Laser eye surgery - glaucoma

My opthalmologist told me my eye pressure in one eye is 28 and has given me drops to use.  In 3 weeks he wants me to come back and consider laser surgery.  I also have the beginning of a cataract.  I am 65 year of age.  Should I see a glaucoma specialist or is this something my opthalmologist can do?  Also, I am very frightened - is this always done in the office?  Thank you.


This discussion is related to Cataracts and glaucoma.

[alicia606]

Hi Marilyn, I've had two laser surgeries.  The first one done in 2001 by my regular ophthalmologist was done in a surgery center.  That was an ALT which is not as gentle as what they seem to use these days (an SLT).  This past year I had an SLT done on my other eye by a glaucoma specialist in his office.  For me, it was a very simple procedure.  I didn't feel any pain or real discomfort.  My husband drove me, but I actually could've driven afterwards (to play it safe you may want someone to drive after the procedure).  That's the good news.  The bad news is that these lasers tend not to be effective.  It wasn't for me and from boards that I've read not very effective for others either.  However, since it's so non-invasive and safe, it's worth a try.

It can be done by a regular ophthalmologist in the office, but it wouldn't hurt to get a second opinion from a glaucoma specialist.  Eye pressure of 28 is high, but some people's eyes can tolerate a high pressure while other people's eyes need very low pressures to keep the optic nerve healthy.  I'm assuming your doctor has done visual fields and other tests to determine the status of your optic nerve and check on possible progression.  If you have any doubts, go for a consult with a glaucoma specialist.

Btw, you don't say how effective the drops have been for reducing your pressure.  There are a lot of different drops and drops are pretty effective.  

Best of luck.  You don't need to be so frightened of this procedure.  And as for the glaucoma, if it is well-controlled, your vision should be fine.  I'm 58 and have had normal-tension glaucoma for 20 years and can still see fine.  At some point, it would be advisable to see a good glaucoma specialist to make sure you are on the right track.  I've seen glaucoma specialists and am now back with my regular ophthalmologist because I like him better.  I've found it difficult to find a glaucoma specialist that I can relate to who is close by.  Best of luck.

[alicia606]

To add to my post above, SLT is extremely safe, but it may have some risks which you may want to investigate.  You do also want to make sure your doctor is quite experienced with the procedure.  You don't want to be one of his first.  

As a side note, while the ALT done in 2001 didn't lower my pressure, somehow the visual field in that eye improved for several years.  Not sure if that was related or not.  

I also have cataracts in both eyes.  I just had cataract surgery on the ALT eye done mid-September.  One note of caution, if and when you get cataract surgery, consider going with a mono-focal instead of a premium multi-focal lens.  I have a premium ReStor lens and regret it.  Also, there is some thought by some (not all) doctors that a premium lens is not a good idea if you have glaucoma.  Also, there are more people getting the premium lenses taken out because of problems and if you already have glaucoma, you don't want to mess around with more eye surgeries than need be.

[Ray T Oyakawa, MD]

As suggested by Alicia606, SLT is probably a better procedure.  I have done SLTs on patients who were controlled with drops but wanted  to decrease the cost of the drops.

It is a very safe procedure and I have rarely had a patient who did not respond (low tension glaucoma with IOP around 11 to 12).

This can be done safely by a general ophthalmologist--NOT very difficult to do.

Dr. O.