Laser Treatments for Glaucoma
Mr Tariq Ayoub - 27 Jun 2021
There are several types of lasers available for the treatment of glaucoma. The type of laser treatment is dependent on the type of glaucoma you have. In this article we will explore the common laser treatments for glaucoma and their effects on your eye.
Fluid build-up in the eye causes an increase of pressure in the eye (called intraocular pressure or IOP). This can result in glaucoma as the optic nerve can be damaged leading to vision loss. Raised IOP without optic nerve damage is called ocular hypertension. Untreated ocular hypertension can result in glaucoma.
Laser treatment can be used to decrease the amount of fluid in the eye, either by increasing the drainage of fluid out of the eye, or by reducing the amount of fluid that is made in the eye. The type of laser treatment employed is generally dependent on the type on glaucoma you have.
The various types of laser treatments for glaucoma include:
Selective laser trabeculoplasty (SLT)
SLT and ALT are used to treat open angle glaucoma or ocular hypertension. SLT and ALT (argon laser trabeculoplasty) are very similar. SLT is a newer form of the treatment and uses a gentler laser. The laser is targeted at the drainage channel in the eye, opening it up so that fluid can drain out of the eye more easily. This lowers IOP, which reduces the risk of damage to the optic nerve.
SLT is used when eye drop medications are not lowering the eye pressure enough or are causing significant side effects. It can also be used as initial treatment in glaucoma. SLT lowers the IOP by about 30% when used as initial therapy. The effects will generally last between 1-5 years, and in some cases, longer than that. If the effects wear off, then the procedure can be repeated
At Oculase, we use SLT laser treatment for open angle glaucoma.
Laser iridotomy and iridoplasty
Laser iridotomy and laser iridoplasty are used to treat angle closure glaucoma or narrow angles. This is where the iris (the coloured bit of the eye) is pushed forward, blocking off the natural drainage pathway for the fluid in the eye. This causes the fluid in the eye to build up, increasing IOP and damaging the optic nerve.
In iridotomy, a small hole is made in the iris with laser. This allows the iris to return to its original position, opening up the natural drainage channel.
In iridoplasty, the laser is targeted at the iris where it blocks the drainage channel, to shrink the iris away and open up the channel again.
In both treatments, opening up the channel means the fluid can drain out of the eye, reducing the IOP.
Cyclodiode laser (including MicroPulse)
This laser is used to treat glaucoma when other types of treatment have failed. The cyclodiode laser targets the ciliary body, the part of the eye where aqueous humour is made. The laser reduces the amount of aqueous being made.
MicroPulse cyclodiode works in the same way, but uses short bursts of energy that allow the ciliary body to cool between pulses and reduce the damage to the surrounding tissue.
What happens during laser treatment for glaucoma?
SLT, Laser iridotomy and laser iridoplasty are performed in clinic. You will sit in front of a laser machine and a special lens is used to aim the laser inside your eye. You may see flashes of bright green or red light during the treatment.
Before the treatment, your eyes will be anaesthetised so you will feel little or no pain or discomfort during the treatment. Additional drops may be used prior to the procedure and after the procedure for optimal outcome and to control any inflammation.
If you have glaucoma or ocular hypertension in both eyes, you can have laser treatment to both eyes on the same day.
Learn more about London and Birmingham’s best laser eye surgeon, Mr Tariq Ayoub.
How long does it take to recover after laser treatment for glaucoma?
After your laser treatment for glaucoma, you can go home the same day. Most people can go back to their normal daily activities the day after their laser treatment.
Right after the treatment, your eye may be irritated and your vision might be blurry, so you should have someone accompany you home.
Are there any side effects of laser treatment for glaucoma?
Laser treatments for glaucoma are generally safe with minimal side-effects. The most important side-effects include uveitis (inflammation inside the eye) which can cause soreness and photophobia, and paradoxically, raised pressure in the eye. Both side-effects can be treated with eye drops. Rarely, the raised pressure cannot be controlled with drops thus requiring further laser or surgery. Extra visual images including bright lights or flashes, or double vision in the treated eye, may rarely occur. Retreatment may be required if the laser is infective.
Will I need more treatment?
Laser treatment works very well for most people, but it doesn’t work for everyone. You may need to wait 1-3 months after the procedure to find out if the treatment has worked.
Some patients can be controlled with just laser treatment. Others require additional IOP lowering and may therefore need to use glaucoma medication as well.
Some people may need to get laser treatment more than once as the treatment wears off over time. You may need other treatment, like surgery.
What are the alternatives to laser treatment for glaucoma?
Alternatives to laser treatment for glaucoma include eye drops, lens replacement surgery, MIGS, trabeculectomy and tube surgery. The suitability of these is dependent various factors including your and severity of glaucoma.
Early detection and regular monitoring is important in managing glaucoma. Anyone above the age of 40 should have a glaucoma assessment every eighteen months that should include a pressure check and nerve assessment.
Led by Mr Tariq Ayoub, Oculase is an eye specialist in London and Birmingham, with convenient clinics in both locations. Book an appointment for a glaucoma assessment today by clicking on the button below.