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Glaucoma Surgery, lasers

Glaucoma surgery; not a pleasing thought, but some surgeries for glaucoma are not that bad.  Both ALT and SLT are very straightforward and relatively painless.  These laser glaucoma surgical procedures are really no inconvenience at all.  You walk into outpatient surgery at your local hospital, or even your opthalmologist's office facilities, and three hours later you are driving home and you're healthy!  Your eye is a little irritated and that is it.  I have "low tension" open angle glaucoma, and was diagnosed in 1998, but I believe I noticed the first symptoms in 1996.

Please see my article about Normal Tension Glaucoma.

Also a tremendous resource for glaucoma information:
http://willsglaucoma.org/

Also make absolutely sure you talk to your doctor about any steroids you might be taking, especially inhaled steroids for allergies, etc.

My ALT glaucoma surgery

I have had ALT (Argon Laser trabeculoplasty) twice in my right eye.  Your opthalmologist will use the laser to make a ring of small holes in your trabecular meshwork, a circle of laser pin pricks around your eye's iris.  It is a very simple process.  When you arrive, and after check in, you will be given a drop in the eye in which the surgery for your glaucoma will be performed.  You then sit, for at least an hour, waiting for the anesthetic medication to take full effect.  During that time you will probably see quite a few seniors going in and out of the laser surgery room.  You will see several pieces of laser equipment, which look like desks with an opthalmoligist's microscope mounted on them.  I chose a chair where I could watch all the coming and goings.  When I was called in, the first thing I noticed was I was seated at a laser that as far as I could tell had not been used that morning, the ALT!  I think many of the laser surgeries that morning were for cataracts, and I believe a different laser is used for cataract laser treatment.

During the Surgery

My opthalmologist as always was comforting.  He used an optical goo and a lens placed directly on the surface of my eye, I presume to accurately stabilize my eye and the laser focusing.  The intensity of the light is extremely high both while the doctor is observing the effects of the laser and during the "blast" it is blindingly bright.  About half way through you really cannot see any more until the laser procedure is completed.  During the surgery the doctor asked "Do you feel that?"  I think perhaps I wasn't reacting sufficiently to the laser "pin prick".  I use the term "pin prick", because it did feel a little like a hot pin hitting my eye for a instant.  While there was a slight discomfort, it really did not bother me at all.  In this case the doctor did about 44 or 45 shots of the laser around the perimeter of my iris.  Typically they would use 40 shots.  It was funny during the surgery, and apparently it had never happened before, but my doctor stepped on my toe several times instead of the laser firing pedal!  I think it must have been the way I was sitting.

After the ALT surgery

After the surgery I sat in the waiting area, again for a substantial period, 45 minutes to a hour.  I believe this is to allow your eye to stabilize so they may get a reliable measure of your Intraocular pressure shortly after the surgery.  My pressure was down slightly.  I was given steroid drops to use for the next five days.

The results of the surgery for Glaucoma

Well unfortunately while initially my pressure did drop significantly after a few months it was back up to normal, (which is bad for me, I have "normal tension glaucoma").  The doctor had said in advance it might take two ALT sessions, so we proceeded through a second ALT surgery.  After time, my pressure returned pretty much to normal.  With the 4 medications I was taking, my IOP was at times 12 which is quite good.  But there were also times where it would climb toward 14-16 which is still normal but, bad for me!

My Glaucoma SLT surgery

Due to relocation I have changed opthalmologists.  My current doctor observed something in my left eye that worried him greatly.  He saw the type of arterial damage he usually only sees in a 70 year olds eye's, at the time I was 51.  His first step is as always to try to lower intraocular pressure even more.  So he recommended SLT (Selective Laser Trabeculoplasty), a newer form of laser treatment.  The ALT above can only ever be used twice in one eye in a lifetime.  It causes some scaring.  The SLT is "ablative" causing less damage to the iris, and can be applied numerous times.  The procedure for the SLT is virtually identical to the ALT.  I will say the SLT apparatus is far more compact than the ALT.  To me I still felt a slight burning pin prick for each laser blast and again about 40 were used.

The results of the SLT glaucoma surgery

Unfortunately the SLT had no impact on my IOP!  The arterial inflammation in my left eye healed by itself.

The next step

The next step is actual trabeculectomy surgery.  I came very close to having this surgery, but held off.  My doctor suggested I have a consultation at Will's Eye Hospital, and as a result of the consultation it was decided as long as my eye stayed stable both at IOP 12 and a stable Visual Field Test, I should just hang in there.  The glaucoma surgery probably would only lower my IOP to 10, below that is probably unsafe, so it is a small gain at a high risk.

The risk of infection

The risk of infection after trabeculectomy surgery worries me greatly.  This is where an incision to create a flap on your upper eye is done, to allow drainage of intraocular fluid.  I do travel occasionally and in many cases to semi-tropical islands where I do enjoy swimming.  Swimming becomes an infection risk after surgery for low tension glaucoma.  It is probably worse for swimming pools than in a tropical island setting, but, who's done that research! 

Costs of glaucoma surgeries

For the ALT I had insurance coverage.

Hope this helped, Bob.

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BHT Revised: 03 Apr 2017

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