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.
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 to Expect
The entire laser trabeculoplasty process takes about 10 minutes. Your surgeon may administer a glaucoma drop immediately before and/or after the surgery as well as an anti-inflammatory drop to prevent post-operative inflammation. Laser trabeculoplasty is an outpatient procedure, and you will go home the same day. However, your eyesight may be blurry, so you may need to arrange for someone to drive you home after your procedure.
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 you have closed-angle glaucoma, 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 to Expect
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. Many patients say they feel a slight pop when the laser is fired but that it is otherwise painless. The entire procedure takes only a few moments for each eye that needs treatment.
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 may prescribe anti-inflammatory drops for about a week following the surgery. 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 options are right for you.