Glaucoma Treatment - Diagnosis, Surgery & Recovery

What Are The Various Treatment Options For Glaucoma?

There are both surgical and non-surgical methods for glaucoma treatment. Let’s explore the glaucoma treatment options:

Surgical treatment

There are several surgical options available for the treatment of glaucoma. Surgical interventions seek to lower intraocular pressure (IOP) and prevent further damage to the optic nerve. Here are some surgical options for glaucoma:

1. Trabeculectomy: This surgery is majorly used for open-angle glaucoma. A trabeculectomy is a major procedure and takes around an hour or less to complete. It is performed under local or general anesthesia. During the procedure, the surgeon begins by numbing the area or administering general anesthesia. They’ll then create an incision in the top of the eye beneath the eyelid to form a channel (bleb) to drain the excess fluid. They’ll then put stitches to hold open the bleb.
2. Glaucoma implant surgery: Glaucoma implant surgery, also known as a tube shunt, may be advised if you have neovascular or congenital glaucoma, though it may also be an option for individuals with other types of glaucoma. In this type of surgery, certain devices are implanted to provide an alternative pathway for the drainage of aqueous humor. A small tube is placed in the eye to allow excess fluid to drain into a reservoir (or plate) found under the conjunctiva (the membrane covering the white part of the eye). This procedure can take 1 to 2 hours approximately. The tube implants decrease pressure in the eye by allowing extra fluid to drain. It is generally done on an outpatient basis with a local anesthetic. 
3. Minimally invasive glaucoma surgery (MIGS): MIGS utilizes micro-incisions and microscopic-sized equipment to reduce pressure in the eye. This surgery takes less time to complete — often just minutes — and has a quicker recovery rate than other types of glaucoma procedures. Type of MIGS include:

• Trabectome: This procedure uses an electrocautery device to remove a portion of the trabecular meshwork, facilitating drainage.
• Ab-interno canaloplasty (ABiC): This procedure involves making a microscopic incision into the drainage tissue and inserting a catheter within the drainage canal. The catheter is then withdrawn while injecting an expansive and clear substance (viscoelastic) throughout the drainage system. By breaking down blockages within the drainage system, fluid drainage is enhanced, and the IOP is improved. 
• Suprachoroidal shunts: In this procedure, small tubes are placed to connect the front of the eye to the suprachoroidal space to support fluid draining from the eye. With minimal serious complications, this procedure effectively lowers eye pressure in severe cases of glaucoma.

1. Laser trabeculoplasty: Laser trabeculoplasty uses lasers to reduce eye pressure by targeting the blockage in the eye’s natural drainage system, also called the trabecular meshwork. This laser treatment is majorly used for the treatment of open-angle glaucoma. Though this laser treatment can successfully manage eye pressure for many individuals with glaucoma, it isn’t suitable for all types of glaucoma, including closed-angle glaucoma.
2. Cyclophotocoagulation (CPC): Cyclophotocoagulation is a laser treatment for glaucoma and works by decreasing both pressure and fluid production in the eye. CPC targets the eye’s ciliary processes, meaning the methods through which the fluid is produced. You’ll remain awake during CPC. A local anesthetic is utilized to numb the eye, and the procedure will only take a few minutes.

Laser peripheral iridotomy (LPI): In this procedure, the surgeon makes a small hole in the outer edge of the iris to open the angle in the eye so that fluid can drain through the meshwork. LPI can also be used in individuals with a closed angle and are deemed high risk for glaucoma, even if they still have normal eye pressure

Non Surgical Treatment For Glaucoma

Recovery after glaucoma surgery is usually pain-free and simple. Most of the post-surgery recovery depends on the procedure and your expectations from the recovery period.

It is common for the patient to experience blurry vision in the operated eye immediately after the surgery. Other temporary side effects after glaucoma surgery are:

• redness, swelling and irritation in the eye
• a feeling that something is stuck in the eye

These side effects are not major and are likely to subside with medications and eye drops. Most people who have glaucoma surgery do not experience significant pain. If you feel pain in the eye, however, you should consult your eye doctor about the best options to relieve it.

Recovery from glaucoma surgery depends from person to person. Visual recovery in the case of minimally invasive surgeries is very short. Typically, the recovery time may range between a few days to a week. Most people can resume daily activities such as reading, watching TV or using phones, computers or other electronic devices within the first few days following surgery. Eye protection (a shield or glasses) prevents bumping or rubbing the eye for the first few days after the surgery.

Avoid the following for a couple of days after glaucoma surgery:

• Bending, straining, or lifting
• Exercises such as running, or lifting heavy weights
• Taking a bath in hot tubs or diving into a swimming pool
• Wearing eye makeup or face cream
• Wearing reusable contact lenses

How To Prepare For Glaucoma Surgery?

Here are some ways to help you prepare for your glaucoma operation:

• Fasting: Depending on the type of glaucoma surgery and anesthesia, you might be required to fast for a certain duration before the procedure. Follow the fasting instructions provided by your doctor.
• Follow the treatment plan: Stick to your doctor’s prescribed medications, eye drops, or other treatments to manage eye pressure.
• Clothing: Wear comfortable, loose-fitting clothing on the day of surgery. Avoid wearing makeup or contact lenses, as they might need to be removed before the procedure.
• Avoid smoking and alcohol: It’s advisable to refrain from smoking and alcohol consumption before and after surgery, as they can affect healing.
• Lifestyle choices: Maintain a healthy lifestyle with a balanced diet, exercise, and proper hydration.
• Medications: Inform your doctor about all the medications you are currently taking, including prescription drugs, over-the-counter medications, and supplements. They will guide you on which medications to continue or stop before operation.
• Monitor eye pressure: If advised by your doctor, regularly check your eye pressure at home using a portable tonometer.
• Protect your eyes: Cover your eyes from the sun’s UV rays by wearing sunglasses. Wear protective eyewear during activities that pose a risk of eye injury.
• Manage health conditions: Control underlying health conditions like diabetes and hypertension, as they can contribute to glaucoma progression.
• Sleep position: Avoid sleeping with your head in positions that might raise eye pressure, such as sleeping on your stomach.
• Avoid overuse of eye drops: Follow your doctor’s instructions for using eye drops. Overusing them can lead to reduced effectiveness of the procedure.

Arrange transportation: Since you might have limited vision immediately after surgery, arrange for someone to drive you to and from the healthcare facility.

What Are The Benefits Of Glaucoma Operation?

Some benefits of glaucoma operation include:

• Reduced eye pressure: Glaucoma surgery aims to reduce intraocular pressure, which is a huge factor that leads to glaucoma progression. By reducing eye pressure, the surgery can help prevent further damage to the optic nerve and preserve vision.
• Reduced reliance on medicines: For some people, glaucoma operation can decrease or eliminate the need for numerous daily eye drop medications, making daily life easier.
• Long-term control: Successful glaucoma surgery can provide long-lasting pressure control, reducing the risk of future vision loss and the need for ongoing adjustments to treatment plans.
• Preserving vision: By effectively controlling intraocular pressure, glaucoma surgery can slow down the disease’s progression, helping preserve your remaining vision.
• Improvement in quality of life: Glaucoma can improve visual function and quality of life, allowing you to engage in day-to-day activities with greater ease and confidence.
• Reduced side effects: Glaucoma medications can occasionally have side effects. Surgery can help lower the need for medications, potentially minimizing these side effects.
• Stability in eye pressure: Successful surgery can lead to more uniform and stable intraocular pressure, reducing the fluctuations contributing to glaucoma progression.
• Enhanced peripheral vision: By regulating intraocular pressure, glaucoma operation can help enhance peripheral vision.

What Are The Recovery Tips To Follow After Glaucoma Surgery?

After glaucoma surgery, following post-operative care is essential for a successful recovery. Here are some post-operative tips to follow after glaucoma surgery:

• Use prescribed eye drops: Your doctor will prescribe eye drops to prevent infection, decrease inflammation, and manage eye pressure. Use these drops exactly as directed by the doctor.
• Wear an eye shield: If your doctor recommends it, wear the eye shield provided to save your eye from accidental rubbing or contact. Follow their instructions on when and how to use it.
• Avoid touching or rubbing: Abstain from touching or rubbing the operated eye. This can prevent irritation and minimize the risk of infection.
• Protect your eye: Avoid activities that could expose your eye to dust, dirt, wind, or other potential irritants. If advised by your doctor, wear sunglasses when outdoors.
• Limit physical activities: For a certain duration, your doctor might suggest you avoid strenuous physical activities and heavy lifting. This helps prevent stress on your eye during the initial recovery phase.
• Hygiene: Keep the area around your eye clean. Use a clean, damp cloth to gently clean your eyelids and eyelashes.
• Avoid eye makeup: Abstain from using eye makeup for the first few weeks after surgery to prevent irritation or contamination.
• Avoid driving: Depending on your doctor’s recommendation and your vision clarity, you might need to avoid driving for a certain period after surgery.
• Stay hydrated: Drink plenty of water to stay hydrated, as this can help in your body’s healing process.
• Sleeping position: If your doctor advises, sleep with your head slightly elevated to reduce inflammation. Avoid sleeping on the side of the operated eye.
• Follow dietary restrictions: If your doctor advises any dietary restrictions, such as avoiding certain foods or beverages, follow them diligently to ensure proper healing.
• Attend follow-up appointments: Attend all scheduled follow-up appointments with your doctor. These visits are crucial for monitoring your progress and adjusting your recovery plan.
• Report abnormal symptoms: If you experience increased pain, redness, swelling, changes in vision, or any other unusual symptoms, contact your doctor instantly.
• Rest and relaxation: During the recovery process, it’s vital to take your time to relax and allow the eye to heal.

It’s important to note that recovery can differ based on the type of glaucoma surgery you underwent. Always follow your doctor’s post-operative instructions and don’t hesitate to reach out if you have any queries or concerns. 

What Are The Risk & Complications Associated With Glaucoma Surgery?

Glaucoma surgery, like any surgery, carries risks and complications. Here are some possible complications that can occur after glaucoma surgery:

• Vision loss: Glaucoma surgery can disrupt your vision. However, vision loss is not a permanent side effect. Therefore, it is more likely that surgery will benefit your vision in the long run.
• Infection: Doctors give antibiotics before, during, and after the surgery to avoid infection. However, on rare occasions, infection inside the eye may occur, which can be very serious and may threaten vision. Infections can occur weeks, months, or even years after the surgery. Therefore, even if it is years after the surgery, if you have early signs of infection such as redness, pain, or excessive tearing, you should consult your ophthalmologist immediately to treat the infection before it becomes serious. 
• Inflammation: Inflammation inside the eye, known as anterior chamber inflammation, can occur after surgery. This might need additional medication to control.
• Elevated or low eye pressure: Glaucoma surgery aims to regulate eye pressure, but in some cases, the pressure might become too high or too low. This condition is known as hypotony. With hypotony, fluid may accumulate behind the retina (choroidal detachment), which can cause a shadow in your peripheral or side vision. Usually, this is temporary as the pressure returns to the intended levels. Sometimes, however, hypotony persists, and surgery must be performed to fix this problem.
• Bleeding: Some postoperative bleeding or subconjunctival hemorrhage might occur, causing redness in the eye. Severe bleeding can lead to complications.
• Cyst formation: Fluid-filled cysts can form on the conjunctiva, which might need to be addressed if they cause discomfort or impact vision.
• Scarring: In some cases, the opening created during surgery might close or scar over time, affecting the procedure’s success.

If you’re considering glaucoma operation, discuss potential risks and complications with your eye surgeon, and make sure to follow their post-operative instructions diligently.

What Happens If Glaucoma Is Left Untreated?

If left untreated, glaucoma can lead to progressive and irreversible damage to the optic nerve. Over time, untreated glaucoma can result in vision loss and even blindness. Here are some potential consequences of untreated glaucoma:

• Peripheral vision loss: Glaucoma initially impacts peripheral vision. As the disease advances, people may develop blind spots or experience tunnel vision, where only a tiny portion of their visual field remains intact.
• Central vision loss: If left untreated, glaucoma can also impact central vision, which is crucial for activities such as reading, driving, and recognizing faces.
• Permanent vision damage: The damage caused by glaucoma is irreversible. Once vision is lost due to glaucoma, it cannot be restored through medication, surgery, or any other means.
• Blindness: In progressive stages, untreated glaucoma can lead to complete blindness. This can greatly impact an individual’s quality of life and independence.
• Decreased quality of life: Vision loss due to glaucoma eye disease can restrict an individual’s ability to perform everyday activities, affect their mobility, and lead to social isolation and depression.
• Impact on safety: Glaucoma-related vision loss can increase the risk of accidents, falls, and injuries.

What Is The Glaucoma Surgery Cost In India?

Various factors can impact the cost of surgery. Some factors that affect the glaucoma surgery cost in India include the following:

• Type of surgery: Different types of glaucoma surgeries are available, including trabeculectomy, tube shunt implantation, laser procedures, and minimally invasive glaucoma surgery (MIGS) techniques. The complexity and type of surgery can significantly impact the cost of glaucoma surgery in India.
• Location: The cost of medical procedures can differ based on the healthcare facility’s location. Therefore, glaucoma surgery costs can vary according to the location of the hospital/clinic. 
• Type of healthcare facility: The type of healthcare facility where the surgery is performed can influence the cost. Private hospitals and specialized eye clinics may have different pricing structures.
• Surgeon’s experience: Surgeons with extensive experience and a high reputation in the field may charge more for their services. 
• Amenities of the healthcare facility: The facilities and amenities offered by the healthcare facility, such as private rooms, state-of-the-art equipment, and post-operative care services, can affect the overall glaucoma surgery cost in India.
• Pre-operative assessments: Diagnostic tests and assessments conducted before the glaucoma surgery, such as imaging scans, visual field tests, and other evaluations, can add to the total cost of surgery.
• Anesthesia: The type of anesthesia used during the surgery, whether local or general anesthesia, can impact the glaucoma surgery cost in India.
• Medications: The cost of medications prescribed before and after surgery, including eye drops and pain relievers, can also contribute to the overall cost.
• Follow-up visits: Post-operative follow-up visits with the surgeon might be included in the overall cost of surgery. The number of follow-up visits needed can affect the overall expense.
• Insurance coverage: The extent of insurance coverage for glaucoma surgery varies. Some procedures might be covered partially or fully by insurance, while others may not be covered at all.
• Technology and equipment: The use of cutting-edge technology and equipment, such as laser devices or specialized surgical tools, can affect the overall cost of the procedure.