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Trabeculoplasty
Trabeculoplasty is a procedure which can be performed to help promote control for glaucoma. It is generally a mild treatment which can usually be done in the doctor’s office. The effect typically lasts from twelve to eighteen months and the treatment can be repeated in appropriate settings. In trabeculoplasty treatment a focused light ray is directed into the drainage tissue. The exact mechanism of how this process works to lower or stabilize intraocular pressure is not known. Byan unknown means the laser energy seems to enhance the natural pathway of fluid circulation and drainage out of the eye. It may take several weeks for the laser effect to develop and then, after about a year to a year-and-a half, the effect seems to fade. The exact time course varies somewhat for each person, however, so it is important to have your pressures monitored at regular intervals after the procedure.
How to Prepare
Being prepared helps your treatment go smoothly and comfortably. We recommend the following steps:
- Plan to be available in the office for several hours on the day of the treatment.
- Eat a good breakfast and take your medicines including your glaucoma medicines in the usual way.
- You might plan to bring a book or other entertainment.
- There is no need to stop blood thinners such as aspirin or motrin; if you use a stronger blood thinner let the technician know during your preop.
- Bring some dark glasses for the drive home. Use your judgment as to whether or not your would like a driver – many patients drive themselves.
About the Laser Treatment
Trabeculaplasty is performed in an outpatient setting and can usually be done in your doctor’s office. Since there are several pre and postoperative steps involved, you should plan to be available for several hours on the day of the treatment. These steps, although time consuming, help make the procedure safe and comfortable. The basic process involves the preoperative evaluation and preparation, the treatment, a recovery period, and the postoperative check.
In the preoperative step, the technician will check your vision, review your medicines, and ask about any changes you may have had since your previous office visit. You will be given a permit about the procedure which you will need to read and sign. If you cannot see to read the permit the technician, or a family member, may read it to you. You will have an opportunity to ask questions or share any concerns you may have at this time. The technician will then place a preoperative eye drop in your eye and you will be instructed where to sit while the medicine takes effect. After the appropriate time intervals you will be escorted to the treatment room.
In the treatment room, anesthetic eye drops will be placed on you eye and you will be seated at the laser instrument. This instrument looks similar to the slit lamp used to check your eyes in the exam rooms. A large contact lens is placed over your eye. It is filled with a sticky jelly which cushions the lens as it rests on the eye. This feels a little bulky and sticky but is not uncomfortable. The lens helps your doctor have a magnified and clearer view into the drainage angle. It also helps you to refrain from blinking or moving your eye during the procedure. As the laser treatment is applied there may be a mild prickling or tingling sensation. The doctor may adjust the power as needed for a good tissue response and can reduce it if needed for your comfort. She may also ask you to move your eye a little between applications and may direct treatment toward a different location in the drainage angle. The doctor can move treatment away from a particularly sensitive area in your eye. These adjustments help keep you comfortable and work toward giving you the best possible opportunity for a successful result.
Once the treatment is completed the lens is removed and the eye area is rinsed with a refreshing eye wash. Post operative eye drops are instilled; you will be instructed to wait for a second drop which is given five minutes later. After that you are free to stay in the office or to step out for a short break. You need to be checked again, however, before you go home. Generally this recheck takes place at approximately one hour postoperatively.
Initially after the treatment your eye sight will be dazzled from the flashing of the laser light. There is often a feeling of fullness or mild swelling in the eye area. These conditions usually clear substantially during the recovery period. However, as the anesthetic wears off, the eye may become a little sore and scratchy. This effect, most commonly, is from rubbing by the contact lens as it rests on the eye. At the proper time interval the technician will call you to the exam room and check your pressure. She will ask about your eye condition and go over your postoperative instructions. A medicated eye drop will be prescribed; it should be used in addition to your regular glaucoma drops.
Most patients can drive themselves home after they have been cleared postoperatively. If possible it is best to go home and rest after the procedure. It is alright to stop for a snack or meal if you are hungry. Most patients become tired later, however, so planning for a quiet rest period is helpful. The eye may remain scratchy and a little light sensitive throughout the day and the vision may be slightly blurred. During this time it is helpful to avoid bright light by staying inside or wearing dark glasses. It is perfectly alright to read and watch TV, but be prepared to rest and close your eyes during these activities if needed. You may use lubricating tear drops and tylenol or aspirin if desired.
Most patients are comfortably able to resume their regular schedule and activities the day following the procedure. The medicated eyedrop is generally needed for several days and should be used as instructed by your doctor’s office. Be sure to continue your usual glaucoma medicine as before. There will be a second postoperative check later on, usually after a few weeks.
Success Rate and Complications
Trabeculoplasty treatment is given to help control the intraocular pressure in an effort to stabilize the glaucoma. Because the treatment is so mild, it does not generally replace the glaucoma drops. However it may augment the benefit from the medicine or it may reduce the need for as much medicine. Your doctor will advise you of any changes you should make in your medication schedule during your follow up visits. Sometimes the initial laser treatment produces a limited benefit in controlling intraocular pressure. An additional session can sometimes provide further pressure lowering benefits. Typically, even if there is a good response, the effect does wear off after twelve to eighteen months. Additional treatment may be recommended at that time.
A successful response to trabeculoplasty treatment occurs in 50 – 80 % of patients. Studies suggest that a higher success rate occurs for eyes that have had no prior surgery of any kind. The most common complication is a postoperative spike in the intraocular pressure. Typically the postoperative pressure fluctuates a little. Rarely a significant rise in pressure occurs, generally within an hour after treatment. This is why it is necessary to check your pressure in the office after recovering for an interval. If a pressure spike is detected it can then be addressed promptly. Mild inflammation can also occasionally develop postoperatively. The medicated eye drop, which is prescribed at the postoperative check, helps reduce inflammation. This allows the eye to become quiet and comfortable.
Trabeculoplasty is a form a laser treatment for the eye used to help glaucoma. It is different from LASIK treatment in that it is not used to improve vision or to reduce the need for glasses. It can, however, help save eye sight which might otherwise be lost. It is preventive rather that restorative. Please discuss this procedure with your doctor to see if it maybe of benefit for you.
