Glaucoma Surgery
When cataract is combined with glaucoma, early cataract surgery is also a treatment for glaucoma, since cataract surgery can be expected to lower intraocular pressure. This fact has been proven by numerous papers over the past 20 years. However, in Japan, cataracts in glaucoma patients are neglected.
In addition, many patients are prescribed cataract medications, which the Ministry of Health, Labor and Welfare announced in 2003 that they are not expected to be effective in treating the condition. The use of ineffective cataract medications while using glaucoma medications is not only pointless, but may even wash out the glaucoma medications and reduce their effectiveness.
Because there are many glaucoma drugs with different mechanisms of action, some patients with advanced glaucoma may be taking more than three different glaucoma drugs in their eye drops, but only two of these drugs can be expected to be fully effective. Two glaucoma drugs, beta blockers and prostaglandins, powerfully reduce intraocular pressure, but the effectiveness of the other drugs is considerably less than these two. In addition, when these two drugs are being used, adding a third drug to them will have little effect.
Therefore, according to the protocol for glaucoma treatment, I use no more than two drugs for glaucoma treatment and aggressively perform glaucoma surgery (EX-PRESS implant) when worsening of glaucoma is anticipated.