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(404) 298-5557

Snellville Medical Office
(770) 736-7020

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Treatments

Medications

A number of medications are currently in use to treat glaucoma. Your doctor may prescribe a combination of medications or change your prescription over time to reduce side effects or provide a more effective treatment. Typically, medications are meant to reduce intraocular pressure and prevent damage to the optic nerve.

Eye drops used in managing glaucoma decrease eye pressure by helping the eye’s fluid to drain better and/or decreasing the amount of fluid made by the eye.

Drugs to treat glaucoma are classified by their active ingredient. These include:

  • prostaglandin analogs
  • beta blockers
  • alpha agonists
  • carbonic anhydrase inhibitors.

Combination drugs are available for patients who require more than one type of medication.

Alpha agonists

Alpha agonists work to both decrease production of fluid and increase drainage. Alphagan P has a purite preservative that breaks down into natural tear components and may be more effective for people who have allergic reactions to preservatives in other eye drops. Alphagan is available in a generic form.

Side effects can include burning or stinging upon instillation of the eye drop, fatigue, headache, drowsiness, dry mouth and dry nose.

Beta blockers

These work by decreasing production of intraocular fluid. They are available in generic form and, therefore, are relatively inexpensive. Systemic side effects can be minimized by closing the eyes following application or using a technique called punctal occlusion that prevents the drug from entering the tear drainage duct and systemic circulation.

Side effects can include low blood pressure, reduced pulse rate, and fatigue. Beta blockers can also cause a shortness of breath in people who have a history of asthma or other respiratory disorders. Additionally, beta blockers can change cardiac activity by decreasing the amount of blood the heart pumps out, which may reduce the pulse rate and/or slow down the heart's response rate during exercise. Rare side effects include reduced libido and depression.

Carbonic anhydrase inhibitors (CAIs)

CAIs reduce eye pressure by decreasing the production of intraocular fluid. These are available as eye drops and as pills. If you need to use more than one type of eyedrop, you may need to take each medicine in a certain order as prescribed by your doctor. If you are using more than one type of eyedrop, wait 5 minutes between eyedrop medicines. The pill form is an alternative for people whose glaucoma is not controlled by medication eye drops.

Side effects of the pill form of these medications can include tingling or loss of strength of the hands and feet, upset stomach, mental fuzziness, memory problems, depression, kidney stones, and frequent urination. Since the eye drop form of this medication is relatively new, long-term studies are yet to be completed. Side effects of the eye drop include stinging, burning and other eye discomfort.

Cholinergic (Miotic)

These medications reduce eye pressure by increasing the drainage of intraocular fluid through the trabecular meshwork. Cholinergics can be used alone or combined with other glaucoma medications. A combination of medications can help control how much fluid is produced in the eye and increase the amount of fluid that drains out of the eye.

Side effects include complaints of dim vision, especially at night or in darkened areas such as movie theaters. This is due to constriction of the pupil. Miotics increase drainage of intraocular fluid by making the pupil size smaller, thereby increasing the flow of intraocular fluid from the eye.

Combined Medications

Combined medications may decrease production of intraocular fluid, and are an alternative for patients who need more than one type of medication. In addition to the convenience of using one eyedrop bottle instead of two, there may also be a financial advantage, depending on your insurance plan.

  • Combigan is a combination of beta blocker and alpha agonist. Side effects of Combigan include the symptoms of beta blockers and alpha agonists.
  • Cosopt is a combination of beta blocker and carbonic anhydrase inhibitor. Side effects of Cosopt include burning and/or stinging of the eyes and changes in sense of taste.
  • Simbrinza is a combination of Brinzolamide (a carbonic anhydrase inhibitor) and Brimonidine (an alpha agonist). Side effects of Simbrinza Suspension include blurred vision, eye irritation, bad taste, dry mouth, and eye allergy. Since Simbrinza is relatively new to the market, long-term follow up of people using this medication is not yet available.

Prostaglandins

Prostaglandin analogs work by increasing the outflow of intraocular fluid from the eye.

They have few systemic side effects but are associated with changes to the eye itself, including change in iris color and growth of eyelashes. Depending on the individual, one brand of this type of medication may be more effective and produce fewer side effects. Prostaglandin analogs are taken as eye drops. They are effective at reducing intraocular pressure in people who have open-angle glaucoma.

In initial studies, between 5% and 15% of people who used this medication reported a gradual change in eye color, due to an increased amount of brown pigment in the iris of the treated eye. The change in eye color occurs slowly and may not be noticeable for several months to years. Other side effects can include stinging, blurred vision, eye redness, itching, and burning. These medications are relatively new to the market, and long term follow up of people who use them is not yet available.


Laser Surgeries

Laser surgeries have become important in the treatment of different eye problems and diseases. There are several types of laser surgery used to treat glaucoma. The type of laser surgery will depend on the form of glaucoma and how severe it is.

Lasers produce a focused beam of light that can make a very small burn or opening in your eye tissue, depending on the strength of the light beam. Laser surgeries are performed in an outpatient setting at Georgia Ophthalmology Associates or in a hospital clinic.

During laser surgery, the eye is numbed so that there is little or no pain. Your doctor then holds a special lens to the eye. The laser beam is aimed into the eye, and there is a bright light, similar to a camera flash. The following are the most common laser surgeries to treat glaucoma:

Selective Laser Trabeculoplasty (SLT) - For the treatment of primary open-angle glaucoma (POAG). SLT uses a laser that works at very low levels. It treats specific cells "selectively”, leaving untreated portions of the trabecular meshwork intact. For this reason, SLT may be safely repeated.

Argon Laser Trabeculoplasty (ALT) - For the treatment of primary open-angle glaucoma (POAG). The laser beam opens the fluid channels of the eye, helping the drainage system work better. In many cases, medication will still be needed.

Micropulse Laser Trabeculoplasty (MLT) - For the treatment of primary open-angle glaucoma (POAG). MLT provides the same pressure-lowering effects as SLT and ALT. It is unique in that it uses a specific diode laser to deliver laser energy in short microbursts. MLT is a relatively new laser procedure.

Laser Peripheral Iridotomy (LPI) - For the treatment of narrow angles and narrow-angle glaucoma.  LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain.

Laser Cyclophotocoagulation - This type of surgery is typically used later in the treatment timeline. Several different types of lasers can be used to lower the ciliary body's ability to make fluid and, therefore, lower the eye pressure. The procedure may need to be repeated in order to permanently control glaucoma.

Pain or Discomfort from Glaucoma Laser Surgery

There is a slight stinging sensation associated with LPI and ALT. In YAG CP laser surgery, a local anesthetic is used to numb the eye. Once the eye has been numbed, there should be little or no pain and discomfort.

Benefits of Glaucoma Laser Surgery

Glaucoma laser surgeries help to lower the intraocular pressure in the eye. The length of time the IOP remains lower depends on the type of laser surgery, the type of glaucoma, age, race, and many other factors. Some people may need the surgery repeated to better control the pressure IOP.

Medication after Glaucoma Laser Surgery

In most cases, medications are still necessary to control and maintain eye pressure. However, surgery may lessen the amount of medication needed.

Recovery Time after Glaucoma Laser Surgery

In general, patients can resume normal daily activities the next day after laser surgery. The procedure is usually performed in an eye doctor’s office or eye clinic. Before the surgery, your eye will be numbed with medicine. Your eye may be a bit irritated and your vision slightly blurry after the surgery. You should arrange a ride home after your surgery.

Risks of Laser Surgery

As with any type of surgery, laser surgery can carry some risks. Some people experience a short-term increase in their intraocular pressure (IOP) soon after surgery. In others who require YAG CP (Cyclophoto-Coagulation) surgery, there is a risk of the IOP dropping too low to maintain the eye’s normal metabolism and shape. The use of anti-glaucoma medication before and after surgery can help to reduce this risk.

Increased Risk of Cataracts

There is a small risk of developing cataracts after some types of laser surgery for glaucoma. However, the potential benefits of the surgery usually outweigh any risks. After a cataract has been taken out with surgery, there often remains an outer membrane lens capsule. This membrane can slowly thicken and cloud vision, just as the cataract did. Laser surgery can open this membrane, helping to clear vision without an operation. This laser procedure is called a capsulotomy.

Patients with both cataracts and glaucoma require a unique surgery. Click here to read more about iStent!

 

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Treatments

Medications

A number of medications are currently in use to treat glaucoma. Your doctor may prescribe a combination of medications or change your prescription over time to reduce side effects or provide a more effective treatment. Typically, medications are meant to reduce intraocular pressure and prevent damage to the optic nerve.

Eye drops used in managing glaucoma decrease eye pressure by helping the eye’s fluid to drain better and/or decreasing the amount of fluid made by the eye.

Drugs to treat glaucoma are classified by their active ingredient. These include:

Combination drugs are available for patients who require more than one type of medication.

Alpha agonists

Alpha agonists work to both decrease production of fluid and increase drainage. Alphagan P has a purite preservative that breaks down into natural tear components and may be more effective for people who have allergic reactions to preservatives in other eye drops. Alphagan is available in a generic form.

Side effects can include burning or stinging upon instillation of the eye drop, fatigue, headache, drowsiness, dry mouth and dry nose.

Beta blockers

These work by decreasing production of intraocular fluid. They are available in generic form and, therefore, are relatively inexpensive. Systemic side effects can be minimized by closing the eyes following application or using a technique called punctal occlusion that prevents the drug from entering the tear drainage duct and systemic circulation.

Side effects can include low blood pressure, reduced pulse rate, and fatigue. Beta blockers can also cause a shortness of breath in people who have a history of asthma or other respiratory disorders. Additionally, beta blockers can change cardiac activity by decreasing the amount of blood the heart pumps out, which may reduce the pulse rate and/or slow down the heart's response rate during exercise. Rare side effects include reduced libido and depression.

Carbonic anhydrase inhibitors (CAIs)

CAIs reduce eye pressure by decreasing the production of intraocular fluid. These are available as eye drops and as pills. If you need to use more than one type of eyedrop, you may need to take each medicine in a certain order as prescribed by your doctor. If you are using more than one type of eyedrop, wait 5 minutes between eyedrop medicines. The pill form is an alternative for people whose glaucoma is not controlled by medication eye drops.

Side effects of the pill form of these medications can include tingling or loss of strength of the hands and feet, upset stomach, mental fuzziness, memory problems, depression, kidney stones, and frequent urination. Since the eye drop form of this medication is relatively new, long-term studies are yet to be completed. Side effects of the eye drop include stinging, burning and other eye discomfort.

Cholinergic (Miotic)

These medications reduce eye pressure by increasing the drainage of intraocular fluid through the trabecular meshwork. Cholinergics can be used alone or combined with other glaucoma medications. A combination of medications can help control how much fluid is produced in the eye and increase the amount of fluid that drains out of the eye.

Side effects include complaints of dim vision, especially at night or in darkened areas such as movie theaters. This is due to constriction of the pupil. Miotics increase drainage of intraocular fluid by making the pupil size smaller, thereby increasing the flow of intraocular fluid from the eye.

Combined Medications

Combined medications may decrease production of intraocular fluid, and are an alternative for patients who need more than one type of medication. In addition to the convenience of using one eyedrop bottle instead of two, there may also be a financial advantage, depending on your insurance plan.

Prostaglandins

Prostaglandin analogs work by increasing the outflow of intraocular fluid from the eye.

They have few systemic side effects but are associated with changes to the eye itself, including change in iris color and growth of eyelashes. Depending on the individual, one brand of this type of medication may be more effective and produce fewer side effects. Prostaglandin analogs are taken as eye drops. They are effective at reducing intraocular pressure in people who have open-angle glaucoma.

In initial studies, between 5% and 15% of people who used this medication reported a gradual change in eye color, due to an increased amount of brown pigment in the iris of the treated eye. The change in eye color occurs slowly and may not be noticeable for several months to years. Other side effects can include stinging, blurred vision, eye redness, itching, and burning. These medications are relatively new to the market, and long term follow up of people who use them is not yet available.


Laser Surgeries

Laser surgeries have become important in the treatment of different eye problems and diseases. There are several types of laser surgery used to treat glaucoma. The type of laser surgery will depend on the form of glaucoma and how severe it is.

Lasers produce a focused beam of light that can make a very small burn or opening in your eye tissue, depending on the strength of the light beam. Laser surgeries are performed in an outpatient setting at Georgia Ophthalmology Associates or in a hospital clinic.

During laser surgery, the eye is numbed so that there is little or no pain. Your doctor then holds a special lens to the eye. The laser beam is aimed into the eye, and there is a bright light, similar to a camera flash. The following are the most common laser surgeries to treat glaucoma:

Selective Laser Trabeculoplasty (SLT) - For the treatment of primary open-angle glaucoma (POAG). SLT uses a laser that works at very low levels. It treats specific cells "selectively”, leaving untreated portions of the trabecular meshwork intact. For this reason, SLT may be safely repeated.

Argon Laser Trabeculoplasty (ALT) - For the treatment of primary open-angle glaucoma (POAG). The laser beam opens the fluid channels of the eye, helping the drainage system work better. In many cases, medication will still be needed.

Micropulse Laser Trabeculoplasty (MLT) - For the treatment of primary open-angle glaucoma (POAG). MLT provides the same pressure-lowering effects as SLT and ALT. It is unique in that it uses a specific diode laser to deliver laser energy in short microbursts. MLT is a relatively new laser procedure.

Laser Peripheral Iridotomy (LPI) - For the treatment of narrow angles and narrow-angle glaucoma.  LPI makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain.

Laser Cyclophotocoagulation - This type of surgery is typically used later in the treatment timeline. Several different types of lasers can be used to lower the ciliary body's ability to make fluid and, therefore, lower the eye pressure. The procedure may need to be repeated in order to permanently control glaucoma.

Pain or Discomfort from Glaucoma Laser Surgery

There is a slight stinging sensation associated with LPI and ALT. In YAG CP laser surgery, a local anesthetic is used to numb the eye. Once the eye has been numbed, there should be little or no pain and discomfort.

Benefits of Glaucoma Laser Surgery

Glaucoma laser surgeries help to lower the intraocular pressure in the eye. The length of time the IOP remains lower depends on the type of laser surgery, the type of glaucoma, age, race, and many other factors. Some people may need the surgery repeated to better control the pressure IOP.

Medication after Glaucoma Laser Surgery

In most cases, medications are still necessary to control and maintain eye pressure. However, surgery may lessen the amount of medication needed.

Recovery Time after Glaucoma Laser Surgery

In general, patients can resume normal daily activities the next day after laser surgery. The procedure is usually performed in an eye doctor’s office or eye clinic. Before the surgery, your eye will be numbed with medicine. Your eye may be a bit irritated and your vision slightly blurry after the surgery. You should arrange a ride home after your surgery.

Risks of Laser Surgery

As with any type of surgery, laser surgery can carry some risks. Some people experience a short-term increase in their intraocular pressure (IOP) soon after surgery. In others who require YAG CP (Cyclophoto-Coagulation) surgery, there is a risk of the IOP dropping too low to maintain the eye’s normal metabolism and shape. The use of anti-glaucoma medication before and after surgery can help to reduce this risk.

Increased Risk of Cataracts

There is a small risk of developing cataracts after some types of laser surgery for glaucoma. However, the potential benefits of the surgery usually outweigh any risks. After a cataract has been taken out with surgery, there often remains an outer membrane lens capsule. This membrane can slowly thicken and cloud vision, just as the cataract did. Laser surgery can open this membrane, helping to clear vision without an operation. This laser procedure is called a capsulotomy.

Patients with both cataracts and glaucoma require a unique surgery. Click here to read more about iStent!

 

(404) 298-5557
465 Winn Way, #10 - Decatur, GA 30030

(770) 736-7020
1700 Tree Lane Road, #135 - Snellville, GA 30078