1. Pharmacotherapy |
2. Trabeculoplasty |
3. Iridotomy |
4. Trabeculectomy |
5. AGV implantation |
6. Lens replacement surgery |
Every minute, one person loses their sight irreversibly due to glaucoma. Every 10 minutes, one child loses their sight. Glaucoma is a chronic eye disease characterised by increased intraocular pressure, decreased visual acuity and gradual atrophy of the optic nerve. It is one of the most common causes of blindness. According to the World Health Organisation, more than 100 million people in the world suffer from this pathology. In the next decade, this figure will increase by another 10%. Is it possible to cure glaucoma, what methods are used for this purpose and how much is the cost – learn from this article.
Pharmacological treatment of glaucoma – is it possible to avoid surgery?
Glaucoma causes irreversible optic nerve atrophy and loss of vision. However, it is possible to slow down the process or even fully stop the progression of the disease. Both conservative and surgical treatments are available abroad.
Medications are the first line of therapy for this disease. They are most effective in the treatment of early-stage glaucoma.
Daily use of eye drops for glaucoma significantly reduces intraocular pressure (IOP). This is achieved by reducing the amount of intraocular fluid and improving its outflow through the drainage system of the eye.
Only a trained ophthalmologist can prescribe the correct medication and the schedule at which it should be taken. He or she develops a treatment plan based on the results of a comprehensive vision diagnosis.
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How does drug therapy for glaucoma work?
The patient is first prescribed one of the first-choice drugs. If the medication proves ineffective, it is replaced with another preferred drug or a combination therapy of several drugs with different mechanisms of action is prescribed.
During the drug treatment of glaucoma, the patient should be regularly observed by an ophthalmologist for 2-4 weeks. Then the results of therapy and the patient’s condition are monitored at least once every 3 months. To prevent the development of resistance to the drugs, they are replaced every 1-2 years.
In the treatment of glaucoma, the following types of eye drops are used:
Prostaglandins | Increase the outflow of fluid from the eye, thereby reducing intraocular pressure. This class of drugs is used once a day. |
Beta-blockers | These drugs reduce the production of fluid in the eye. Depending on the patient’s condition, these medications are prescribed to be taken 1-2 times a day. |
Alpha-adrenergic agonists | Drops that reduce the formation of fluid in the eye and at the same time increase its outflow. Drugs of this class are prescribed 2-3 times a day. |
Carboanhydrase inhibitors | Reduce the production of fluid in the eye. They are used 2-3 times a day.. |
Rho-kinase inhibitors | Medicines that reduce eye pressure. They inhibit the Rho-kinase enzymes responsible for increasing fluid. These medications are used 1 to 2 times a day. |
Myotic or cholinergic medicines | Increase the outflow of fluid from the eye. They are taken up to 4 times a day. |
Efficacy of conservative treatment
All patients with glaucoma undergo drug therapy to reduce intraocular pressure. According to the American Society of Ophthalmology, eye drops can be used to stop the development of the disease in 60% of patients. Laser and surgical treatment is indicated for the remaining 40%.
Possible side effects of medications for glaucoma
Glaucoma medications can help preserve vision, but they can also cause side effects. Properly prescribed medications do not cause complications in 96% of cases. Rarely, taking certain medications and eye drops can cause:
tingling or itching in the eye;
redness of the eye and the skin around it;
clouding of the iris;
palpitations;
respiratory distress;
dry mouth.
How much does glaucoma drug treatment abroad cost?
The price of conservative treatment for glaucoma abroad depends on the stage of the disease and the choice of specific drugs. The cheapest way to treat this disease is in clinics in Turkey or Korea. The initial cost of the course in 2023 is $250.
Clinics for glaucoma drug therapy
Foreign patients most often choose clinics in Germany, Israel, Austria, Turkey and Korea. They have a choice of both specialised eye centres and multi-profile hospitals. Among the most popular are:
CLINIC APPOINTMENT
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Patients’ feedback on glaucoma treatment abroad
Clinic: Memorial Ataşehir Hospital
Procedure: Drug therapy for glaucoma
Patient’s age: 49 years old
Patient from: Kyiv
Christina: “I am leaving a review about how I cured glaucoma, or to be more precise, was able to control it. I was treated for glaucoma without surgery in Turkey. It was possible because the disease had just started to appear. Pills and eye drops were prescribed to control the condition. Even now I take these medications on a schedule. I can say one thing – it works! My eyesight is not getting worse, and that’s the most important thing!”
Clinic: Spreebogen
Procedure: Drug therapy
Patient’s age: 45 years
Patient from: Kharkiv
Olga: “I did not know whether glaucoma could be treated medically, but after reading a lot of positive reviews about it, I decided to try it myself. I went to Germany for glaucoma treatment with normal eye pressure. For this, I chose the Spreebogen Clinic. Here I was prescribed a course of drug therapy. The daily medication has borne fruit: the progress of the disease has stopped. I am happy with the result.”
Trabeculoplasty – laser treatment of open-angle glaucoma
Trabeculoplasty is a minimally invasive surgery that is performed using a laser. It is designed for people with open-angle glaucoma. The ophthalmologist uses a laser unit to improve the drainage system of the eye. After such an intervention, the outflow of fluid is normalised and the pressure in the eye is reduced.
Indications for selective trabeculoplasty
This method is used when medications in the form of eye drops are ineffective or cause serious side effects. It can be used as an initial treatment for glaucoma. Trabeculoplasty is suitable for patients with primary or secondary open-angle glaucoma.
Contraindications to laser trabeculoplasty
This treatment modality is contraindicated in inflammatory or uveitic glaucoma. Also, it is not used to combat congenital and closed forms of the disease. Other contraindications are specified by an ophthalmologist.
How is laser trabeculoplasty done?
Laser trabeculoplasty uses a focused beam of light to treat the drainage system of the eye. The procedure does not require hospitalisation.
Before the intervention, anaesthetic drops are injected into the eye. Using a special microscope, laser beams are delivered to the affected areas of the drainage area of the eye.
The procedure lasts 5-10 minutes. The patient does not experience any painful sensations. During trabeculoplasty, he can see flashes of green and red colour. Three days after the operation, the intraocular pressure decreases.
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Modern laser trabeculoplasty techniques allow 9 out of 10 patients to stop the progression of glaucoma. Please contact our coordinators. We will organise travel for treatment to a clinic that meets your requirements.
Results of the laser trabeculoplasty
According to the National Health Service, the final results of treatment occur after 1-3 months. Trabeculoplasty is performed to preserve the vision you have at the time of surgery. It will slow the progression of the pathology, but it cannot restore or improve lost vision. The operation is successful in about 3 out of 4 patients.
Complications after laser trabeculoplasty
The operation goes without complications in 97% of cases. In some patients, after the intervention, the pressure in the eyes temporarily increases. To control this condition, eye drops are prescribed.
Among the temporary side effects of trabeculoplasty are:
inflammation and clouding of the iris;
decreased vision;
pain.
Cost of trabeculoplasty abroad
The price of laser trabeculoplasty is formed taking into account the level of the medical centre and the doctor’s qualification. The cost of laser glaucoma treatment is also influenced by the technique of the operation.
The approximate price of trabeculoplasty abroad is as follows:
| Country | Cost |
|---|---|
| Turkey | from $2,000 |
| Germany | from €2,800 |
| South Korea | from $2,500 |
| Austria | from €2,500 |
Where is glaucoma trabeculoplasty performed abroad?
Laser treatment of glaucoma patients is performed in specialised and narrow-profile medical centres. Many patients choose clinics in Turkey and Germany for such interventions. The most popular hospitals with medical tourists are:
Reviews of selective trabeculoplasty abroad
Clinic: Dunyagöz Clinic
Procedure: Trabeculoplasty
Patient’s age: 38 years
Patient from: Murmansk
Igor: “After reading many reviews about trabeculoplasty abroad, I decided to go to Turkey for glaucoma treatment. My choice fell on the Dunyagöz Clinic. Here I underwent additional diagnostics and then had laser trabeculoplasty. The procedure lasted no more than 10 minutes. As a result, the disease has been stopped.”
Clinic: Hangil Hospital
Procedure: Trabeculoplasty
Patient’s age: 45 years
Patient from: Irkutsk
Ksenia: “I decided to leave a review about the laser trabeculoplasty I had abroad. I have glaucoma of the 3rd degree. I knew that only surgery could help me. So I turned to the Korean clinic Hangil. Here I had trabeculoplasty with an argon laser. Everything went well. My glaucoma eye treatment is successful. My vision has stopped falling.”
Iridotomy – laser treatment of closed-angle glaucoma
Iridotomy is an operation to treat closed-angle glaucoma with a laser. Using a laser machine, the ophthalmologist creates a tiny hole in the iris. This hole allows the fluid inside the eye to move normally through the drainage system. The procedure is sometimes called an iridectomy.
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Indications and contraindications for iridotomy
The procedure is used to combat primary and secondary mixed or closed-angle glaucoma. It is an additional measure, which is prescribed after the main surgical intervention in case of incomplete excision of the iris.
Iridotomy is also performed as a preliminary step before trabeculoplasty. It is indicated in patients with open-angle glaucoma and a relatively narrow-angle of the anterior chamber.
Iridectomy should not be performed in cases of corneal opacity and shallow anterior chamber depth. It is contraindicated in inflammatory lesions of the optical system in the acute phase.
How does iridotomy treat glaucoma?
The procedure is performed on an outpatient basis. Before the procedure, the ophthalmologist uses eye drops for anaesthesia and pupil constriction. A special contact lens is placed on the eye. It makes it possible to direct a high-energy laser beam to the iris and make a hole in it.
Iridotomy lasts from 5 to 15 minutes. The patient can go home 2 hours after the intervention. For the first hour after the hole is made in the iris, vision is blurred. Then it begins to recover.
After the treatment, an eye patch is not required. Anti-inflammatory eye drops are prescribed for 3-5 days. A control visit to the ophthalmologist is carried out after 1-6 weeks. If the patient used eye drops for glaucoma before the procedure, they are not cancelled.
Can glaucoma be treated with iridectomy?
The effectiveness of the procedure varies depending on the degree of disease progression. According to data cited by the U.S. National Library of Medicine, in acute closed-angle glaucoma, positive results are achieved in approximately 65-76% of cases.
Possible complications after iridotomy
This procedure has the lowest risk of complications compared to other glaucoma treatments. In rare cases, patients experience inflammation or bleeding inside the eye.
How much does an iridotomy cost in 2023 abroad?
The cost of the procedure is formed taking into account the price policy of the country, as well as the level of the medical centre.
The initial price of iridotomy for one eye is:
| Country | Cost |
|---|---|
| Turkey | from $320 |
| Germany | from €900 |
| South Korea | from $400 |
| Austria | from €700 |
Where is iridotomy performed abroad?
Reviews of glaucoma treatment with iridotomy
Clinic: Liv Ankara Clinic
Procedure: Iridotomy
Patient’s age: 44 years
Patient from: Odessa
Olga: “I went to Turkey for laser treatment of glaucoma with low intraocular pressure. I chose Liv Ankara Clinic. The procedure was painless and quick. My vision is no longer falling. The ailment has receded.”
Clinic: Batıgöz Clinic
Procedure: Iridotomy
Patient’s age: 39 years
Patient from: Gyumri
Anahit: “I decided to leave a review about laser treatment of glaucoma. I went to Turkey, Batigöz Clinic, for the procedure. I can say only one thing – I received all the help that I needed. The disease has stopped progressing so far. Thank you!”
Trabeculectomy for advanced glaucoma
Trabeculectomy is a surgical intervention performed to reduce intraocular pressure in stage 3 and 4 glaucoma. It is among the most common surgical methods to combat this pathology in adults. The intervention is used in open-angle and chronic closed-angle glaucoma. It is also used to treat pathologies of inflammatory and traumatic nature.
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Contraindications of trabeculectomy surgery for glaucoma
previous unsuccessful trabeculectomy;
damaged conjunctiva;
Stevens-Johnson syndrome;
neovascular glaucoma;
uveitic glaucoma;
total blindness.
How is trabeculectomy performed?
During the operation, the eye surgeon creates a tiny flap in the sclera. He then makes a small hole in the eye to let fluid out. Fluid from the eye can drain through the flap into a bubble where it is absorbed by the intraocular tissues. This way the pressure is reduced and the progression of the disease is slowed.
Trabeculectomy is performed under general or local anaesthetic. It lasts from 45 minutes to 1 hour. After the intervention, a patch is placed on the eye, which is removed after 1-2 days.
After the operation, patients stop taking any medication for glaucoma. They are given a course of antibiotics and steroids to prevent the risk of infection.
Prognosis of trabeculectomy in the treatment of glaucoma
Trabeculectomy is the “gold standard” in the treatment of advanced glaucoma. According to the World Glaucoma Association, 80% of patients can keep their intraocular pressure normal for 5 years or longer after trabeculectomy.
Complications of trabeculectomy
Although trabeculectomy is considered a safe procedure, it can cause some side effects. They include:
infection of the wound surface;
eyelid drooping;
swelling around the eye and haemorrhage;
scarring;
excessive decrease in intraocular pressure;
retinal detachment.
Price of trabeculectomy surgery abroad
The cost of trabeculectomy in foreign hospitals is formed taking into account the severity of the pathology, as well as the qualification of the ophthalmologist.
The initial price of this intervention on one eye is:
| Country | Cost |
|---|---|
| Turkey | from $2,100 |
| Germany | from €3,500 |
| South Korea | from $2,360 |
| Austria | from €3,100 |
Where is trabeculectomy best performed abroad?
Surgical treatment of glaucoma is successfully performed in ophthalmological centres and departments of leading hospitals in Turkey, Korea or the Czech Republic. Medical tourists also choose Israel and Germany. The clinics in demand in these destinations are:
Trabeculectomy Reviews
Clinic: Batıgöz Clinic
Procedure: Trabeculectomy
Patient’s age: 57 years old
Patient from: Sevastopol
Nikolay: “I would like to leave my feedback about glaucoma surgery. The intervention was carried out in the Turkish hospital Batigöz. To be honest, I was a little worried that it would get worse, but everything went well. In 40 minutes I was able to stop the development of the disease. It’s been 2 years now and my eyesight is still the same. Thank you!”
Clinic: Spreebogen Clinic
Procedure: Trabeculectomy
Patient’s age: 50 years
Patient from: Kharkiv
Mikhail: “I went to Germany for treatment of glaucoma of the 4th degree. I did not want to be treated in my native country. I had already been treated. So, I got from the 1st stage of glaucoma to the last one. I chose the Spreebogen Clinic. Here I had a trabeculectomy, which was able to slow down the disease. I hope the result will last a long time.”
Glaucoma valve implantationа
Ahmed glaucoma valve implant (AGV) is used in the treatment of complex and advanced glaucoma in adults and children. These devices are designed to drain intraocular fluid from the anterior chamber into an external reservoir where a fibrous capsule forms approximately 4-6 weeks after surgery to regulate outflow.
The Ahmed glaucoma valve is most commonly used to perform the operation. It contains a flow restrictor that prevents the intraocular fluid from draining excessively.
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Indications and contraindications for glaucoma valve implantation
The operation is indicated for patients for whom glaucoma drug therapy has been ineffective. It is also used when glaucoma surgery has been unsuccessful. Glaucoma valve implantation as a primary procedure, is performed when:
neovascular glaucoma – an increase in intraocular pressure associated with vascular disease of the eye, particularly diabetes;
traumatic form of the disease;
paediatric glaucoma;
glaucoma caused by malformations of the eye.
The glaucoma valve implant should not be placed in cases of eye inflammation, blindness and severe diseases of the nervous, cardiovascular or respiratory systems.
How is glaucoma valve implantation performed?
The intervention is performed under general or local anaesthesia. It lasts 25-30 minutes. During the operation, the ophthalmologist makes a conjunctival incision on the basis of the arch in the upper part of the eyeball.
The implant is fixed between the two rectus muscles. A silicone tube draining fluid inside the eye is inserted 2-3 mm into the anterior chamber, ciliary sulcus or vitreous cavity.
After installation of the drainage system, the superficial scleral flap is returned to its place and fixed with two sutures. To prevent infection of the operated area, the doctor injects a broad-spectrum antibiotic under the conjunctiva. Then he applies a monocular dressing.
Outcomes and complications of Ahmed glaucoma valve
According to data published on the website of the US National Library of Medicine, after 12 months, the success rate of this operation was 66,7%. Patients may experience spikes and decreases in intraocular pressure after implant placement. This is due to inflammation in the operated area or too much fluid outflow. Such side effects require monitoring by the doctor. If necessary, the patient undergoes a second intervention.
How much does a glaucoma implant cost abroad?
Glaucoma valve implantation abroad is performed by qualified eye surgeons who have more than 10 years of experience in such interventions. The cost of this operation varies depending on the characteristics of the disease.
The approximate cost of implant placement is:
| Country | Cost |
|---|---|
| Turkey | from $2,300 |
| Germany | from €3,900 |
| South Korea | from $2,600 |
| Austria | from €3,200 |
Where glaucoma valve implantation is performed abroad?
To have glaucoma valve implantation, foreigners most often go to Turkey or Germany. Among the most popular medical centres in this direction are:
Lens replacement surgery for glaucoma
Eye lens removal surgery is predominantly performed on patients with primary closed-angle glaucoma. This type of disease occurs when fluid cannot drain out of the eye. It is treated with laser peripheral iridotomy, in which the parts of the eye that facilitate the outflow of fluid are opened.
80% of patients with closed-angle glaucoma have cataracts. These two pathologies are often diagnosed together and significantly impair vision. Therefore, removal of the lens of the eye is the preferred option to combat both cataracts and glaucoma.
The artificial lens (IOL) is much smaller in volume than the natural lens. Therefore, it does not obstruct the outflow of intraocular fluid, thereby reducing the pressure in the eye.
Replacement of the lens stops the further development of glaucoma and prevents the need for additional surgical interventions. Artificial lenses from world manufacturers in Germany, the United States or the United Kingdom are used abroad: Alcon, CarlZeiss and Rumex. They have a long service life and minimal risks of rejection by the patient’s body.
How is the lens of the eye removed?
The operation is performed under local anaesthesia. It lasts from 5 to 15 minutes. The ophthalmologist makes a 2 mm long incision on the cornea. Ultrasound or laser is used to destroy the affected lens. A flexible artificial lens is placed in its place. Sutures are not required. Vision is restored within 3 hours after the intervention. If necessary, the patient is prescribed eye drops to control the inflammatory process.
APPOINTMENT FOR EYE LENS REMOVAL
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Results of eye lens replacement
According to the results of the European Quality of Life-5 Dimensions questionnaire, 95% of patients with closed-angle glaucoma and cataracts report that their vision improved and did not fall after lens replacement. 79% of patients no longer needed to continue the course of drug therapy with eye drops. To compare, after iridotomy, this indicator was only 39%.
Complications after eye lens removal
Surgery performed by a qualified specialist with many years of experience reduces the risks of side effects to a minimum.
After lens replacement, the following complications may occur in some patients:
inflammation of the eye;
displacement of the IOL;
secondary cataract;
haemorrhage in the eye;
increased intraocular pressure.
How much does lens replacement surgery cost abroad?
The approximate price of lens surgery in 2023 is shown in the table below.
| Country | Cost |
|---|---|
| Turkey | from $1,900 |
| Germany | from €4,300 |
| South Korea | from $3,000 |
| Austria | from €4,300 |
Which clinics perform eye lens removal abroad?
Medical tourists who need eye lens surgery choose Turkish, German, Korean or Czech hospitals. Most often foreigners go to medical centres such as:
Summary
Glaucoma is a progressive eye disease characterised by increased intraocular pressure, decreased visual acuity and gradual atrophy of the optic nerve.
Drug treatment of the disease is indicated for all patients. The progression of glaucoma at 1st and 2nd stages can be stopped with conservative treatment. The maximum effect can be achieved if you adhere to the medication schedule developed by the doctor.
Trabeculoplasty is a minimally invasive intervention performed for open-angle glaucoma. It is successful in 3 out of 4 cases.
Iridotomy is indicated in the initial stages of the disease. It is used for the treatment of closed-angle glaucoma. During the procedure, a laser is used to create a tiny hole in the iris of the eye. This hole normalises the outflow of intraocular fluid.
Trabeculectomy is the gold standard for treating advanced glaucoma. After trabeculectomy, 8 out of 10 patients have normal intraocular pressure for 5 years or longer.
Glaucoma valves are artificial filtering devices that reduce intraocular pressure by draining fluid into the external subconjunctival space. The effectiveness of this method is about 80%.
CONTACT MEDIGLOBUS EXPERTS
Learn more about modern glaucoma treatment methods abroad from the coordinators of the international medical platform MediGlobus.
Sources:
- 1. American Academy of Ophthalmology
- 2. National Centre for Biotechnology Information
- 3. American Academy of Ophthalmology
- 4. American Foundation for the Advancement of Public Health
- 5. ScienceDirect full-text database
- 6. American Academy of Ophthalmology
- 7. National Centre for Biotechnology Information
- 8. National Institute for Medical Research
- 9. National Health Service of England
- 10. National Library of Medicine
- 11. National Library of Medicine: Korean Journal of Ophthalmology
