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GLAUCOMA: Treatment options when drops fail

Glaucoma for the majority of people that are diagnosed early, means […]

By Published On: 10 January 20123.6 min read

Glaucoma for the majority of people that are diagnosed early, means very simple treatment with as little as one eye drop in each eye just before going to bed  no big deal.

About one in ten people do not respond to traditional glaucoma treatment – in the form of eye drops and oral medications – and that used to mean they would go blind for sure.

Luckily, modern science and technology has brought about three newer treatment options for treatment-resistant glaucoma. They are laser therapy, and two types of eye surgery.

But before we have you look at the alternatives, let’s have a look at the traditional, conservative treatment for glaucoma – eye drops and oral medications.

Primary Treatment – Pharmacotherapy

Eye drops and oral medications help relieve intraocular pressure (IOP) through biological changes to the eye structures (that’s the ultra-simplified version of what those medications do). They either increase drainage of eye fluid to release the pressure, or they prevent additional production of eye fluid (also known as aqueous humor).

Sometimes they don’t always work for a variety of reasons. If you have a tremor in your hands, or you have very painful arthritis in your hands, you understand that eye drops can be extremely difficult to administer. This can interfere with treatment of glaucoma through drops. Another reason for medications not working is due to the fact that if you can’t “see” the problem, you’ll forget to take your medicine! Some other reasons for medications not helping to treat glaucoma are the inability to cope with side effects of the medications, or they simply aren’t responding to the medications they are given.

Sometimes additional drops are added, or you may be changed to a combination drop, to increase the effect.  When it becomes obvious that medication will not help, it’s time to look at the alternatives.

Laser Therapy

Known as selective laser trabeculoplasty (or SLT), a laser is used on the eye in order to relieve IOP. This is a non-invasive procedure that will cause an increase in eye fluid drainage. It is often used as an adjunct therapy for those already on glaucoma eye drops. It can be performed several times, usually 6 months apart. This treatment is effective for roughly 60% of patients. For the remaining 40%, additional medications or surgery is required within five years of the initial laser treatment.

Filtration Surgery

Termed as trabeculectomy in the medical field, this procedure is surgical, creating a drainage channel for eye fluid. The excess fluid will be reabsorbed by blood vessels around the eye, and a drainage flap with adjustable sutures can be created by the surgeon which will control IOP. This is the end of the line treatment for glaucoma. Most patients do not progress to this stage.

Drainage Implants

For those who would not do well with a trabeculectomy (or have not done well with it) and their IOP is not under control, or if they have other eye problems preventing filtration surgery as a viable option, there are drainage implants. Another surgical option, these are drainage tube implants that are placed in the front chamber of the eye (called “shunts”). Small plates are then sewn into the side of the eyes, and the drainage tubes direct fluid to those plates. Then, the excess fluid is absorbed by the tissues that surround the plates.


The latest shunt available for the treatment of this eye condition is the iStent – a tiny device that allows better fluid drainage from the eye. It can be placed in the eye during cataract surgery and has been shown to be as effective as the combined effect of two glaucoma drops.

As knowledge and research continues to grow on the subject of glaucoma, more effective medications and therapeutic options are coming out that can help arrest the development of glaucoma.

It is also reasonable to say that maybe we already have adequate treatment options for glaucoma.  What we need is better education.  Better education of the patient so they are more likely to be compliant with their medications and better education of undiagnosed patients so that they have regular eye examinations.

At The Eye Practice, Dr Jim Kokkinakis has lectured to both university students and to qualified optometrists about glaucoma, its diagnosis and its treatments.  Make an appointment for your regular eye test now on 9290 1899 or BOOK AN APPOINTMENT ONLINE.


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