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.
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.
Symptoms of glaucoma
Glaucoma does not usually cause any symptoms to begin with.
It tends to develop slowly over many years and affects the edges of your vision (peripheral vision) first.
For this reason, many people do not realise they have glaucoma, and it’s often only picked up during a routine eye test.
If you do notice any symptoms, they might include blurred vision, or seeing rainbow-coloured circles around bright lights.
Both eyes are usually affected, although it may be worse in 1 eye.
Very occasionally, glaucoma can develop suddenly and cause:
- intense eye pain
- nausea and vomiting
- a red eye
- a headache
- tenderness around the eyes
- seeing rings around lights
- blurred vision
When to get medical advice
Visit an opticians or a GP if you have any concerns about your vision.
If you have glaucoma, early diagnosis and treatment can help stop your vision getting worse.
Without treatment, glaucoma can eventually lead to blindness.
If you develop symptoms of glaucoma suddenly, go to your nearest eye casualty unit or A&E as soon as possible.
This is a medical emergency that may require immediate treatment.
Types of glaucoma
There are several different types of glaucoma.
The most common is called primary open angle glaucoma. This tends to develop slowly over many years.
It’s caused by the drainage channels in the eye becoming gradually clogged over time.
Other types of glaucoma include:
- acute angle closure glaucoma – an uncommon type caused by the drainage in the eye becoming suddenly blocked, which can raise the pressure inside the eye very quickly
- secondary glaucoma – caused by an underlying eye condition, such as inflammation of the eye (uveitis)
- childhood glaucoma (congenital glaucoma) – a rare type that occurs in very young children, caused by an abnormality of the eye
Causes of glaucoma
Glaucoma can occur for a number of reasons.
Most cases are caused by a build-up of pressure in the eye when fluid is unable to drain properly.
This increase in pressure then damages the nerve that connects the eye to the brain (optic nerve).
It’s often unclear why this happens, although certain things can increase the risk, including:
- your age – glaucoma becomes more common as you get older
- your ethnicity – people of African, Caribbean or Asian origin are at a higher risk
- your family history – you’re more likely to develop glaucoma if you have a parent or sibling with the condition
- other medical conditions – such as short-sightedness, long-sightedness and diabetes
It’s not clear whether you can do anything to prevent glaucoma, but having regular eye tests should pick it up as early as possible.
Tests for glaucoma
Glaucoma can usually be detected during a routine eye test at an opticians, often before it causes any noticeable symptoms.
The tests are carried out in the opticians by an optometrist.
You should have a routine eye test at least every 2 years.
Several quick and painless tests can be carried out to check for glaucoma, including vision tests and measurements of the pressure inside your eye.
If tests suggest you have glaucoma, you should be referred to a specialist eye doctor (ophthalmologist) to discuss treatment.
Treatments for glaucoma
It’s not possible to reverse any loss of vision that occurred before glaucoma was diagnosed, but treatment can help stop your vision getting worse.
The treatment recommended for you will depend on the type of glaucoma you have, but the options are:
- eyedrops – to reduce the pressure in your eyes
- laser treatment – to open up the blocked drainage tubes or reduce the production of fluid in your eyes
- surgery – to improve the drainage of fluid
You’ll also probably need regular appointments to monitor your condition and check the treatment is working.
Glaucoma Surgery Side Effects
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.
Laser Treatment For Glaucoma Cost
The cost of any glaucoma surgery depends on what type of procedure it is. Typically, glaucoma surgeries are divided into two categories for the purposes of billing.
- Laser surgery: These operations tend to be the least expensive, the least invasive, and the fastest to recover from. You can get a laser glaucoma procedure either in an ophthalmologist’s office or at an ambulatory surgery center, which further reduces costs since they are fully outpatient surgeries.
The cost of these procedures can range from $1,000 to $2,000, and you can likely get some insurance coverage since they are considered medically necessary. Talk to your eye doctor’s office to determine your out-of-pocket cost after insurance coverage. - Incisional surgery: These require specialized sedation and an eye surgeon in a hospital setting, so they tend to be much more expensive — often around $11,000. However, they are medically necessary so you can work with your health insurance to determine the extent of coverage.
Glaucoma treatment, including prescription eye drops and surgery, is considered medically necessary. Your vision insurance may not cover this treatment, but your standard health insurance will. There will be copays for doctors’ visits and prescription medications, but you can get better financial help for this type of necessary operation compared to “cosmetic” operations like LASIK.
Both your eye doctor’s office and your insurance provider can give you information on your coverage and what you can expect to pay out of pocket.