How to Treat Glaucoma

If you or your loved one has been diagnosed with glaucoma, you may be feeling anxious. That's understandable since glaucoma is a leading cause of blindness. Early detection and treatment are key to preventing vision loss.

There are several types of glaucoma, but all of them damage the eye's optic nerve — a bundle of fibers that connects the retina to the brain and is essential for good vision. Glaucoma can affect one or both eyes. It generally starts by limiting your peripheral (side) vision, then progresses to affecting your central vision.

Fortunately, a range of treatments can help patients manage the condition:

Eye drops

Your ophthalmologist may prescribe eye drops for your glaucoma, giving precise directions to follow. There are various types of eye drops. Your doctor will determine which eye drops are appropriate for your specific case.

• Beta-blockers and carbonic anhydrase inhibitors work by reducing the amount of fluid in the eyes of patients with glaucoma and consequently lowering pressure in the eye. (Carbonic anhydrase inhibitors are also sold as pills.)
• Miotics and prostaglandin analogs lower the pressure by increasing drainage of fluid from the eye.
• Alpha agonists deliver a double whammy by both decreasing the amount of fluid and increasing drainage.
• Finally, Rhopressa lowers the pressure by targeting certain enzymes whereas Vyzulta works by upping the amount of oxygen that reaches the eye.

According to GoodRx, eye drop prices range from about $3 for 5ml of the beta-blocker Timolol 0.5%¹ to $215.53 for 2.5ml of Vyzulta 0.024%² and $283.82 for 2.5ml of Rhopressa 0.02%.³

Laser treatment

Eye drops don't work for everyone, so your doctor may recommend laser surgery. The main goal is to drain fluid from your eye with a beam of light. Before proceeding, an ophthalmologist will numb your eyes to prevent any pain or discomfort. The doctor will then hold a special lens to the eye and direct the laser beam onto the eye. You may experience blurry vision and soreness in the eye right after surgery. About two hours later, the ophthalmologist will check the pressure in your eyes. Someone will have to drive you home, and you may still need to balance your eye pressure with medication after surgery. Laser surgery costs between $1,000 and $2,000.⁴

Microsurgery

Microsurgery is another treatment option for some patients. Trabeculectomy involves making a small cut in the eye to take out some tissue and get rid of the excess fluid. Another surgical way of draining the fluid, called drainage implant surgery, entails implanting a tiny tube in the eye. Finally, minimally invasive glaucoma surgery or MIGS uses extremely small equipment and incisions to lower the eye pressure in a less invasive way than the traditional surgical approaches.

The average cost of glaucoma surgery involving incisions is about $11,000.⁴

Tips for Living With Glaucoma

Lifestyle changes will help to keep the condition in check. It's also important to follow your doctor's directions exactly for taking any prescribed medications and not to miss any doses.

• Exercise with caution. Aerobic exercise such as walking, biking and swimming may lower eye pressure, but you should ask your doctor if you can lift heavy weights or do certain yoga poses. Headstands and most head-down yoga positions are a no-no.
• Eat healthy. A diet rich in dark, leafy greens, such as kale and spinach, and fish with lots of omega-3 fatty acids, including salmon and mackerel, may benefit your eye health.
• Do not smoke. Smoking increases your risk of blood pressure, eye inflammation, diabetes and cataracts, which in turn boost the risk of glaucoma. If quitting poses a challenge, ask your doctor for guidance.
• Limit caffeine use. The jury is still out on whether caffeine is truly harmful to people with glaucoma. However, it does increase the degree of pressure in the eye, so don't overdo it. As stated by Gary S Hirshfield, MD, on the website of the American Academy of Ophtalmology: “I would say go ahead and enjoy your coffee, tea or energy drink—always with an 'eye' toward reasonable moderation, as in all things."
• Elevate your head when sleeping. Sleeping on a wedge pillow may help keep eye pressure in check.
• Don't drink too much fluid at once. Keeping hydrated is essential, but try to not consume too much liquid at one time and instead spread out your fluid intake over the course of the day. This will prevent straining your eyes.
• Use eye protection. Wear sunglasses outside and use protective glasses when engaging in contact sports and goggles when swimming.
• Refrain from rubbing. Your eyes may itch when you are on glaucoma medication, but don't rub them to avoid irritation. Your doctor may prescribe you special drops for dryness.
• Drive safely. You should be able to drive if your doctor says it is fine and you are able to still pass your state's vision test.

Helping a Parent With Glaucoma

Learning that your parent has glaucoma may cause you to worry as much as if you had it yourself. Although it is not possible to prevent glaucoma, you may help keep their eyes as healthy as possible through the following behaviors:

Regular eye exams. Early detection helps prevent the problem from getting worse. Your parent should have their eyes examined with a frequency that depends on their age. People between ages 40 and 54 should have glaucoma testing every 1 to 3 years; those between 55 and 64 should have it every 1 to 2 years; and after 65 every 6 months to 1 year.⁵

Following instructions. Make sure that your parent follows the doctor's instructions regarding how often and when to take their medication. Set up reminders on their phone or ask their health provider about their medication schedule and call your parent to remind them to take it.

Exercise. Encourage your mom or dad to go for a walk or jog three or more times a week. Exercise will help to keep their eye pressure balanced.

Have them protect their eyes. Suggest your parent use special glasses to protect their eyes when playing sports.

Finally, do not forget about your own eye health. Even if you are younger than 40, you should get a glaucoma exam every 2 to 4 years. People at high risk of glaucoma, such as those with a family history of the condition, should have their eyes examined for glaucoma every 1 to 2 years after the age of 35.⁵

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