Laser Surgery for Glaucoma: How It Works and What to Expect

Glaucoma is a group of eye conditions that damage the optic nerve. The optic nerve provides a link between the eye and the brain so that you can see.

There’s no cure for glaucoma, but there are effective treatments that can keep your vision safe. Medicated eye drops are a first-line treatment for glaucoma, but it’s not the only option. Laser surgery is another effective treatment option for glaucoma. While laser surgery can’t cure or reverse glaucoma, it can keep glaucoma from getting worse. 

Here’s how laser surgery works for glaucoma. 

How does laser surgery for glaucoma work?

Laser surgery is a type of eye surgery performed by an ophthalmologist with special training in glaucoma treatment. Laser surgery helps fluid drain from the eye, which lowers the pressure inside the eye. Glaucoma laser surgery is safe and effective. 

It’s not usually the first-choice treatment for glaucoma. But for people who aren’t getting good results from eye drops or other medications, laser surgery can help lower intraocular pressure and keep vision from getting worse. 

During laser surgery, the ophthalmologist uses a laser to target specific areas in the eye. Ophthalmologists are able to make smaller, more precise changes to the eye with a laser than they can with a scalpel (knife) or other surgical tools. 

There are four main types of laser surgery that can help treat glaucoma.

Selective laser trabeculoplasty

Selective laser trabeculoplasty can treat primary or secondary open-angle glaucoma. The laser sends low-energy signals to the tissue responsible for fluid drainage inside the eye. The tissues then start working harder, which allows fluid to drain out of the eye more easily. One benefit of selective laser trabeculoplasty is that it’s able to target specific areas of the drainage meshwork in the eye. You can also have repeat treatments with this type of laser surgery. 

Selective laser trabeculoplasty can lower intracranial pressure by 30%. But it can take up to 3 months to get the full effects of the surgery.

Argon laser trabeculoplasty

Argon laser trabeculoplasty is also used to treat primary or secondary open-angle glaucoma. This procedure has been around longer than selective laser trabeculoplasty but uses a higher energy laser. In this procedure, a laser is used to widen the drainage angle and open any closed areas of the drainage meshwork in the eye. 

Argon laser trabeculoplasty can be done as a one-step or two-step procedure. But you can only have a single round of treatment. It cannot be repeated like selective laser trabeculoplasty.  

Laser peripheral iridotomy

Laser peripheral iridotomy (LPI) is a type of laser surgery recommended for people with angle-closure glaucoma. It’s also sometimes recommended for people who are at risk for developing angle-closure glaucoma but don’t have glaucoma yet. 

During this laser surgery, the ophthalmologist uses a laser to create a tiny and precise incision (hole) in the iris (colored part of the eye). This allows fluid inside the eye to drain, which lowers the pressure inside the eye. 

Cyclophotocoagulation

Cyclophotocoagulation is a type of laser surgery that can treat advanced forms of glaucoma. During this procedure, the laser sends energy to the ciliary process and causes it to shrink. The ciliary process makes the fluid that fills the eye. By shrinking the ciliary process, cyclophotocoagulation permanently lowers how much fluid the eye can make. This in turn lowers the pressure inside the eye. Cyclophotocoagulation can lower your intraocular pressure by 20% to 30%. 

How do you prepare for laser procedures?

There’s not much you need to do to prepare for laser surgery. But before your procedure you should:

• Talk with your healthcare professionals. Let your other healthcare professionals know that you’re having laser surgery for glaucoma. They may ask you to hold off on taking certain medications or limit other activities. Your ophthalmologist will also let you know if you should stop using glaucoma eye drops and other medications. 

• Arrange a ride to and from your procedure. It’s a good idea to have someone drive you home from your procedure since your vision may not be at its best afterwards. 

• Get your home ready. You may have a list of “dos” and “don’ts” that you’ll need to follow after glaucoma surgery. Your eye care team will go over these with you before your laser surgery. You can get ready for these restrictions ahead of time. For example, if you can’t bend over after surgery, move things from lower cabinets to countertops or higher cabinets ahead of time. 

What should you expect on the day of your laser surgery for glaucoma?

Before your laser surgery, your eye doctor will place numbing drops in your eye. These drops will keep you from feeling any pain or discomfort during the laser procedure.

Next, your ophthalmologist will use a special lens to look inside your eye. They may need to place a special gel in between the lens and your eye. This might feel strange and make your vision blurry. But your eye doctor will wash it out afterwards.

Then it’s time for the laser surgery. You may notice a bright white light beam or flashing red or green lights during the laser procedure, which takes between 5 and 15 minutes.

After that, your eye doctor may ask you to wait in the office for 10 to 15 minutes. Then they’ll check your eye pressure one more time. 

Before you leave, your doctor may prescribe drops to use after your laser procedure. These are different drops than the drops you may normally take for glaucoma. Your eye care team will go over how to use these drops after surgery. They’ll also let you know when it’s time to follow up with them to see how you’re healing from surgery.

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Written by:

Nishika Reddy, MD

Nishika Reddy, MD, is an attending physician at the University of Utah. She provides comprehensive and cornea medical care at the Moran Eye Center and serves as clinical assistant professor.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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