What types of laser eye surgery are available for glaucoma?

In glaucoma, the aqueous humor, the clear fluid that gives the eye its shape, drains from the eye more slowly than usual. This can cause a buildup of pressure in the eye, which can damage the optic nerve. The damage may lead to vision loss and blindness.

Selective laser trabeculoplasty (SLT) is a type of laser eye surgery that can help improve aqueous humor flow through the drainage angle, the area of the eye where the white covering called the sclera meets the colored area called the iris.

Who can benefit from SLT?

Doctors may recommend SLT for people with open-angle glaucoma (OAG).

In OAG, the most common type of glaucoma, the area of the eye responsible for draining fluid, called the anterior angle, is wide open. However, a blockage or an overproduction of aqueous humor prevents fluid from draining effectively through the main drainage pathway, called the trabecular meshwork.

What does SLT involve?

SLT may help stimulate the drainage system of the eye and relieve pressure.

During SLT, a doctor uses a small laser to widen the drainage angle of the eye. The laser pulls on the outer layers of the trabecular meshwork, increasing the tension in the drainage passage, which can improve the outflow of eye fluid.

The procedure typically costs $332–$752. Medicare may cover a portion of the cost under Medicare Part B.

How effective is SLT?

SLT is generally effective at reducing pressure in the eye and can lower intraocular pressure by around 30% when it is the first-line therapy.

If a person already uses eye drops, the reduction in eye pressure may be less, but it may be possible to reduce the number of eye drops a person needs.

The effects of SLT last 1–5 years. A doctor may need to repeat the procedure to manage intraocular eye pressure.

Laser peripheral iridotomy (LPI) can help prevent painful attacks of acute glaucoma, which occur when eye pressure rises suddenly.

Who can benefit from LPI?

A doctor may recommend LPI for someone who has angle-closure glaucoma (ACG), which people also refer to as closed-angle glaucoma.

ACG is a form of glaucoma in which a blockage between the two eye chambers prevents the flow of aqueous humor. The fluid can rapidly build up in the front of the eye, which can cause a sudden increase in pressure.

Doctors may also recommend LPI for people with anatomically narrow angles who are at risk of developing ACG. People of South Asian, Chinese, and Inuit descent have a higher risk of developing ACG than other populations.

Learn about the difference between OAG and ACG.

What does LPI involve?

During an LPI procedure, a doctor will use a laser beam to create a tiny hole in the iris. The hole allows the fluid to flow toward the drainage angle, which relieves pressure.

What does LPI cost?

A person may require more than one LPI session. The procedure typically costs $416–$783. As it is medically necessary, it is often covered by insurance minus a deductible.

How effective is LPI?

Studies have found different rates of effectiveness for LPI as a treatment for ACG.

A 2018 review discussed various studies:

• One small study found LPI was effective, and the angle of the eye remained open in most people who had undergone one LPI session.
• Another small study also suggested LPI was generally effective for at least 3 months after treatment and reduced intraocular pressure.
• One randomized, controlled study found LPI was associated with higher failure rates and lower intraocular pressure reduction than medical therapy.

Cyclophotocoagulation is a laser eye surgery that can reduce the production of aqueous humor in the eye. The laser alters the ciliary body, a part of the eye involved in producing the fluid.

Who can benefit from cyclophotocoagulation?

Cyclophotocoagulation may benefit people with chronic OAG and people with refractory glaucoma. Refractory glaucoma does not respond to treatment, such as medication, to reduce eye pressure.

Doctors may recommend cyclophotocoagulation when medications, other laser therapy, or surgical interventions, such as SLT, are ineffective or unsuitable.

What does cyclophotocoagulation involve?

In cyclophotocoagulation, a doctor uses a laser beam to target the area of the eye responsible for producing aqueous humor fluid.

There are different types of cyclophotocoagulation, including:

• Transscleral cyclophotocoagulation: In this procedure, a doctor applies about 10–20 spots of laser treatment to the eye.
• Endocyclophotocoagulation (ECP): In ECP, a doctor makes two incisions in the eye before applying the laser.
• Micropulse diode laser transscleral cyclophotocoagulation: This procedure uses a continuous wave laser, allowing for a more focused heat application to the ciliary body. The laser delivers repetitive micropulses to the eye.

What does cyclophotocoagulation cost?

The procedure may cost $1,677–$2,714. Medicare may cover a portion of the cost.

Read about Medicare and glaucoma care.

How effective is cyclophotocoagulation?

Different types of cyclophotocoagulation have different rates of effectiveness. A 2018 review of studies notes the following:

• One study found that transscleral cyclophotocoagulation reduced eye pressure in 72% of children with glaucoma.
• In a study of 68 eyes, researchers found that ECP helped reduce eye pressure in 90% of people with glaucoma.
• Researchers found that MTSCPC reduced eye pressure by 45% in one study. In another study, MTSCPC was effective in 80% of people with refractory glaucoma.

Laser eye surgery for glaucoma is typically an outpatient procedure, which means a person does not have to stay in a hospital afterward. The treatment usually takes about 20–30 minutes.

Steps

The surgery typically involves the following steps:

1. A doctor may administer local anesthesia through eye drops or an injection to numb the eye. In some cases, a person may require general anesthesia.
2. The doctor uses a lid speculum to hold the eyelid open.
3. They aim a strong laser beam of light into the eye, which may cause flashes of green or red light to cross the person’s vision.
4. The doctor uses the laser to help fluid drain from the eye and relieve pressure.

Most people do not experience discomfort or pain during the treatment.

After surgery

After laser eye surgery for glaucoma, a person may temporarily experience the following:

• redness
• pain
• swelling
• dry eyes, which eye drops can help alleviate

Laser eye surgery is highly effective in treating glaucoma.

However, the treatment is not effective for everyone and may not be a permanent solution. Depending on the type of procedure they receive, a person may require multiple laser treatments or the results may wear off over time.

Most people with glaucoma who have laser surgery will still require medication to treat the condition.

Laser eye surgery is one of several treatments for glaucoma. A doctor will recommend a specific type of laser surgery based on the type and severity of a person’s glaucoma. Types of surgery include selective laser trabeculoplasty, laser peripheral iridotomy, and cyclophotocoagulation.

During laser surgery for glaucoma, a doctor typically uses a laser to improve fluid drainage from the eye and reduce pressure.

Although laser eye surgery is highly effective for glaucoma, the condition may require a combination of treatments. It may also require repeated surgery.