Glaucoma is a disease of the optic nerve which leads to a loss of nerve fibres with a gradual loss of visual field. This can lead undetected to blindness. There are two major groups of glaucoma in adults, open angle and narrow angle glaucoma. In most cases, the intraocular pressure is elevated and it is this pressure that damages the optic nerve. In open angle glaucoma, the pressure is permanently or almost permanently elevated above normal without treatment. In narrow-angle glaucoma, the pressure can vary greatly, and even if it is often measured within the normal range, repeated short periods of very high intraocular pressure are sufficient to cause significant damage to the optic nerve. In both types of glaucoma there are no symptoms most of the time, the disease runs in the background. That is why prophylactic examinations by an ophthalmologist are recommended from 40 onwards - the earlier the glaucoma is detected, the better it can be treated. Although the disease is chronic and cannot be definitively cured, it can be slowed down and stopped so that there is no (or no significant) loss of vision. There are many different subtypes of glaucoma - congenital, childhood, young adult, after other eye diseases or eye injuries. These can also go undetected for lack of pain and other symptoms, but are rare overall.
Practically all forms of glaucoma are treated by lowering the eye pressure. Inside the eye, the so-called ocular fluid (aqueous humor) circulates, which is constantly produced and drains off again via microchannels. In glaucoma, the natural outflow and thus the natural pressure regulation are disturbed. In order to regulate the eye pressure, we use eye drops, laser or surgery, or a combination of these. A treatment strategy is determined individually for each patient depending on the type of glaucoma, the structure of the eye and the stage of the disease.
Many different drugs in drop form are available. The treatment of glaucoma almost always starts with such eye drops, which can be combined in different ways. If the pressure-lowering effect is not sufficient, laser treatment or surgery must be considered.
There are different types of lasers and different treatment methods that can be used depending on the case.
Selective laser trabeculoplasty (SLT)
Selective laser trabeculoplasty (SLT) is a laser treatment of the trabecular meshwork (a complicated mesh with pores and microchannels) in the chamber angle to achieve improved drainage of the inner eye water and thus a low intraocular pressure. SLT is only used in open angle glaucoma and is a gentle treatment, but the exact pressure-lowering effect is difficult to predict. If the effect is insufficient or diminishing, the treatment can be repeated.
In laser iridotomy, a small opening is made in the iris to create a direct connection between the posterior and anterior chambers of the eye. This is used in narrow-angle glaucoma to prophylactically prevent pressure peaks and a glaucoma attack or therapeutically in the case of a glaucoma attack.