How Glaucoma Is Treated

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Glaucoma treatments run the gamut from the use of a variety of different medications to innovative laser or surgical procedures, and more. Usually, your practitioner will decide which approach is likely to control your eye pressure and best help maintain sight.

Here's how glaucoma treatments can help, from options you can start on your own to things your doctor may prescribe in the office.

Man looking up and instill drops in his eye

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Home Remedies and Lifestyle

While glaucoma needs to be managed by a doctor, there are some things you may be able to do on your own to help enhance other pressure-lowering measures. Here are some approaches you can try:

  • Exercise regularly. For some open-angle glaucoma cases, this has been shown to lower eye pressure.
  • Avoid some types of exercise. Avoid weight-bearing exercise, as well as any other exercise that involves holding your breath and yoga poses where the head may be lowered, since these have been known to raise eye pressure.
  • Eat foods high in antioxidants. Since the optic nerve can be damaged by high levels of oxidative stress, consuming high levels of antioxidants may lower this and possibly protect against further injury. Some foods to consider include fruits such as pomegranate and acai berries, dark green leafy vegetables, dark chocolate, tea, and bilberry.
  • Stay away from alcohol, cigarettes, and caffeine, which in excess may increase eye pressure.
  • Forgo playing wind instruments or blowing up balloons. This can raise eye pressure.

Overcoming Myths

With a disease like glaucoma, which can be a "silent thief of sight," you may have to put to rest some erroneous thinking about this condition. Keep in mind that:

  • It's a myth that if you have 20/20 vision and no symptoms you can't have glaucoma. Unfortunately, many people don't notice symptoms until the disease has reached the moderate-to-severe stage.
  • The elderly are not the only ones who get glaucoma. While older people are more prone to glaucoma with eight times the risk of those in their 40s, this is a disease that can affect even babies.
  • The assumption that you need high eye pressure to have glaucoma is off base. Even if you have normal pressure, you can still lose sight to this disease, while there are those with high eye pressure who never develop glaucoma.
  • Thinking that you can forgo treatment if you don't have any symptoms is wrong, Even though there is no cure for the disease, treatments can help slow down vision damage.
  • It's not true that just because no one else in the family has glaucoma you won't get it either. While genes can play a role, it's not uncommon for just one person in the family to have glaucoma.

Over-the-Counter Therapies

In addition to home treatments, there are some over-the-counter options available at local stores to consider as well. Approximately 50% of glaucoma patients rely on some form of alternative therapy to help treat the disease.

Many scan the vitamin aisles for potential remedies. Vitamin B12 may possibly improve the visual field, but evidence is limited. Reaching for vitamin C won't necessarily help either. While this is found in the fluid of the eye, the amount needed to effectively lower eye pressure would be so great it would lead to problems such as diarrhea and dehydration.

Herbal remedies may also be on the radar. The antioxidant ginkgo biloba may improve visual fields in some, but evidence is limited. The thinking is that this may improve blood flow and protect nerves. The American Academy of Ophthalmology stresses that herbal remedies should never be used in place of proven therapies.

Prescriptions

The most common way to forestall glaucoma in the United States is by using prescription eye drops. While this cannot cure or reverse the disease, it can help to keep it from getting worse by tamping down eye pressure. These may work to protect the optic nerve in different ways.

While some prescription drops help the eye to drain better, others work to keep the production of fluid in the eye down. The class of drugs a drop belongs in depends upon the active ingredient.

These classes include:

  • Prostaglandin analogs: Among these drops, which increase fluid outflow, are Xalatan (latanoprost), Lumigan (bimatoprost), TravatanZ (Travoprost), and Zioptan (tafluprost).
  • Beta blockers: These drops, which include timolol (brand names Betimol, Istalol, Timoptic) and Betoptic (betaxolol), work by reducing the amount of fluid produced by the eye.
  • Alpha-adrenergic agonists: Agents such as lopidine (apraclonidine) and brimonidine (brand names Aphagan P, Qoliana) both reduce the amount of fluid produced and allow for increased drainage.
  • Carbonic anhydrase inhibitors (CAIs): These drops, Trusopt (dorzolamide) and Azopt (brinzolamide), reduce the amount of fluid made by the eye.
  • Rho khinase inhibitors: A new class, it has been available since April 2018 and includes the agent Rhopressa (netarsudil). This works to increase drainage in the eye.
  • Nitric oxides: This class of medications relaxes the drainage system of the eye improving outflow. The agent, Vyzulta (latanoprostene bunod), has a nitric oxide component, as well as one that works as a prostaglandin analog.
  • Miotic or cholinergic agents: These agents include Isopto Carpine (pilocarpine), Mimims Pilocarpine (Canada), and Pilocar, which help fluid to drain better from the eye.

Potential Side Effects

In most cases, glaucoma medicines are well tolerated. Still, some may experience some side effects. These can include:

  • Discomfort such as stinging, burning or redness
  • Eye color changes or darkening of the skin around the eye at times with prostaglandin analogues
  • Fatigue with beta blockers or alpha agonists
  • Headache, or drowsiness with alpha agonists
  • Shortness of breath at times with beta-blockers

Surgeries and Specialist-Driven Procedures

In some cases, practitioners may suggest undergoing glaucoma surgery to improve fluid drainage in the eye. Some involve lasers to help improve eye drainage, such as argon laser trabeculoplasty, selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI).

Argon Laser Trabeculoplasty

This is used for open angle glaucoma to improve outflow. Micro-injuries caused by applying the laser to the drainage tissue result in this releasing healing factors that allow the tissue to function more normally. By doing this, more fluid can flow from the eye and allow pressure to lower.

Selective Laser Trabeculoplasy

This works in a similar fashion to argon laser trabeculoplasty but with a YAG laser instead. With this approach, only pigmented cells are targeted while the rest of the drainage tissue remains intact. One of the advantages of this approach is that it is repeatable, while ALT can't be done more than twice.

Minimally Invasive Glaucoma Surgery (MIGS)

With this approach targeting mild glaucoma, minuscule implants are placed by edge of the colored portion of the eye to allow fluid to enter the drainage tissue. The MIGS remain in place permanently. One of the perks of this procedure is that it tends to be safer and patients usually recover faster.

Laser Peripheral Iridotomy (LPI)

For those with narrow-angle glaucoma where the area between the colored portion of the eye and the clear covering is too small, this is one option. The idea is to use the laser to make a tiny hole in the colored iris to offer another drainage route.

Trabeculectomy

This trabeculectomy procedure, done in some form since 1900, works by removing a piece of the drainage tissue. This allows fluid to leak through the wall of the eye relieving pressure. While this is often a very successful pressure-lowering approach, potential problems include very low eye pressure, infection risk, and cataract development.

Complementary and Alternative Medicine

In addition to traditional medicine, some may also consider alternative approaches to lower pressure. However, this is something that should always be discussed with your practitioner.

Marijuana use is sometimes touted by some as a way to reduce pressure. The American Academy of Ophthalmology does not recommend this approach.

The problem is that while this can lower eye pressure for a short while, eye pressure must be controlled 24 hours a day. Marijuana use is simply not practical. The amount needed to be consumed would affect mood and mental clarity.

Meditation is another possibility. However, while this may enhance your mood and lower your pressure a little, the reduction won't be enough to help with your glaucoma.

A Word From Verywell

Whatever approach you may currently be using to treat glaucoma, keep in mind the plethora of others available should you need them. In some cases, these may also be combined to further lower pressure. The aim, as always, is to keep your vision sharp and your optic nerve healthy.

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Article Sources
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