Laser Treatment Glaucoma

Contributing Author: Elana Rosenberg, M.D.

Glaucoma is a collection of diseases that irreparably damages the eye’s optic nerve, which is responsible for our visual information from the eyes to the brain. Intraocular pressure (IOP) is often associated with discussions on glaucoma as it is the most important risk factor for disease development, particularly as it is the only modifiable one. Elevated intraocular pressure within the eye is the result of an imbalance between the fluid produced within the eye and the fluid that normally drains out of the eye. Over time, this increased intraocular pressure can damage the optic nerve, leading to characteristic patterns of vision loss or even total blindness. Although there is no cure for glaucoma, early detection and treatment is essential as it can help preserve your visual field, which is the goal of all glaucoma therapies.

First line glaucoma treatments usually include prescription eye drops to help lower the pressure inside the eye. Laser procedures are another way to safely & effectively lower eye pressure, and they can be done either alone or in combination with the use of eye drops, collectively working to further lower the pressure inside the eye depending on disease severity. In the more complex cases of glaucoma, oral medications or surgical interventions may also be necessary.

According to the Glaucoma Research Foundation (GRF), laser treatments are the most prevalent treatment for glaucoma when primary treatment fails. In some cases, laser procedures are the first-line treatment, depending on the type of glaucoma and its severity. Laser treatment for glaucoma works by helping the aqueous fluid in the eye drain and, thus, reducing eye pressure. The procedures can be done in your doctor’s office or at an outpatient surgery center. Your ophthalmologist will determine the right treatment option for you.

What Happens During Laser Treatment for Glaucoma?

Lasers emit a focused beam of light on the area of interest, depending on the type of laser treatment. This laser energy helps remodel the drainage system of the eye allowing for improved outflow.

Laser procedures typically performed in the office and without the need for sedation. The procedure begins with application of a local anesthetic drop to numb the eyes in order to ease the patients discomfort throughout the procedure. Then, your doctor will aim the laser into the eye using a special lens. You may see flashes of bright green or red light during treatment.

Given the fact that glaucoma is generally a bilateral disease process, your doctor will often perform the laser procedures on both eyes, with a few days or weeks in between the treatments.

Types of Laser Treatment for Glaucoma

There are several types of laser treatments for glaucoma. The right treatment plan depends on the form of glaucoma and its severity.

The most common forms of laser treatment for glaucoma include:

Laser trabeculoplasty – There are two types of laser trabeculoplasty procedures: selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT). Both SLT and ALT treat primary open-angle glaucoma or ocular hypertension and work by targeting the laser at the eye’s drainage channel and opening it so that fluid can flow out of the eye more easily. This laser application reduces intraocular pressure, lowering the risk of optic nerve damage. SLT is a newer form of laser allowing less scar tissue development and the option of repeatability if determined to be successful.
Laser peripheral iridotomy (LPI) – This laser treatment is generally used to treat narrow angles and narrow-angle glaucoma (also known as angle-closure glaucoma). Narrow-angle glaucoma occurs when the angle between the iris and cornea is too small, causing the iris to relatively block fluids drainage from the ey, resulting in the potential increase in eye pressure. Laser iridotomy uses a laser to make a small opening in the iris, thereby allowing the iris to refrain from assuming the configuration that can cause the blockage and potential acute rise in pressure. This opening created by the laser looks to help maintain the natural drainage channel in the eye. Unlike other forms of laser treatment for open angle glaucoma, this form of laser treatment typically only needs to be once per eye.
Laser cyclophotocoagulation – This laser technology can reduce the eye’s production of aqueous humor in complex angle-closure glaucoma and open-angle glaucoma cases. There are two types of laser cyclophotocoagulation: transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation. Both work by altering the fluid-forming cells in the eye’s ciliary body to reduce the fluid production and lower eye pressure. These procedures may need to be repeated multiple times in an attempt to successfully lower eye pressure.

Your doctor will advise you on which type of laser treatment is most suitable for you, as well as its risks and benefits, before proceeding with the procedure.

Are There Any Side Effects to Laser Treatment?

Light sensitivity and soreness are the most common side effects of laser treatment for glaucoma. While not necessary, your doctor may prescribe drops to alleviate any soreness.

Glaucoma Laser Treatment Recovery Time

According to the National Eye Institute (NEI), recovery from glaucoma treatment is almost immediate. The treatments are relatively quick, and patients can resume normal activities upon the leaving the office. You may experience mild irritation and blurry vision soon after the treatment. Most patients are able to drive themselves home from the procedure. As there is no cure for glaucoma, patients still need to follow-up with an eye care provider after these laser treatments to ensure proper pressure control.

Pros and Cons of Laser Treatment for Glaucoma

Laser treatment is conducted more often than conventional surgery for glaucoma due to its many benefits, such as lower risk of complications, greater safety profile, and ability to be performed at the doctor’s office as opposed to the hospital.

However, there are also a few risks to laser treatments that must be considered before undergoing the treatment. Some people may experience a short-term spike in eye pressure within one to four hours of the procedures. Your doctor may give you topical hypotensive medications before and after the procedure to prevent/lessen this risk. Furthermore, patients who specifically undergo cyclophotocoagulation laser treatment are at higher risk for persistent inflammation and abnormally low eye pressure.

Other risks of laser treatment for glaucoma include:

Iris inflammation
Pain/discomfort
Light sensitivity
Corneal swelling
Decreased vision from corneal swelling
Bleeding in the eye (rare)

In more complex glaucoma cases, treatments can sometimes result in cataract formation. However, the potential benefits of lowering the eye pressure usually outweigh any possible risks.

Although glaucoma laser treatments help to reduce eye pressure, the length of time the eye pressure remains low depends on the type and severity of glaucoma, the laser treatment performed, the patient’s age, race, as well as other factors. If determined to be effective, certain laser procedures (i.e. SLT/cyclophotocoagulation), may be repeated to continuously manage the patient’s glaucoma.

Glaucoma Laser Treatment Cost

The cost of laser treatment for glaucoma can range from $1,000 to $2,000. In many cases, the insurance will cover a portion to all of this procedure as it is medically necessary. Out of pocket cost will vary from patient to patient depending on the insurance coverage and deductible. You can discuss this further with your doctor and office staff. Laser treatments tend to be less expensive treatment options since they can usually be performed in the ophthalmologist’s office as opposed to hospitals.

Other Types of Glaucoma Surgery

Given the fact that glaucoma is not a curable condition, disease progression is still possible in spite of eye drop use and/or laser treatments. In these cases, surgical intervention may be necessary to further lower the eye pressure and better control the disease state. Although glaucoma surgery is not a cure for glaucoma and cannot undo the vision loss from the disease, it can help slow or delay progression of the disease.

According to the National Eye Institute (NEI), the types of glaucoma surgery used to reduce eye pressure include:

Trabeculectomy – This type of surgery is typically reserved for those cases of more advanced open or closed angle glaucoma where drops and laser are not successful in controlling the eye’s pressure. It is usually done at an outpatient surgery center under local anesthesia and usually takes as little as ten to fifteen minutes to complete. During this surgery, your eye surgeon will create a tiny flap in the sclera underneath the upper eyelid, allowing extra fluid to drain to an external pocket and reduce the eye’s pressure.
Glaucoma-implant surgery – This surgery is typically reserved for specific types of glaucoma including neovascular glaucoma and glaucoma secondary to trauma or inflammation or when previous eye surgeries have resulted in the formation of scar tissue on the eye. It is usually done at an outpatient surgery center under local anesthesia and usually takes as little as ten to fifteen minutes to complete. . During this surgery, your surgeon implants a tiny tube or shunt into the white part of your eye that connects to an external reservoir to help drain the fluid and reduce the eye’s pressure.
Minimally invasive glaucoma surgery (MIGS) – Your doctor may suggest one of several different types of minimally invasive glaucoma surgeries which can be coupled with cataract surgery or can be performed as stand-alone procedures in some instances. Collectively, these minimally invasive procedures look to lower the eye pressure by either enhancing the ability of the eye fluid to reach/drain out of the natural channel or by removing some of the scar tissue with in the channel, resulting in an easier path out. This relatively new approach has a more favorable safety profile compared to more invasive glaucoma surgeries. But along with the lower risk comes the realization that these procedures may not lower the eye pressure a significant amount.

Before proceeding with any glaucoma surgery, it is important to carefully consider each one and discuss all options with your care team to ensure you’re having the right treatment.

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