MR ALEX BANEKE - OPHTHALMIC SURGEON - GLAUCOMA & CATARACT
If you've been diagnosed with glaucoma, it's important to know that the most effective treatments focus on reducing eye pressure, which is key to slowing the progression of the condition. There are several ways to lower eye pressure, including medications, laser treatments and surgical options.
With the right treatment plan, we can help protect your vision and manage your glaucoma effectively.
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Understanding Your Glaucoma Medications: Eye drops
When it comes to managing glaucoma, reducing eye pressure is key to slowing the progression of the condition. There are several treatment options available, including eye drops, tablets, and even some newer treatments. Here's a guide to help you understand the different medications used in glaucoma treatment and what to expect from each.
An expert guide:
How to Apply Eye Drops
Step 1: Shake the bottle well.
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Step 2: Tilt your head back, pull down your lower eyelid with one hand, and hold the bottle with your other hand resting on your forehead or nose.
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Step 3: Place a drop into your eye.
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Step 4: If you're not sure the drop went in, it's okay to try again.
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Step 5: After applying the drop, close your eyes and press gently between your lower eyelid and nose for 1-2 minutes. This helps prevent the medication from draining into your nose and throat, which can reduce side effects.
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Step 6: Wait 5 minutes between applying different drops.
Eye Drops: Your First Line of Defence
Most patients with glaucoma will be treated with eye drops. With many different types available, it can be a bit confusing to know which one is right for you. Each type of drop works to lower eye pressure, but the effectiveness and side effects can vary from person to person. Some drops are also available in preservative-free formulations, which may be helpful if you have dry eyes or wear contact lenses.
Prostaglandin Analogues
Prostaglandin analogues such as Latanoprost (Xalatan™), Travoprost (Travatan™), and Bimatoprost (Lumigan™), are powerful in reducing eye pressure, often by around 30%. These drops work by increasing fluid outflow from the eye.
Common side effects include mild stinging, eye redness, and increased eyelash growth. In rare cases, they can cause changes in eye colour and fat loss around the eyes.
Bimatoprost may be slightly more effective at treating your glaucoma but comes with a higher chance of side effects.​​
Beta-blockers
Beta-blockers like Timolol (Timoptol™/Tiopex™) and Betaxolol (Betoptic™) reduce fluid production in the eye and can also increase fluid outflow.
They are slightly less effective than prostaglandin analogues but have fewer aesthetic side effects.
Cholinergic agonists
Cholinergic agonists, like Pilocarpine, help by constricting the pupil and increasing fluid outflow.
They’re usually used in emergencies and can cause headaches and reduced night vision.
Carbonic anhydrase inhibitors
Carbonic anhydrase inhibitors include drops like Dorzolamide (Trusopt™) and Brinzolamide (Azopt™). These medications reduce fluid production in the eye and can lower pressure by around 20%.
Side effects may include stinging, redness, and a metallic taste. In rare cases, they can affect your blood cells.
Alpha-agonists
Alpha-agonists, such as Brimonidine (Alphagan™) and Apraclonidine (Iopidine™), lower fluid production and increase fluid outflow. They can cause redness, itching, and dry mouth.
Some patients may develop conjunctivitis, which means the drops need to be stopped. It's also important to avoid using these if you're on certain antidepressants like amitriptyline.
New options
Newer options include nitric oxide donating prostaglandins such as Latanoprostene bunod (Vyzultar™), which are similar to prostaglandin analogues but also increase fluid outflow through the eye's internal drainage system.
Rho-kinase/ norepinephrine transport inhibitors, like Netarsudil (Rhokiinsa™) or the combination of Latanoprost and Netarsudil (Roclanda™), are new drugs that work by several mechanisms to reduce eye pressure.
These newer drugs may cause side effects like eye redness and increased watering.
Understanding your Glaucoma Medications: Tablets
If you’re considering any tablet-based treatments, it’s crucial to have a detailed discussion with your eye specialist to ensure it’s the best option for your specific situation and health conditions.
Acetazolamide Tablets (Diamox™)
Acetazolamide (Diamox™) is a carbonic anhydrase inhibitor, similar to certain eye drops used in glaucoma treatment. It's very effective at reducing eye pressure, but because of its potential side effects, it’s typically used only for short periods, such as when your eye pressure is particularly high or while you're waiting for surgery. Acetazolamide is available in both regular and slow-release (SR) formulations, and there's little difference in their effectiveness, so either can be used depending on your needs.
Side Effects of Acetazolamide
While Acetazolamide is effective, it can cause some side effects. Commonly, you might experience dizziness, tiredness, tingling in the fingers, and increased urination. In rare cases, it may lead to changes in your blood cells or worsen kidney stones. It’s particularly important to avoid or use a lower dose of Acetazolamide if you have sickle cell anaemia, kidney stones, or severe kidney or liver disease. The medication can also reduce potassium levels, so you might be advised to consume high-potassium foods or drinks, such as a banana, a serving of spinach, or a glass of tomato juice, with each tablet. In some cases, your doctor may prescribe Sando-K potassium supplement tablets to take alongside Acetazolamide.
Nicotinamide
There is ongoing research investigating whether oral nicotinamide tablets - at a dose of 1.5g daily for 6 weeks followed by 1.5g twice daily - may slow glaucoma progression. Nicotinamide does not reduce eye pressure but may slow glaucoma progression via a different mechanism: improving mitochondrial function. As trials on nicotinamide are ongoing, it is not currently recommended as a treatment by most glaucoma specialists.
Side Effects of Nicotinamide
Nicotinamide may not be suitable for everyone. It is contraindicated if you have impaired liver function, are pregnant, have a history of cancer, or are taking certain medications such as doxycycline, isoniazid, pyrazinamide, or carbamazepine. If you fall into any of these categories, it’s important to discuss this with your doctor before considering nicotinamide as part of your treatment plan.
SURGICAL TREATMENT
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Surgical Treatment for Glaucoma: What You Need to Know
If you’ve been diagnosed with glaucoma, and other treatments haven't sufficiently controlled your eye pressure, your doctor may recommend surgery. One of the most common surgical procedures for glaucoma is a trabeculectomy. This surgery aims to lower the pressure inside your eye to prevent further damage to your optic nerve and preserve your vision. It’s important to know that while trabeculectomy can help stop or slow down vision loss, it won’t improve your vision from its current level, and your vision might temporarily worsen before it stabilises.
Trabeculectomy surgery is a highly effective option for reducing eye pressure and slowing the progression of glaucoma for most patients. While it won’t improve your current vision, it can help prevent further vision loss and reduce your need for eye drops. As with any surgery, there are risks involved, but with careful monitoring and follow-up, most patients achieve good outcomes.
Trabeculectomy surgery works by creating a new pathway for fluid to drain out of the front part of your eye (the anterior chamber).
During the procedure, your surgeon creates a small “trap door” in the wall of your eye (the sclera). This allows fluid to flow into a tiny reservoir called a “bleb,” which is located under the conjunctiva—the thin, clear tissue that covers the white of your eye. After the operation, you might notice a small blister-like bump on the top of your eye when you look in the mirror.
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The trap door is carefully closed with stitches that can be adjusted after surgery to control the flow of fluid and the pressure inside your eye. The conjunctiva is also stitched, and these stitches are usually removed about a month after the operation. To help prevent the trap door from scarring and closing, an anti-scarring agent called mitomycin C is applied during the surgery.
Trabeculectomy is successful in about 7 to 8 out of 10 patients. However, about 1 in 20 patients may need to return to the operating theatre for an adjustment in the months following the initial surgery.
While serious complications are rare (about 1 in 250 patients), they can include infection, bleeding, or very low eye pressure. A serious infection called blebitis can occur at any time after surgery, so it’s crucial to seek immediate medical attention if your eye becomes increasingly red, sticky, or painful.
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After trabeculectomy surgery, approximately 1 in 3 patients may develop a cataract within two years, and your glasses prescription could change. You should wait about three months after surgery before getting a new prescription from your optician and avoid using contact lenses during this time. Additionally, about 1 in 20 patients may develop a droopy eyelid as a result of the surgery. In very rare cases, the eye can become persistently uncomfortable, which may require further surgery to correct.
On the day of your trabeculectomy, plan to spend several hours in the hospital. After checking in, you’ll be taken to the operating theatre, where a sterile blue drape will be placed over your face, and your eye will be cleaned with iodine. An oxygen tube will provide oxygen under the drape. You’ll receive a local anaesthetic, which involves an injection around the eye. If you’re having a local anaesthetic, you can eat and drink as normal on the day of surgery.
Some patients find it helpful to take a mild sedative, such as diazepam, to relax during the procedure. If you do opt for sedation, it’s important to have a friend or relative accompany you home. The operation itself takes about an hour, and you should not feel any pain. However, if you start to feel uncomfortable, let your surgeon know so that more anaesthetic can be administered.
Most patients go home the same day after surgery. It’s a good idea to have someone accompany you home, especially if you’ve had general anaesthetic, sedation, or have poor vision in your other eye. You’ll need to clean your eye when you remove the dressing the next morning—simply wash your hands and use cooled boiled water on a clean cotton pad to do this.
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For the first month after surgery, avoid swimming, bending, and heavy lifting. You can wash your hair a few days after surgery, but take care to avoid getting water in your eye. If you have help at home, consider washing your hair backwards over a sink. You’ll be given an eye shield to wear at night for the first 2 to 4 weeks. Most patients need 2 to 3 weeks off work, and it’s important to avoid contact sports. In the future, always wear protective goggles when playing ball sports.
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Your eye may be red, uncomfortable, and slightly swollen after surgery, and your eyelid might droop. In most cases, these symptoms will improve over time. However, if you experience increasing redness, pain that doesn’t improve with paracetamol, significant blurred vision, or a sudden very watery eye, seek urgent care at an eye casualty.
Surgical Treatment for Glaucoma: Understanding Tube Surgery
If you're dealing with glaucoma and other treatments haven't effectively managed your eye pressure, tube surgery might be recommended. This procedure is designed to lower the pressure inside your eye, helping to slow down or stop the progression of vision loss. While tube surgery won’t improve your current vision, it can be an important step in preserving the vision you still have. Here’s what you need to know about this surgical option.
Tube surgery is a highly effective option for reducing eye pressure and slowing the progression of glaucoma. It is especially suitable for patients who have complex glaucoma or who have had previous surgery.
While it won’t improve your current vision, it can help prevent further vision loss and may reduce your need for eye drops.
As with any surgery, there are risks involved, but with careful monitoring and follow-up, most patients achieve good outcomes.
For more information, please click here to access a presentation, including a video of a Paul™ tube surgery being performed (please note that this is a video of surgery on a real patient, which some individuals might find challenging to watch).
Tube Surgery
Tube surgery involves inserting a small tube, usually about half a millimetre in diameter, into the front chamber of your eye. This tube is attached to a soft plastic or silicone plate, which is positioned about 1 centimetre behind the cornea (the clear front part of the eye). The plate sits between or under the muscles that move your eye, and the tube drains fluid from the eye into a small reservoir known as a “bleb.” The bleb, which lies over the tube plate, helps to reduce scarring. This makes tube surgery particularly useful for eyes that are more prone to scarring, such as those that have already undergone multiple operations.
The tube is covered with a patch made from donor tissue, typically from the pericardium (the sac surrounding the heart). Because donor tissue is used, you won’t be able to donate blood following tube surgery. There is a very small theoretical risk of infections that cannot be screened for, although this risk is extremely low. After the operation, you may notice a small raised area under your eyelid and a whitish patch next to the cornea when looking in the mirror. These changes usually become less noticeable over time.
Types of Tubes
There are different types of tubes used in this surgery, including Paul™, Baerveldt™, and Ahmed™ tubes. They all work in a similar way, but there are some differences in how they manage fluid flow. For example, the Ahmed™ tube has a built-in valve that controls the flow of fluid, so stitches aren’t needed to regulate pressure. However, some studies suggest that the Baerveldt™ tube might be slightly more effective at reducing eye pressure than the Ahmed™ tube. In Paul™ and Baerveldt™ tubes, stitches are often used to control fluid flow initially and are usually removed about 2-3 months after surgery.
Success Rates and Risks
Tube surgery is successful in about 7 out of 10 patients. However, about 1 in 20 patients may need to return to the operating theatre for an adjustment within a few months of the initial operation. The risk of a complication that could permanently damage your vision is about 1 in 200.
Potential serious complications include tube exposure, infection, bleeding, corneal failure (which may require a corneal transplant), and problems with either high or low eye pressure. A serious infection called blebitis can occur at any time after surgery, so it’s crucial to seek immediate medical attention if your eye becomes red, sticky, or painful.
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You might develop a cataract after tube surgery, and your glasses prescription could change. It’s best to wait about three months after the operation before getting a new prescription from your optician. You should also avoid using contact lenses during this time. Approximately 1 in 20 patients may experience a droopy eyelid after surgery, and because the tube plate is placed near or under the eye muscles, some patients may experience double vision. In most cases, this double vision resolves within 3-6 months.
What to Expect on the Day of Surgery
On the day of your operation, you can expect to spend several hours in the hospital. After arriving on the ward, your details will be checked, and you’ll be taken to the operating theatre. A sterile blue drape will be placed over your face, and your eye will be cleaned with iodine. You’ll receive a local anaesthetic, which involves an injection around the eye. If you’re having local anaesthetic, you can eat and drink as normal on the day of surgery. A mild sedative, such as diazepam, may also be given, as the operation can take some time.
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Some surgeons prefer to perform tube surgery under general anaesthetic or with stronger sedatives administered through a vein. If this is the case, your anaesthetist may ask you not to eat on the day of the operation and to only drink clear fluids until two hours before the surgery. The operation itself typically takes about one to one and a half hours. You shouldn’t feel any pain during the procedure, but if you start to feel uncomfortable, let your surgeon know so they can administer more anaesthetic.
After Surgery: Recovery and Care
Most patients go home the same day after surgery. It’s important to have someone accompany you home. The morning after surgery, you may need to clean your eye. Wash your hands and use cooled boiled water on a clean cotton pad to do this.
For the first month, avoid swimming, bending, and heavy lifting.
You can wash your hair a few days after surgery, but take care to avoid getting water in your eye. If you have help at home, you can wash your hair backwards over a sink.
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You’ll need to wear an eye shield at night for the first 2 to 4 weeks after surgery. Most patients need 2-3 weeks off work.
It’s important to avoid contact sports and to wear protective goggles when playing any ball sports in the future.
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Your eye will be more vulnerable after the operation. Initially, it may be red, uncomfortable, and slightly swollen, and your eyelid might droop. In most patients, the appearance of the eye returns to normal in the months following surgery. However, if you notice increasing redness, pain that doesn’t improve with paracetamol, or significant blurred vision, seek urgent care at an eye casualty.
Understanding Preserflo™ Surgery for Glaucoma
If you’re living with glaucoma, you know how important it is to manage the pressure inside your eye to protect your vision. Preserflo™ surgery is one option that may help reduce this pressure, slowing down or even stopping further damage to your visual field. While Preserflo™ won’t improve your current vision, it can be a crucial step in preserving what you have. Here’s everything you need to know about this procedure.
Preserflo™ surgery is a promising option for reducing eye pressure and slowing the progression of glaucoma.
While it won’t improve your current vision, it can help preserve what you have and may reduce your need for regular eye drops.
Although there’s less evidence supporting Preserflo™ compared to other procedures, many surgeons now prefer it due to its similar success rates, fewer variables, shorter procedure time, and potentially lower risk of serious complications.
For more information, you can explore the following resources:
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Video: Preserflo™ Surgery in a Real Patient (Please note this is a surgical video which some individuals may find challenging to watch)
Preserflo™ Surgery
Preserflo™ surgery involves inserting a small tube, known as the Preserflo™, into the front chamber of your eye.
This tube drains fluid into a reservoir, called a “bleb,” which forms under the conjunctiva—the delicate skin covering the white part of your eye. After the operation, you might notice a shallow blister at the top of your eye when you look in the mirror. The bleb created during Preserflo™ surgery is usually positioned further back and is shallower than the one formed during trabeculectomy surgery. This positioning often makes it less visible, making Preserflo™ a good option for patients who wear contact lenses.
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Unlike traditional tube surgeries, the Preserflo™ tube is smaller (about 1/3 of a millimetre in diameter) and does not require a plate or stitches to control fluid flow. This can make the procedure quicker and potentially more comfortable during recovery.
What to Expect During and After Surgery
On the day of your surgery, you’ll spend several hours in the hospital.
After arriving on the ward, your details will be checked, and you’ll be taken to the operating theatre. A sterile blue drape will be placed over your face, and your eye will be cleaned with iodine. You’ll receive a local anaesthetic, which involves an injection around the eye. If you’re having local anaesthetic, you can eat and drink as normal on the day of surgery. Some patients also opt for a mild sedative, such as diazepam, to help them relax during the procedure. If you choose sedation, a friend or relative should accompany you home.
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The operation itself takes about 45 minutes. You shouldn’t feel any pain, but if you do start to feel uncomfortable, let your surgeon know so they can top up your anaesthetic.
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After surgery, most patients go home the same day. It’s important to have someone accompany you, especially if you’ve had general anaesthetic, sedation, or have poor vision in your other eye.
he morning after surgery, you may need to clean your eye—simply wash your hands and use cooled boiled water on a clean cotton pad. For the first month, avoid swimming, bending, and heavy lifting. You can wash your hair a few days after surgery, but take care to avoid getting water in your eye. If you have help at home, you can wash your hair backwards over a sink.
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You’ll need to wear an eye shield at night for the first 2 to 4 weeks after surgery. Most patients need 2 to 3 weeks off work. It’s also important to avoid contact sports and wear protective goggles when playing any ball sports in the future.
Success Rates and Risks
Preserflo™ surgery is relatively new, and while there’s less long-term evidence compared to other procedures like trabeculectomy, early results are promising. Success rates from studies suggest that Preserflo™ is effective in 5 to 8 out of 10 patients. A minority of patients experience low eye pressure after surgery, which might require injections of a gel into the front chamber of the eye, or a follow-up procedure to place a stitch in the Preserflo™ to increase the pressure.
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Serious complications are rare but can include infection, bleeding, corneal failure (which might require a corneal transplant), and high or low eye pressure. The risk of a complication that could permanently damage your vision is around 1 in 250. A serious infection called blebitis can occur at any time after surgery, so it’s important to seek immediate medical attention if your eye becomes increasingly red, sticky, or painful.
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You may also develop a cataract after surgery, and your glasses prescription could change. It’s best to wait about three months before getting a new prescription from your optician. If you’re a contact lens wearer, discuss this with your surgeon as some patients may be advised not to wear them post-surgery. About 1 in 20 patients develop a droopy eyelid, and in rare cases, the eye can become persistently uncomfortable, which may require further surgery to correct.
Exploring Minimally Invasive Glaucoma Surgery (MIGS)
If you’re managing glaucoma, there are several surgical options available to help lower the pressure in your eye and protect your vision. Minimally Invasive Glaucoma Surgery (MIGS) is a newer category of procedures that have gained popularity in recent years due to their lower complication rates and the fact that they can often be performed quickly, often alongside cataract surgery. However, it’s important to know that while MIGS can be effective, the evidence supporting these procedures isn’t as strong as that for more established surgeries like trabeculectomy or tube surgery.
MIGS offers a less invasive approach to managing glaucoma, with the potential for lower complication rates and quicker recovery times.
However, the evidence supporting these procedures is still evolving, and they may not be suitable for everyone.
Discussing your options with your eye specialist will help you determine if MIGS is the right choice for you.
For more detailed information, you can explore the following resources (please note they are designed for use by health professionals):
Minimally Invasive Glaucoma Surgery (MIGS)
MIGS, or Minimally Invasive Glaucoma Surgery, refers to a range of procedures that aim to lower eye pressure using various methods, typically without creating a reservoir (or “bleb”) under the conjunctiva, as is done in more traditional glaucoma surgeries.
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The procedures can be grouped into three main categories:
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Trabecular Bypass Devices: These devices, such as iStent™ and Hydrus™, bypass the eye’s natural drainage system (the trabecular meshwork) to improve fluid flow into the second part of the drain, known as Schlemm’s canal.
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Trabecular Meshwork Excision Devices: Devices like the Kahook™ Dual Blade Trabectome and Omni, remove or cut the trabecular meshwork to enhance fluid drainage into Schlemm’s canal.
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Suprachoroidal Drainage Devices: These devices, including Miniject™, drain fluid from the front chamber of the eye into the deeper tissues of the eye (the suprachoroidal space). Another device, Cypass™, was previously used for this purpose but has been withdrawn from the market due to safety concerns.
What Do We Know About the Effectiveness of MIGS?
The effectiveness of MIGS varies depending on the specific device used, and the overall evidence supporting these procedures is still developing. Here’s a summary of what we know:
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Hydrus™: There is evidence suggesting that combining cataract surgery with a Hydrus™ implant can reduce the need for intraocular pressure-lowering medication and further reduce eye pressure compared to cataract surgery alone, especially in patients with mild to moderate open-angle glaucoma. Hydrus™ may be more effective than iStent™ in these cases.​
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iStent™: The evidence for iStent™ is less robust, with low-quality studies suggesting it may help some patients achieve better control of their eye pressure and reduce their reliance on eye drops. However, there’s variability in the reported complications, and more high-quality research is needed.
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Trabectome: Currently, there is no strong evidence supporting the effectiveness of Trabectome in treating open-angle glaucoma.
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Cypass™: While early trials showed that Cypass™ could help patients achieve medication-free control of glaucoma, long-term concerns about damage to the cornea led to its withdrawal from the market.
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Miniject™: The Miniject™ device is designed to work similarly to Cypass™ but without the associated risks of corneal damage. Early trials are promising, and suggest Miniject™ may reduce eye pressure by 35-40% and eliminate the need for eye drops in about half of patients. However, these trials were funded by the manufacturer, and further independent research is needed to confirm these results.
What to Expect During and After MIGS
If you’re considering MIGS, it’s usually performed alongside cataract surgery or as a standalone procedure. The surgery typically takes less time than more invasive glaucoma surgeries, and most patients can go home the same day. After surgery, you’ll need to follow specific care instructions to help your eye heal properly. This includes using prescribed eye drops, avoiding heavy lifting, and wearing an eye shield at night for a few weeks.
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You’ll also have follow-up appointments to monitor your recovery and make any necessary adjustments. Fewer follow up appointments are usually needed compared to traditional glaucoma surgery. As with any surgery, there are risks involved, so it’s important to report any unusual symptoms to your doctor right away.
LASER TREATMENT
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​Laser Treatments for Glaucoma: Your Guide
If you’re living with glaucoma, you know how crucial it is to manage the pressure in your eye to prevent further damage to your vision. Laser treatments offer effective ways to reduce eye pressure, often as a complement or alternative to eye drops and surgery. Here’s a guide to understanding the different laser options available for treating glaucoma.
Laser treatments for glaucoma, including SLT, Yag PI, and Cyclodiode, offer valuable options for reducing eye pressure and protecting your vision.
While each procedure has its benefits and risks, they are generally safe and can be highly effective in managing glaucoma.
Your eye specialist will help you determine the best treatment option based on your individual needs and the stage of your glaucoma.
For more information on Yag PI, please see the animated video explaining the procedure: Yag PI Laser Treatment Video.
Selective Laser Trabeculoplasty (SLT)
Selective Laser Trabeculoplasty (SLT) is a relatively straightforward laser treatment that can help reduce eye pressure. It’s often used as an alternative to, or in addition to, eye drops. SLT works for around 7 out of 10 patients and can keep eye pressure lower for up to 5 years. If needed, it can be repeated.
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SLT uses short pulses of low-energy light to target melanin-containing cells in the trabecular meshwork, which is the part of your eye responsible for fluid drainage. This laser treatment activates cells called macrophages, which help remodel the trabecular meshwork and improve fluid outflow.
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On the day of your SLT treatment, your eyes will be numbed with anaesthetic drops, which may cause temporary blurring and a mild headache. The laser procedure is quick, taking about 5-10 minutes per eye, and is performed on a machine similar to the one used in routine eye exams. After the procedure, you might need to wait for an hour to have your eye pressure re-checked, and you’ll be given drops to use for up to a week.
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The laser may take up to 6 weeks to fully take effect, so you’ll have a follow-up appointment around that time to check your eye pressure. Although SLT is generally safe, it’s still surgery, so there’s a small risk of complications such as temporary blurred vision, mild headaches, or a slight rise in eye pressure. In rare cases, inflammation or persistent blurred vision may occur, but these are usually manageable.
Yag Laser Peripheral Iridotomy (PI)
Yag Laser Peripheral Iridotomy (PI) is a laser treatment primarily used for patients with angle-closure glaucoma or those at risk of developing it due to a narrow drainage angle in the eye. This procedure involves creating a tiny hole in the iris (the coloured part of the eye) to open up the drainage angle and reduce the risk of pupil block, which can lead to increased eye pressure.
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Yag PI helps lower the risk of developing or worsening angle-closure glaucoma, though it doesn’t eliminate the risk entirely. In some cases, cataract surgery may be a better option, particularly for patients over 50, as it provides more space for fluid to drain and can be more effective than Yag PI. However, younger patients might want to avoid cataract surgery due to the loss of near-focus ability and higher complication risks compared to Yag PI.
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The procedure itself is quick and usually requires one or two visits to the laser room. You’ll receive anaesthetic drops and a contact lens will be placed on your eye to help focus the laser. Some patients might feel slight pressure or mild pain during the procedure, and temporary blurring is common afterwards, usually clearing by the next day.
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Yag PI is a very safe procedure, but like any surgery, there are potential risks. These include a temporary rise in eye pressure, slight blurring or ghosting of images, and very rarely, inflammation, bleeding, or damage to the retina. Your doctor will discuss whether Yag PI is right for you based on your specific risk factors.
Cyclodiode Laser Treatment
Cyclodiode is a laser treatment used primarily for reducing eye pressure in advanced or end-stage glaucoma, particularly when other treatments haven’t been successful. It’s performed in an operating theatre, and a strong local anaesthetic injection is given around the eye before the laser is applied over the sclera (the white part of the eye).
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Cyclodiode works by damaging the ciliary body, the part of the eye that produces aqueous fluid. By reducing fluid production, this treatment lowers eye pressure. Traditionally, Cyclodiode was reserved for end-stage glaucoma because of the potential for severe damage to the ciliary body and the eye itself. However, newer techniques, using lower doses or micropulse diode, have made it possible to use Cyclodiode earlier in the disease process with a lower risk of complications.
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While Cyclodiode can be an effective treatment, it’s still primarily used for patients with significant vision loss or those whose glaucoma hasn’t responded to other surgeries.