Glaucoma Surgery: What to Expect

What Is Glaucoma?

Glaucoma is an eye disease caused primarily by increased pressure inside the eye, known as intraocular pressure (IOP). The increase in IOP is usually due to the buildup of excess fluid inside the eye. The major concern with the increased pressure is the damage it causes to the optic nerve, resulting in vision loss and even blindness. Damage to the optic nerve is permanent, and is a leading cause of blindness in people over 60. But early detection and treatment can often prevent glaucoma-related vision loss and blindness.

While it is impossible to predict how quickly glaucoma may develop, people who have suffered an eye injury or have a family history of glaucoma are often at a higher risk of developing this serious eye disease. Recent studies also show that diabetes, heart disease, and high blood pressure are additional risk factors.

What Are the Symptoms of Glaucoma?

The most common type of glaucoma is known as open-angle glaucoma (OAG), which has no obvious symptoms until irreparable damage has occurred. It is often referred to as the ‘Silent Thief of Sight.’

In contrast, closed-angle glaucoma, a far more rare form of the disease, often presents with some or all of these symptoms:

• Blind spots in the peripheral vision
• Severe pain in the eye or forehead
• Eye redness
• Decreased or blurred vision
• Headache
• Nausea
• Vomiting

When You Should Consider Getting Glaucoma Surgery

Reducing the pressure in your eye is the first defence in glaucoma treatment. Often this can be achieved through prescription eye drops, oral medications and laser therapy. While more research is needed, it appears that reducing your intake of caffeine and trans fatty acids may also lower your risk.

Sometimes, even with full compliance to the prescribed medical treatments, patients with glaucoma may need eye surgery. While surgery cannot restore any lost vision, it can help protect your remaining vision and prevent this condition from worsening.

What to Expect With Glaucoma Surgery

There are many types of glaucoma surgery. An ophthalmologist can assess your condition and help decide which surgery is the best option for you.

Types of Glaucoma Surgery

• Minimally invasive glaucoma surgery (MIGS) – MIGS requires only a small incision and typically involves the use of tiny implants to increase the outflow of the pressure-causing fluid from the eye. It tends to cause fewer side effects and complications than standard glaucoma surgeries and are most effective for early- or medium-range glaucoma.
• Types of MIGS include:

• • Microtrabeculectomy – Micro-sized tubes are inserted into the drainage angle to drain the fluids.
  • Internal trabecular bypass procedure – Implanting a tiny stent or shunt devices within the trabecular meshwork.

• Selective laser trabeculoplasty (SLT) – in this surgery, a laser is used to create tiny holes to enhance the outflow drainage of the eye fluid and lower eye pressure.
• Trabeculectomy – This procedure is a more significant surgery than MIGS, and is used when more significant reduction of intraocular pressure (IOP) is needed to control glaucoma. During this procedure, a piece of the trabecular meshwork is removed to increase the outflow of aqueous fluid from the eye. This procedure is performed on the upper portion of the eye so that the incisions are covered by the upper eyelid, and not visible to you or others.
• Iridotomy and iridectomy – For a less common form of glaucoma, called narrow-angle glaucoma (or closed angle glaucoma), a surgeon may use a YAG laser to create a small hole in the iris to allow liquid to drain through it and reach the trabecular meshwork. The iridectomy involves using a laser to create a small hole in your iris, which allows the iris to move and opens up the access of the fluid to improve its outflow out of the eye.

All glaucoma surgery procedures are done to reduce the IOP.

What Are Some Glaucoma Surgery Side Effects and Complications?

All glaucoma surgery procedures have become safer with every new advance, but complications sometimes occur.

The risk of side effects and complications depends on which type of glaucoma surgery you undergo. They can include:

• Eye redness or pain
• Irritation of the cornea
• Continued high eye pressure
• Low eye pressure
• Infection
• An increased risk of cataracts after surgery
• In rare cases, varying levels of vision loss

Dr. Hollander will help you decide which type of surgery is the best choice for your specific needs.

What to Expect on the Day of Glaucoma Surgery

Glaucoma surgery may be carried out under local anesthetic (while you’re awake) or general anesthetic (while you’re asleep). Typically, a glaucoma surgery takes 45 minutes to an hour.

Some patients experience mild sensations that are uncomfortable, similar to what would occur after any surgery.

What to Expect After Glaucoma Surgery

MIGS and SLT surgery usually only require a few days of recovery, while the trabeculectomy glaucoma surgery recovery process usually takes from 3 to 6 weeks. Here’s what to expect during your post-op recovery from trabeculectomy eye surgery:

Blurred Vision and Minor Discomfort

It is common for your vision to become blurred after the procedure. This can last up to 6 weeks. Your eyes may also water or tear up more than usual during the recovery period. Swelling and redness are also common a few days following the surgery.

No Operating a Vehicle

Driving is not recommended while recovering from glaucoma surgery. Your eye surgeon will provide you with post-op guidelines.

Follow Your Doctor’s Orders

Following the surgery, the eye doctor will prescribe antibiotic drops to prevent infection, and anti-inflammatory eye drops and ocular lubricants to make your eyes less irritated. The drops may cause your pupils to become dilated. You will also need to schedule a follow-up appointment with your doctor to make sure your eyes are healing as expected.

What Can You Expect Going Forward?

The vast majority of people who undergo glaucoma surgery find the benefits are long-lasting. For others, the opening in the eye may begin to close up and additional surgery may be needed. Post-surgical eye examinations and regular eye pressure checks by Dr. Hollander may prevent any possible issues in the future.

If you are considering glaucoma surgery, Dr. Hollander will be happy to address all questions and concerns you may have. Please feel free to be in touch and schedule your appointment today.

Our practice serves patients from New York City, Manhatten, The Bronx, and Brooklyn, New York and surrounding communities.