Glaucoma treatments and medication options

Glaucoma is one of the leading causes of sight loss in the UK. The RNIB estimates that approximately 718,000 people are living with the condition. Glaucoma can lead to irreversible damage, but with proper treatment and regular checkups, you can slow down or even prevent vision loss, particularly if the disease is detected early on.

The primary approach to treating glaucoma involves reducing intraocular pressure (IOP), and there are various options available, including prescription eye drops, oral medications, laser treatment, surgery, or a combination of these methods.

This can seem a little confusing and overwhelming for those new to glaucoma, so we’ve written an article to educate people on what treatments and medications are available and the difference between them. We always suggest that if you have any questions about what medication or treatment is right for you, speak to your ophthalmologist.

Prescription Eye Drops

Prescription eye drops are often the initial treatment choice for glaucoma. They work by either improving the drainage of fluid from the eye or reducing the production of fluid. Depending on your specific needs, you may be prescribed multiple eye drops. There are a few that may be recommended to you. The names of them can be perplexing. All eye drops have a generic name associated with the active ingredient, and some also have a trade name. Certain drops are recognized by their brand name, which is chosen by the drug-developing company. Here are a few of the commonly prescribed:

Some patients who are new to eye drops occasionally have difficulty using them, for tips on this, you can read our eye drops blog

Once you have been prescribed eye drops, it is important to see your consultant ophthalmologist at least once per year, at these meetings they will review your condition and discuss how you’re finding your medication. If they feel you’d benefit from switching eye drops to help treat your glaucoma, they will recommend it at this point.

OcuPlan partner with over 100 consultant ophthalmologists all over the UK and we ensure that all our patients are seen frequently enough. To learn more and find your local ophthalmologist, click here.

Laser Glaucoma Treatments

If your consultant ophthalmologist feels that eye drops aren't benefiting your condition, they may recommend laser treatment, there are a few options that your consultant will talk you through:

SLT and ALT are both used to manage open-angle glaucoma or ocular hypertension. These procedures involve the use of laser technology to target the eye's drainage channel, opening it up to allow for more efficient fluid drainage. This effectively lowers the intraocular pressure, subsequently reducing the risk of damage to the optic nerve.

Notably, these treatments are performed in a regular eye clinic setting rather than an operating theatre, and typically only take around 20 minutes to complete. During the procedure, a local anesthetic is administered to numb the eye, and post-treatment, patients may receive eye drops to minimize swelling.

While both SLT and ALT achieve similar outcomes, SLT is a more recent variation of the treatment, utilizing a slightly gentler laser approach.

Laser iridotomy and laser iridoplasty are effective interventions for managing angle closure glaucoma, a condition where the iris is pushed forward, obstructing the natural drainage pathway for eye fluid. This blockage causes fluid buildup, elevating the intraocular pressure and potentially leading to damage to the optic nerve.

In the case of iridotomy, a precise laser is used to create a small hole in the iris, allowing it to return to its original position and thereby reopening the natural drainage channel.

On the other hand, in iridoplasty, the laser targets the area of the iris responsible for blocking the drainage channel, causing the iris to contract and restore the channel's openness.

Both treatments effectively facilitate the drainage of fluid from the eye, thereby reducing IOP.

These procedures are typically conducted under local anaesthetic , ensuring you remain awake while the eye remains numb. Most patients can return home on the same day. To manage any potential swelling, you may receive eye drops as part of the aftercare.

When other glaucoma laser treatments prove ineffective, the cyclodiode laser is offered as an alternative. Specifically, it targets the ciliary body, responsible for producing aqueous humor in the eye, and reduces its production, effectively managing the condition.

During the procedure, which typically takes around 20 minutes, a local anesthetic is administered to numb the eye, and post-treatment, you may receive eye drops to minimize swelling.

An advanced technique known as MicroPulse cyclodiode operates similarly but utilizes short bursts of energy, allowing the ciliary body to cool between pulses. This helps to minimize damage to the surrounding tissue while still achieving the desired therapeutic effect.

Alternative treatments

If both eye drops and laser treatment have proved to be ineffective, your consultant ophthalmologist may recommend surgery, here are a few of the common surgery options:.

A trabeculectomy is a surgical procedure designed to facilitate the drainage of fluid from the eye into a small blister known as a bleb. This bleb is located beneath the surface of the eye, specifically within the conjunctiva (a thin, clear membrane that protects your eye). By creating a specialized passageway, the procedure enables the fluid to bypass the usual drainage channel, acting as a trap door for its passage. As a result, the drainage of aqueous fluid is enhanced, leading to a reduction IOP.

By lowering the intraocular pressure, the procedure alleviates the pressure exerted on the optic nerve, thereby reducing the likelihood of vision loss. It's important to note that any vision already lost due to glaucoma cannot be regained, and the procedure does not cure glaucoma.

The iStent is a tiny titanium tube, measuring one millimetre in size, which is inserted into the eye's natural drainage channel. Its purpose is to circumvent any obstructions in the drainage pathway, thereby enhancing the outflow of fluid from the eye and reducing intraocular pressure. Typically, two or even three iStent devices are commonly implanted to maximize the likelihood of achieving a significant decrease in IOP.

Non medical treatments

As well as medical treatments, certain lifestyle and home remedies may help you manage high eye pressure and promote eye health:

While some alternative medicine approaches may have benefits for overall health, none have been proven to be effective as a remedy for glaucoma. It is advisable to discuss any alternative treatments or supplements with your consultant to understand their potential benefits and risks.

OcuPlan was created for people with glaucoma, to provide cost effective consultant led care. We have over 500 optician stores and 100 consultants all over the UK who provide the gold standard of care for people living with glaucoma, ensuring they are seen regularly and provided with a treatment plan to help preserve their vision. If you’d like to learn more about how Ocuplan can help you, please call us on 0207 173 5200.