Trabeculoplasty- a Laser Treatment for Glaucoma

Over three million Americans have glaucoma, but only half of them are aware of it. Glaucoma is a disease of the eye, that when left untreated, can result in blindness. In fact, glaucoma is the leading cause of blindness in the world. In

At the age of forty-nine, I noticed that upon awakening, I could look up at the ceiling and have “floaters” in my eyes, which appeared as webs of black easing across my eye. These were not severe and seemed to disappear after I was up and active, but they became a daily occurrence. When I went to the doctor for my annual physical, I mentioned them, and although he said floaters were more common as one ages, he asked how long it had been since I had had an eye exam.

Unfortunately, like most people, I had been to “walk-in places” to have glasses fitted, and usually they did the “puff of air” test to check my eye pressures. Sometimes they dilated my eyes with drops but not every time. I usually visited them once every year or two, when I felt my eyeglass prescription was changing. My doctor wanted me to see a doctor that specializes in the eye, an Ophthalmologist, for a complete exam. I had never done that in the past.

I was surprised to hear after my visit to the eye doctor, that I had damage to both optic nerves, even though my eye pressures were normal. A test was done to measure my field of vision, what you see to the sides, below and above you when you are looking ahead. My field of vision was abnormal in both eyes. I realized then I should have been having thorough exams on my eyes, not just for eyeglasses. I was diagnosed with normal tension glaucoma.

Rather than proceed with prescription drops, which are commonly used for glaucoma, my doctor recommended a laser procedure known as Trabeculoplasty. This is sometimes used as an initial treatment of glaucoma. A clear fluid is always flowing through the eye. It is believed in glaucoma, damage to the network the fluid flows through can become narrowed or blocked, resulting in damage. With trabeculoplasty, a laser is used to make tiny cuts in the trabecular meshwork of the eye, which is a kind of drain system.

I discussed the risks with the doctor, which she listed as “a slight risk of blindness” from complications of the procedure. She also said there was a much, much higher risk of blindness if the glaucoma is left untreated. She did say the most common complication from this procedure, is that sometimes a “spike of pressure” occurs after surgery, which can damage the eye. She assured me there are now drops they use beforehand to prevent this. She also told me this is one of the first eye procedures young interns learn to do, and that she had done more of them than she could count. The plan was to have the procedure on one eye, wait a week, and then have the procedure on the other eye. I agreed.

I was told the procedure could be done at the doctor’s office, and would be painless. I asked if I needed to bring anyone with me to drive, and she said I should be fine to drive myself. (That did not prove to be the case, and I was glad I brought my husband along.) The day of the procedure on the first eye, I arrived at the doctor’s office. After being called back, I was given a “puff of air” pressure test in both eyes and a quick vision-screening test by reading the eye chart. These measurements were recorded. Then I was given a drop of medicine in the eye to deaden it. I returned to the waiting room for about thirty minutes before I was called back again.

This time I was given a medication drop in the eye to prevent the “pressure spike” we had discussed. A small lens coated with a lubricant that looked like petroleum jelly was placed over the eye by having me look down while she placed it, and then look up. This did not hurt, but I did feel pressure as she held it. The lens looks like a shot glass, and is about that size, with the bottom of the “shot glass” being the part that is cupped over the eye. I thin put my chin in a chin cup and sat before the laser machine. The doctor’s assistant laid her hand on the back of my head to make sure I did not move during the procedure. (I admit that made me nervous, thinking I was going to be in agony while being held down!) The doctor then began the procedure, and all I heard was a zap, zap, zap of the machine. There was no pain. Occasionally, the doctor would ask me to look down, or look right, etc. The procedure lasted about one to two minutes. It was painless.

After the procedure, the lens is taken off the eye, and my eye felt like it was full of the lubricant that is used on the lens, which felt thick. The doctor’s assistant rinsed my eye by squirting a clear solution while I held a paper towel under my eye. This part felt wonderful. However, I still felt like my eye was “goopy” for a while afterward. After the procedure, my pressures and vision were again checked and I was allowed to leave. My vision was blurred for a couple of hours, but it could have been from the “goop” as much as from the procedure. I was glad to have my husband to drive me.

I returned to have the other eye done a week later, and have had no complications from either procedure. If your doctor orders this procedure, discuss the advantages and complications with him. This procedure may not be appropriate for your type of glaucoma. If you decide to have it, rest assured that it was painless to me, and as my doctor said, the benefits far outweighed the risks.

I return to my doctor twice a year for visual field testing and eye exams. I do not use drops because my glaucoma was normal tension. However, I intend to continue to follow my doctor’s advice as to treatment options. Eyesight is too precious to be lost, when it can be prevented.