Laser Treatment Options for Glaucoma

Laser surgery has become a desirable option as an intermediate glaucoma treatment between medications and traditional surgery and some doctors use it as an initial treatment prior to starting drops. It can be a good option if you are on more than one eye medication or if you do not tolerate a particular eye drop because of an allergy or other side effects. There are two main options for laser treatment, depending on what type of glaucoma (open or closed angle) you have.

Laser Trabeculoplasty

If you have open-angle glaucoma and the disease is progressing despite the use of medication, your doctor may recommend laser trabeculoplasty as an initial surgical option.

The malfunctioning internal drainage system of your eye is the cause of glaucoma, leading to an increase in intraocular pressure (IOP). Laser trabeculoplasty uses a focused beam of light to treat the drainage angle in your eye and improve the flow of fluid. Contrary to what you may think, newer laser technology does not burn your eye or create a large hole. Instead, the laser makes subtle changes to the eye’s drainage system to make it easier for fluid to flow out of the front part of the eye. This, in turn, lowers the IOP.

There are two different types of lasers which are used for trabeculoplasty – ALT (argon laser trabeculoplasty) and SLT (selective laser trabeculoplasty). ALT uses heat, whereas SLT uses a lower energy laser beam that’s sometimes referred to as a “cold laser.” There is no noticeable difference between the two procedures from a patient point of view. Both procedures have no systemic side effects and they are both safe, office-based procedures.

What Happens During Laser Trabeculoplasty

The entire laser trabeculoplasty process takes about 10 minutes. You will be given topical anesthesia (numbing drops) to numb your eye. Your surgeon will use a slit lamp microscope and lens to guide the laser beam to the trabecular meshwork where fluid drains from the eye. A total of 50 to 100 laser applications are generally administered, depending on whether a half treatment (180 degrees) or a full treatment (360 degrees) is needed.

What to Expect

Laser trabeculoplasty is an outpatient procedure, and you will go home the same day. However, your eyesight may be blurry, so you will need to arrange for someone to drive you home after your procedure.

Outcomes of Laser Trabeculoplasty

Both ALT and SLT have been proven safe and effective in lowering intraocular pressure and are equally capable of lowering eye pressure in patients with various types of open-angle glaucoma. Laser trabeculoplasty, on average, lowers eye pressure by approximately 20-25 percent. The effect of the surgery will usually last somewhere between 1 to 5 years. If intraocular pressure is too high even after the procedure, your doctor can still prescribe eye drops to lower eye pressure to a safe level.

Laser Iridotomy

If you have closed-angle glaucoma [link to Glaucoma landing page], you may be a candidate for laser iridotomy. Because angle closure is on a progressive spectrum, all closed-angle glaucoma patients began with a narrow angle. Even if you have otherwise healthy eyes, a narrow angle could lead to closed-angle glaucoma.

The goal of laser iridotomy is to create a small hole in the iris to balance the pressure behind the iris and open the angle to allow the aqueous humor (fluid) to flow. Most patients respond well to laser iridotomy, but sometimes the degree of closure is so great that there is irreversible blockage. In this case, it is necessary to use glaucoma drops, cataract surgery or additional glaucoma surgeries.

What Happens During Laser Iridotomy?

To prepare for the procedure, your surgeon will go over all the medications you are currently taking and may ask you to stop taking a medication until after surgery. Your surgeon will administer eye drops and numbing drops before the procedure. The entire procedure takes only a few moments for each eye that needs treatment.

Your surgeon will administer eye drops about an hour before the procedure to make your pupil smaller, stretch your iris and keep IOP controlled during the surgery. After an hour, your surgeon will numb your eye with anesthetic, and ask you to sit at a machine that looks like a slit lamp microscope used during eye exams. As you focus on a target beam of light, your surgeon will begin the laser treatment. Many patients say they feel a slight pop when the laser is fired but say it is otherwise painless.

What to Expect

Laser iridotomy is an outpatient procedure and you can go home the same day, but you may need a caregiver to provide your transportation if the vision is blurred after the surgery. Your doctor will prescribe anti-inflammatory drops for about a week following the surgery. A small percentage of patients may need additional treatment called iridoplasty or they may need cataract surgery or glaucoma filtering surgery. Talk to your doctor about what options are right for you.

Outcomes of Laser Iridotomy

In most cases, laser iridotomy is sufficient to open the narrowed or closed angle. A small percentage of patients may need additional treatment with cataract surgery or glaucoma filtering surgery depending on the effectiveness of the iridotomy.

Talk to your doctor about what type of laser procedure would help your glaucoma. Contact a treatment center near you to schedule a consultation.