Glaucoma surgery in Sydney to help protect vision from further damage

Glaucoma surgery works by lowering pressure inside the eye, using laser or surgical techniques to improve fluid drainage or reduce fluid production when drops or other treatments are not enough

Glaucoma surgery in Sydney to help protect vision from further damage

Glaucoma surgery works by lowering pressure inside the eye, using laser or surgical techniques to improve fluid drainage or reduce fluid production when drops or other treatments are not enough

With glaucoma surgery, patients may achieve lower eye pressure and better long-term control

Explore how glaucoma surgery works, who it may suit, and what to expect before, during, and after treatment

What is glaucoma and what are the symptoms?

Glaucoma is a disease that causes damage to your optic nerve and progressively becomes worse over time. In most cases, the damage is caused through an increased pressure inside the eye.

To find out more about symptoms and diagnosis, please visit our overview of the glaucoma eye condition.

Unfortunately, there is no cure for glaucoma. But there are a number of treatment options available to help reduce eye pressure and minimise or prevent further vision loss. Sometimes a combination of treatments may be used. Patients with glaucoma need ongoing care by an Ophthalmologist.

Long-term use of eye drops is very effective in controlling eye pressure for most people with glaucoma. However, these medications can sometimes stop being effective or may cause side-effects, such as stinging or irritation. It’s important that you don’t stop eye drop treatment without consulting your ophthalmologist first, as this may lead to further loss of vision.

Laser surgery has become increasingly popular as an intermediate step between drugs and traditional surgery though the long-term success rates are variable. Types of laser treatment for glaucoma include:

Trabeculoplasty
This is the most common procedure for open-angle glaucoma. It takes between 10-15 minutes, is painless and can be performed in a doctor’s office. The laser changes the structure of the eye’s drain allowing the aqueous fluid to pass out more easily. This can delay or avoid further glaucoma surgery altogether.

Selective Laser Trabeculoplasty (SLT)
A newer laser treatment for open-angle glaucoma that uses very low levels of energy. For this reason, it is believed that SLT, unlike other types of laser surgery, may be safely repeated.

Laser Peripheral Iridotomy (LPI)
The preferred method for managing a wide variety of angle-closure glaucomas. This laser is most often used to treat an anatomically narrow angle and prevent angle-closure glaucoma attacks. An opening is made through the iris, allowing aqueous fluid to flow from behind the iris directly to the anterior chamber of the eye. This allows the fluid to bypass its normal route.

Cycloablation
Cycloablation reduces the amount of aqueous humour in the eye by destroying part of the ciliary body, which produces the fluid. This treatments is usually reserved for use in eyes that either an elevated IOP after having failed other more traditional treatments.

What to expect with glaucoma laser surgery

  • Your doctor will check your IOP one hour following laser surgery. You may go home and resume your normal activities following surgery
  • It may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medications, many patients are eventually able to discontinue some of their medications
  • After this procedure, many patients respond well enough to be able to avoid or at least delay surgery
  • Your eye doctor is the best judge of determining whether or not you will still need glaucoma medication. It is important to follow post operative instructions even if the symptoms appear to have subsided
  • Complications with laser are minimal, which is why this procedure has become increasingly popular and some centres are recommending the use of laser before drops in some patients.

This is the most common type of glaucoma surgery. This is used in both open-angle and closed-angle glaucoma. About 50 per cent of patients no longer require glaucoma medications after surgery for a significant length of time.

What to expect during your trabeculectomy surgery

  • A trabeculectomy usually only involves day surgery
  • The surgeon creates a passage in the sclera (the white part of the eye) for draining excess eye fluid. A flap is created that allows fluid to escape, but which does not deflate the eyeball
  • A small bubble of fluid called a “bleb” forms over the opening on the surface of the eye, which is a sign that fluid is draining out into the space between the sclera and conjunctiva. Occasionally, the surgically created drainage hole begins to close and the IOP rises again. This happens because the body tries to heal the new opening, as if it was an injury
  • The number of post-operative visits to the doctor varies, and some activities, such as driving, reading, bending and heavy lifting must be limited for two to four weeks after surgery.

A small silicone tube is connected to one or more plates, which are sutured to the surface of the eye, usually not visible. Fluid is collected on the plate and then absorbed by the tissues in the eye. This type of surgery is thought to lower IOP less than trabeculectomy but is preferred in patients whose IOP cannot be controlled with trabeculectomy or who have previous scarring.

Newer, non-penetrating glaucoma surgery, which does not enter the anterior chamber of the eye, shows great promise in minimising postoperative complications and lowering the risk for infection. However, such surgery generally does not currently lower IOP as much as trabeculectomy. Furthermore, long term studies are needed to assess these procedures and to determine their appropriate role treating glaucoma patients.

In the past, glaucoma and cataract surgery were two separate procedures. The iStent has been available in Australia since 2014 and consists of two very small, titanium stents that are surgically implanted into the tissue that drains fluid away from the eye. This is the first device that has been approved in conjunction with cataract surgery in patients with mild or moderate open-angle glaucoma and a cataract who are currently on IOP medication.

  • Protects eye tissue that often gets damaged by traditional surgeries
  • Can be safely implanted during cataract surgery
  • Has a rapid recovery time
  • Allows for future treatment options for preserving vision.

Clear guidance for your eye care journey

Eye treatment options can vary from person to person. We help you understand what is happening and what care may be right for you

Step 1: REACH OUT

The first step is to book an assessment so your symptoms, concerns, or vision goals can be discussed with the clinic. Give our friendly team a call or use our easy online calendar to book a free assessment.

Step 2: WE’LL MEET

At your visit, our refractive surgeons will examine your eyes, explain the findings, and talk through the treatment options that may be appropriate for your condition and needs.

Step 3: ENJOY COMFORT

After treatment, the aim is to help you see more clearly, feel more comfortable, and manage your eye health with greater confidence. Depending on your condition and treatment plan, this may make daily life feel easier and more manageable.

Find comfort and clarity for your eyes

Take our free online assessment to discover the next step toward healthier, more comfortable vision

Hi, I’m Dr John Males

I’m the owner and principal surgeon at Envision Eye Centre, specialising in laser vision correction, cataract, and corneal surgery. With over 15 years’ experience, I’ve been involved in introducing advanced procedures such as SMILE® and laser-assisted cataract surgery in Australia. I’ve held leadership roles at St Vincent’s Hospital and Sydney Eye Hospital, and I continue to contribute to teaching and research through the University of Sydney. My focus is always on delivering safe, precise, and personalised care, using the latest technology to help patients achieve the best possible visual outcomes.

Dr John Males

M.B B. Sc. (Med)(Hons) MMed (Clin Epi) FRANZCO