Can Laser Surgery Correct Eye Pressure

Laser surgery uses a very focused beam of light to cut, break down, or destroy tissue. Doctors use laser surgery when medicines fail to control vision loss caused by glaucoma. Laser surgery is done more often than conventional surgery for glaucoma.

The major advantages of laser surgery over conventional surgery for glaucoma include:

  • Less bleeding.
  • Less injury to tissues.
  • The ability to do most laser procedures without the person having to be admitted to the hospital.

The most common complication from laser surgery for glaucoma is increased pressure within the eye. The pressure may be normal immediately after laser surgery but then may rise sharply within 1 to 4 hours, especially in people who have severe glaucoma. The doctor may give you eyedrop medicine before and after surgery to prevent this complication. Other complications may include:

  • A brief period of inflammation of the colored part of the eye (iris).
  • Bleeding in the eye.
  • Cloudiness of the clear covering (cornea) over the iris. This does not usually last long.
  • Blockage of the drainage angle when the cornea and the iris stick together.
  • Pain.
  • Decreased vision.

Can Laser Surgery Correct Eye Pressure

There are several different treatments for glaucoma, including eyedrops, laser treatment and surgery. The best treatment for you will depend on your circumstances.

Treatment can’t reverse any loss of vision that has already occurred, but it can help stop your vision getting any worse.

Your treatment plan

Your treatment will largely depend on which type of glaucoma you have. The most common type, primary open angle glaucoma, is usually treated with eyedrops. Laser treatment or surgery may be offered if drops don’t help.

Treatment for other types of glaucoma may include:

  • primary angle closure glaucoma – immediate treatment in hospital with medicine to reduce the pressure in the eye, followed by laser treatment
  • secondary glaucoma – eyedrops, laser treatment or surgery, depending on the underlying cause
  • childhood glaucoma – surgery to correct the problem in the eye that led to the build-up of fluid and pressure

You’ll also be advised to attend regular follow-up appointments to monitor your eyes and check that treatment is working. It’s important not to miss any of these appointments.

The main treatments are described below.

Eyedrops

Eyedrops are the main treatment for glaucoma. There are several different types that can be used, but they all work by reducing the pressure in your eyes.

They’re normally used between 1 and 4 times a day. It’s important to use them as directed, even if you haven’t noticed any problems with your vision. Your sight is at risk if you don’t stick to the recommended treatment.

You may need to try several types before you find the one that works best for you. Sometimes you may need to use more than one type at a time.

Eyedrops can cause unpleasant side effects, such as eye irritation, and some aren’t suitable for people with certain underlying conditions.

How to apply eyedrops

Wash your hands before and after applying the drops. To apply eyedrops:

  • use your finger to gently pull down your lower eyelid
  • hold the bottle over your eye and allow a single drop to fall into the pocket you have created in your lower eyelid
  • close your eye and keep it closed for a few minutes

If you’re using different types of eyedrops, allow at least 5 minutes between using the different types.

After you have put in the eyedrops, gently press in the inside corner of the eye (over the eyelid) for about a minute. This reduces the drainage of the eyedrop from the eye, which helps to increase its effect. It also helps to reduce any side effects.

Types Of Laser Eye Surgery For Glaucoma

Laser treatment

Laser treatment may be recommended if eyedrops don’t improve your symptoms.

This is where a high-energy beam of light is carefully aimed at part of your eye to stop fluid building up inside it.

Types of laser treatment include:

  • laser trabeculoplasty – a laser is used to open up the drainage tubes within your eye, which allows more fluid to drain out and reduces the pressure inside
  • cyclodiode laser treatment – a laser is used to destroy some of the eye tissue that produces the liquid, which can reduce pressure in the eye
  • laser iridotomy – a laser is used to create holes in your iris to allow fluid to drain from your eye

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 may still need to use eyedrops after having laser treatment.

Surgery

Surgery may be recommended in rare cases where treatment with eyedrops or laser haven’t been effective.

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.

Glaucoma surgery may be carried out under local anaesthetic (while you’re awake) or general anaesthetic (while you’re asleep).

Most people won’t need to take eyedrops 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.

Other types of glaucoma surgery include:

  • trabeculotomy – similar to a trabeculectomy, but an electric current is used to remove a small part of the eye-drainage tubes
  • viscocanalostomy – part of the white outer covering of the eyeball (the sclera) is removed so fluid can drain from your eye more easily
  • deep sclerectomy – the drainage tubes in your eye are widened, sometimes by implanting a tiny device inside them
  • trabecular stent bypass – a tiny tube is placed into your eye to increase the drainage of fluid

After surgery, your eye might water and be red, and your vision may be slightly blurred for up to 6 weeks but should return to normal.

The hospital will give you advice about which activities you can do while you recover. Most people are advised to keep their eye dry, and avoid driving, reading and heavy lifting for at least a week.

Pros And Cons Of Laser Surgery For Glaucoma

As with any operation, there are risks associated with glaucoma surgery. This article discusses different risks so you can have an open dialogue with your eye surgeon (ophthalmologist). It’s important to note, however, that surgery has very high success rates in substantially slowing the progression of glaucoma. When it comes to surgical intervention for advanced glaucoma cases, the benefits typically outweigh the risks. The following are (rare) glaucoma surgery risks or side effects to discuss with your doctor:

  • Vision loss
  • Bleeding in the eye
  • Infection
  • Low eye pressure (or hypotony)
  • Scarring
  • Cataract formation

Below we discuss each of the risks and why we believe the benefits outweigh them.

Vision Loss

In the short term after your operation, glaucoma surgery temporarily disrupts your vision. It is important to understand that permanent vision can be reduced, or even, in very rare instances, totally lost as a result of any of these glaucoma operations; however, vision loss is not a common permanent side effect. Therefore, it is more likely that surgery will benefit your vision in the long run.

Bleeding

With any of these operations, complications can occur even with the best surgical techniques. Uncommon or rare complications include bleeding inside the eye, infection, and fluid pockets behind the retina due to very low eye pressures. Bleeding inside the eye can be a very serious complication, so you should talk with your ophthalmologist if you are on blood thinners and follow his/her instructions about continuing or discontinuing the medication prior to surgery.

Infection

Eye doctors give antibiotics before, during, and after the surgery, as well as maintain meticulous sterile techniques to try and avoid any infection. However, on very rare occasions, infection inside the eye may occur, which can be very serious and may threaten vision. These infections can occur weeks, months, or even years after the surgery. Therefore, even if it is years after the surgery, if you have early signs of infection such as redness, pain, or excessive tearing, you should call and see your ophthalmologist immediately in order to treat infection before it becomes serious. Caught early, most infections can be adequately treated with antibiotic drops.

Low Eye Pressure

Sometimes, the surgery can lead to eye pressures that are too low, also called hypotony. This is more common soon after the surgery. With hypotony, fluid may collect behind the retina (choroidal detachment), which can cause a shadow in your peripheral or side vision. Usually this is temporary as the pressure returns to the levels that were intended. Sometimes, however, hypotony persists and surgery must be performed in order to fix this problem.

Scarring

More common than eye pressure that is too low, these glaucoma surgeries may fail over time due to the natural healing or scarring tendencies of the eye, resulting in eye pressures that are higher than intended. Sometimes, the scarring is so intense that the operation may fail to achieve a lowered pressure and you may need to restart your glaucoma medications or undergo revisions in the clinic or repeat surgery in the operating room.

Cataract

Cataract formation most likely will be accelerated by glaucoma surgery, but luckily cataracts are fairly easy to fix surgically. Sometimes glaucoma surgeries are combined with cataract surgery if your ophthalmologist feels that the cataracts are having a moderate to significant impact on your vision. However, for some glaucoma surgeries it is better to perform the glaucoma surgery alone and address the cataract later in a second operation.

Safer Procedures on the Horizon

MIGS (minimally invasive glaucoma surgery) are a group of newer procedures that are usually combined with cataract surgery to lower eye pressure to the mid-teens range. In most instances, the safety profile of these procedures is higher than the more traditional glaucoma surgeries described above. However, this enhanced safety profile is counterbalanced by a more modest eye pressure reduction. Therefore, these procedures are usually combined with cataract surgery for patients with early- to moderate-stage glaucoma. For patients with advanced glaucoma, the MIGS procedures are less likely to achieve the low eye pressures needed.