Glaucoma is one of the leading causes of blindness in the United States, according to CDC. It affects an estimated 2.7 million Americans, and only 50% of those people realize that they are suffering from this disease. Glaucoma is a disease which affects the eye’s optic nerve, resulting in vision loss and blindness. Glaucoma patients have a steady buildup of fluid pressure inside the eye, affecting the eyesight over time. The people most commonly affected by glaucoma are patients over the age of 60. Early treatment is key to fight the effects of glaucoma. If you have glaucoma, your doctor may take you through the following treatment options.
Prostaglandins (eye drops)
Eye drops are the first choice when it comes to treating patients with glaucoma. The goal of glaucoma treatment is to reduce intraocular pressure by either helping the fluid to drain better or by decreasing the fluid produced in the eye. According to the Glaucoma Research Foundation (GRF), they work by increasing the outflow of fluid from the eye. The possible side effects of these drugs include a change in (and darkening of) eye color and eyelash growth.
Beta-blockers (eye drops)
According to the GRF, beta-blockers are the second most used glaucoma eye-drop drug. They work by decreasing the production of fluid in the eye, and in most cases, need to be used twice daily. Some possible side effects of these drugs lung problems (wheezing in people with asthma), diabetes, and depression. For these reasons, make sure your doctor is aware of your medical history before prescribing these particular medications.
Alpha agonists (eye drops)
Alpha agonists work by both decreasing fluid production and increasing fluid drainage. These drugs has a very high frequency of allergic reactions and a possible side effect of making the user very tired during the day. For this reason, it is not the first choice in glaucoma treatment.
Carbonic anhydrase inhibitors (eye drops or pills)
According to John’s Hopkins Glaucoma Center of Excellence, these pills or eye-drops work by blocking the enzyme that facilitates the production of aqueous humor (eye fluid). This lowers eye pressure, halting glaucoma damage. This is now available as eye drops. Side effects of the eye drops include stinging and an unpleasant taste in the mouth. Possible side effects of the pill are much more serious and may include fatigue, depression, pins and needles in the lips and fingers, kidney stones, and aplastic anemia. For this reason, the pills are only used for a short period when a patient is facing serious, acute high pressure in the eyes.
Parasympathomimetics (eye drops)
This type of eye drop works on the other half of the unconscious nervous system from the alpha and beta sympathetic system, according to John’s Hopkins Glaucoma Center of Excellence. It improves the outflow of fluid by causing the tiny muscles in the eye to contract. It also has a visible side effect of making the pupil small. These eye drops have many possible side effects including blurred, dim vision, sinus-headache-like pain, eye redness, and occasional detachment of the retina. For this reason, they are rarely used to treat glaucoma.
Epinephrine drugs work both by decreasing the rate of aqueous humor production and increasing the outflow of fluid from the eye. This type of eye drop is used to treat glaucoma, and it is also used during eye surgery. Side effects include conjunctival deposits from the eye, blocked tear ducts, and heart palpitations.
Hyperosmotic agents (oral and intravenous medication)
This medication is reserved for people with very eye high pressure, as it is designed to lower eye pressure quickly. The medication is given in a drinking solution, or by infusion into a vein. The medication quickly lowers fluid volume in the eye and is only given once, during an emergency and under careful observation.
Half of the individuals being treated for glaucoma require more than one of the drugs mentioned above to keep pressure under control. There are a few “combination” drugs available which contain more than one glaucoma medication and have shown good results in lowering eye pressure.
Occasionally, when a patient cannot tolerate eye drops or if the eye drops are not effective enough, they will undergo laser surgery. Laser is a great option for glaucoma patients, and may even be used as a primary treatment method in certain cases. With laser surgery, the ocular pressure is reduced in one shot and may eliminate the need for eye drops or pills for many years. In the laser surgery, an iris hole will be made in one or both eyes with the use of eye drop anesthesia. The procedure is relatively painless and usually requires only one sitting.
Surgery is usually the last option for a patient with glaucoma. Traditional surgery has the highest chance of vision-loss itself, although it is not very common. The goal of surgery in an operating room is to create a new drainage channel for the fluid. The most common types of glaucoma surgeries include a trabeculectomy. Here the surgeon creates a tiny flap in the white part of the eye for fluid to drain from; tube-shunt surgery which includes insertion of a glaucoma drainage device into the eye; or diode laser cyclodestruction.