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How Does Glaucoma Surgery Work? Risks, Benefits, & More

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Man has left eye checked with loupe during his eye exam.

Roughly 3 million Americans have glaucoma. It’s the second most common cause of blindness globally. Since there are often very few symptoms, many people don’t even know they have glaucoma. That’s why it’s important to get regular eye exams, to catch the disease early before vision loss occurs.

If you are diagnosed with glaucoma, there are a wide variety of treatment options, including surgery. Read on to discover those options as well as what to expect if you do need surgery.

What is Glaucoma?

Glaucoma is a disease that damages your optic nerve. It’s often a result of abnormally high pressure inside your eye. There are several different types of glaucoma, but they’re usually grouped into two main categories: open-angle glaucoma and angle-closure glaucoma. 

Open-angle Glaucoma

Open-angle glaucoma is the most common type of glaucoma. It occurs when the pressure in your eye increases as a result of fluid draining too slowly. The pressure often builds gradually and isn’t painful. You might not even notice it until you lose peripheral vision.

Angle-closure Glaucoma 

Angle-closure glaucoma occurs when your iris blocks drainage. It’s caused by a rapid increase in pressure inside your eye and is a medical emergency.

Treatments to Try Before Surgery

Surgery is generally a last resort in treating glaucoma. The goal of all glaucoma therapy is to lower the pressure in your eye. There are several ways to do this:

Prescription Eye Drops

Eye drops are usually the first type of treatment for glaucoma. There are many varieties. Prostaglandin analogs (PGAs) and alpha-adrenergic agonists reduce pressure in the eyes by increasing the outflow of fluid. 

Beta blockers work by decreasing the production of fluid, as do carbonic anhydrase inhibitors. Rho kinase inhibitors suppress the enzymes responsible for fluid increase. 

Drops may be needed from 1-4 times per day. Your optometrist may try a combination of the different types of eye drops in order to achieve the desired result.

Oral Medications

Many of the active ingredients in eye drops are also available in oral medication. If topical eye drops don’t work for you, your ophthalmologist might prescribe medicine in pill form.

Lifestyle Changes

Large amounts of caffeine may increase eye pressure, so limiting your intake can help prevent glaucoma. 

Sleeping with your head elevated at roughly 20 degrees has been shown to reduce eye pressure. A wedge pillow is a good way to keep your head angled while you sleep.

Drinking too much liquid in a short period of time can temporarily increase eye pressure. Sip smaller amounts of liquid throughout the day to stave off thirst and keep the pressure from rising.

Laser Treatment 

If you have open-angle glaucoma, laser trabeculoplasty might be an option. A small laser beam works to open clogs in your eye, relieving intraocular pressure.

The procedure is performed in your doctor’s office and is relatively painless. Generally, you can go back to your normal activities the next day. 

Laser treatment often needs to be repeated and most people will need to continue taking medication or eye drops, even after the procedure.

Person undergoing glaucoma surgery.

Types of Glaucoma Surgery

If no other treatment options work, or you have particularly severe glaucoma, your optometrist might determine that surgery is the best option for you. There are several types of surgery:

Trabeculectomy

Performed under local or general anesthesia, a trabeculectomy opens a new drainage hole in the eye. It takes between 45-60 minutes.

Glaucoma Implant Surgery

There are several different types of implants but all are intended to drain fluid and reduce pressure. Small shunts are inserted into your eye to allow for fluid outflow. This surgery takes about an hour.

Minimally Invasive Glaucoma Surgery

Minimally invasive glaucoma surgeries (MIGS) are a group of relatively new procedures that use microscopic-sized equipment. They were designed to reduce complications arising from other surgery types and require less postoperative care.

Risks Associated With Surgery

Much like any surgery, there are potential risks to glaucoma surgery. It’s important to weigh the risks and benefits and discuss them with your optometrist.

Some of the risks include:

  • Cataracts
  • Infection
  • Vision loss
  • Low pressure
  • Eye pain
  • Scar tissue
  • Swelling
  • Bleeding

Many of these complications are rare and your optometrist will monitor your recovery closely to help manage and mitigate any that do occur.

Benefits of Glaucoma Surgery

Surgery will not restore vision loss, so it’s important to identify glaucoma before vision loss occurs. The best way to do this is to visit your optometrist for regular eye exams

The benefits of glaucoma surgery might include no longer needing eye drops or medications,  and preventing your vision from getting worse. Glaucoma surgery has high success rates.

Recovery and Aftercare

After surgery, your eye might be sore and uncomfortable. If necessary, you’ll be prescribed medication to help deal with any pain.

You might have blurry vision, sometimes lasting up to twelve weeks. Avoid driving. 

You won’t be able to wear contact lenses in the weeks following surgery and you should also avoid getting water in your eyes.

High-impact exercise and strenuous activities should also be avoided. Since lowering your head might be very painful, you should abstain from activities like yoga that require bending.

Plenty of rest helps with healing and getting enough sleep will aid recovery.

Don’t touch your eyes. You might have to sleep with a shield on your eye to prevent any inadvertent rubbing or scratching.

Recovery times and protocols will vary depending on your specific case and the type of surgery you have. There will be plenty of follow-ups with your eye care professional to make sure everything is healing and working as it should. 

Get Professional Advice

The best way to prevent damage to your vision from glaucoma is to identify it early on by scheduling regular eye exams. Your optometrist will help you take a proactive approach by identifying your risk factors and screening you regularly for glaucoma. 

If surgery or other treatments are necessary, your eye care professional will determine the best course of action, tailored to your individual needs.

Written by Daniel Rowan

Reno optometrist, Dr. Daniel Rowan, was raised in Western Canada and attended Norwich University in Vermont on a hockey scholarship. After obtaining a Bachelor of Science degree in both biology and sports medicine, he received his Doctor of Optometry (OD) degree from the New York College of Optometry in 2001. He performed rotations in a Queens VA hospital, specializing in glaucoma care, and an outpatient eye clinic in the Bronx. Immediately after graduating, he moved to Nevada and is now considered a top Reno optometrist. He is a member of the American Optometric Association and is board-certified by the National Board of Examiners in Optometry for the treatment and management of ocular diseases.
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