Selective
Laser Trabeculoplasty (SLT)
SLT is a very gentle laser treatment for open angle glaucoma. It can decrease eye pressure just as much as one of our most effective drops. The pressure lowering effect is not permanent (typically 1-3 years), but the laser can be repeated multiple times in most people.
Video by American Academy of Ophthalmology (AAO).
1
How does it work?
SLT laser is applied to the trabecular meshwork. This meshwork is like a sieve which covers the internal drainage channel in the eye. Over the following 4-6 weeks, the body responds to the laser treatment by changing the meshwork to allow more fluid to leave the eye. This lowers the eye pressure.
2
What are the risks?
A major study done in the United Kingdom called the LiGHT trial showed that SLT (in the right patient) is as safe as using drops. Some possible adverse effects include:
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Inflammation - This can usually be avoided by using anti-inflammatory drops after treatment
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Blurred vision – Usually caused by a lubricating gel needed for the procedure. It typically goes away within minutes to a few hours.
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Pressure spike – It is rare to get a significant eye pressure spike. When it does happen, it is usually short lived and can typically be controlled with a short course of drops or tablets. Pressure is always checked 1 hour after laser to make sure that the pressure is okay before leaving the clinic.
3
Recovery
SLT laser is so gentle that there are no major restrictions after the procedure. There can be some blurred vision, but this usually resolves within an hour or two.
4
Are glaucoma drops still needed afterwards?
SLT is usually only a part of the treatment plan, so at least one drop is usually still needed. Some patients with very mild glaucoma, however, can get off drops all together as long as they continue with regular pressure checks and follow-up.
5
What if it does not work?
There are many other treatments in the form of medications and surgeries to control eye pressure if SLT does not work for you.
Laser
Peripheral Iridotomy
(LPI)
Fluid drains from the eye through the internal drainage channel found in the “angle” of the eye. Angle closure can lead to increased eye pressure and glaucoma. Laser peripheral iridotomy creates a microscopic opening in the iris of the eye to help open the angle.
Video by American Academy of Ophthalmology (AAO).
1
Who needs LPI?
LPI can be used for people who have acute angle closure, chronic angle closure, or are at risk of angle closure. Your eye doctor can identify those who are at high risk of glaucoma due to angle closure.
2
What are the risks?
LPI is a very common and safe procedure, but there are some risks. Some of the risks include:
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Inflammation – controlled with anti-inflammatory drops after the procedure
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Blurry Vision – typically resolves within 24 hours after the procedure
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Glare – this typically goes away within days, but very rarely, it can be an ongoing issue. Laser technique can minimize the risk even further
-
Bleeding – This is microscopic inside the eye. It typically resolves within a few days but can cause some blurring of the vision
-
Pressure spike – This rarely occurs, but when it does, it can typically be controlled with a short course of drops or tablets
3
Are glaucoma drops still needed afterwards?
If you were using pressure drops before LPI, you may still need them afterwards. It depends on each individual’s drainage system. This will be evaluated at your follow-up visit.
4
What if LPI does not work?
There are many other treatments in the form of medications and surgeries to open the angle and control eye pressure if LPI is not enough.
Trabeculectomy
Trabeculectomy is the oldest and most common glaucoma surgery. It creates a new drainage pathway for fluid to leave the eyeball and collect under the eyeball’s skin surface (conjunctiva). This creates a small blister on the surface of the eyeball underneath the upper lid. From there, the fluid goes back into the blood stream; it does NOT come out in your tears.
Video by American Academy of Ophthalmology (AAO).
1
How is the surgery done?
Underneath the upper eyelid, an opening is made in the skin surface of the eyeball. A small flap is made in the white part of the eye (sclera). Underneath that flap, a small opening is made into the eyeball itself so that fluid/pressure can escape. The flap is then stitched loosely back in place so that only a small trickle of fluid is leaving the eyeball. The skin surface in then closed with stitches. A small shallow blister called a “bleb” forms on the eyeball, underneath the upper eyelid. Because it is underneath the eyelid, it is often not visible when looking in the mirror.
2
What should you expect after surgery?
The eye is often patched after surgery until the next morning. After the first follow-up with the surgeon, new eye drops are started. These drops include anti-inflammatories and antibiotics. Usually, some or all glaucoma drops are stopped right after surgery. These may or may not be restarted in the future.
The eye can be scratchy and irritated, especially for the first few days. Vision will be blurry and can go up and down for the first few weeks. This is normal. Any sudden changes, or significant pain or vision changes should be mentioned immediately to your doctor.
Follow-up visits can be frequent after surgery. You can expect at least weekly follow-ups for the first few weeks after surgery. Changes in drops, special contact lenses, quick laser treatments, scar tissue treatments, stitch removals etc. may be needed depending on how your eye heals.
Restrictions after surgery are for at least two weeks. These include:
-
No driving until vision has stabilized and you still meet legal driving standards
-
Avoid any heavy lifting, bending below the waist, straining/exertion
-
Avoid getting water directly in the eye
-
Avoid rubbing the eye
3
What are the risks?
Trabeculectomy surgery for the majority can be done safely and effectively. There are some risks, but when the surgery is recommended, the benefits outweigh those risks. Some of the main risks include:
-
Bleeding – blood in the tears in the first week or two after surgery can be normal. Severe bleeding at the back of the eye is rare, but can cause vision loss.
-
Cataract – any eye surgery can speed up the development of cataract. There are safe and effective surgical treatments for cataract if this happens
-
Pressure is not low enough – sometimes, the pressure does not go low enough to control the glaucoma. Other treatments may be needed to further lower the pressure
-
The pressure goes up due to healing – too much scar tissue can stop the surgery from working well. This can often be helped using an office procedure to add anti-scarring medication and physically break up the scar tissue.
-
Pressure is too low – This can cause blurred vision, but usually gets better on its own after a few weeks. If the pressure does not go up, small procedures may be needed to help bring up the pressure.
-
Infection – eye infections after surgery can be serious and cause loss of vision. Antibiotic drops work well to prevent this. There is a small risk of infection even after the surgery has healed. If the eye ever becomes very red, painful, and has blurred vision, it should be checked as soon as possible by an eye doctor.
-
Vision loss – it is rare to have significant permanent vision loss due to surgery. Eyes at higher risk include those with very bad glaucoma where the vision was already rapidly getting worse.
4
Does trabeculectomy cure glaucoma?
There is no way to cure glaucoma. Surgery can help to control glaucoma by stopping or slowing its progression.
5
Will my vision be better after surgery?
Glaucoma surgery is meant to slow or stabilize glaucoma. It cannot reverse glaucoma related vision loss.
6
How long do the effects of trabeculectomy last?
Trabeculectomy surgery can help lower the pressure for many years. Scar tissue can eventually stop it from working. Small office procedures can often get it working well again. The length of the effects of trabeculectomy is dependent on many factors specific to your body.
Tube Shunt
Tube shunts are surgical implants which help to drain fluid out of the eye to relieve pressure. The two main types of tube shunts are the Ahmed Valve and the Baerveldt. They are both made out of silicone and consist of a tube attached to a plate. The plate is stitched to the white part of the eye, way back underneath the eyelid. The tube enters the eyeball itself. The fluid that leaves the eye goes back into the blood stream and does NOT come out in your tears.
Video by American Academy of Ophthalmology (AAO).
1
How is the surgery done?
Underneath the upper or lower eyelid, an opening is made in the skin surface of the eyeball. The plate of the implant is stitched to the white part of the eye (sclera) far back from the front of the eye. The tube is then inserted into the eyeball near the front of the eye. A small piece of donated sclera or cornea is used to help cover the tube. This tissue graft helps to prevent the tube from rubbing through the surface. The skin surface is then closed over top of all of this. Because most of the surgery is underneath the eyelid, it is often not visible when looking in the mirror.
2
What should you expect after surgery?
The eye is often patched after surgery until the next morning. After the first follow-up with the surgeon, new eye drops are started. These drops include anti-inflammatories and antibiotics. Sometimes, the glaucoma drops are stopped right after surgery, but sometimes they need to be continued.
The eye can be scratchy and irritated, especially for the first few days. Vision will be blurry and can go up and down for the first few weeks. This is normal. Any sudden changes, or significant pain or vision changes should be mentioned immediately to your doctor.
Follow-up visits can be frequent after surgery. You can expect at least weekly follow-ups for the first two weeks after surgery.
There are differences in healing between Ahmed and Baerveldt tube shunts. For Ahmeds, pressures can sometimes be too low for the first week or two, then go high around 4 weeks after surgery. Baerveldts often have pressures that are too high for the first few weeks, then go low around 5 weeks after surgery. Your doctor will make treatment adjustments based on the way you heal.
Restrictions after surgery are for at least two weeks. These include:
-
No driving until vision has stabilized and you meet legal driving standards
-
Avoid any heavy lifting, bending below the waist, straining/exertion
-
Avoid getting water directly in the eye
-
Avoid rubbing the eye
3
What are the risks?
Tube shunt surgery for most people can be done safely and effectively. There are some risks, but when the surgery is recommended, the benefits outweigh those risks. Some of the main risks include:
-
Bleeding – blood in the tears in the first week or two after surgery can be normal. Severe bleeding at the back of the eye is rare, but can cause vision loss.
-
Cataract – any eye surgery can speed up the development of cataract. There are safe and effective surgical treatments for cataract if this happens
-
Pressure is not low enough – sometimes, the pressure does not go low enough to control the glaucoma. Other treatments may be needed to further lower the pressure
-
The pressure goes up due to healing – too much scar tissue can stop the surgery from working well. Tubes are more resistant to scar tissue than some other surgeries.
-
Pressure is too low – This can cause blurred vision, but usually gets better on its own after a few weeks. If the pressure does not go up, small procedures may be needed to help bring up the pressure.
-
Infection – This is very rare in tube shunts. Eye infections after surgery can be serious and cause loss of vision. Antibiotic drops work well to prevent this. There is a small risk of infection even after the surgery has healed. If the eye ever becomes very red, painful, and has blurred vision, it should be checked as soon as possible by an eye doctor.
-
Vision loss – it is very rare to have significant vision loss due to surgery. Eyes at higher risk include those with very bad glaucoma where the vision was already rapidly getting worse.
-
Double vision – There is a very small risk of double vision. When it does happen, it usually gets better on its own.
-
Swelling of the cornea – The clear dome at the front of the eye is the cornea. Occasionally, the cornea can become cloudy years later which could require another surgery.
4
Does the tube shunt cure my glaucoma?
There is no way to cure glaucoma. Surgery can help to control glaucoma by stopping or slowing its progression.
5
Will my vision be better after surgery?
Glaucoma surgery is meant to slow or stabilize glaucoma. It cannot reverse glaucoma related vision loss.
6
How long do the effects of the tube shunt last?
Tube shunts can help lower the pressure for many years. Scar tissue can eventually stop it from working. Small office procedures can often get it working well again. The length of the effects of tube shunts is dependent on many factors specific to your body.
Gonioscopy Assisted Transluminal Trabeculotomy
(GATT)
GATT surgery aims to open up the eye’s internal drainage channel (Canal of Schlemm) by manually opening the covering meshwork/membrane (trabecular meshwork.) This allows fluid in the eyeball more direct access to the drainage system back to the blood stream. This lowers the eye pressure, especially in types of glaucoma where the meshwork is clogged or not working well.
1
How is the surgery done?
Tiny wounds are made in the eyeball. A special lens is used to see the trabecular meshwork in the internal angle of the eye. A small opening is made in the trabecular meshwork and a very fine suture/thread is placed through the opening into the drainage canal. Micro-instruments are used to thread the suture through the canal. The suture is then gently pulled to open up the trabecular meshwork.
2
What should you expect after surgery?
After the surgery, new eye drops are started to help with the healing. Any glaucoma drops used before are often continued as well.
The eye can be scratchy and irritated, for the first few days. Vision can be quite blurry and can go up and down for the first few weeks. This is normal due to some expected blood in the eye from the procedure. Any sudden changes, or significant pain or vision changes should be mentioned immediately to your doctor.
Restrictions after surgery include:
-
No driving until vision has stabilized and you meet legal driving standards
-
Avoid any heavy lifting, bending below the waist, straining/exertion (about 2 weeks)
-
Avoid getting water directly in the eye (about 1 week)
-
Avoid rubbing the eye (about 3 weeks)
3
What are the risks?
GATT is considered a micro or minimally invasive glaucoma surgery. Compared to other glaucoma surgeries, it is lower risk in most people. Some of the risks include:
-
Bleeding – blood inside the front of the eye is expected. This typically clears on its own between 3 days and 3 weeks. If it is not clearing well, small procedures can be done to help.
-
Cataract – any eye surgery can speed up the development of cataract. There are safe and effective surgical treatments for cataract if this happens
-
Pressure is not low enough – sometimes, the pressure does not go low enough to control the glaucoma. Other treatments may be needed to further lower the pressure
-
The pressure goes up – the pressure can sometimes go up temporarily during the healing. Medication adjustments are usually enough to control this.
-
Infection – This is extremely rare. Eye infections after surgery can be serious and cause loss of vision. Antibiotic drops work well to prevent this. If the eye ever becomes very red, painful, and has blurred vision, it should be checked as soon as possible by an eye doctor.
-
Vision loss – it is very rare to have significant vision loss due to surgery
4
Does GATT cure glaucoma?
There is no way to cure glaucoma. Surgery can help to control glaucoma by stopping or slowing its progression.
5
Will my vision be better after surgery?
Glaucoma surgery is meant to slow or stabilize glaucoma. It cannot reverse glaucoma related vision loss.
iStent
iStents are tiny implants (just one third of a millimetre in length!) which help lower eye pressure. They are surgically placed through the meshwork that covers the eye’s internal drain. iStents often lower the pressure only a small amount, but they are one of the safest and least invasive glaucoma surgeries. They are usually combined with cataract surgery.
Video by American Academy of Ophthalmology (AAO).
1
What should you expect after surgery?
After the surgery, new eye drops are started to help with the healing. Any glaucoma drops used before are often continued as well.
The eye can be scratchy and irritated, for the first few days. Vision will be blurry, but usually starts to improve within a day or two. Any sudden changes, or significant pain or vision changes should be mentioned immediately to your doctor.
Restrictions after surgery include:
-
No driving until vision has stabilized and you meet legal driving standards
-
Avoid any heavy lifting, bending below the waist, straining/exertion (about 2 weeks)
-
Avoid getting water directly in the eye (about 1 week)
-
Avoid rubbing the eye (about 3 weeks)
2
What are the risks?
iStent is considered a micro or minimally invasive glaucoma surgery. Compared to other glaucoma surgeries, it is lower risk in most people. When combined with cataract surgery, they do not increase risk any more than cataract surgery itself. Some of the risks include:
-
Bleeding – blood inside the front of the eye is expected, but usually very minimal. This typically clears on its own within days. If it is not clearing well, small procedures can be done to help.
-
Cataract – any eye surgery can speed up the development of cataract. There are safe and effective surgical treatments for cataract if this happens
-
Pressure is not low enough – sometimes, the pressure does not go low enough to control the glaucoma. Other treatments may be needed to further lower the pressure
-
The pressure goes up – blood and sometimes a response to the medications can cause the pressure to go up temporarily during the healing. Medication adjustments are usually enough to control this.
-
Infection – This is extremely rare. Eye infections after surgery can be serious and cause loss of vision. Antibiotic drops work well to prevent this. If the eye ever becomes very red, painful, and has blurred vision, it should be checked as soon as possible by an eye doctor.
-
Vision loss – it is very rare to have significant vision loss due to surgery
3
Does the iStent cure glaucoma?
There is no way to cure glaucoma. Surgery can help to control glaucoma by stopping or slowing its progression.
4
Will my vision be better after surgery?
Glaucoma surgery is meant to slow or stabilize glaucoma. It cannot reverse glaucoma related vision loss.
PreserFlo
PreserFlo is tiny implant made from a special material previously used only for heart stents. It creates a new drainage pathway for fluid to leave the eyeball and collect under the eyeball’s skin surface (conjunctiva). This creates a small blister on the surface of the eyeball underneath the upper lid. From there, the fluid goes back into the blood stream; it does NOT come out in your tears.
1
How is the surgery done?
Underneath the upper eyelid, an opening is made in the skin surface of the eyeball. A small opening is made in the white part of the eye (sclera). One end of the Presserflo is placed through the small opening into the eyeball so that fluid/pressure can escape. The other end is left outside of the eyeball on the sclera. The skin surface in then closed with stitches. A small shallow blister called a “bleb” forms on the eyeball, underneath the upper eyelid. Because it is underneath the eyelid, it is often not visible when looking in the mirror.
2
What should you expect after surgery?
The eye is often patched after surgery until the next morning. After the first follow-up with the surgeon, new eye drops are started. These drops include anti-inflammatories and antibiotics. Usually, some or all glaucoma drops are stopped right after surgery. These may or may not be restarted in the future.
The eye can be scratchy and irritated, especially for the first few days. Vision will be blurry and can go up and down for the first few weeks. This is normal. Any sudden changes, or significant pain or vision changes should be mentioned immediately to your doctor. Very low pressures are common early on after surgery.
Follow-up visits can be frequent after surgery. You can expect at least weekly follow-ups for the first few weeks after surgery. Changes in drops, special contact lenses, scar tissue treatments, stitch removals etc. may be needed depending on how your eye heals.
Restrictions after surgery are for at least two weeks. These include:
-
No driving until vision has stabilized and you still meet legal driving standards
-
Avoid any heavy lifting, bending below the waist, straining/exertion
-
Avoid getting water directly in the eye
-
Avoid rubbing the eye
3
What are the risks?
PreserFlo surgery for the majority can be done safely and effectively. There are some risks, but when the surgery is recommended, the benefits outweigh those risks. Some of the main risks include:
-
Bleeding – blood in the tears in the first week or two after surgery can be normal. Severe bleeding at the back of the eye is rare, but can cause vision loss.
-
Cataract – any eye surgery can speed up the development of cataract. There are safe and effective surgical treatments for cataract if this happens
-
Pressure is not low enough – sometimes, the pressure does not go low enough to control the glaucoma. Other treatments may be needed to further lower the pressure
-
The pressure goes up due to healing – too much scar tissue can stop the surgery from working well. This can often be helped using an office procedure to add anti-scarring medication and physically break up the scar tissue.
-
Pressure is too low – This can cause blurred vision, but usually gets better on its own after a few weeks. If the pressure does not go up, small procedures may be needed to help bring up the pressure.
-
Infection – eye infections after surgery can be serious and cause loss of vision. Antibiotic drops work well to prevent this. There is a small risk of infection even after the surgery has healed. If the eye ever becomes very red, painful, and has blurred vision, it should be checked as soon as possible by an eye doctor.
-
Vision loss – it is rare to have significant permanent vision loss due to surgery. Eyes at higher risk include those with very bad glaucoma where the vision was already rapidly getting worse.
4
Does PreserFlo cure my glaucoma?
There is no way to cure glaucoma. Surgery can help to control glaucoma by stopping or slowing its progression.
5
Will my vision be better after surgery?
Glaucoma surgery is meant to slow or stabilize glaucoma. It cannot reverse glaucoma related vision loss.
6
How long do the effects of PreserFlo surgery last?
PreserFlo surgery can help lower the pressure for many years. Scar tissue can eventually stop it from working. Small office procedures can often get it working well again. How long the effects of surgery last depends on many factors specific to your body.
Xen Implant
The Xen is very tiny 6mm tube made of collagen. It creates a new drainage pathway for fluid to leave the eyeball and collect under the eyeball’s skin surface (conjunctiva). This creates a small blister (called a “bleb”) on the surface of the eyeball underneath the upper lid. Because it is underneath the eyelid, it is often not visible when looking in the mirror. From there, the fluid goes back into the blood stream; it does NOT come out in your tears.
1
How is the surgery done?
The Xen implant can be inserted in either of two ways:
-
Underneath the upper eyelid, an opening is made in the skin surface of the eyeball. A small opening is made in the white part of the eye (sclera). One end of the Xen is placed through the small opening into the eyeball so that fluid/pressure can escape. The other end is left outside of the eyeball on the sclera. The skin surface in then closed with stitches.
-
Small openings are made at the edge of the cornea (similar wounds to cataract surgery). The Xen implant in inserted from the inside of the eye so that one end is under the eyeball skin surface (conjunctiva) and the other end is inside the eyeball. This technique usually does not require stitches.
The chosen technique depends on a particular patient’s anatomy, disease process and circumstances.
2
What should you expect after surgery?
The eye is often patched after surgery until the next morning. After the first follow-up with the surgeon, new eye drops are started. These drops include anti-inflammatories and antibiotics. Usually, some or all glaucoma drops are stopped right after surgery. These may or may not be restarted in the future.
The eye can be scratchy and irritated, especially for the first few days. Vision will be blurry and can go up and down for the first few weeks. This is normal. Any sudden changes, or significant pain or vision changes should be mentioned immediately to your doctor. Very low pressures are common early on after surgery.
Follow-up visits can be frequent after surgery. You can expect at least weekly follow-ups for the first few weeks after surgery. Changes in drops, special contact lenses, scar tissue treatments, stitch removals etc. may be needed depending on how your eye heals.
Restrictions after surgery are for at least two weeks. These include:
-
No driving until vision has stabilized and you still meet legal driving standards
-
Avoid any heavy lifting, bending below the waist, straining/exertion
-
Avoid getting water directly in the eye
-
Avoid rubbing the eye
3
What are the risks?
Xen surgery for the majority can be done safely and effectively. There are some risks, but when the surgery is recommended, the benefits outweigh those risks. Some of the main risks include:
-
Bleeding – blood in the tears in the first week or two after surgery can be normal. Severe bleeding at the back of the eye is rare, but can cause vision loss.
-
Cataract – any eye surgery can speed up the development of cataract. There are safe and effective surgical treatments for cataract if this happens
-
Pressure is not low enough – sometimes, the pressure does not go low enough to control the glaucoma. Other treatments may be needed to further lower the pressure
-
The pressure goes up due to healing – too much scar tissue can stop the surgery from working well. This can often be helped using an office procedure to add anti-scarring medication and physically break up the scar tissue.
-
Pressure is too low – This can cause blurred vision, but usually gets better on its own after a few weeks. If the pressure does not go up, small procedures may be needed to help bring up the pressure.
-
Infection – eye infections after surgery can be serious and cause loss of vision. Antibiotic drops work well to prevent this. There is a small risk of infection even after the surgery has healed. If the eye ever becomes very red, painful, and has blurred vision, it should be checked as soon as possible by an eye doctor.
-
Vision loss – it is rare to have significant permanent vision loss due to surgery. Eyes at higher risk include those with very bad glaucoma where the vision was already rapidly getting worse.
4
Does the Xen Implant cure my glaucoma?
There is no way to cure glaucoma. Surgery can help to control glaucoma by stopping or slowing its progression.
5
Will my vision be better after surgery?
Glaucoma surgery is meant to slow or stabilize glaucoma. It cannot reverse glaucoma related vision loss.
6
How long do the effects of Xen Implant surgery last?
Xen Implant surgery can help lower the pressure for many years. Scar tissue can eventually stop it from working. Small office procedures can often get it working well again. How long the effects of surgery last depends on many factors specific to your body.
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