Therapy for Glaucoma

Once you have been diagnosed with glaucoma, the goal is to stop the progression of vision loss.

Determining Damage

To this end, first a determination is made as to how much damage your optic nerve has sustained and how much of your corresponding vision has been lost. 

A direct visualization of your optic nerve can be made and an estimate of the amount of damage inferred. A photo can be taken for comparison in the future. 

The amount of vision loss can be judged with a visual field test, in which flashing lights are presented to your side and central vision by a computer and you push a button. 

Once the test is over, a diagram of your vision with many measurements can be printed out and followed over time. If progression on this vision assessment test can be documented, you may need more aggressive treatment.


The goal of current glaucoma treatment is to lower pressure in the eye by turning the faucet off or by making the drain work more efficiently using eye drops.

If fluid balance cannot be restored to the level where no further optic nerve damage is occurring,  laser treatment can be attempted or a new drain may be made for the eye surgically.

As you recall, high pressure in the eye is not the only contributing factor to glaucoma. The amount of oxygen that reaches the optic nerve is also important, as are genetics. Currently, nothing can be done to alter your genetics. 

As far as reestablishing a sufficient oxygen level in the eye, there are no direct treatments. We believe that exercise, and control of high blood pressure, diabetes, high cholesterol, and stopping smoking may be beneficial to this end.

Controlling Pressure

There are three major avenues for eye pressure control:

Drops: There are many exciting medications that come to market each year that can turn the faucet of the eye down or make the drain of the eye function more efficiently. This serves to lower the amount of fluid in the eye and decreases the pressure being placed on your optic nerve.

Laser: A laser may be fired directly into the drain of your eye to try to stimulate increased drainage. Again, this serves to lower the amount of fluid in the eye and decreases the pressure being placed on your optic nerve.

Surgery: The main goal of surgery is to create a new drainage system for the eye. This can be done by fashioning a trap door on the surface of the eye to allow pressure and fluid buildup to escape when there is an excess within the eye (trabeculectomy). Unfortunately, your own body can create scar tissue that may close this trap door off. Therefore, anti-scarring medications may be supplemented during and maybe after surgery around the trap door to prevent the trap door from scarring down. 

Alternatively, a plastic tube can be placed into the eye connected to an implant that will drain the fluid directly out of the eye.

By no means is this a complete description of glaucoma and it is not intended to be. It is a brief synopsis made in laymen's terms. This is a quick overview of the issues that you and your doctor face in choosing the best course of action to prevent you from vision loss.

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