What Is Glaucoma Surgery?

Glaucoma is a disease that causes increased pressure in the eye (intraocular pressure, or IOP). The pressure builds up in the aqueous humor and doesn’t drain properly, resulting in optic nerve damage.

In this article, we’ll discuss the details of glaucoma surgery, including the five types, the surgery’s risks and benefits, and how to tell if you need the procedure. We’ll also discuss costs and what to expect from the procedure.

What is Glaucoma Surgery?

Glaucoma surgery is a surgical eye procedure that lowers eye pressure to reduce the damaging effects of glaucoma. The procedure can slow down the progression of glaucoma and prevent 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.

What are the 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.

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.

2. Electrocautery

Electrocautery is a minimally invasive glaucoma surgery (MIGS). During this procedure, the surgeon creates 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

During trabeculectomy, the surgeon creates a small flap in the white area of the affected eye, which 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 procedure that involves placing a small drainage tube, known as an aqueous shunt or tube shunt, in the affected eye. This helps drain the fluid and reduce IOP.

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

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).

Risks vs. Benefits of Glaucoma Surgery

Glaucoma surgery has a very high success rate and significantly slows the progression of glaucoma. The following are rare risks associated with glaucoma surgery:

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

Despite these risks, the benefits of slowing glaucoma outweigh the risks. Especially in the case of advanced glaucoma. 

Is Glaucoma Surgery Worth It? 

Glaucoma research indicates that if fluid buildup in the eye is ignored, optic nerve damage will occur over time, resulting in vision loss.

Glaucoma surgery is often worth the trouble because it focuses on draining the excess fluid, preventing further damage. However, we advise working with your ophthalmologist to explore the other potential options that suit your needs.

Do I Need Glaucoma Surgery?

Surgery is not the only option for treating glaucoma. Medications can be used to treat glaucoma in its early stages.

Your eye doctor may prescribe pills or glaucoma eye drops. If medications don’t work, your doctor may suggest glaucoma surgery. Keep in mind that glaucoma surgery can’t reverse vision loss or cure it, but it may help prevent it from worsening over time.

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.

How Much Does Glaucoma Surgery Cost?

The cost of glaucoma surgery depends on the type. Laser surgery is usually less expensive but averages about $1,300 to $4,000 or more, depending on where it’s performed.

The fact that it can be performed in your doctor’s office or an ambulatory surgical facility significantly reduces the cost. Incision surgery often requires a hospital stay, so it can cost $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.

What to Expect Before & After Surgery

Glaucoma surgery is done at your doctor’s office or an outpatient facility. Below is what to expect before and after surgery:

Before Glaucoma Surgery

Before undergoing surgery, the medical staff will prepare you mentally to ensure you’re comfortable. You will then go to the operating room, where you will lie on the operating table. An anesthesiologist will also be present to administer sedatives to keep you relaxed during surgery.

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.

After Glaucoma Surgery

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.

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What To Do During the Recovery Process

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, like heavy lifting and bending.

After incision surgery, you can recover in 2 to 4 weeks. On rare occasions, the eye may stabilize fully for months. Doing the following can help improve the 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. 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. Makeup can worsen the healing process and increase the risk of infection or complications.