When and why Glaucoma Surgery

In previous articles, it has been made abundantly clear that glaucoma is a serious ocular disease and if not properly treated could cause blindness. We also discussed the different types of glaucoma, the means by which the intraocular pressure rises and the subsequent damage produced in the optic nerve, visual field and the vision.

Today, we shall be responding to the question of many a patient with regards to when and why a patient with glaucoma is operated on as this has proven a topic of a lot of curiosity.{{more}}

Once a patient is diagnosed with glaucoma, the initial treatment constitutes medication – specifically eye-drops (Timolol, Alphagon, Trusoft etc) with the intention of controlling and maintaining the intraocular pressure within a normal range (below 21 mm Hg) and preventing loss of visual field and vision decline.

Unfortunately, sometimes, it becomes necessary to use a second line of treatment and this is surgery, which can be non-invasive. It is done by the ophthalmologist in his office with the use of laser (Iriodotomy), or invasive done in the Operating Theater (trabeculectomy). Both techniques have the same objective – improving the drainage of aqueous humour and, therefore, controlling the intraocular pressure.

When is glaucoma operated? Well, glaucoma surgery should be done when, in spite of local treatment with eye-drops, we are not able to neither control the intraocular pressure nor lower it. It is also indicated where the patient is losing vision even when using eye-drops, and in special situations where the patient is mentally or physically challenged which prevents them from adequately following the medication regimen.

The increase in intraocular pressure above its normal level produces a progressive death of the optic nerve cells and tissue, with decline of the visual field and blindness. This in itself answers the question as to why it is necessary to operate on a patient with glaucoma.

One very important point that must be made clear to these patients is that the objective of this surgery is to lower and control the intraocular pressure and to detain the progress of the disease. It is NOT to improve their vision, although once the eye-pressure is controlled there could be some improvement in the sight.

We should not forget that “prevention is better than cure”, therefore a regular visit to your ophthalmologist is very necessary if you have been diagnosed with or suspect that you have this dangerous disease.

Dr. Pedro A. F. Suarez
Consultant Ophthalmologist (MCMH)