By Dr. Philip S. Garza
You may have heard your eye doctor mention “eye pressure.”
The eye is a pressurized organ, like a basketball. Eye pressure is an important part of keeping your eyes healthy — but if it stays too high for too long, it can damage the optic nerve in the back of your eye. That damage is called glaucoma, and it’s one of the leading causes of vision loss worldwide.
The good news for those with high eye pressure? We have more ways than ever to safely and effectively lower eye pressure — often without starting with daily prescription drops. At Thomas Eye Group, we offer in-office laser treatments and advanced minimally-invasive procedures that can control pressure and protect your vision with fewer drawbacks, less daily hassle, and excellent long-term results.
Inside your eye is a clear fluid called aqueous humor. It flows into the front part of your eye, nourishes your eye tissues, and drains out through a natural filter called the trabecular meshwork, located where the clear front part of the eye (cornea) meets the colored part (iris).
Think of it like water in a sink: the faucet is always running a little, and the drain lets water out at the same rate. If the drain slows or the faucet runs too fast, fluid builds up. In the eye, this raises your intraocular pressure (IOP) — also called “eye pressure.”
Normal eye pressure is usually between 10 and 21 mmHg (millimeters of mercury). We check it during your exam with a gentle touch of a small device.
If your eye pressure stays too high, it can damage the optic nerve — the “cable” that carries vision signals to your brain.
The tricky part? High eye pressure usually has no symptoms in the early stages. You can’t feel it. That’s why regular eye exams are so important — they let us catch changes early and take steps to protect your sight.
Glaucoma isn’t just one disease — it’s a group of conditions that damage the optic nerve, often related to high eye pressure. Knowing the main subtypes will help you understand the language we use later when talking about your treatment options.
This is the most common form of glaucoma in the Western hemisphere. In open-angle glaucoma, the drainage angle where fluid leaves the eye is free of physical obstruction, but the eye’s drainage system doesn’t drain fluid as well as it should. This causes pressure to build slowly over time. It usually has no symptoms until serious vision loss has occurred.
In this type, the drainage angle becomes narrow or blocked, either suddenly (acute angle closure) or gradually (chronic angle closure). Sudden closure can cause severe eye pain, blurry vision, halos around lights, headache, nausea, and vomiting — and is a medical emergency. Gradual closure causes slow damage to the optic nerve over time that, as in open-angle glaucoma, usually has no symptoms until serious vision loss has occurred.
Here, the optic nerve becomes damaged even though the measured eye pressure is within the “normal” range. The exact cause is not always known, but blood flow to the optic nerve may play a role. The treatment is still to lower the eye pressure, but patients with normal tension glaucoma may need a lower eye pressure target than other patients and require traditional glaucoma surgery earlier to achieve this.
A serious, often aggressive type of glaucoma caused by abnormal new blood vessels (neovascularization) growing on the iris and into the drainage angle. This growth blocks fluid outflow and raises eye pressure.
Neovascular glaucoma is most often linked to conditions like advanced diabetic eye disease, central retinal vein occlusion, or other problems that reduce blood flow to the eye. It typically requires a combination of treatments, including controlling the underlying cause, injections and laser procedures to shrink abnormal vessels, and surgeries to control pressure.
This includes glaucoma caused by another eye problem, such as inflammation, trauma, steroid medication use, pigment dispersion, or pseudoexfoliation syndrome.
A rare type that occurs in infants or children, usually due to abnormal development of the eye’s drainage system.
Most of the procedures we describe in the following sections — especially selective laser trabeculoplasty (SLT), minimally invasive glaucoma surgery (MIGS), and sustained drug delivery implants — have been studied and FDA-approved for open-angle glaucoma, since it’s the most common type in the U.S. and Europe.
However, some of these same techniques can also be used for other types of glaucoma, such as angle-closure or secondary glaucomas, in certain situations. When a treatment is used for a glaucoma type it wasn’t specifically approved for, this is called “off-label” use — and it’s a common, well-accepted practice in glaucoma care when the benefits outweigh the risks. Your doctor will explain if and why a treatment might be used off-label in your case.
In the past, almost everyone with open-angle glaucoma started treatment with daily prescription drops. Today, research shows that, for most patients, starting with a gentle in-office procedure — such as Selective Laser Trabeculoplasty (SLT) — is at least as effective as drops, and often easier to maintain long-term.
That’s why, for many people with open-angle glaucoma or high eye pressure, our first recommendation is a laser or minimally invasive glaucoma surgery (MIGS) procedure. These approaches can control pressure for years without the burden of daily medication — and drops can still be added later if needed.
Advanced, tiny-incision procedures that lower pressure with fast recovery and fewer risks than traditional surgery.
Examples include:
Most MIGS procedures can be performed in patients who do not need cataract surgery or who have already had it. Some, like Hydrus, must be done at the same time as cataract surgery for insurance to cover it (use without concurrent cataract surgery is off-label). MIGS procedures can also be combined with sustained drug delivery implants (see below) to achieve maximum pressure lowering and reduce or eliminate the need for glaucoma drops.
These tiny devices deliver medication inside the eye for months to years at a time, removing the need to remember daily drops:
These can be used alone or alongside MIGS or laser procedures for even better pressure control.
Current and emerging MIBS techniques include:
Compared to the more traditional glaucoma surgeries discussed below:
MIBS can be an excellent option for patients needing more pressure lowering than MIGS or medications can provide, but who may benefit from a less aggressive procedure than traditional glaucoma surgeries.
In modern glaucoma care, drops are often added later if more pressure-lowering is needed after a procedure or sustained delivery implant.
They can:
They work well for many people, but require strict daily use and can cause side effects.
For advanced glaucoma or when other options have failed:
Glaucoma is a chronic, incurable disease. Our goal is to preserve the vision you have for as long as possible, but it’s important to understand that no current treatment can restore vision already lost from glaucoma. Unless combined with cataract surgery, glaucoma procedures are generally designed to preserve, not improve, vision.
Over the course of a lifetime, most patients will need a series of procedures to maintain safe eye pressure. None of these procedures offer permanent results — their effectiveness may change over time, and pressure can begin to rise again.
The path can sometimes be unpredictable. Even with the best planning, challenges can arise — such as scar tissue blocking fluid flow, a bleb that heals closed, or the need to combine multiple treatments to reach the goal. That’s why glaucoma care works best as a partnership between patient, surgeon, and the larger care team, with ongoing monitoring and timely adjustments.
At Thomas Eye Group, our patients benefit from the Interventional Glaucoma Clinic: a core group of fellowship-trained glaucoma surgeons working within a larger medical glaucoma care team. Together, we can expertly manage any roadblocks that emerge, adjust your treatment plan as needed, and use every available tool to protect your vision for life.
Your treatment plan is all about:
With today’s technology, we can match you with the right treatment at the right time — and often make it easier to manage than ever before.
If you’re over 40, have a family history of glaucoma, or have been told you have high eye pressure, it’s time for a pressure check.
Schedule an exam at Thomas Eye Group — and let’s protect your sight together. Call 678-892-2020 or schedule online today.
