By Roger M. Kaldawy, M.D

Milford Franklin Eye Center

Glaucoma is one of the leading causes of preventable blindness, affecting millions of people worldwide. Often called the “silent thief of sight,” glaucoma usually develops slowly and without symptoms. By the time people notice vision changes, significant and irreversible damage may already have occurred.

So, what exactly is glaucoma, and how is it treated today? Let’s take a closer look at this common but serious eye condition—and the many advanced treatments now available.

What Is Glaucoma?

Inside your eye, a clear fluid called aqueous humor circulates to nourish tissues and maintain healthy pressure. Normally, this fluid drains through tiny channels. In glaucoma, those channels become blocked or don’t work properly. Pressure builds up and damages the optic nerve—the cable that carries visual signals from your eye to your brain.

The most common type, called open-angle glaucoma, develops slowly over time. Other forms, like angle-closure glaucoma or normal-tension glaucoma, are less common but can also cause vision loss.

How Is Glaucoma Detected?

Because glaucoma often has no warning signs, regular eye exams are essential. Your eye doctor can measure your eye pressure, examine your optic nerve, perform a visual field test, and use imaging (like OCT scans) to look for early damage. Detecting glaucoma early is the best way to preserve your vision.

Treatment Options

The main goal in treating glaucoma is to lower eye pressure and protect the optic nerve. Fortunately, there are now many options—from simple eye drops to sophisticated laser and surgical procedures.

1. Eye Drops

Eye drops are usually the first line of defense. They either help your eye drain fluid better or slow down its production.

• Prostaglandin Analogs (like latanoprost, bimatoprost, and travoprost): These are among the most common and effective glaucoma drops. They’re typically used once a day and can lower eye pressure well. Some patients may notice red eyes, longer eyelashes, or a slight darkening of the iris or eyelid.

Now, there’s an exciting new advancement: iDose TR—a tiny injectable device placed inside the eye that slowly releases medication over many months, so patients don’t have to use daily drops. Another long-lasting option is Durysta, a biodegradable implant that steadily delivers medicine inside the eye. These treatments reduce the burden of daily drop use and help maintain consistent eye pressure.

• Beta Blockers (like timolol): These reduce the eye’s fluid production. They’re effective but can sometimes cause fatigue, slower heart rate, or breathing issues in patients with asthma.

• Alpha Agonists (like Brimonidine) and Carbonic Anhydrase Inhibitors (like Dorzolamide): These drops also lower eye pressure in different ways, though they can cause dryness, mild stinging, or allergic reactions in some patients.

For those who struggle to remember daily drops or experience side effects, these new sustained-release options are changing how we manage glaucoma and are quickly replacing drops as first line of treatment:

2. Laser Treatment (SLT)

Selective Laser Trabeculoplasty, or SLT, is a gentle, in-office laser procedure that helps the eye’s natural drainage system work better. It takes only a few seconds, is painless, and can lower pressure just as well as daily drops for many patients. SLT is safe, repeatable, and eliminates the need to remember medications (drops)—it’s a great choice for many patients. SLT is quickly replacing drops as first line treatment for glaucoma. 

3. Minimally Invasive Glaucoma Surgery (MIGS)

For patients needing more pressure reduction—or those already having cataract surgery—MIGS procedures are an excellent option. These involve placing tiny stents or micro-devices (like the iStent, Hydrus Microstent, or Xen Gel Stent) to improve drainage through small, self-sealing incisions. Recovery is usually quick, and the risks are lower than with traditional surgeries.

4. Advanced Glaucoma Surgeries

In more advanced cases, or when other treatments aren’t enough, traditional surgeries can achieve stronger pressure control.

• Trabeculectomy: This surgery creates a new pathway for fluid to drain from the eye.

• Aqueous Shunt or Tube Implants: These use small drainage tubes to help fluid leave the eye safely.

Although these procedures require close follow-up, they remain highly effective for patients with advanced glaucoma, however they are risky procedures.

In Summary

The good news is that glaucoma care has advanced tremendously. From effective drops and innovative implants like iDose TR and Durysta, to gentle laser treatments and modern microsurgeries, we have more tools than ever to protect your sight.

The key is early detection and ongoing care. Regular eye exams allow your doctor to catch glaucoma before it causes permanent damage and to tailor treatment to your specific needs.

At Milford Franklin Eye Center, we are committed to offering the latest advancements in glaucoma care, including iDose TR. We are proud to have performed one of the first iDose TR procedures in New England at our Cataract and Surgery Center of Milford. As a leader in advanced eye care technology, we are thrilled to be among the pioneers of this groundbreaking treatment. Our surgery and surgeon were featured in a segment broadcasted on Channel 5 TV. We are available for second opinions and dedicated to providing world-class outcomes. 

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