Glaucoma is a chronic disease defined by characteristic optic nerve damage. It is a multi-factorial disease and affects over 40 million people worldwide. Glaucoma is a slowly progressive and irreversible disease and in most cases, causes a painless loss of eyesight. It is, in short, “the silent thief of sight.”

The damage to the optic nerve is commonly caused by a fluid imbalance, or pressure, in the eye, as well as possible alterations in the blood flow to the optic nerve. It is well established that lowering the intraocular pressure can slow the process of the optic nerve damage. The degree of pressure lowering necessary to prevent optic nerve damage is individualized for each person and each optic nerve. The greater the optic nerve damage, the lower the intraocular pressure is needed to achieve stability and prevent further optic nerve damage and further visual field loss.

Previously, topical medications are used as a first line treatment. In many situations, multiple medications are tried to achieve the desired pressure level. These drops can have side-effects causing ocular irritation and in some cases eye-color change. However, recent research, including a significant study known as the LIGHT study, suggests that there might be a more effective first-line treatment option: Selective Laser Trabeculoplasty (SLT). The LIGHT study compared the effectiveness of SLT to that of eye drops as the initial treatment for glaucoma. The results showed that SLT can lower eye pressure as effectively as eye drops and over time, SLT patients had comparable or even better outcomes than those who started with eye drops. Many patients who start with SLT either need fewer or no eye drops afterward. This means fewer daily medications and potentially fewer side effects and a cost saving to patients. SLT can be repeated and typically the effect of this procedure can last 3-5 years

When glaucoma is well,  routine pressure checks every 6 months (and at least twice a year) along with regular optic nerve examinations are essential to monitoring control. Examinations are commonly aided by testing of the nerve fiber layer thickness of the optic nerve, optic nerve photos, and visual field testing. This testing can be done yearly or more frequently based on the level of glaucoma progression.

Unfortunately, there can be difficulties with compliance, cost and side effects with many of these medications and laser therapy is commonly substituted as a first line therapy. Recently there have been further technologic advances for better control of the intraocular pressure. Minimally invasive glaucoma surgical procedures, so-called MIGS involve alterations of the drainage area that are performed inside the eye.

This article was originally written on 6/20/2022 by Angelique Pillar, MD and updated on 09/15/2024