Glaucoma treatment, surgery and recovery

Glaucoma, often called the ‘silent thief of sight’, refers to a group of eye conditions that damage the optic nerve, usually due to high pressure within the eye – known as high intraocular pressure (IOP). Left untreated, it can lead to irreversible vision loss. Fortunately, advances in medical and surgical treatments offer hope for slowing or even stopping the progression of this disease. Here’s a guide to the current treatment options available.

Glaucoma treatment options

Medications

Medicated eye drops are the first line of treatment for most glaucoma patients. These eye drops reduce the IOP by either decreasing fluid production within the eye or increasing fluid drainage from the eye. By lowering the volume of fluid within the eye, the physical pressure on the optic nerve decreases, which prevents glaucoma progression.

For many patients, medicated eye drops are a very effective and simple treatment to manage the progression of glaucoma.

Occasionally, your glaucoma specialist may also recommend oral medication – however, this depends on the glaucoma type and how advanced it is.

Glaucoma laser surgery

Laser surgery is typically offered when glaucoma medications alone are not adequately controlling eye pressure. Glaucoma laser surgery is performed in the clinic and does not require admission to a day surgery. Before the procedure you will receive anaesthetic eye drops to numb the eye, so there is little or no discomfort.

Glaucoma laser surgeries include:

Selective laser trabeculoplasty (SLT) – this uses laser pulses focused on the eye’s drainage system to stimulate clearance of debris and improve fluid outflow, which in turn lowers eye pressure. While this is a highly effective glaucoma treatment, it can wear off after a few years.
YAG laser peripheral iridotomy – the laser creates a small hole in the iris (the coloured part of the eye) to improve fluid drainage from the eye. This treatment is used for a specific type of glaucoma known as angle-closure glaucoma.

When medications and laser treatments are insufficient, surgical interventions may be needed. There are several types of glaucoma surgery available – these are usually performed as a day procedure.

Glaucoma surgery

Minimally invasive glaucoma surgery (MIGS)

MIGS techniques are newer and involve implanting a microscopic-sized stent (e.g. iStent, Hydrus or iTrack devices) into the drainage system of the eye to bypass the outflow obstruction and lower IOP. This glaucoma surgery only requires a small incision to insert the stent and has a favourable safety profile with fast recovery times. MIGS is recommended for mild-to-moderate glaucoma.

Learn more about MIGS here.

Minimally invasive bleb surgery (MEBS)

MEBS procedures implant tiny devices (e.g. XEN or Preserflo) that divert eye fluid into a ‘bleb’ or lake of fluid. While MEBS is less invasive and offers quicker recovery times than traditional glaucoma surgeries, its long-term effectiveness is still being researched.

Glaucoma filtration surgery

Glaucoma filtration surgery (also called a trabeculectomy) is the traditional glaucoma surgery that involves creating a tunnel to help fluid flow from the eye. Anti-scarring medicines – such as mitomycin C – are used to prevent the new drainage pathway from scarring and closing over. Although trabeculectomy is very effective, it has a slow recovery period and is typically reserved for patients with moderate-to-advanced glaucoma.

Glaucoma drainage devices

Glaucoma drainage devices (e.g. Baerveldt, PAUL or Molteno) are small tubes that are surgically implanted into the eye to divert fluid into a reservoir hidden beneath the upper eyelid. This option is usually only offered for advanced glaucoma where trabeculectomy is not appropriate or has failed.

Recovery time for glaucoma surgery

Glaucoma surgery recovery will vary depending on the type of surgery you receive. MIGS and MEBS procedures are the least invasive glaucoma surgeries and offer the quickest recovery times. Typically, patients can resume their normal activities after 2 weeks.

Conventional glaucoma surgeries, such as trabeculectomy and drainage device surgeries, have a longer recovery time and patients will require post-operative follow-up appointments for 6–8 weeks following their surgery.

More specific recovery information will be provided by your glaucoma surgeon.

Costs of glaucoma surgery

Most glaucoma surgeries are subsidised by Medicare, with further coverage by health funds for those who are privately insured. Your out-of-pocket costs will depend on the type of surgery, glaucoma implant used and your level of healthcare cover. It is recommended you confirm costs with your surgeon, day surgery and health fund prior to having surgery.

Find a glaucoma surgeon near you

Vision Hospital Group has a team of specialist glaucoma surgeons across our network of day surgeries in New South Wales, Victoria, Queensland and South Australia.

Use our specialist directory to find a glaucoma surgeon.