Glaucoma: Forms & treatment options (Surgery & Laser) in Turkey

Understanding How Glaucoma Treatment Works

Glaucoma treatment works by lowering intraocular pressure, because high pressure inside the eye is the main modifiable cause of optic nerve damage. Treatments either reduce the production of aqueous humor (the fluid inside the eye) or improve its drainage. Treatment cannot reverse vision loss that has already occurred, which is why early diagnosis and treatment matter.

Open-angle glaucoma is the most common form worldwide, about 7 cases out of 10 according to a meta-analysis published in Ophthalmology (Tham et al., 2014). Angle-closure glaucoma is more frequent in Asia.

Medical Management with Eye Drops

Treatment usually starts with prescription eye drops used every day, even when you have no symptoms. Prostaglandin analogs (latanoprost, travoprost, bimatoprost, tafluprost) are the most widely used first-line drops. They are generally well tolerated but can cause eye redness, longer eyelashes and darkening of the iris or eyelid skin.

More than one drug is often needed to control eye pressure. Beta-blockers (timolol),carbonic anhydrase inhibitors and alpha-adrenergic agonists are commonly added. More recent drops include ROCK inhibitors (netarsudil). Beta-blocker drops can affect the heart and breathing: tell your ophthalmologist if you have asthma or a heart condition, and never stop your drops without medical advice.

Laser Treatment

Laser can be used when eye drops are not enough, or as the first treatment. In the LiGHT trial (Lancet, 2019),74% of patients treated first with selective laser trabeculoplasty (SLT) needed no eye drops to control their eye pressure at 3 years.

• Selective laser trabeculoplasty (SLT): done in the clinic under numbing drops. The doctor places a lens on the eye and applies low-energy laser pulses to the drainage tissue (trabecular meshwork). The full pressure-lowering effect can take several weeks to appear. The effect fades over time and the procedure can be repeated.
• Laser peripheral iridotomy: creates a tiny opening in the iris to unblock the drainage angle. It is the standard treatment for angle-closure glaucoma.

Eye pressure is usually checked shortly after the laser, then at a follow-up visit a few weeks later.

Surgical Options

Surgery is offered when eye drops and laser do not keep the pressure low enough to protect the optic nerve.

• Trabeculectomy: the reference operation for decades. The surgeon creates a small flap in the white of the eye, under the upper eyelid, so that fluid can drain under the conjunctiva.
• Drainage implants (tubes, shunts): small devices that create an alternative outflow path, often used after a failed trabeculectomy or in complex glaucoma.
• Minimally invasive glaucoma surgery (MIGS): techniques such as iStent, Hydrus or XEN use smaller incisions. They usually cause fewer serious complications than trabeculectomy, but the pressure reduction is often more modest. They are mainly used for mild to moderate glaucoma, often together with cataract surgery.
• Cyclophotocoagulation: laser treatment of the ciliary body to reduce fluid production, reserved for refractory or painful cases.

Most operations are done as day surgery. Afterwards, the eye may be sore or red, and vision may be blurry for some time. Surgery can also cause eye pressure that is too low, infection, cataract or, rarely, loss of vision. Glaucoma requires lifelong follow-up: your ophthalmologist sets the interval between visits, often every few months.