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  • Q&A with Australian Health Practitioners

    What are the pros and cons of surgery for glaucoma?

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    Glaucoma
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    Glaucoma Australia

    Glaucoma Australia is the peak glaucoma awareness/education/support association in Australia.It is a national, not-for-profit registered charity dedicated to providing educational services to raise awareness about … View Profile

    Glaucoma surgery is usually reserved only for patients in whom eye drops or laser are unable to control the eye pressure sufficiently. If the eye pressure remains uncontrolled, there will be progressive damage to the nerve of the eye and eventual vision loss. The main benefit is that glaucoma surgery will lower the eye pressure, and thus prevent or at least slow down further visual loss from glaucoma. The main aim of surgery is to maintain vision and to prevent blindness from glaucoma. However, surgery is not without its risks. The main risks are eye pressure that becomes too low (causing vision loss), failure (this causes the eye pressure to increase again), infection and bleeding.

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    Dr David Wechsler

    Ophthalmologist (Eye Specialist)

    Because of the risks associated with surgery we tend to treat people with drops and laser, sometimes even multiple drops first. As mentioned above surgery tends to be reserved for those cases where drops and laser cannot adequately control the glaucoma/slow the rate of vision loss.

    Having said that, patients with advanced or poorly controlled glaucoma are often on multiple drops which can lead to side-effects and when it finally comes to glaucoma surgery one benefit of glaucoma surgery is that patients usually dont have to take glaucoma medications after the surgery if all goes well. The other advantage of surgery is that we can also achieve a lower intraocular pressure, and also a more consistent intraocular pressure without variability. There is a school of thought that in advanced glaucoma more consistent intraocular pressure control can be beneficial in preventing deterioration.  

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    Dr Colin Clement

    Ophthalmologist (Eye Specialist)

    The advantage of surgery is that it can potentially achieve much lower intraocular pressures compared to either medication or laser. This can be of great benefit in eyes that require very low intraocular pressures to slow or halt progression of glaucoma. There is very good evidence to show eyes that present for the first time with advanced glaucoma are likely to get better results in the long term if surgery is the initial treatment. However, this evidence has not influenced the practice patterns of most ophthalmologists to date - most will still offer either medications or laser as initial treatment in this circumstance.

    The disadvantage of surgery is the potential complications and side effects. Any surgery is associated with risks and glaucoma surgery is no different. There may be complications from the anaesthetic or the surgery itself. Complications from the surgery, depending on the type of surgery performed, can include intraocular pressure too low or too high, excessive intraocular inflammation, bleeding within the eye, blurred vision after surgery and sight threatening infection.

    When making a decision about surgical treatment, the benefits of the surgery need to be weighed against the risks. If the potential for harm exceeds the potential to do good, or there is a safer alternative that can achieve the same outcome, then surgery should be avoided.

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