Surgery

If surgery is suggested, it is first prudent to try trabeculoplasty. A trabeculoplasty is usually done on people with other types of glaucoma if medicine alone has not lowered the IOP enough. This procedure is only minimally effective in people with normal-tension glaucoma because they already have an IOP in the normal range.

During a trabeculoplasty, the ophthalmologist uses a laser beam to place small spots on the trabecular meshwork, which further opens the holes in the trabecular meshwork, allowing the fluid (aqueous humor) to flow better out of the eye, which, in effect, lowers IOP.

You will sit at a slit lamp while the ophthalmologist performs the procedure. A special contact lens (called a goniolens) is placed on your eye so your ophthalmologist can view the trabecular meshwork.

A full treatment generally consists of 100 spots placed over the entire trabecular meshwork. This may be divided between 2 sessions consisting of 50 spots over each half of the trabecular meshwork. The entire procedure usually takes 30 minutes or less and is relatively painless.

IOP is usually reduced, but, unfortunately, this decrease in IOP is not usually permanent. It may last up to 3-5 years following a trabeculoplasty, if successful.

Following the trabeculoplasty, your eye doctor will prescribe medicine to prevent inflammation. You will also continue with your glaucoma medicine.

In severe cases with progressive vision loss, trabeculectomy may be attempted. During trabeculectomy, your ophthalmologist creates an alternate pathway (or drainage channel) in the eye to increase the passage of fluid (aqueous humor) from the eye, which helps in lowering IOP.