Our Summary

This paper discusses recent advances in the treatment of glaucoma, a common eye disease that can lead to blindness. Traditionally, medication has been the first approach to treatment, but there are problems with this - mainly that many patients don’t take their medicine as they should, which means it doesn’t work as well as it could. Recent research has shown that certain types of eye surgery can be very effective in treating glaucoma, even at an early stage of the disease.

These surgeries, known as micro-invasive glaucoma surgeries (MIGS), have shown promising results in controlling the pressure inside the eye (a key factor in glaucoma) and slowing down the progression of the disease. However, some of these procedures are only allowed to be performed at the same time as cataract surgery, limiting their use.

Other procedures that can be done independently have also shown good results. These include surgeries such as gonioscopy-assisted transluminal trabeculotomy, trabecular ablation with the Trabectome, excisional goniotomy with the Kahook Dual Blade, ab interno canaloplasty, and combined canaloplasty and trabeculotomy using the OMNI system. These surgeries have been shown to reduce the pressure in the eye and decrease the need for medication.

In conclusion, these surgical procedures could offer significant benefits for glaucoma patients, especially those who would benefit from early treatment, by reducing both eye pressure and the need for medication.

FAQs

  1. What are the benefits of early standalone surgery for glaucoma patients?
  2. What are the limitations of medical therapy for glaucoma treatment?
  3. What are some of the Micro-Invasive Glaucoma Surgery (MIGS) options available for patients with mild-moderate primary open-angle glaucoma?

Doctor’s Tip

A helpful tip a doctor might tell a patient about glaucoma surgery is to consider early standalone surgery, such as micro-invasive glaucoma surgery (MIGS), as an option to help control intraocular pressure and reduce the need for medication. These procedures, including selective laser trabeculoplasty and various MIGS options, have been shown to be effective in controlling glaucoma and may offer advantages over traditional medication therapy. It is important to discuss all available treatment options with your doctor to determine the best course of action for managing your glaucoma.

Suitable For

Patients who are typically recommended glaucoma surgery are those with mild to moderate primary open-angle glaucoma who have poor adherence to medication regimens or who are at risk for progression despite medication therapy. Additionally, patients who have undergone cataract surgery or who are precataractous may be recommended for certain micro-invasive glaucoma surgery (MIGS) procedures that can only be performed at the time of cataract surgery. These patients may benefit from standalone MIGS procedures such as selective laser trabeculoplasty, gonioscopy-assisted transluminal trabeculotomy, trabecular ablation with the Trabectome, excisional goniotomy with the Kahook Dual Blade, ab interno canaloplasty, or combined canaloplasty and trabeculotomy using the OMNI system. These procedures offer meaningful reductions in both intraocular pressure and medication burden for patients who may benefit from early surgery.

Timeline

Before glaucoma surgery:

  1. Patient is diagnosed with glaucoma through a comprehensive eye exam, including intraocular pressure measurement, optic nerve evaluation, and visual field testing.
  2. Patient may undergo a trial of medical therapy, including eye drops, to lower intraocular pressure.
  3. Patient may experience challenges with adherence to medication regimen, leading to suboptimal intraocular pressure control.
  4. Patient may consider alternative treatment options, such as selective laser trabeculoplasty or micro-invasive glaucoma surgery.

After glaucoma surgery:

  1. Patient undergoes glaucoma surgery, such as gonioscopy-assisted transluminal trabeculotomy, trabecular ablation, excisional goniotomy, ab interno canaloplasty, or combined canaloplasty and trabeculotomy.
  2. Patient experiences a meaningful reduction in intraocular pressure and medication burden post-surgery.
  3. Patient may require follow-up appointments with their ophthalmologist to monitor intraocular pressure and assess the success of the surgery.
  4. Patient may experience improved quality of life and reduced risk of disease progression due to successful glaucoma surgery.

What to Ask Your Doctor

  1. What are the potential risks and benefits of glaucoma surgery compared to continuing with medication therapy?
  2. How long is the recovery period after glaucoma surgery and what can I expect during this time?
  3. Will I still need to use glaucoma medications after surgery, and if so, how many and for how long?
  4. What is the success rate of the specific type of glaucoma surgery recommended for me?
  5. How often will I need follow-up appointments after surgery to monitor my eye pressure and overall eye health?
  6. Are there any lifestyle changes or precautions I should take after undergoing glaucoma surgery?
  7. What are the potential complications or side effects associated with the specific type of glaucoma surgery being recommended?
  8. How do I know if the surgery is not successful and what are the next steps in that case?
  9. Are there any alternative treatment options to consider before proceeding with glaucoma surgery?
  10. How experienced are you in performing this type of glaucoma surgery and what is your success rate with previous patients?

Reference

Authors: Radcliffe N. Journal: Curr Opin Ophthalmol. 2023 Mar 1;34(2):138-145. doi: 10.1097/ICU.0000000000000927. Epub 2022 Nov 14. PMID: 36373756