Overcoming Glaucoma: Laser versus Incisional Surgical Approaches

Choice of Treatment is not Limited by Age but is Case-Specific

Robert M Schertzer, MD, FRCSC
Glaucoma & Anterior Segment Surgery
Multimedia Technology
Medical Director Visual Field and Optic Nerve Head Imaging Units
VHHSC/UBC Eye Care Centre

When pharmaceutical treatment of glaucoma proves ineffective, several surgical options remain available. In fact, some types of glaucoma may be best handled with immediate surgical intervention, even without prior medical management. Ocular surgery is any procedure that causes an alteration in the structure of the eye and can be laser (using a light) or incisional (using microsurgical blades). The type of surgical intervention indicated will depend on the mechanism of the glaucoma.

Laser surgery
There are three types of laser surgery used in treating glaucoma: trabeculoplasty, iridotomy, and cycloablation.

Trabeculoplasty, usually performed with an Argon green laser, is the application of laser energy next to the drainage channels (trabecular meshwork) around the circumference of the iris inside the eye (the coloured part of the eye.) This is used only for open-angle types of glaucoma, especially chronic ("primary") open angle glaucoma, pseudoexfoliation glaucoma, or pigmentary glaucoma.