Lowering intraocular pressure is the cornerstone of glaucoma management. Multiple treatment approaches are available, and the best strategy is tailored to each patient's specific needs and disease characteristics.
Medical Treatment (Eye Drops)
Eye drops are typically the first line of treatment. Several classes of medications are available, including prostaglandin analogs, beta-blockers, alpha-agonists, carbonic anhydrase inhibitors, and rho-kinase inhibitors. Each class works through different mechanisms to either reduce fluid production or increase drainage. Many patients require two or more medications for adequate pressure control.
Laser Treatment
Selective Laser Trabeculoplasty (SLT) is an effective and safe office procedure that enhances the eye's natural drainage. It can be used as a first-line treatment or in addition to eye drops. The procedure takes just a few minutes and carries minimal risk. Other laser procedures include laser peripheral iridotomy for angle-closure glaucoma and cyclophotocoagulation for advanced cases.
Minimally Invasive Glaucoma Surgery (MIGS)
MIGS procedures represent a revolutionary advance in glaucoma surgery. These micro-surgical techniques use tiny devices or stents to improve drainage with fewer complications and faster recovery than traditional surgery. MIGS can be performed alone or combined with cataract surgery. Examples include iStent, Hydrus, and Xen gel stent. Prof. Leshno is experienced in the latest MIGS techniques.
Traditional Glaucoma Surgery
When medications and laser treatment are insufficient, surgical options include trabeculectomy (creating a new drainage pathway) and glaucoma drainage devices (tube shunts). These procedures can achieve significant and sustained IOP reduction. Prof. Leshno is an expert in both trabeculectomy and valve implant surgeries, with extensive training from Columbia University Medical Center.