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  • Q&A with Australian Health Practitioners

    Trabeculectomy

    I have been told that I am having LOW-pressure Glaucoma about 7 years ago. I have been putting eye drops every night in both eyes. I have been told until recently that my Glaucoma was stable and thickness of the optical nerve remains the same thickness. About 4 months ago when I visited the Eye Specialist, based on the Field Test results, told me that I need to undergo Laser Procedure to reduce eye pressure. Then I saw a second opinion and I was told that I need to undergo Trabeculectomy. Both are based on Field Test results. How reliable is the Field Test? I have seen many Ophthalmologists reading my Eye pressure incorrectly thinking that I have HIGH-pressure Glaucoma. Would Trabeculectomy help to reduce eye pressure? What are the pros and cons of having Surgery?
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    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

    Normal tension glaucoma can be stable for many years on treatment, with IOP remaining basically unchanged but then may suddenly progress. It usually takes 2-3 visual field tests (typically 3) in a year to accurately detect true glaucoma field progression as there can be considerable variability. Your ophthalmologist would usually weigh up the potential for irreversible visual field loss and how that impacts on vision. Sometimes it is better to move forward rather than allow this loss to happen, just to prove a point. It is a judgement call made between the patient and the treating ophthalmologist.

    In simplest terms, the right IOP for a patient is one where the glaucoma does not get worse. It is very difficult to achieve very low pressures which may be necessary to halt glaucoma progression with drops sometimes and that is when surgical options such as trabeculectomy, which has been around since 1968, are explored. Laser (SLT) is non invasive with very few risks. Typically it works with higher pressures (most modern SLT trials do not include patients with an IOP under 18 for that reason) though, as it is non-invasive and low risk, sometimes it is explored in patients with lower IOP especially if surgery is considered best avoided.

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