Glaucoma Treatment in Singapore

The front part of the eye is filled with a clear fluid known as aqueous humor. This fluid nourishes and maintains the structures at the front of the eye and is usually circulated through the pupil and out through the trabecular meshwork, which are the drainage channels of the eye. When the channels are blocked, there is an imbalance between the production and drainage of the fluid, leading to a build-up of fluid in the eye. This results in increased eye pressure.

However, not everyone with increased eye pressure will develop glaucoma. The onset of the disease will depend on the level of pressure the optic nerve can tolerate without getting damaged. This level varies from person to person. Some people are able to withstand higher levels of eye pressure than others. When the pressure goes beyond what the eye can tolerate, there will be damage to the optic nerve and can lead to progressive vision loss if left untreated.

There is no exact cause to why the drainage channels get blocked, but there are a few possible risk factors that can lead to the development of glaucoma. To make matters worse, there are usually no symptoms presented in the early and moderate stages. When symptoms start to appear, the condition has generally progressed to become more severe. Regular screening and early detection are key to managing the disease and preventing visual loss.

There are two types of glaucoma, namely Open-Angle and Closed-Angle.

Open-Angle Glaucoma 

Open-angle glaucoma is the most common type. It is largely related to age and therefore results in a chronic condition. Due to the natural aging process, the drainage process gradually becomes less efficient over time, even when the channels are opened. This causes the fluid to be retained in the eye and with time, the build-up increases the pressure within the eyeball. There are usually no symptoms presented in such cases.

Closed-Angle Glaucoma

Closed-angle glaucoma is less common and may be acute or chronic. As its name suggests, closed-angle glaucoma happens when the drainage angle is completely closed and blocked. This can cause a sudden build-up of pressure in the eye, resulting in an acute onset. Symptoms experienced could include:

• Pain in the eye
• Redness of the eye
• Headache or nausea
• Blurred vision
• Presence of “haloes”

When this happens, seek medical attention immediately. Surgery might be needed to allow the fluid to be drained out.

If you are above 40 years old and have a family history of glaucoma, it is highly advisable to go for a comprehensive eye assessment every 1 to 2 years. Other possible risk factors include:

• Chronic diseases like diabetes and high blood pressure
• Certain ethnicity backgrounds
• History of eye injuries
• High myopia
• Long-term use of steroids

Unfortunately, glaucoma cannot be cured, but the progression of the disease can be controlled. Treatment is dependent on the type of glaucoma and the stage of the condition.

A glaucoma eye specialist may be particularly helpful when:

• Eye pressure remains higher than target despite medication.
• The condition is progressing despite treatment.
• Side effects from drops are affecting day-to-day life or compliance.
• The glaucoma is at an advanced stage at the point of diagnosis.
• The eye anatomy is complex, such as narrow angles or previous eye surgery.
• Both eyes are affected and require coordinated management

Specialist-led care allows the treatment plan to be tailored based on intraocular pressure readings, optic nerve imaging, visual field testing and the patient’s lifestyle and tolerance for long-term treatment. This is particularly relevant for patients with both open-angle and closed-angle features, or where multiple treatment modalities need to be combined.

Several factors influence the most suitable choice of glaucoma treatment:

• Type of glaucoma: Open-angle and closed-angle glaucoma respond to different interventions. Closed-angle glaucoma often requires laser iridotomy or surgery to address the angle blockage, while open-angle is typically managed initially with drops or SLT.
• Severity: Mild glaucoma may be controlled with drops alone, while moderate to advanced cases may benefit from earlier consideration of laser or surgical options.
• Response to medication: If eye pressure remains high or progression continues despite consistent drop use, the treatment plan may be escalated.
• Tolerance of drops: Some patients experience ocular surface irritation, allergy or systemic side effects from glaucoma drops, which can affect the choice of treatment.
• Eye anatomy: Narrow angles, previous surgery or other anatomical considerations influence which procedures are appropriate.
• Lifestyle factors: The ability to maintain a consistent drop regimen, attend regular follow-up and manage the long-term nature of treatment all play a role in planning.

A glaucoma eye specialist works through these factors with the patient to identify a plan that addresses the disease while remaining practical for daily life.

Glaucoma treatment is a long-term commitment. After starting treatment, patients can generally expect:

• Regular follow-up visits: Initial visits may be more frequent to assess response, with the schedule extending once the condition is stable. Visits typically include pressure checks, optic nerve assessment and visual field testing.
• Ongoing pressure monitoring: Eye pressure can fluctuate, and consistent monitoring allows the treatment plan to be adjusted if pressure rises above target.
• Continued treatment in most cases: Drops, when prescribed, are typically used long-term. Laser and surgical procedures may reduce reliance on drops but rarely eliminate the need for ongoing care.
• Vision protection: Treatment aims to preserve remaining vision and slow further damage. Vision that has been lost to glaucoma cannot be restored, which is why early diagnosis and consistent treatment matter.

Patients are encouraged to attend all follow-up appointments and to report any new symptoms, side effects or concerns between visits.