Glaucoma is the world’s leading cause of irreversible vision loss,” says Cleveland Eye Clinic glaucoma specialist Alexander Kosmidis, M.D., but patients have treatment options that range from conservative to aggressive in nature. These treatments can help preserve vision and prevent further damage. Learn about the two most common treatments for glaucoma: medicated eye drops and selective laser therapy.

Depending on the type of glaucoma you have, and how advanced it is, treatments can include:

• Medicated eye drops
• Laser therapy
• Minimally invasive glaucoma surgery (MIGS)
• More invasive glaucoma surgery (in rare cases)

Many ophthalmologists, however, recommend eye drops or laser therapy as the first line of treatment to try, as they are both effective and the safest, least-invasive options.

Since the 1950s, eye drops containing a variety of medicines have been used to treat open-angle glaucoma, the most common type of glaucoma in the U.S. These drops lower intraocular (internal eye) pressure, or IOP. Elevated IOP is the primary cause of vision loss in glaucoma. IOP rises when the eye’s drainage system becomes blocked over time, causing fluid to build up that gradually damages the optic nerve.

Eye drops for treating glaucoma must be used according to a strict daily schedule. They:

• Are available by prescription only
• May be taken nightly, twice, or three times daily
• Must be taken consistently, so a patient must be committed
• Are covered by insurance

“It is only with daily treatment, regular faithful use of these medicines, that we can truly help lower pressure and ultimately save vision,” Kosmidis says.

When using eye drops, some patients may experience:

• Redness
• Irritation or stinging upon entry
• Occasional blurred vision

The vast majority of patients become accustomed to these effects, however, and are able to use drops long-term.

With “simple, daily drop therapy,” Kosmidis says he’s able to control IOP and help preserve vision in the vast majority of his patients.

Over the past 20 years, minimally invasive procedures like selective laser trabeculoplasty (SLT) have emerged for treating glaucoma by lowering IOP. SLT lowers pressure by applying energy to open the eye’s drainage system, allowing excess fluid to leave the eye. 

Dr. Kosmidis explains that SLT:

• Is a simple procedure performed in-office 
• Is performed on people of all ages
• Takes approximately two minutes to perform
• Doesn’t require anesthesia
• Is “well-tolerated” and “relatively painless”
• Can be especially helpful for patients who experience side effects from eye drops, or have trouble remembering to take their drops

If your IOP increases again after undergoing SLT, the procedure can be repeated, though its effect and how many times it can be redone is limited. Your doctor may recommend eye drops if SLT does not adequately manage your IOP. 

Kosmidis says that, while some patients may experience blurred vision for a day or two following SLT, the effect generally corrects itself without issue.

Staying in close contact with your ophthalmologist is imperative, says Kosmidis, regardless of whether glaucoma therapy is begun with eye drops or laser therapy. Follow-up visits every four to six months are needed to ensure that your eye pressure remains at a level that will help prevent further vision loss.