“Glaucoma is the world’s leading cause of irreversible vision loss,” states Cleveland Eye Clinic glaucoma specialist Alexander Kosmidis, M.D. A number of treatments are available to patients, however, he says, ranging from conservative to aggressive in nature. These treatments can help preserve and “really prevent” any further loss of vision. The two most common treatments for glaucoma are medicated eye drops and a procedure called selective laser therapy (SLT)*

Glaucoma Treatment Options

Kosmidis explains that a doctor will discuss common treatment options with a glaucoma patient:

• Eye drops
• Laser
• Minimally invasive glaucoma surgery (MIGS)
• Actual glaucoma surgery (in very rare cases)

In most glaucoma cases, vision can be preserved with either eye drops or laser therapy.

What to Know About Eye Drops

Since the 1950s, eye drops containing a variety of medicines have been used to treat open-angle glaucoma. These drops lower intraocular (inside the eye) pressure, or IOP. Elevated IOP is the primary cause of vision loss in glaucoma. IOP rises when the eye’s drainage system becomes blocked over time, causing fluid to build up that gradually damages the optic nerve.

Eye drops for treating glaucoma must be used according to a strict daily schedule. They:

• Are available by prescription only
• May be taken nightly, twice, or three times daily
• Must be taken consistently for effectiveness, so a patient must be committed
• Are covered by insurance

“It is only with daily treatment, regular faithful use of these medicines that we can truly help lower pressure and ultimately save vision,” states Dr. Kosmidis.

Side effects

When using eye drops, some patients may experience:

• Redness
• Irritation or stinging upon entry
• Occasional blurred vision

The vast majority of patients become accustomed to these effects, however, and are able to use drops long-term.

With “simple, daily drop therapy,” Kosmidis says he’s able to control IOP and help preserve vision in the vast majority of his patients.

Glaucoma Laser Treatment: What Is SLT?

Over the previous 20 years, minimally invasive procedures like selective laser trabeculoplasty (SLT) have emerged for treating glaucoma. Their goal is the same as for eye drops: lowering IOP. SLT lowers pressure by applying energy to the drainage system so as to open it, allowing excess fluid to leave the eye. 

Dr. Kosmidis explains that SLT:

• Is a simple procedure performed in-office 
• Is performed on people of all ages
• Takes approximately two minutes
• Doesn’t necessitate anesthesia
• Is “well-tolerated” and “relatively painless”
• Can be useful as a first step toward lowering IOP for many patients
• Can be especially helpful for patients who experience side effects from eye drops or have trouble remembering to take their drops
• Is usually covered by insurance 

If pressure increases again following SLT, the procedure can be repeated, though its effect and how many times it can be redone is limited. An eye drop may be employed if pressure again rises.

While some patients may experience blurred vision for a day or two after SLT, Kosmidis says, the effect is rare and generally corrects itself without issue.

Close Monitoring

Staying in close contact with your ophthalmologist is imperative, says Kosmidis, regardless of whether glaucoma therapy is begun with eye drops or laser therapy. Follow-up visits every four to six months are needed to be sure eye pressure remains at a safe level so vision can be preserved.

*Cleveland Eye Clinic. (2021, November 16). Open-Angle Glaucoma Treatment: Eye Drops vs. SLT [Video file]. Clear Choice Laser. Retrieved from https://www.youtube.com/watch?v=DqSiAEVh27U