The Glaucoma Research Foundation (GRF) Patient Summit highlights the latest in glaucoma treatment advances, providing patients with practical information to help them live their best lives with the condition. In this fourth recording from the fourth annual GRF Patient Summit, Mary Qiu, M.D., Assistant Professor of Ophthalmology and Visual Sciences at the University of Chicago, discusses current laser and surgical options for glaucoma, including in-office lasers, operating room lasers, and traditional glaucoma surgeries.*

In-office lasers

Selective laser trabeculoplasty (1:15)

Performed in the doctor’s office, selective laser trabeculoplasty (SLT) targets the pores of the eye’s drainage system, the trabecular meshwork. The energy stimulates the tissues to drain better without harming the tissue—like unclogging a drain pipe, Qiu explains.

Who undergoes SLT?

• People with open-angle glaucoma who can’t tolerate eye drops
• People with angle-closure glaucoma, if the laser can reach the target area 

SLT benefits include:

• Reducing eye pressure by roughly 20% in about 80% of patients
• No incisions or bleeding
• No sedation or surgical gown required
• Takes about 15 minutes to perform, in-office
• Quick and easy recovery

SLT risks are few, but the procedure’s period of effectiveness is unpredictable. It can be repeated if needed, however, and eye drops can still be used to help control pressure.

What to expect:

After eye drops are administered to numb the eye and prevent pressure spikes, a special contact lens is inserted, to keep your eye open.

You’ll hear about “a hundred clicks,” then see a flash of light as the laser energy enters the drainage system. There is very little discomfort. 

Laser peripheral iridotomy (6:04)

Also done in-office, laser peripheral iridotomy (LPI) is used to prevent or treat angle-closure glaucoma. LPI makes a tiny hole in the iris to allow trapped fluid to enter the front of the eye where it can drain naturally. 

Who undergoes LPI?

Qiu recommends LPI for people at risk for angle closure who don’t have easy access to eyecare (who live in a remote area, for example). LPI is also often used for people experiencing an acute angle-closure attack involving a sudden spike in pressure.

LPI benefits include:

• Minimally invasive 
• Takes only minutes to perform, in-office
• No special precautions or risk of infection
• Quick recovery time
• May prevent more invasive glaucoma surgery

LPI risks include the possibility of multiple attempts needed to open a hole in brown-colored irises, which tend to have thicker tissue. This can cause pain and inflammation. If the hole closes, a second LPI is needed. There may also be temporary bleeding from the iris hole, which stops on its own.

Operating room lasers

Cyclophotocoagulation (12:38)

In cyclophotocoagulation (CPC), a noninvasive laser is used on the outside of the eye, causing the ciliary body to produce less fluid. It’s done in the operating room so the patient can be sedated and no discomfort is felt. Either numbing medicine in the eye socket with light sedation is used or a deeper sedation is employed.

Who undergoes CPC?

CPC is usually reserved for people with severe eye damage or very low vision. 

CPC benefits include:

• Takes just a couple of minutes 
• No incisions, noninvasive
• No infection or bleeding risk
• Recovery is quick, with normal activity resumed the next day

CPC risks involve: 

• • Bleeding from the eye-numbing medication
  • Inflammation from the laser itself, causing pain and soreness
  • Eye pressure going too low, causing complications

• Unpredictability as to how far eye pressure will go down, and for how long

What to expect:

You would check in to an operating room, wear a surgical gown, and have an IV inserted into your arm. You may wake up during the procedure but won’t feel anything. Afterward, just for that day, a patch is typically placed on the eye (still numb) to avoid scratching. The numbing medication wears off by the next morning. 

Micropulse CPC (19:24)

Micropulse CPC is a gentler version of conventional CPC, involving a continuous, repetitive pulsing. This version of CPC is performed on people with better vision.

Endoscopic CPC (19:54)

Endoscopic CPC is a version of the laser treatment in which a probe goes into the eye through a tiny incision to directly treat the ciliary body. This can be done alongside cataract surgery, or after such surgery. There is a low risk of infection.

Traditional glaucoma surgeries

Trabeculectomy (20:32)

In a trabeculectomy, a “trap-door” is made in the side of the eye so that fluid can exit. The trapdoor is made from the patient’s own tissue and held down with stitches. Medication is used to prevent scarring and closure of the trap-door. If closure does happen, a second procedure is needed.

Who undergoes a trabeculectomy?

• People with very high eye pressure
• People with advanced disease
• People with a very low target pressure

Trabeculectomy benefits include:

• Significant reduction in pressure
• Potential for getting off all eye drops
• Been done for decades

Trabeculectomy risks are “much higher” because the procedure is more invasive. Infection risk is ongoing since the anti-scarring medication thins the eye skin near the surgical area. Other risks can include:

• Bleeding during surgery, and
• Bleeding and/or vision loss after surgery, if pressure drops too low

What to expect:

The surgery lasts from 30-60 minutes. Patients are sedated and comfortable. Afterward, a patch is worn temporarily. 

• Anti-inflammatory eye drops are used for weeks or months afterward.
• An antibiotic is provided to prevent infection.
• Multiple follow-up visits are required, but eye drops may be stopped if your eye pressure remains stable. 
• Recovery involves avoiding bending, straining, and lifting; protecting the eye by wearing a shield during sleep, etc. 

People with contact lenses may not be good candidates for the procedure.

Tube shunt  (24:53)

Similar to a trabeculectomy, a tube shunt allows fluid to exit the eye into the space beneath the skin of the eye. The tube has a plastic straw that remains open, and can’t be seen or felt.

Who undergoes tube shunt implantation?

Tube shunts are for people who need their eye pressure lowered immediately.

Tube benefits include:

• Significantly lowers eye pressure 
• No risk of scarring over
• Tube remains constant in size

Recovery generally doesn’t take longer than three to four weeks.

Speak with your doctor about the benefits and risks of the various available treatments, to determine which may be the safest and most effective option for your unique situation.

*Glaucoma Research Foundation. (2022, August 16). Current and New Surgical Laser and Surgical Treatment Options for Glaucoma [Video file]. Retrieved from https://www.youtube.com/watch?v=AwM4qL_2iD4