, they may get a member of their team to assess your visual fields again, by asking you to identify small flashes of light on a screen.
What are my treatment options?
After your appointment, the ophthalmologist will recommend treatment depending on what type of glaucoma you have. The most common type of glaucoma is called primary open-angle glaucoma, and is usually treated with eye drops. There are several different types of eye drops, however, and they all aim to reduce the pressure in your eyes. You may be told to use the drops one to four times a day, depending on the type of drop you’re given. It’s important to remember that eye drops can cause side effects and irritation — so talk to your ophthalmologist if you’re worried about how these may affect you.
You may not notice any change in your eyes when using the drops, but either way you need to continue to use the drops as recommended. When you return for a follow-up visit, the ophthalmologist will assess your eye pressure and visual fields to see if the drops are working. If one type of eye drop isn’t effective, then you can try a different type. You may ultimately be offered the option of laser treatment or surgery if the eye drops aren’t at all effective for you.
If you are prescribed eye drops and are having difficulties using them, talk to the nurse at the eye clinic, and they can help you learn how to insert eye drops and even provide you with devices to make it easier. Remember, if you are given eye drops to lower the pressure in your eye you will need to use them on an ongoing basis. If you stop using them the pressure can rise and you may start to lose sight without even being aware of it.
Another option your ophthalmologist might discuss with you is surgery. This is commonly used to improve the drainage of the fluid from the eye, and there are a number of different ways it can be done.
Laser treatment is one type of surgery that your ophthalmologist may suggest if eye drops are ineffective at reducing pressure and curtailing nerve damage. It’s also an option if you have serious problems inserting eye drops which can’t be solved. In laser treatment, a very tiny high energy beam of light is used to improve drainage inside your eye. Laser trabeculoplasty is a form of laser surgery that uses a laser to open up the drainage tissue within your eye. Alternatively, the laser can be used to destroy some of the eye tissue that produces the liquid, which can reduce pressure in the eye. This is known as cyclodiode laser treatment. A laser can also be is used to create tiny holes in your iris to allow fluid to drain from your eye, known as laser iridotomy.
Laser treatment is generally carried out under local anaesthetic, though you may feel some discomfort or heat during the treatment. You may be given eye drops to use after treatment either in the short term or on an ongoing basis, and you will need to return to an eye specialist for monitoring of your eyesight, fields, and pressures.
Some people who don’t respond to eye drops and for whom laser treatment isn’t suitable or successful may be offered something called a trabeculectomy. This surgery can be done under local or general anaesthetic and aims to lower the eye pressure. This is achieved by making a small hole in the tough outer wall of the eye (sclera), which is covered by a thin ‘trap-door’ of eye tissue. The fluid inside the eye drains through the trap-door to a small reservoir (bleb) just under the eye surface, hidden by the eyelid. The trap-door is then stitched carefully to ensure the fluid drains from the eye at the optimum level. It shouldn’t cause a lot of pain after surgery, although your eye may water and be a bit red. For most people, though, surgery will mean that you no longer need to use eye drops to reduce the pressure in your eye.
It’s important to ask your ophthalmologist to talk through your options for treatment as this will depend on you and your eye health. Glaucoma is not generally something that can be cured, though some treatments, such as laser treatment or surgery aim to permanently lower the pressure inside your eyes by improving the drainage. This, unfortunately, will not restore any vision which has already been lost, but aims to maintain your vision at the same level. You will, however, still need regular checks in case the pressure rises again.
Future treatment options
There are new treatments in the pipeline for glaucoma. These include a tiny stainless-steel device which allows fluid to drain out of the eye, a little probe which travels through a tiny incision and uses thermal energy to improve drainage, and a treatment called canaloplasty which uses an extremely fine catheter to enlarge the eye’s natural drainage canal and relieve pressure inside the eyes. The benefits of all these treatments include the fact that they are minimally invasive, reducing pain and minimising side effects.
Researchers are also looking at new ways to combine eye drops to make them work better and easier to take. In the longer term, research is being done into treating brain and nerve tissue to help it regenerate, as well as investigating how stem cells can help protect the optic nerve.