Medical Treatment of Glaucoma

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Glaucoma surgery may be carried out under local anaesthetic while you're awake or general anaesthetic while you're asleep.

Back to the Future – Has Medical Treatment of Glaucoma Improved?

Most people won't need to take eye drops any more after trabeculectomy, and you shouldn't be in a lot of pain after surgery. Your doctor should discuss which type of surgery they recommend, as well as any risks and benefits, before you decide whether to go ahead. After surgery, your eye might water and be red, and your vision may be slightly blurred for up to 6 weeks but should return to normal. The hospital will give you advice about which activities you can do while you recover. Most people are advised to keep their eye dry, and avoid driving, reading and heavy lifting for at least a week.

Page last reviewed: 15 February Next review due: 15 February Your treatment plan Your treatment will largely depend on which type of glaucoma you have. Treatment for other types of glaucoma may include: primary angle closure glaucoma — immediate treatment in hospital with medication to reduce the pressure in the eye, followed by laser treatment secondary glaucoma — eye drops, laser treatment or surgery, depending on the underlying cause childhood glaucoma — surgery to correct the problem in the eye that led to the build-up of fluid and pressure You'll also be advised to attend regular follow-up appointments to monitor your eyes and check that treatment is working.

The main treatments are described below. Eye drops Eye drops are the main treatment for glaucoma. How to apply eye drops To apply eye drops: use your finger to gently pull down your lower eyelid hold the bottle over your eye and allow a single drop to fall into the pocket you have created in your lower eyelid close your eye and keep it closed for a few minutes If you're using different types of eye drops, allow at least 5 minutes between using the different types.

Laser treatment Laser treatment may be recommended if eye drops don't improve your symptoms. Types of laser treatment include: laser trabeculoplasty — a laser is used to open up the drainage tubes within your eye, which allows more fluid to drain out and reduces the pressure inside cyclodiode laser treatment — a laser is used to destroy some of the eye tissue that produces the liquid, which can reduce pressure in the eye laser iridotomy — a laser is used to create holes in your iris to allow fluid to drain from your eye Laser treatment is usually carried out while you're awake.

You may still need to use eye drops after having laser treatment. It is vital that pharmacists understand the pathophysiology of glaucoma and the goals of therapy. Pharmacists should counsel patients that the goal of treatment is to prevent progression of glaucoma by lowering IOP. Pharmacists also need to remind patients that many of the adverse effects of the medications are brief and will go away in time. This may help to improve adherence to the regimen. Absorption of certain medications, especially beta-blockers and drugs that can produce anticholinergic effects, may produce serious systemic side effects.

Therefore, pharmacists should counsel patients on the proper instillation of eyedrops, including the use of punctal occlusion pressing on the bridge of the nose to prevent the drops from entering the nasolacrimal duct. Simply closing the eye but not blinking is an equally effective alternative. Either of these procedures should be done for about 2 minutes.

Adherence is a problem with glaucoma patients. In the case of poor adherence to therapy, pharmacists can recommend that the prescriber consider a combination product. Pharmacists should also consider recommending a preservative-free product for patients experiencing ocular side effects as previously discussed.

A combination product may also be a good recommendation if a patient is experiencing side effects due to preservatives and a preservative-free product is not commercially available. Glaucoma is an irreversible optic neuropathy that leads to visual-field defects and potentially blindness. Prostaglandin analogues are the most effective at lowering IOP and are considered first-line therapy. Other options for initial monotherapy include timolol and brimonidine. Pharmacists must be aware of potential local and systemic effects to help promote adherence and enhance treatment of glaucoma.

World Health Organization.

A Renaissance in Glaucoma Research

Prevention of blindness and visual impairment. Accessed October 1, American Optometric Association. National Eye Institute. Glaucoma, open-angle. The number of people with glaucoma worldwide in and Br J Ophthalmol. Prevalence of open-angle glaucoma among adults in the United States. Arch Ophthalmol. American Academy of Ophthalmology Glaucoma Panel. Accessed October 15, Quigley HA. The ocular hypertension treatment study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma.

Am J Ophthalmol. Emerging perspectives in glaucoma: optimizing hour control of intraocular pressure. Primary open-angle glaucoma. N Engl J Med. An overview of glaucoma management for pharmacists. US Pharm.

List of Glaucoma Medications (21 Compared) -

Accessed May 12, Chapter Pharmacotherapy: A Pathophysiologic Approach. The pathophysiology and treatment of glaucoma: a review. The definition and classification of glaucoma in prevalence surveys. Care of the Patient with Open-Angle Glaucoma. Salmon JF. Meta-analysis of hour intraocular pressure studies evaluating the efficacy of glaucoma medicines.

Comparative efficacy and tolerability of topical prostaglandin analogues for primary open-angle glaucoma and ocular hypertension. Learn about these well-described risk factors. There are many effective and different treatments for open-angle glaucoma, but the one unifying concept is that all current treatments are designed to lower eye pressure. Learn about uveitis: symptoms associated with this eye condition, treatment options, and how it is related to glaucoma. BrightFocus makes innovative science possible around the world— 1, research projects involving more than 4, scientists in 22 countries.

The first few weeks after a diagnosis can be overwhelming, and leave you with many questions and concerns. If you are managing a new diagnosis, we have a Getting Started Guide that will help you understand and manage your disease.

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Laser Surgery for Glaucoma

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You can help find a cure for glaucoma Give now. Types of Medications Alpha Adrenergic Agonists This medication both reduces aqueous humor production and increases its outflow. It normally lowers eye pressure, but the length of time that pressure remains low depends on many factors, including: Age of the patient Type of glaucoma Other medical conditions that may be present Many cases still need continued medication but possibly in lower amounts.

To reduce eye pressure, the doctor directs a laser toward the: Trabecular meshwork tissue near the cornea and iris that drains the aqueous humor from the eye into the blood Iris Ciliary body Retina Types of laser surgery include: Trabeculoplasty The trabeculoplasty procedure is often used to treat open-angle glaucoma. Laser Peripheral Iridotomy Laser peripheral iridotomy is frequently used to treat angle-closure glaucoma, in which the angle between the iris and the cornea is too small and blocks fluid flow out of the eye.

Cyclophotocoagulation This procedure is usually used to treat more aggressive or advanced open-angle glaucoma that has not responded to other therapies. Scatter Panretinal Photocoagulation This laser procedure destroys abnormal blood vessels in the retina that are associated with neovascular glaucoma. The most common side effects of laser surgery are: Temporary eye irritation Blurred vision Small risk of developing cataracts Surgery Eye doctors often use conventional surgical procedures also called incisional therapies for glaucoma after other treatment strategies, such as medications and laser surgery, have failed.

When deciding on a treatment option, an ophthalmologist will take into account the unique aspects of each person's case, including the: Severity of the disease Response to medication Other health issues Read more about the risks and benefits of glaucoma surgery.

What’s New in Glaucoma Medical Therapy?

Trabeculectomy During a trabeculectomy , the ophthalmologist cuts a flap in the white part of the eye sclera , removes a piece of trabecular meshwork eye tissue located around the base of the cornea , and sutures the flap. Responses to this procedure vary: Many people are able to discontinue glaucoma medication afterward. There may also be continued changes to the optic nerve. Sometimes a second trabeculectomy must be performed. Potential short-term side effects of this procedure include: Blurred vision Bleeding in the eye Infection.

Peripheral Iridectomy Eye doctors use this procedure for angle-closure glaucoma. Canaloplasty and New Implant Devices These devices and procedures are used to enhance the aqueous humor outflow to decrease eye pressure. Potential Treatments for Glaucoma Researchers are investigating many potential treatments for glaucoma and testing them in human clinical trials.

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