Glaucoma is a serious, lifelong chronic disease, but for many people glaucoma doesn’t have to lead to blindness, says optometrist and dry eye specialist Dr. Melanie Denton. Knowing what kind of glaucoma you have can help determine which treatment is best for you, and there are many options. Here she discusses the different types of glaucoma and their available treatments.*

Types of glaucoma

The three main types of glaucoma are:

• Primary open-angle glaucoma (POAG). This is the most common type. It tends to run in families, and while most people with POAG are over 65, younger people can still develop it.
• Normal-tension glaucoma (NTG). NTG is a form of open-angle glaucoma, but is not related to high intraocular pressure (IOP), Denton says. A range of 10-20 is considered “normal,” but IOP is also individual. You may have a “normal” IOP, but if you are unusually sensitive, even normal pressure might be high for you. NTG can be caused by reduced blood supply to the optic nerve. Denton says that, when diagnosing NTG, she looks for patients with:
  • Migraines
  • Raynaud syndrome
  • Poor blood perfusion
  • High blood pressure (and who are on medication)

• Angle-closure glaucoma (ACG). ACG can be either acute or chronic. Acute ACG can escalate very quickly, and Denton cautions that people of Asian and Native American descent are at higher risk. ACG is most often found in older adults who have high prescriptions and who still have their natural eye lenses (not replaced with cataract surgery). 

In acute ACG, the eye’s drainage system becomes blocked, causing a sudden rise in IOP. Immediate emergency medical attention is necessary to avoid blindness. 

Symptoms of an acute attack can include:

• Blurred vision
• Severe headache
• Eye pain
• Nausea and vomiting
• Rainbow halos around lights

Another glaucoma type is called secondary glaucoma, which results from some other eye condition, trauma, tumor, inflammatory disorder like uveitis, or vascular issue from diabetes.

Can I avoid blindness with glaucoma?

“Treatment cannot reverse damage that has already occurred,” Denton says, “but it can prevent further vision loss.” Treatments to halt or slow glaucoma progression include:

• Medications
• Laser surgery
• Glaucoma (or filtering) surgery
• A combination of the above methods

Medications may come in the form of eye drops, pills, and/or ointments. They are a common first choice for treating glaucoma.

Laser therapy, another popular first choice, avoids cutting directly into the eye, so is minimally-invasive and helps prevent infections. Laser surgeries include selective laser trabeculoplasty and peripheral iridotomy (specifically used for narrow-angle issues).

Glaucoma (filtering) surgeries include:

• Trabeculectomy
• Drainage implant (shunt)
• Canaloplasty 
• Micro-invasive glaucoma surgeries (MIGS)
• Laser cyclophotocoagulation

Filtering surgeries, which involve directly cutting into the sclera (white part) or iris (colored part) of the eye, carry higher risks of:

• Infection
• Leakage from the incision
• Eye pressure that is too low
• Hemorrhages inside the eye

Speak with your doctor about the most appropriate treatment options for your glaucoma type and progression status.

*Eye School with Dr. D. (2022, August 10). What Is Glaucoma? Will You Always Go Blind With Glaucoma? [Video File]. https://www.youtube.com/watch?v=qhWI4wSCZ_M