When Eye Drops Don’t Work Anymore: Surgical Treatments for Glaucoma

Glaucoma occurs when the pressure inside your eye, called intraocular pressure, increases and starts to damage the optic nerve. This nerve contains more than a million tiny nerve fibers, which die off gradually. As more fibers deteriorate, you develop blind spots. When all of them die, you lose eyesight entirely. 

The good news? Treatment can slow vision loss from glaucoma, especially if you’re diagnosed early. At iSight Vision Care in Fountain Valley, California, ophthalmologist Vicki Lin, MD, first treats glaucoma using eyedrops to lower your intraocular pressure. If your intraocular pressure remains high, she may recommend switching to different eyedrops, combining eyedrops, or getting surgery to relieve the pressure in your eyes. 

Dr. Lin specializes in advanced glaucoma surgeries to slow or prevent optic nerve damage from glaucoma. Depending on your needs, she may recommend one of the following procedures.

Laser Trabeculoplasty

Trabeculoplasty is a type of surgery that creates a channel for fluid to flow out of the eye, reducing the pressure inside. You might still need eyedrops after the surgery, but you won’t need to use them as often. 

Dr. Lin specializes in a form of trabeculoplasty called Selective Laser Trabeculoplasty (SLT). In this procedure, she uses a laser to restructure the drainage channels for better fluid drainage from your eyes. This surgery is repeatable and results last 1-5 years.

Laser peripheral iridotomy (LPI)

LPI, another laser surgery for glaucoma, involves using a laser to create a small hole in a part of your eye called the iris. This opening improves fluid drainage to regulate intraocular pressure. This is the treatment of choice in patients with narrow angle glaucoma.  LPI succeeds in about 70% of cases.

Goniotomy

Goniotomy, performed under local or general anesthesia, is a microsurgical procedure in which Dr. Lin creates a small incision in the trabecular meshwork of your eye between the cornea and iris. This incision is done with a small blade to improve fluid drainage similar to a trabeculoplasty.    This is often done in combination with cataract surgery.

Durysta

For patients with difficulty instilling drops or those with severe eye pain related to dry eye syndrome, Durysta can be used instead. Durysta is a 10 micro-gram tablet injected under local anesthesia into the eye. Once placed, the tablet slowly dissolves over the course of one year, releasing a glaucoma medication called bimatoprost, which helps lower eye pressure. 

Xen gel stent

The Xen gel stent is a tiny tubular device that eye surgeon can implant in your eye. It’s smaller than a grain of rice and acts as a drainage tube for intraocular fluid. 

Get in touch

Are you concerned your eyedrops are no longer helping your glaucoma? Surgical treatment could be your next step. Call iSight Vision Care or request an appointment online to explore your options today.