Glaucoma - Treatment

Highlights	Risk Factors	Lifestyle Changes
Introduction	Diagnosis	Resources
Causes	Treatment	References
Symptoms	Medications
Outlook	Surgery

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Treatment

Most treatments for glaucoma are aimed at reducing ocular pressure and its fluctuations. Early treatment with medications, surgery, or both can nearly always maintain safe pressure of the aqueous humor, thus preventing optic nerve damage and blindness. The choice between surgery and medications and when to start treatment is not always straightforward. For example, with the introduction of beta blockers and newer glaucoma drugs, there has been a decline in surgeries. It is not clear, however, which drugs are more effective than others and if, over time, any will actually prevent surgery. The patient should discuss all issues with both the regular doctor and ophthalmologist.

Decision to Start Treatment

Many people have high IOP but no sign of nerve damage, and over 20 years, only between 10 - 30% of these people will actually develop glaucoma. Nevertheless, once glaucoma has destroyed optic nerve fibers, no known treatment can reverse the damage.

Indeed, studies are suggesting that in people with glaucoma, even very small differences in pressure may mean the difference between disease progression and stability. An important trial reported that, on average, treating patients when their glaucoma was first detected reduced IOP by 25%. In addition, treatment reduced the risk for progression by 17%. This well-conducted trial confirmed previous findings supporting early treatment for glaucoma. Another study found that treatment with eye drops halved the risk of developing open-angle glaucoma in African Americans who had elevated intraocular pressure. Some evidence suggests that early treatment to lower IOP may be beneficial even in patients with normal tension glaucoma.

However, not all individuals with early signs of glaucoma (elevated IOP or normal tension glaucoma) develop optic nerve damage and serious vision problems. Nor does treatment prevent progression in a large minority of patients. Medications used for glaucoma also can carry significant side effects and risks, including for serious cataracts.

Some experts suggest, then, that treatment is warranted only in people with early signs of glaucoma who have risk factors for progressive disease and vision loss (e.g., thinner corneas, larger cup to optic disc ration, older age, and elevated pressure).

Considerations for Drug Treatments

A number of effective drugs are now available for treating glaucoma. The drugs reduce pressure in the eye but all have a number of side effects that affect other parts of the body. Some of these side effects can be quite severe. Many of the drugs used for glaucoma also interact with common medications for other conditions. To compound the difficulties, many patients require multiple drugs. As a result, only about half of patients comply with their treatments. (About a quarter can be cajoled into resuming treatment, but the rest refuse their medications.)