Glaucoma surgery
How long does glaucoma surgery take?
Do they put you to sleep for glaucoma surgery?
What type of surgery is performed to treat glaucoma?
Glaucoma diagnosis
Glaucoma is a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged.
It's usually caused by fluid building up in the front part of the eye, which increases pressure inside the eye.
Glaucoma can lead to loss of vision if it's not diagnosed and treated early.
It can affect people of all ages, but is most common in adults in their 70s and 80s.
Surgery involves either laser treatment or making a cut in the eye to reduce the intraocular pressure. The type of surgery your doctor recommends will depend on the type and severity of your glaucoma and the general health of your eye.
Your eye doctor will give you prescription eye drops or oral medicine to lower the pressure in your eye. If drugs don’t work, surgery is the next step.
If the medicine causes severe side effects like high blood pressure, rapid heartbeat, or impotence, you may want to try surgery instead. Some people need it right away if their eye pressure is high and puts their vision at risk.
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Here are some types of laser surgery for glaucoma:
Argon laser trabeculoplasty (ALT): This opens clogs in your eye so fluid can drain out. Your doctor may treat half of the clogs first, see how well it works, then treat the other half later. ALT works in about 75% of people with the most common kind of glaucoma.
Selective laser trabeculoplasty (SLT): If ALT doesn’t work so well, your doctor may try this. Your doctor beams a highly targeted low-level laser at just the spots where there’s pressure. You can do SLT a little at a time.
Laser peripheral iridotomy (LPI): If the space between your eye’s iris (the colored part) and cornea (the clear outer layer) is too small, you can get narrow-angle glaucoma. Fluid and pressure build up in this area. LPI uses a laser beam to create a tiny hole in the iris. The extra fluid can drain and relieve pressure.
Cyclophotocoagulation: If other laser treatments or surgery doesn't ease fluid buildup and pressure, your doctor can try this. He’ll beam a laser into a structure inside your eye to ease pressure. You may need to repeat it over time to keep your glaucoma in check.
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After Laser Surgery
Your eyesight may be a little blurry right after the treatment. It may feel a little sore, too. In a couple of hours, the doctor will check your eye pressure. You’ll need someone to drive you home after the surgery.
You may need to stay on your medications after laser surgery to keep your eye pressure under control.
What are some other types of surgery for glaucoma?
If laser surgery or drugs don’t relieve your eye pressure, you may need a more traditional operation. You might have to go into the hospital or surgery center, and you’ll probably need a few weeks to heal and recover.
What can you expect during surgery?
You’ll get drugs to numb your eye and relax you. You shouldn’t feel any pain. You may feel really drowsy during the operation.
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How successful is glaucoma surgery?
Most of the related studies document follow-up for a one year period. In those reports, it shows that in older patients, glaucoma filtering surgery is successful in about 70-90% of cases, for at least one year.
Occasionally, the surgically-created drainage hole begins to close and the pressure rises again. This happens because the body tries to heal the new opening in the eye, as if the opening were an injury. This rapid healing occurs most often in younger people, because they have a stronger healing system. Anti-wound healing drugs, such as mitomycin-C and 5-FU, help slow down the healing of the opening. If needed, glaucoma filtering surgery can be done a number of times in the same eye.
How long does glaucoma surgery take?
It’s done in a hospital and usually takes 1 to 2 hours. In this operation, the surgeon implants a tiny tube, or shunt, onto the white of your eye. The tube helps extra fluid drain out of your eye, lowering your eye pressure. Recovery time after conventional glaucoma surgery usually does not last longer than 3-4 weeks. In rare occasions, it may linger up to several months.
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Do they put you to sleep for glaucoma surgery?
Laser treatment is usually carried out while you're awake. Local anaesthetic drops are used to numb your eyes – you may just feel a brief twinge of pain or heat during the procedure. You can usually go home the same day, but you’ll need someone to drive you home.
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What type of surgery is performed to treat glaucoma?
The most common type of surgery for glaucoma is called trabeculectomy. It involves removing part of the eye-drainage tubes to allow fluid to drain more easily.
Most people won't need to take eye drops any more after trabeculectomy, and you shouldn't be in a lot of pain after surgery.
Your doctor should discuss which type of surgery they recommend, as well as any risks and benefits, before you decide whether to go ahead.
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Glaucoma diagnosis
There are several quick and painless tests that can be carried out by an optometrist if they suspect you have glaucoma after a routine eye test.
- Eye pressure test
An eye pressure test (tonometry) uses an instrument called a tonometer to measure the pressure inside your eye.
The optometrist will put a small amount of painkilling medication (anaesthetic) and dye into the front of your eye. They will then shine a light into your eye and gently touch the surface of it with the tonometer.
Some optometrists use a different instrument, which uses a puff of air and doesn't touch the eye, to check pressure.
- Gonioscopy
Gonioscopy is an examination to look at the front part your eye – the fluid-filled space between the coloured part (iris) and the clear window of the front of the eye (cornea). This is where the fluid should drain out of your eye.
A gonioscopy can help to determine whether this area (the "angle") is open or closed (blocked), which can affect how fluid drains out of your eye. It will tell your optometrist what type of glaucoma you have.
- Visual field test
A visual field test (sometimes called perimetry) checks for missing areas of vision.
You may be shown a sequence of light spots and asked to press a button to indicate which ones you can see. Some dots will appear at the edges of your vision (your peripheral vision), which is often the first area to be affected by glaucoma.
If you can't see the spots in the periphery, it may mean the glaucoma has damaged your vision.
- Optic nerve assessment
The optic nerve, which connects your eye to your brain, can become damaged in glaucoma, so an assessment may be carried out to see if it's healthy.
For the test, eye drops will be used to enlarge your pupils. Your eyes are then examined using either:
- a slit lamp (a microscope with a bright light)
- optical coherence tomography – a type of scan where special rays of light are used to scan the back of your eye and produce an image of it
The eye drops used to widen your pupils could temporarily affect your ability to drive, so you'll need to make arrangements for getting home after your appointment.
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