There is a lot more to glaucoma than eye pressure, at present the only way we can treat glaucoma is by lowering eye pressure. The good news is that if we get the eye pressure down to a safe level, in almost all cases of glaucoma we will halt the disease, or at least slow it down so that significant vision impairment does not occur in the patient’s lifetime. The level of pressure that is safe is different for each patient, so we set “target pressures” for each individual. (Generally speaking, the lower the eye pressure the better).
Most glaucoma patients instil eye drops to keep their eye pressures at a safe level. A patient may be on one, two or more different glaucoma eye drops. Laser treatment (laser trabeculoplasty) is a very safe and generally painless way to treat glaucoma and should be considered for all newly diagnosed cases of glaucoma. Successful laser treatment can keep the eye pressure down for many years without requiring eye drops. (The laser used is very different from the laser used to allow people to manage without glasses.) Surgery is also used to treat glaucoma: it is employed when the eye pressure cannot be controlled by drops and laser, and when patients cannot tolerate eye drops (or manage to get them in regularly). Several large studies in Britain and the USA have shown that surgery should also be considered for newly diagnosed glaucoma.
Having glaucoma means that you must have a life-long association with your ophthalmologist. The disease can be controlled but not cured, and it is essential that patients are seen regularly (for most, this is six monthly). Typically, glaucoma is well controlled for a number of years but then at a follow-up visit it is found that control has been lost, e.g. the visual field is worse, and a change in treatment is necessary. It is the optometrist’s, the ophthalmologist’s, and the patient’s responsibility to make sure that patients do not become “lost to follow-up”.