If you’ve been diagnosed with glaucoma, you’re probably already familiar with the typical options in glaucoma treatment: eye drops, laser treatment or traditional surgery. While these are certainly effective, especially when glaucoma is diagnosed early, researchers have been working hard to offer new glaucoma treatments. Their goal is not only to improve outcomes but also reduce the treatment’s side effects and frequency of use.
 

What is the Goal of Glaucoma Treatment?

Before we dive into the new options, it’s important to understand the goal of any glaucoma treatment. At present, glaucoma is not curable. However, treatment can significantly slow the progression of the disease. Glaucoma damages the optic nerve and the nerve fiber layer in the eye. Extra fluid builds up in the front part of the eye (anterior chamber) which increases the fluid pressure (Intraocular pressure or IOP). Reducing this intraocular pressure is the primary objective of any glaucoma treatment. 
 

What are the Limitations of Standard Glaucoma Treatments (Eyedrops)?

Prescription medication in the form of eye drops are the simple front-line treatment for glaucoma.  Using eye drops seems like an easy option but there are several challenges that can reduce its effectiveness. It can be difficult to get all the medicine in the eyes, especially for older adults with less of a steady hand. In addition, since they must be applied daily, individuals may forget. Sometimes the patients think that the drops have no perceivable benefit because in the early stages of glaucoma, the patients have no symptoms.  If they think this way then patients sometimes make instilling their eye drops a lower priority and forget accidentally, or purposefully if the drops have unpleasant side effects like burning or red eyes.
 

Other Glaucoma Treatments

• Selective Laser therapy (SLT): Selective Laser trabeculoplasty is a less invasive option than other surgery options.  Your surgeon uses a small laser beam to improve drainage in the trabecular meshwork which then lowers intraocular pressure (IOP). It may take a few weeks before the full effect of this procedure becomes apparent.
• Filtering Surgery (Trabeculectomy):  During trabeculectomy surgery, your surgeon creates an opening in the white of the eye (sclera) and removes part of the trabecular meshwork to allow fluid to drain more efficiently, thus lowering IOP.
• Drainage Tubes. In this procedure, your eye surgeon inserts a small tube shunt in your eye to drain away excess fluid to lower your eye pressure.
• Minimally Invasive Glaucoma Surgery (MIGS). Your surgeon may suggest a MIGS procedure to lower your eye pressure. These procedures generally require less immediate postoperative care and have less risk than trabeculectomy or installing a drainage device. Surgeons implant a tiny device to allow fluid to drain from the eye, reducing internal pressure. Some devices (iStent) are implanted during cataract surgery. Cataract surgery alone lowers pressure, but the combination of both is more effective and can lower the need for medication. There are a number of MIGS techniques available, and your surgeon will discuss which procedure may be right for you.

What are Recent Advances in Glaucoma Treatment?

Alternatives or Improvements to Eye Drops
The Glaucoma Research Foundation reported several new developments on the horizon. These technologies focus on reducing patient error in applying eye drops which would make the medication more effective and improve the quality of life for the patient. Here are some of the products underway:

• A polymer, like a contact lens, would contain the drug; it would sit under the eyelid and release the medication over several months

• Microneedles would inject medication into a specific spot to be most effective

• Implantable extended-release devices using engineered highly precise microparticles and nanoparticles

• Polymer-based intraocular delivery technologies that would allow customizable sustained release

• Drops that allow the medication to get into the eye more easily

• Tear duct plugs that release medication

In addition, people with glaucoma who take more than one eye drop per day are beginning to see those medications available as a single, combined eye drop. Such combination products include Cosopt (timolol and dorzolamide), Combigan (timolol and brimonidine) and Simbrinza (brinzolamide and brimonidine).

Monitoring Eye Pressure

An easy, accurate way to measure eye pressure is critical to monitoring the progress of glaucoma and adjusting treatment as needed. For patients that require more frequent testing of their eye pressure, there’s now an at-home tonometer called iCare HOME. There’s no puff of air and no eye drops. The patient can easily share the information with their eye doctor.

If you have a glaucoma diagnosis, you can feel confident that your glaucoma treatment options are only going to improve in the years ahead. Although the disease is not curable, it is very manageable with the right treatment.