All glaucoma requires a thorough examination to determine which treatment is the most appropriate among the various medications, laser and surgery.
The use of drops, which normalize the intraocular pressure, can stop the evolution of certain types of glaucoma. In case of treatment failure, poor tolerance or intraocular pressure that does not decrease, laser is an effective medical alternative. On the other hand, for other types of glaucoma, only surgery will stop the evolution of the disease. It should be noted that there is currently no treatment that acts to restore lost vision.
Medical treatment of glaucoma
Various anti-glaucoma medications (eye drops) are instilled into the eye daily.
More than 30 different eye drops or combinations of treatments are available and prescribed by the doctor depending on the stage of the disease and the patient's tolerance. These medications act either by reducing the production of aqueous humor inside the eye or by increasing the outflow through the trabeculum or the uveoscleral pathway, thus decreasing intraocular pressure.
Laser treatments for glaucoma
> SLT, Selective Laser Trabeculoplasty: low energy laser treatment designed to stimulate the eye's natural drainage system, the "trabeculum". It presents little risk, is painless and can be performed during the consultation. It often allows for a reduction in intraocular pressure and even the discontinuation of medication.
> Peripheral Iridotomy under YAG laser: this laser is used to create a micro-perforation of the iris which allows to widen the iridocorneal angle of patients with narrow or closed angle glaucoma. It reduces the risk of future glaucoma and prevents acute glaucoma attacks.
> Peripheral Iridoplasty with ARGON Laser: this technique helps to reduce the size of the peripheral iris by moving it away from and preventing contact with the trabeculum, as this is the primary cause of trabecular damage.
Surgical treatments
> Trabecular pathway: the trabeculum, a 360 degree "natural or physiological" canal encircling the iris tips, is the main drainage pathway in the eye. Surgical treatments consist of augmenting the reduced capacity of the drainage function by implantation of a stent in a portion of the trabeculum (iStent), by dilation of the entire canal (canaloplasty ab interno), by surgical opening of the inner wall of the canal in the case of more advanced disease (GATT), or by a combination of these microinvasive procedures. These new operations are grouped under the acronym MIGS for "Microinvasive Glaucoma Surgery Techniques". To learn more, visit our glaucoma page.
> Subconjunctival route: This is a standard drainage route that has been used for many years by glaucoma surgeons. A trabeculectomy, the removal of the pre- or intratrabecular obstruction, is performed when the function of the trabecular drainage system is impaired.
Dr. Sharkawi has introduced several new published surgical techniques that make operations safer and more effective compared to traditional techniques. He is the most experienced in Baerveldt tube implantation in complex adult glaucoma and pediatric cases.
To learn more about glaucoma treatments and MIGS: TEDxUmontreal - Georges Durr - "How to fight glaucoma".