Glaucoma is one of the most common causes of irreversible blindness, impacting millions of people worldwide. Glaucoma is characterised by gradual damage to the optic nerve and is frequently linked with high intraocular pressure (IOP), a major risk factor for progression of the disease. While medications and laser treatments are important for treating IOP, surgical intervention is sometimes required for patients with worsening glaucoma despite conventional treatments. Let’s take a look at the importance of IOP control, the variety of surgical techniques available, and how these operations assist to maintain vision.
The Importance of Controlling Intraocular Pressure ( IOP)
IOP is a key component in the development and progression of glaucoma. The eye constantly creates a fluid known as aqueous humor, which maintains internal pressure and supplies vital nutrients. This fluid exits through a network of channels, principally the trabecular meshwork. However, in glaucoma, these drainage pathways become clogged or ineffective, resulting in fluid accumulation and increasing pressure inside the eye. In angle-closure glaucoma, the drainage pathways are narrowed, hence obstructing the flow of aqueous fluid out of the eye. Elevated IOP will then damage the optic nerve over time, eventually resulting in vision loss.
Lowering IOP is the only proven approach for slowing the progression of glaucoma. Even in situations of normal-tension glaucoma, where IOP remains within normal limits, research shows that lowering IOP can help protect the optic nerve. As glaucoma can cause significant vision damage or blindness if not treated appropriately, timely intervention is essential. Surgery is an alternative long-term solution for patients whose IOP remains uncontrolled despite medications and laser treatments, resulting in a more stable IOP reduction.
Surgical Procedures for Glaucoma Treatment
There are several surgical procedures available for managing glaucoma, each with its own strategy to enhance fluid drainage or reduce fluid production in the eye. The type of surgery is determined by the severity of the condition, the patient’s reaction to previous therapies, and unique eye anatomy.
Trabeculectomy has always been the “gold standard” for glaucoma surgical treatment. It is one of the most commonly performed glaucoma surgeries. During this treatment, the surgeon makes a small incision in the sclera (the white area of the eye) to allow excess fluid to drain, generating a reservoir known as a “bleb”. This efficiently reduces IOP by circumventing the eye’s natural drainage system. Trabeculectomy is highly effective for intermediate to severe glaucoma, although surgery is associated with potential complications including eye infection, scarring, or over-filtration, which can result in an excessively low IOP (hypotony).
Another approach is the use of glaucoma drainage devices, often known as tube shunts. These implants serve as an alternate aqueous humour drainage channel. Unlike trabeculectomy, which depends on the eye’s natural tissues to regulate outflow, tube shunts provide a more controlled and predictable drainage method. These devices are especially useful for patients who have complex or refractory glaucoma, where conventional surgery may be ineffective.
Minimally Invasive Glaucoma Surgery (MIGS) is one of the newest type of surgical treatment that offers a safer and less invasive way to control IOP. These operations include the implantation of tiny stents or the excision of a part of the trabecular meshwork to improve natural drainage. MIGS procedures, such as the iStent Infinite and Hydrus microstent, are frequently performed alongside cataract surgery and are excellent for patients with mild to moderate glaucoma. MIGS procedures are becoming a popular alternative for early surgical intervention because of their faster recovery time.
How Glaucoma Surgery Helps Preserve Vision
The primary goal of glaucoma surgery is to avoid future optic nerve damage by keeping IOP under control. Unlike cataract surgery, which can restore lost vision, glaucoma surgery cannot undo any vision loss . However, it is crucial to go for eye screening to diagnose glaucoma early and upon diagnosis, to control the IOP and prevent further disease progression and preserve remaining vision.
Glaucoma surgery maintains a regulated IOP by establishing new drainage channels or lowering fluid production. This relieves any persistent pressure on the optic nerve, lowering the possibility of further vision loss. In many situations, surgery allows patients to reduce or eliminate their need for regular eye drops, which can be costly and also associated with adverse effects such as pigmentation and redness.
Another key advantage of glaucoma surgery is improved quality of life. Patients with well-controlled IOP can continue to engage in daily activities such as reading, driving, and socialising without risk of unexpected vision loss. Surgery can make the difference between having functional vision and total blindness.
Glaucoma Surgery at Asia Pacific Eye Centre
At Asia Pacific Eye Centre (APEC), we offer glaucoma surgery to help patients effectively manage their intraocular pressure (IOP) and preserve their vision. Our team, led by skilled glaucoma specialists, provides a comprehensive range of surgical options, including Minimally Invasive Glaucoma Surgery (MIGS) tailored to each patient’s needs. Using innovative technology, we ensure safe, precise, and effective treatment to slow glaucoma progression and prevent blindness. With a commitment to personalised care and long-term eye health, APEC is the destination for those seeking glaucoma management in Singapore.
