Glaucoma treatment, eye drops or laser?

Table of Contents

Glaucoma treatment options (POAG).

The common form of glaucoma (POAG) may be treated with eye drops or laser. Both give excellent results. Most people choose eye drops, perhaps because they are familiar with them and it sound less intimidating than laser treatment. At a recent meeting of ophthalmologists an informal survey was taken as to the treatment they would choose for themselves. A clear majority voted for laser treatment.

Glaucoma eyedrops.

This is the traditional treatment. As with everything else, there are pros and cons. The good thing about them is that, used consistently once or twice daily, they control the glaucoma in most patients. Among the downsides are:

  • They can be expensive (you have to use them for lifetime).
  • They are inconvenient (you have to use them daily).
  • Some people have a hard time instilling eye drops.
  • They may cause eye discomfort by worsening dry eye symptoms or by causing allergic reactions. Both of these may require additional office visits for their control.
  • Sometimes they discolor the skin around the eye. 

Selective Laser Trabeculoplasty (SLT).

SLT works by opening microscopic channels that drain fluids inside the eye. This reduces the pressure in most patients (about 85%). There is no need for eye drops while the pressure is under control. In patients with resistant glaucoma (requiring daily use of two or more types of eye drops) the reduction of pressure by laser may not be complete, but it is often sufficient to allow stopping the use of one or more eye drops.

The effect of SLT tends to wear off over time. The rate of wearing off is not predictable – it depends on patient’s individual characteristics. In 50-60% of patients the pressure still remains under control after 5 years. If pressure rises, SLT may be repeated or the patient needs to start using eye drops.

Complications of laser treatment are rare. If they occur at all, they are mild and brief. There may be a brief increase in pressure which is treated with glaucoma medications. Sometimes there is mild inflammation or a brief period of blurred vision.

SLT is done in our office. It takes only minutes to perform and is easy on the patient. There is no pain. There are no shots. Only anesthetic eye drops are used. Normal activities, such as driving and work, may be resumed on the same day. After SLT patients can drive themselves home.

SLT is a well established procedure. It has been FDA approved for over 10 years. It is covered by Medicare and other insurances. In 2008, a study compared the cost of SLT and eye drops. Over 5 years, the cost for eye drops was $6,571 higher than for the SLT (savings to you will also depend on whether or not you have drug insurance). For most people, out-of-pocket expenses for SLT are minimal, usually only the unmet deductible and co-pay.

You will need the same follow-up regardless whether you choose to be treated with eye drops or laser.

In summary, SLT is an excellent option for those who tend to forget to use the eye drops, have problems administering them, cannot tolerate them, find them too expensive, do not wish to use medications because of pregnancy or do not wish to use eye drops for any reason.