How Is Glaucoma Treated?
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Medically reviewed by Christine L. Larsen, MDMedically reviewed by Christine L. Larsen, MD
Glaucoma is a group of eye diseases that can lead to vision loss and blindness. It is caused by damage to the optic nerve, a part of the back of the eye. It can affect anyone, but some groups may be at higher risk, including people who are older than 60, have diabetes, or have a family history of glaucoma.
There are a few types of glaucoma, but the most common is open-angle glaucoma. Open-angle glaucoma develops over time and is caused by your eye having trouble draining fluid. This can lead to increased pressure in your eye, which can damage the optic nerve.
Glaucoma has no cure, but early intervention and treatment can prevent or delay vision loss. A doctor specializing in eye health, such as an optometrist or ophthalmologist, can work with you to recommend a treatment plan, including medicine, laser treatment, or surgery.
Medications
Medication is often the first course of action for glaucoma treatment. If you have glaucoma, your eye care provider will likely prescribe eye drops. Eye drops can reduce the pressure in your eyes, preventing further damage.
Eye drops can work in one of two ways. Some drops drain the fluid in your eye to lower eye pressure. These drops include:
Prostaglandins: These homrone-like substances include Xalatan (latanoprost), Travatan Z (travoprost), Zioptan (tafluprost), and Lumigan (bimatoprost).
Rho kinase inhibitor: This protein affects cell shape and size. One example of this medication is Rhopressa (netarsudil).
Nitric oxides: Medications like Vyzulta (latanoprostene bunod) include this combination of nitrogen and oxygen.
Miotic or cholinergic agents: These medications affect neurotransmitters (chemical messengers in the nervous system) and include Isopto Carpine (pilocarpine).
Other types of eye drops reduce the production of eye fluid. These eye drops include:
Alpha-adrenergic agonists: This class of medication includes lIopidine (apraclonidine) and brimonidine (sold under brand names like Alphagan P and Qoliana).
Beta-blockers: These blood pressure-lowering medications can also help with glaucoma. They include Betoptic (betaxolol) and timolol (sold under brand names like Betimol, Istalol, and Timoptic).
Carbonic anhydrase inhibitors: This class of medication includes Trusopt (dorzolamide) and Azopt (brinzolamide).
The eye drops are used daily. Depending on which kind your doctor prescribes, you may need to use them up to four times daily.
Eye drops will not improve your glaucoma, but they will prevent further damage. Therefore, it’s important to continue using them as prescribed to maintain your eye health.
Laser Treatment
Depending on the type of glaucoma you have, your eye care specialist may recommend laser treatment. Like prescription eye drops, laser treatment can help drain your eye fluid and reduce pressure. During the treatment, your doctor will numb your eyes using eye drops and direct a laser, or light beam, into your eyes.
Your eye care provider can perform laser treatment in their office. They may do both eyes on the same day or do the eyes a few weeks apart. Your eyes will be blurry afterward, so arranging a ride home from the doctor’s office is important. Otherwise, you can likely resume normal activities the following day.
After treatment, you may need to continue using prescription eye drops. It’s possible that the effect of the laser treatment can wear off, so you may need subsequent treatment or surgery depending on how well the laser treatment works for your glaucoma.
Surgery
Your eye care provider will likely only recommend surgery for your glaucoma if eye drops and laser treatment are ineffective or not well-tolerated. As with other glaucoma treatments, surgery can’t improve your vision but can prevent further vision loss.
Your eye care provider would likely do surgery on one eye at a time, with recovery lasting about 2-4 weeks. You will need to use eye drops (different from your glaucoma treatment eye drops) to help your eyes heal. Many people find that surgery is effective long-term, while some need a second surgery.
Trabeculectomy
Trabeculectomy is used for open-angle glaucoma and only takes about one hour in the hospital. During this surgery, the doctor makes a small opening under your eyelid to allow eye fluid to drain.
Rather than general anesthesia, they will most likely give you medicine to numb the area and reduce any stress. While you probably won't need to stay over in the hospital, you will need someone to take you home.
Glaucoma Implant Surgery
Glaucoma implant surgery can be used for multiple kinds of glaucoma, including glaucoma that's present at birth (congenital glaucoma) and glaucoma caused by an injury. Neovascular glaucoma, which is when new blood vessels form over the iris and anterior chamber angle (the part of the eye located between the cornea and iris), is another type of glaucoma that can benefit from glaucoma implant surgery.
The surgery only takes about one to two hours in the hospital. For glaucoma implant surgery, the doctor will put a tiny tube into your eye to help drain fluid. You would likely be awake for the surgery but receive medication so that you don't feel any discomfort and so that you stay relaxed.
You probably don't need to stay overnight at the hospital, but you will need to get a ride home.
Minimally Invasive Glaucoma Surgery (MIGS)
For milder glaucoma cases, minimally invasive glaucoma surgery (MIGS) can be used. MIGS refers to a group of new surgeries that use one of several kinds of new stents or filtration devices in your eye to reduce eye fluid.
MIGS reduces recovery time and decreases side effects compared to trabeculectomy and glaucoma implant surgery. However, the reduction in eye pressure with MIGS may not be substantial. Talk with your healthcare provider about the MIGS approach they will use and its effect on your glaucoma.
Medicated Implant
The newest glaucoma therapy is a medication placed inside the eye for long-term treatment. Durysta (bimatoprost SR) was approved by the U.S. Food and Drug Administration in 2020 and iDose TR in 2023, but several other sustained-release drug delivery systems are in development or under review.
For Durysta, a healthcare provider at a clinic or operating room inserts a medication-filled implant into your eye. The drug is steadily released over a span of 3-4 months to manage eye pressure. Since the implant is biodegradable, it does not need to be removed when all the medication has been released.
The iDose is an implantable reservoir inserted into the eye through an incision in the cornea.
Sustained-release glaucoma therapies are thought to be more efficient than eye drops since you don't have to remember to administer medication each day. This treatment type might increase in popularity in the coming years as more treatment options become available and more research is done on them.
Living With and Managing Glaucoma
If you’re diagnosed with glaucoma, it’s important to stay on top of treatment to reduce your chances of further vision loss. Glaucoma typically affects your peripheral vision (what you see to the side while looking forward) first. Without proper treatment, glaucoma may be more likely to eventually affect your central vision (what you see when looking forward).
Your eye doctor can work with you to choose the best treatment methods and then check in with you to see if they’re working. They may check your eye pressure to identify any changes quickly and prevent further damage.
In addition, healthful lifestyle choices can help reduce the impact of glaucoma on your vision. Talk with your healthcare provider about your weight and blood pressure, which can contribute to glaucoma. You should also avoid smoking (or consider quitting if you currently smoke) and aim to be physically active several days a week.
A Quick Review
Glaucoma is a common eye condition that affects millions of Americans. Damage to your optic nerve can gradually lead to vision loss and potentially blindness. There is no cure for glaucoma. Instead, treatment focuses on preventing or delaying further vision loss.
Treatment usually begins with medicated eye drops. Laser therapy and surgery may also be needed. If you’re diagnosed with glaucoma, it’s important to work with your eye doctor to reduce your chances of further vision damage.
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