Pros & Cons of Laser Surgery for Glaucoma: What to Know

Laser surgery can provide immediate relief from glaucoma-related pain and pressure, but it is also associated with certain risks that should be weighed carefully. 

Glaucoma laser surgery lowers intraocular pressure for a period of time. In most cases, patients need to continue using medications that control intraocular pressure, such as eye drops, but laser surgery generally results in the need for less medication.

What Is Laser Surgery for Glaucoma?

Laser surgery for glaucoma may refer to one of various kinds of procedures, all of which use a laser. During the procedure, the surgeon uses laser light to create a small opening in a part of the eye to drain the aqueous humor and decrease intraocular pressure (IOP). They may also apply a laser beam with extra pressure.

For example, laser surgery — often laser peripheral iridotomy (LPI) — is frequently indicated when the patient has a pupillary block or is not experiencing proper drainage of the aqueous flow. 

Patients diagnosed with angle-closure glaucoma or secondary angle closure glaucoma may benefit from the surgery. It may also be recommended for the management of other forms of glaucoma related to pupillary block.

Pupillary block is the main trigger that causes acute angle-closure glaucoma, and it happens when the flow of the aqueous humor in the eye is obstructed from the posterior to anterior chambers. This block occurs between the pupillary part of the iris and lens.

The opening that is made during laser treatment allows fluid to flow more freely from inside to the outside of the eye, thereby reducing the eye pressure inherent with glaucoma. 

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How Lasers Are Used to Treat Glaucoma

Four basic laser treatments may be used to treat glaucoma. 

Laser Peripheral Iridotomy (LPI)

You may need LPI if the space narrows between the cornea (clear outer layer) and iris (colored part of the eye). This narrowing triggers fluid and pressure buildup, thus the need for an LPI. The surgeon directs a laser beam to create a small hole in the iris to get rid of the additional fluid and relieve the pressure.

Argon Laser Trabeculoplasty (ALT)

ALT is used to unclog the eye, so the excess fluid can drain out of it. Sometimes, the surgeon treats half of the clogs initially to see how the surgery will work. 

ALT is used to treat primary open-angle glaucoma, ocular hypertension (closed angle glaucoma), and secondary open angle glaucoma.

Selective Laser Trabeculoplasty (SLT) 

SLT is performed with a precision low-level laser. The doctor points the light at areas with high pressure, with each application done in small doses.

SLT is often the first line of therapy for open-angle glaucoma. It’s frequently recommended for patients already using glaucoma eye drops. 

The low levels of light that are used decrease pressure by directing the fluid through the natural drainage passage of the eye. The results of a single treatment can last two to three years and sometimes longer.

Cyclophotocoagulation

If other laser treatments do not work, your eye doctor will usually try cyclophotocoagulation. When performing this surgery, the eye doctor directs the laser beam into a structure inside the eye to ease the pressure. This process may be repeated to keep the disease in check.

Other Surgeries

If laser treatments are not successful, the eye doctor might recommend an in-hospital operation called a trabeculectomy.

Trabeculectomy

Trabeculectomy is a process by which the surgeon removes a portion of the eye’s natural tissue and creates the opening needed to reduce the pressure within the eye. 

Trabeculectomy is standard treatment for glaucoma — for both open-angle and closed-angle glaucoma as well as primary and secondary forms of the disease. If laser applications do not work, the eye doctor may find this incisional surgery helpful.

Pros of Laser Surgery for Glaucoma

Laser surgery for glaucoma has many benefits, including these:

• Immediate relief from glaucoma-related pain and pressure
• Prevention of complete loss of vision
• Outpatient procedure
• Quick recovery period and downtime (about a week)

Possible Cons of Laser Surgery for Glaucoma

Some of the drawbacks associated with glaucoma laser surgery may include the following:

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

With laser surgery for glaucoma, the benefits outweigh the potential negatives and risks. As a result, it’s often recommended by eye doctors as a successful way to improve your vision and prevent future vision loss. While the potential for complications exists, issues are rare and treatable in most cases.

Is Laser Surgery Right for Me?

Your eye doctor will assess your overall eye health and the severity of your glaucoma to determine the best path forward. In some cases, laser surgery might not be the best option, and trabeculectomy might be the preferred choice. 

Often, laser surgery is recommended as the initial treatment for glaucoma that has been recently diagnosed or progressed further. If the laser surgery isn’t successful in lowering intraocular pressure, trabeculectomy might be recommended.

References

1. Optic Nerve. (May 2016). American Academy of Ophthalmology.

2. Normal Tension Glaucoma. (April 2022). American Academy of Ophthalmology.

3. Open Angle Glaucoma. (August 2022). StatPearls.

4. What Is Glaucoma? Symptoms, Causes, Diagnosis, Treatment. (December 2022). American Academy of Ophthalmology.

5. What Is Angle-Closure Glaucoma? (2022). Glaucoma Research Foundation.

6. Intraocular Pressure. (July 2022). StatPearls

7. Laser Treatment for Glaucoma. (July 2021). National Eye Institute.

8. Pupillary Block, Angle-Closure Glaucoma Produced by an Anterior Chamber Air Bubble in a Nanophthalmic Eye. (September 1996). JAMA Ophthalmology.

9. Laser Peripheral Iridotomy. (December 2022). American Academy of Ophthalmology.

10. Laser Trabeculoplasty: ALT vs SLT. (December 2022). American Academy of Ophthalmology.

11. Repeat Selective Laser Trabeculoplasty for Glaucoma Patients: A Systematic Review and Meta-Analysis. (September–December 2021). Journal of Current Glaucoma Practice.

12. Treating Glaucoma. (2022). Glaucoma Research Foundation.

13. Cyclophotocoagulation. (November 2001). Ophthalmology. American Academy of Ophthalmology.

14. Trabulectomy. (2013). ScienceDirect.

15. Lifestyle Habits and Glaucoma. (January 2022). American Academy of Ophthalmology.

16. Laser Trabeculoplasty as First-Line Glaucoma Treatment. (March 2019). The Lancet.

17. Researchers Discover Predictor of Laser Treatment Success in Patients With Glaucoma. (August 2020). University of Missouri School of Medicine.