There are many procedures that are done to treat glaucoma, depending on the type of glaucoma you are diagnosed with. When eye drops are not indicated or not effective, your ophthalmologist may recommend one of these procedures. Click here to learn more about glaucoma
Laser Iridotomy (LI): A laser iridotomy is a procedure to treat or prevent narrow angle glaucoma. This procedure is indicated when the drainage angles of the eye are very narrow and susceptible to closing, thus causing a sudden increase in the intraocular pressure. Since aqueous humor, or the fluid of the eye, is constantly being produced, it must always be constantly drained at an equal rate to have a normal eye pressure. During this procedure, a laser is focused on the iris, or colored part of the eye. A small hole is created in the iris to improve the flow of fluid and create an additional drainage channel should the normal drainage channels close. This small hole is not visible to the naked eye. If you have some features of narrow angle, your ophthalmologist can determine whether this would be a recommended procedure. Having this done in advance rather than during an acute attack of narrow angle glaucoma is preferable so that you can minimize any possible damage to the vision.
This is an outpatient procedure done in our office. The eye is numbed with drops and a lens is used to focus the laser light on the correct portion of the eye. The procedure itself just takes a few minutes. Complications following the procedure are rare but can include a spike in eye pressure, inflammation or bleeding inside the eye, and others. A steroid (anti-inflammatory) drop is prescribed for use after the procedure to minimize these complications. Usually this procedure lasts a lifetime; however, occasionally scarring or closing of the hole can occur and re-treatments can be needed. This is why it is important to follow with your ophthalmologist after the procedure regularly.
Argon Laser Trabeculoplasty (ALT): Laser trabeculoplasty is a laser procedure that may be recommended to reduce the eye pressure in glaucoma patients. An in-office laser is used to target the pigment cells in the drainage angle of the eye, thereby reducing the eye pressure. You may be a candidate for ALT if you have glaucoma that is not well controlled with eye drops alone, if you have difficulty with compliance to your eye drops, have an allergy to one or more eye drops, or have difficulty obtaining or administering the glaucoma drops. It is also done in the office with use of a numbing drops and a special lens to visualize the drainage angles of the eye. As with other laser procedures, ALT can incite inflammation or cause a pressure spike within the eye. Your ophthalmologist will prescribe anti-inflammatory drops for temporary use after the procedure and monitor closely for any of these side effects. Blurred vision or slight discomfort is common for a day or two after the procedure. The eye pressure-lowering effects of ALT may last for a couple to several years depending on the patient, but may be repeated in the future if needed.
Micro Invasive Glaucoma Surgery (MIGS): These are newly available procedures for patients who have mild to moderate open angle glaucoma. Previously, surgical intervention was reserved for patients with moderate to severe glaucoma. There are several different devices and procedures available within the MIGS spectrum, and our surgeons often perform the iStent procedure at the time of cataract surgery to better control the glaucoma or lessen the need for eye drops. Your surgeon will discuss whether you are a good candidate for this type of procedure.
Advanced Glaucoma Procedures: These include surgical procedures like trabeculotomy, valved or non-valved glaucoma drainage implants, and others. These are typically performed by a glaucoma specialist in more advanced cases of glaucoma.