Glaucoma is a term covering several diseases caused by high fluid pressure, which leads to loss of vision. While surgery is not the first line of treatment, except in a medical emergency, some operations can help to relieve fluid pressure. (Learn More)

With several types of glaucoma and various options for treatment before surgery, your doctor may have you combine lifestyle choices and medication to see how your eyes respond. (Learn More)

There are a few different approaches to surgery, with the most minimally invasive being the preferred approaches, if possible. (Learn More) Because glaucoma is considered a medical problem, your health insurance can cover many of the costs, but the price also varies based on whether you can undergo an outpatient procedure or if you need to be in a hospital room. (Learn More)

Like all types of vision surgery, there are risks with glaucoma operations, but these are minimal compared to the benefits. (Learn More)

It is important to work with your eye care team to determine when glaucoma surgery is necessary and which type you might benefit from. Your eye doctor will help you manage your glaucoma at all stages, advising you when surgery is needed. (Learn More)

What Is Glaucoma, and When Is Surgery Needed?

hazel eyes

The term glaucoma covers several eye diseases caused by high fluid pressure in the eye itself. This fluid pressure damages the optic nerve and can lead to blindness, when left untreated.

The goal of medical treatments for glaucoma is to lower fluid pressure so you do not lose any more vision. Unfortunately, many people experience some vision loss before their optometrist or ophthalmologist prescribes eye drops or recommends surgery. This is because the most common form of glaucoma doesn’t trigger symptoms in its early stages.

There are five types of glaucoma surgery, each designed to improve fluid draining from the eye to reduce intraocular pressure. Your eye doctor will recommend one of these based on your individual circumstances, including how much vision you have lost, how quickly the pressure in your eyes goes up, and how healthy your eyes are otherwise.

Most optometrists or ophthalmologists approach glaucoma surgery as a last resort, but it can be a viable option for early treatment in some cases. There are also risks to undergoing surgery, including the potential for worse eyesight and even blindness, though the chances of these happening are low.

Surgery is rarely the first treatment choice, but your doctor will advise when it is appropriate for your situation. Glaucoma surgery is an important treatment option for moderate or severe forms of glaucoma, so you can keep as much vision as possible for as long as possible.

Optometrists Typically Treat Certain Types of Glaucoma With Medication Before Surgery

There are numerous types of glaucoma. The term glaucoma covers almost anything that leads to high pressure inside the eye that begins to damage the optic nerve. The two most common forms are:

  • Open-angle glaucoma. This accounts for about 90 percent of glaucoma diagnoses, and it is caused by the slow clogging of the eye’s drainage canals. The name comes from the wide, open angle between the iris and the cornea. This condition develops slowly, and it is a chronic, lifetime disease.
  • Angle-closure glaucoma. This form of glaucoma is also caused by a blockage of the eye’s drainage canals. In contrast to open-angle glaucoma, angle-closure glaucoma develops quickly and demands immediate medical attention. There are other symptoms, including headaches, eye pain, and nausea that indicate this type of glaucoma has set in.

There are nine other types of glaucoma that are caused by birth defects, problems with the iris, or a symptom of an underlying medical problem or trauma. Some of these forms of glaucoma benefit from lifestyle changes, while others require immediate medical treatment.

If you have a family history of glaucoma or have received a diagnosis of high intraocular pressure but have no vision loss, you can help to manage your glaucoma risk with the following:

  • Healthy diet
  • Regular exercise
  • Limiting caffeine intake
  • Staying hydrated
  • Sleeping with your head elevated
  • Taking medications as prescribed and understanding if high intraocular pressure is a side effect of a particular medication

There are also several types of prescription eye drops that can be used to manage high eye pressure and reduce vision loss caused by glaucoma. Your optometrist may prescribe these if you receive a glaucoma diagnosis. It is important to take these drops as prescribed regularly, so your eye pressure can lower.

All types of glaucoma require diagnosis from a medical professional. In many cases, you may have glaucoma and not know it. If you rely on noticing symptoms like blind spots, you will not know you have this eye disease until the condition has advanced to the point of near blindness. Regular eye exams involve measuring your eye pressure as well as dilating your pupils so your optometrist can see your retina’s health. With consistent exams, your eye doctor can spot the signs of glaucoma early.

Types of Glaucoma Surgery

There are five basic approaches to surgery that treat many types of glaucoma.

  1. Laser trabeculoplasty: Also called laser therapy, this procedure treats open-angle glaucoma in your eye doctor’s office. A small laser makes miniscule incisions in the trabecular meshwork, which are some of the channels through which your eyes drain. It may take a few weeks before the operation takes full effect.

    Although the standard treatment plan for most glaucoma patients has been to avoid surgeries, including minor laser operations, unless absolutely necessary, some newer medical studies have found that low-impact selective laser trabeculoplasty (SLT) can be the first intervention for open-angle glaucoma, followed by prescription eye drops.

  2. Filtering surgeries: These are performed without laser assistance. Your eye surgeon will make an incision in the sclera, or the white of your eye, and remove part of the trabecular meshwork in a trabeculectomy or simply make small incisions in a trabeculotomy.

    Both these procedures create a “controlled flow” of aqueous humor from your eye, to reduce pressure. A goniotomy is a similar procedure, but designed specifically to alleviate fluid pressure in the eyes of newborns or infants.

    An iridectomy surgically removes a small piece of the iris to allow better flow for people with narrow-angle glaucoma.

  3. Drainage tubes: Your eye surgeon may decide to implant drainage tubes in your eyes to drain excess aqueous fluid.
  4. Minimally invasive glaucoma surgery (MIGS): This is an umbrella term for surgeries that can lower your intraocular pressure without the same high risks as drainage tubes or trabeculoplasty. There is also less recovery time and postoperative risk associated with these operations.

    For example, a deep sclerectomy involves a minimally invasive incision into the sclera to create another place for the eye to drain. A newer procedure, called a viscocanalostomy, opens a small space for your surgeon to put a tiny piece of viscoelastic gel into your eye to hold open a new drainage port so your eye pressure lowers.

  5. Laser peripheral iridotomy: This operation creates a small incision in your iris to drain aqueous humor from your eye. This procedure is typically used for angle-closure glaucoma, which is considered a medical emergency.

Typically, your optometrist or ophthalmologist will try to control your eye pressure with eye drops, or a combination of eye drops and laser procedures, since these are minimally invasive. Drainage tubes and filtering surgery both require an operating room and a specific surgeon. Since traditional surgeries involve longer recovery times, they are usually considered last-resort options.

Although these types of surgery can save your vision, they will not improve it. Damage from glaucoma is permanent, and lost sight cannot be recovered. Your eye doctor will always attempt to balance the risks of glaucoma surgery with the risk of vision loss, so you will have fewer health concerns while maintaining your vision.

The Cost of Glaucoma Surgery

woman calculating cost

The cost of any glaucoma surgery depends on what type of procedure it is. Typically, glaucoma surgeries are divided into two categories for the purposes of billing.

  • Laser surgery: These operations tend to be the least expensive, the least invasive, and the fastest to recover from. You can get a laser glaucoma procedure either in an ophthalmologist’s office or at an ambulatory surgery center, which further reduces costs since they are fully outpatient surgeries.

    The cost of these procedures can range from $1,000 to $2,000, and you can likely get some insurance coverage since they are considered medically necessary. Talk to your eye doctor’s office to determine your out-of-pocket cost after insurance coverage.

  • Incisional surgery: These require specialized sedation and an eye surgeon in a hospital setting, so they tend to be much more expensive — often around $11,000. However, they are medically necessary so you can work with your health insurance to determine the extent of coverage.

Glaucoma treatment, including prescription eye drops and surgery, is considered medically necessary. Your vision insurance may not cover this treatment, but your standard health insurance will. There will be copays for doctors’ visits and prescription medications, but you can get better financial help for this type of necessary operation compared to “cosmetic” operations like LASIK.

Both your eye doctor’s office and your insurance provider can give you information on your coverage and what you can expect to pay out of pocket.

Risks Associated With Glaucoma Surgery

Both laser procedures and operation room surgery have a risk of side effects. Side effects may include:

  • Short-term vision loss.
  • Bleeding inside the eye (very rare).
  • Infection.
  • Fluid pockets behind the retina due to pressure being too low.
  • Low eye pressure (hypotony).
  • Scarring in and around the eye, leading to vision loss.
  • Cataracts.

It is important to know that these side effects are not common. If your eye doctor decides you need surgery, the benefits outweigh the risks.

If you undergo any glaucoma surgery and experience one or more of the effects listed above, you should contact your eye surgeon immediately. Some of these may also be diagnosed at your postsurgical exam, so it is important to attend these follow-up appointments.

Glaucoma Surgery May Be Necessary for You

Depending on the type of surgery you need, your eye surgeon, optometrist, and/or ophthalmologist will inform you about aftercare. You may need a few days of rest at home; you may need prescriptions like antibiotic eye drops; you will need someone to drive you home after you are released from the clinic or hospital.

Incisional surgery may require that you take a significant amount of time off work. If you are concerned about the cost, risks, or recovery time of the procedure your eye doctor recommends, ask questions about these issues, and inquire if there are other options to explore.

If you have glaucoma, especially if it does not respond to eye drop treatment, a surgical treatment can lower your eye pressure and help you maintain your vision for as long as possible.

 

References

Glaucoma. American Optometric Association.

Glaucoma Treatment. (August 2019). American Academy of Ophthalmology (AAO).

Types of Glaucoma. (October 2017). Glaucoma Research Foundation.

Lifestyle Modifications May Help Control Glaucoma Progression. (July 2017). Ophthalmology Times.

Do I Need Surgery for My Glaucoma? WebMD.

When is Glaucoma Surgery Needed? (December 2013). American Academy of Ophthalmology (AAO).

How Much Does Glaucoma Treatment Cost? Cost Helper.

Glaucoma Surgery Overview. (October 2017). Glaucoma Research Foundation.

Glaucoma Surgery Series: The Risks and Benefits of Glaucoma Surgery. (April 23, 2018). BrightFocus Foundation.