Eye Problems

• Surgery: Surgery is generally used when medical treatment fails to appropriately lower IOP; however, surgery may be utilized as initial therapy for POAG, especially if patients are unable to use or prefer not to use eye drops. Laser trabeculoplasty is the surgery of choice (AAO A:1 evidence), lowering IOP by increasing aqueous outflow. Laser surgery is highly successful, lowering the IOP sufficiently about 75% of the time. Surgery may be repeated or medication added if the drop in IOP is insufficient.²⁸ Other surgical interventions are incisional in nature and include trabeculectomy or aqueous shunts, both of which should be reserved for those who fail medication or laser trabeculoplasty. Other treatments including acupuncture/acupressure and herbal medication lack direct evidence of success.

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