Medical vs Surgical Treatment of Glaucoma

The current scenario of medical and surgical treatment of glaucoma has changed drastically in the last two decades. There are now multiple effective topical medication (eye drops) for medical management of glaucoma. Some of the eye drops are used only once a day which is quite convenient to the patient.

The surgical options are also many. It is always a matter of dilemma for the patient to decide between using the eye drops for the rest of his or her life or choose the surgical options to hopefully not need any medical treatment later.

What Are the Available Surgical Options

The patients of open angle type of glaucoma may be advised laser surgery – ALT (argon laser trabeculoplasty) or SLT (selective laser trabeculoplasty). The effect of trabeculoplasty usually does not last long and re-treatment or surgery may be advised later.

The patients of angle closure type of glaucoma benefit from laser peripheral iridotomy and the results are usually good.

The most commonly performed glaucoma surgery is trabeculectomy which is quite effective but the chances of complications are also more.

Non-penetrating glaucoma surgeries also achieve good intraocular pressure (IOP) control. They include:

  1. Deep sclerectomy (may or may not include a collagen implant)
  2. Viscocanalostomy
  3. Canaloplasty

In the recent years, more devices have been developed for surgical intervention in glaucoma cases. Here are some of the shunts, implants and stents (minimally invasive glaucoma surgeries – MIGS) used in glaucoma surgery:

  1. Tube shunt implants – Molteno glaucoma implant, Baerveldt glaucoma implant and Ahmed glaucoma valve
  2. iStent, Glaukos Corp
  3. CyPass Micro-Stent, Alcon Laboratories
  4. Xen Gel Stent, Allergan
  5. InnFocus Micro-Shunt, Transcend Medical

Efficacy of Surgical Treatment Over Eye Drops

Currently available medical and surgical treatment options for glaucoma are both effective. The only major difference between them is that there is a hassle of using the eye drops everyday if the patient wants to control IOP only with medical treatment whereas the IOP remains under control after a surgical procedure or a series of procedures.

What Would Be the Ideal Treatment of Glaucoma

The ideal treatment of glaucoma would be a single surgical procedure which permanently keeps the intraocular pressure in a range which does not further cause glaucomatous damage and the disease does not progress.

Unfortunately such a single treatment option is not available presently. To achieve optimal disease control, we need to combine various medical and surgical options. The patient also needs to be in regular follow-up to monitor the optic nerve health and visual field changes.

Why Glaucoma May Progress in Spite of the Treatment

It is important to know that glaucoma is a multifactorial condition. Intraocular pressure (eye pressure) is only a risk factor which can be controlled with the options mentioned above.

There are some genetic, vascular and structural factors which are involved in the causation of glaucoma. Therefore systemic evaluation of patients of glaucoma is extremely important for complete management of this condition.