Glaucoma Treatment & Specialist Care | Specialty Vision

Medications and Eye Drops & Laser Treatments for Glaucoma & Surgical Interventions & Innovative Therapies: Sustained-Release Drug Delivery

Topical medications are often the first line of defense against glaucoma. These eye drops are designed to either reduce the production of aqueous humor or increase its outflow from the eye, thereby lowering IOP. New classes of medications have emerged recently, along with established treatments that have been the backbone of glaucoma management for many years.

• Beta Blockers: Medications such as Betimol, Timoptic, and Betoptic work by reducing the production of aqueous humor.
• Carbonic Anhydrase Inhibitors: Agents like Azopt and Trusopt slow fluid production within the eye. They are sometimes used in combination with other medications.
• Alpha-Adrenergic Agonists: Drugs such as Lopidine and Alphagan P not only lower fluid production but also help improve drainage.
• Prostaglandin Analogs: Medications including Xalatan, Travatan Z, and Lumigan increase the outflow of fluid from the eye, making them some of the most effective options available.
• Cholinergic Agents: Agents like Isopto Carpine work by increasing fluid drainage through pupil constriction.
• Rho Kinase Inhibitors: Newer medications such as netarsudil are designed to improve outflow by acting on the trabecular meshwork, the eye’s drainage system.

For some patients, the daily administration of eye drops can be challenging. Recently, sustained-release drug delivery systems have been developed to alleviate these difficulties. For example, implants that slowly release medication directly into the eye have been showing promise in maintaining steady IOP levels, which may help overcome issues with compliance and side effects associated with traditional eye drops.

Laser therapy is another effective option for many patients, either as an alternative to or in combination with medications. These treatments use precise laser energy to help open the drainage pathways in the eye, facilitating improved outflow of the aqueous humor.

• Selective Laser Trabeculoplasty (SLT): This procedure targets the drainage cells and is often recommended for open-angle glaucoma. Studies have even suggested that SLT might be considered as a first-line treatment due to its safety profile and effectiveness.
• Argon Laser Trabeculoplasty (ALT): ALT also helps improve the drainage of aqueous humor, though it may be reserved for cases where medications have not sufficiently controlled the eye pressure.
• Laser Peripheral Iridotomy: Typically used for angle-closure glaucoma, this laser procedure creates a small hole in the iris to allow fluid to flow more freely, thereby relieving the pressure build-up.

Both SLT and other laser interventions are performed in an office setting and tend to have quick recovery times, making them a convenient option for many patients.

When medications and laser treatments do not provide adequate pressure control, surgical options may be considered. Advances in surgery have led to less invasive and highly effective procedures that target fluid drainage directly.

• Trabeculectomy: In this procedure, a tiny flap is created in the sclera (the white part of the eye) to facilitate fluid drainage into a small reservoir called a bleb. This helps to lower the eye pressure significantly.
• Glaucoma Drainage Devices: Tubes or shunts are implanted to provide an alternative drainage route for the aqueous humor. These devices are often used in more advanced cases or when other surgeries have not been successful.
• Minimally Invasive Glaucoma Surgery (MIGS): MIGS procedures are designed to reduce the risk of complications and allow for faster recovery. They include techniques such as trabecular bypass and shunt placement with only miniature incisions, making them attractive for patients with less severe glaucoma.
• Cyclophotocoagulation: This laser procedure targets the ciliary body, reducing the production of aqueous humor and thereby lowering intraocular pressure.

Our glaucoma specialist is meticulous about evaluating all contributing factors, from the severity of nerve damage to the patient’s overall health, before recommending a surgical approach. These procedures are performed in state-of-the-art surgical centers with careful post-operative monitoring.

For patients who struggle with the daily routine of administering eye drops or experience side effects from topical medications, new sustained-release treatments are emerging as promising options. These innovative therapies deliver a constant dose of medication over weeks or even months, ensuring stable IOP levels with minimal disruption to everyday life. For example, implants such as iDose TR offer a hands-free method of maintaining eye pressure without the need for daily drops. Similarly, treatments like Durysta have been approved for use as an injectable option that slowly releases medication over a prolonged period. These methods not only support consistent management of glaucoma but also address common issues like noncompliance and irritation associated with traditional medications.