Glaucoma

Glaucoma often develops slowly and without early symptoms, which is why it is sometimes called the “silent thief of sight.” In the early stages, most people notice no change in vision, but as the condition progresses, it typically causes gradual loss of side (peripheral) vision, which may go unnoticed at first. In more advanced stages, vision can become tunnel-like, and if untreated, glaucoma can lead to permanent vision loss or blindness. 

Treatment for glaucoma depends on the type of glaucoma and is aimed at lowering eye pressure to protect the optic nerve and prevent further vision loss.

Open-angle glaucoma, the most common type, is usually treated first with eye drops that reduce eye pressure either by decreasing fluid production or improving fluid drainage. If drops are not sufficient or tolerated, laser treatments such as selective laser trabeculoplasty (SLT) may be used, and in some cases surgery is recommended to create new drainage pathways for fluid.

Angle-closure glaucoma is treated more urgently because eye pressure can rise suddenly and severely. Laser peripheral iridotomy is commonly performed to create a small opening in the iris, allowing fluid to flow normally and relieving pressure, often followed by eye drops or further treatment as needed. In both types, regular monitoring is essential, as glaucoma treatment is long-term and tailored to each individual.

Selective Laser Trabeculoplasty (SLT) is a laser treatment used to lower eye pressure in people with open-angle glaucoma or ocular hypertension. It works by gently stimulating the eye’s natural drainage system (the trabecular meshwork) to improve fluid outflow, helping reduce pressure without cutting or damaging tissue. SLT is usually performed in the clinic, takes only a few minutes, and can reduce or sometimes replace the need for glaucoma eye drops, although its effect may wear off over time and can be repeated if needed. 

Laser peripheral iridotomy (LPI) is a laser procedure used to prevent or treat angle-closure glaucoma. A small opening is created in the coloured part of the eye (the iris), allowing fluid inside the eye to flow more freely and relieving pressure buildup. The procedure is quick, performed in the clinic, and helps reduce the risk of sudden rises in eye pressure that can threaten vision. 

Glaucoma surgery is used when eye drops or laser treatments are not enough to control eye pressure and protect the optic nerve. The aim of surgery is to improve fluid drainage from the eye or reduce fluid production, thereby lowering eye pressure.

There are different types of glaucoma surgery, including trabeculectomy, which creates a new drainage pathway; glaucoma drainage devices (tube shunts), which divert fluid to a small implanted tube; and minimally invasive glaucoma surgery (MIGS), which uses tiny implants or techniques with faster recovery and fewer risks, usually combined with cataract surgery. The choice of surgery depends on the type and severity of glaucoma and the individual patient’s needs.