Glaucoma Surgery

What is Glaucoma Surgery?

Glaucoma surgery is a surgical eye procedure that reduces the damaging effects of glaucoma. 

Glaucoma is a disease that may be associated with increased pressure in the eye (intraocular pressure or IOP). Pressure builds up if the aqueous humor does not drain properly.

The aqueous humor is the clear fluid filling the space between the cornea and the lens.

If the IOP is left to build up, optic nerve damage may occur. Glaucoma is essentially damage to the optic nerve.

The optic nerve is vital because it consists of nerve fibers that carry signals from the retina to the brain. Damage to the optic nerve may lead to blindness.

According to experts, lowering eye pressure can prevent or slow down the progressive damage to the optic nerve.¹ This is possible through glaucoma surgery.

Do I Need Glaucoma Surgery?

Surgery is not the only option for treating glaucoma. 

During the early stages, glaucoma can be treated with medications. For example, your eye doctor can prescribe pills or glaucoma eye drops.

If medications don’t work, your doctor may suggest glaucoma surgery. 

Note that glaucoma surgery can’t reverse vision loss or cure it, but it may help prevent it from worsening over time.²

There are different types of surgeries based on the type of glaucoma under treatment. However, these surgeries also come with risks. 

For instance, in rare cases, glaucoma surgery can increase the risk of cataracts, low eye pressure, or vision loss.

Talk to your doctor about the risks and benefits of the type of glaucoma surgery you may need.

5 Types of Glaucoma Surgery

The following are types of glaucoma surgeries proven to restore normal eye pressure:

1. Laser surgery

Laser therapy is a common treatment for glaucoma. For instance, selective laser trabeculoplasty (SLT) is a first-line treatment for open-angle glaucoma.³

During SLT surgery, an ophthalmologist uses a laser beam to make microscopic holes in the eye that enable eye fluid to flow better.

Other types of laser surgeries for glaucoma include argon laser trabeculoplasty (ALT) and laser peripheral iridotomy (LPI)

According to the Glaucoma Research Foundation (GRF), laser glaucoma surgery may reduce intraocular pressure by 20 to 30%. It’s effective in roughly 80% of patients.⁴

2. Electrocautery

Electrocautery is a minimally invasive glaucoma surgery (MIGS).⁵ 

During this procedure, the surgeon will create a tiny incision in the eye's drainage tubes using a device known as a trabectome.

The device uses heat to remove tissue in the eye, releasing the built-up fluid.

According to studies, trabectome surgery can reduce eye pressure by 30 percent.⁶

3. Trabeculectomy

Trabeculectomy is also effective in reducing IOP. 

During trabeculectomy, the surgeon will create a small flap in the white area of the affected eye. This creates a drainage pathway for excess fluid.

You may need medication after the surgery to prevent scar tissue from forming. 

4. Drainage Implant Surgery

Drainage implant surgery is an invasive surgical procedure.

It involves the placement of a small drainage tube known as an aqueous shunt or tube shunt in the affected eye to drain the fluid.⁷

Glaucoma drainage implant surgery is performed in a hospital or an outpatient surgical facility. It usually takes about an hour or less to perform the procedure.

5. Microtrabeculectomy

Microtrabeculectomy involves inserting microscopic-sized tubes into the drainage angle to drain excess aqueous fluid. 

The fluid drains from the anterior chamber of the eye to beneath the conjunctiva (the eye's outer membrane). 

What to Expect Before & After Surgery

Glaucoma surgery is done at your doctor's office or an outpatient not facility.

Below is what to expect before and after surgery:

Before

Before undergoing surgery, the medical staff will prepare you mentally to ensure you're comfortable. You will then go to the operation room, where you will lie on the operating table.

In the room, there will be an eye surgeon, a nurse, and surgical assistants.

Your eyes will be cleaned and your face covered, leaving only the infected eye exposed.

Your doctor will also install devices to monitor your heart rate, blood pressure, and oxygen levels throughout the procedure.

An anesthesiologist will also be present to administer sedatives to keep you relaxed during surgery.

After

After surgery, you'll be allowed to rest your eyes for a moment.

During this time, your eye doctor will continuously monitor your eye pressure. If everything seems okay, you'll be discharged. 

However, before you leave, the eye doctor will instruct you on the dos and don'ts after glaucoma surgery.

You may also be required to schedule a follow-up appointment.

After glaucoma surgery, your eye will be patched up for some time. This may affect your ability to see. In addition, the effects of sedation also affect your ability to operate machinery. 

To be safe, make sure you have someone to drive you home.

Recovery

Glaucoma recovery is quick. You can return to your daily activities one day after laser surgery.

However, eye doctors recommend avoiding activities that cause pressure in the eye for a few weeks. Activities that may strain the eyes include heavy lifting and bending.

Incision surgery may take 2 to 4 weeks to recover. On rare occasions, it may take months for the eye to stabilize fully.

Do the following to ensure a smooth recovery process:

• Protect the eye from injury. Do not remove the eye shield placed by your doctor unless advised to do so.
• Protect your eyes from direct sunlight: Do this by wearing sunglasses.
• Ensure good hygiene. Keep your face clean and avoid touching the eye with dirty hands.
• Administer anti-inflammatory and antibiotic medication. Ensure you use your postoperative eye drops as directed by your eye doctor.
• Control pain. Eye pain is normal after glaucoma surgery.⁸ Using pain medications can make your recovery process more bearable.
• Avoid contact lenses. Contacts can affect the healing process.
• Avoid strenuous activities. These may include bending, jogging, weight lifting, etc.
• Avoid eye makeup. Do this for a few weeks to prevent contact with eyes.

Risks vs. Benefits of Glaucoma Surgery

Surgery has a very high success rate in significantly slowing the progression of glaucoma. 

In the case of advanced glaucoma, the benefits outweigh the risks.

The following are rare risks associated with glaucoma surgery:⁹

• Vision loss
• Bleeding in the eye
• Scarring
• Infection at the surgery site
• Low eye pressure (or hypotony)
• Cataract formation

Is Glaucoma Surgery Worth It? 

Glaucoma research indicates that optic nerve damage will occur over time if fluid buildup in the eye is ignored. This may lead to vision loss.

Glaucoma surgery is worth it because it focuses on draining the excess fluid, preventing further damage.

Despite the rare instances of complications, glaucoma surgery has a high success rate.

However, we advise working with your ophthalmologist to explore the best options for you.

How Much Does Glaucoma Surgery Cost?

The cost of glaucoma surgery will depend on the type of surgery in question.

Laser surgery is usually less expensive and averages about $1,300 to $4,000 or more depending on where it’s performed.¹⁰ 

The fact that it can be performed in your doctor's office or an ambulatory surgical facility reduces the cost significantly.

Incision surgery often requires a hospital stay. For this reason, it can have a higher cost of $7,000 to $11,000 or more.

Glaucoma surgery is deemed medically necessary and is therefore covered by medical insurance or Medicare. 

Your vision insurance may not cover the procedure, but your private medical insurance can. In this case, the cost will depend on your coverage plan.

Summary

• Glaucoma surgery is a surgical procedure done on the eye to reduce intraocular pressure in the eye caused by fluid buildup.
• If left untreated, glaucoma can result in optic nerve damage.
• Glaucoma surgery aims at creating a drainage pathway for the fluid, thus lowering eye pressure.
• The different glaucoma surgeries include laser surgery, electrocautery, trabeculectomy, microtrabeculectomy, and drainage implant surgery.
• An ophthalmologist administers these procedures in a medical setting that includes nurses and surgical assistants.
• Although there are associated risks such as bleeding eyes, cataracts, scarring, and low eye pressure, glaucoma surgery is usually successful and worth it. 
• Expect to be discharged the same day after surgery. However, depending on the type of surgery, it may take a few weeks to recover fully.
• While recovering, remember to protect your eyes from injury and contamination. Also, follow your doctor's care instructions, including follow-up visits.