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Glaucoma Treatment
Glaucoma is a group of eye diseases that damage the optic nerve, which carries images from your eye to your brain. It usually has no early warning signs, and any vision lost to glaucoma cannot be restored. Treatment lowers the pressure inside your eye to protect the sight you still have.
Maybe your eye doctor just told you your eye pressure is high. Or maybe you have used glaucoma drops for years and wonder if there is an easier way. At San Francisco Eye Institute, fellowship-trained glaucoma specialists Dr. Patricia Wong and Dr. Cassandra Tran treat glaucoma at every stage for patients in San Francisco. We offer prescription eye drops, in-office laser treatment, and minimally invasive glaucoma surgery (MIGS). At every visit, our goal is to protect your vision with as little disruption to your life as possible.
What Is Glaucoma?
Your eye constantly makes a clear fluid that keeps it healthy. That fluid drains out through a tiny filter near the front of your eye, where the colored iris meets the clear cornea. When this drain stops working well, fluid backs up and pressure builds. Over time, that pressure damages the optic nerve.
Glaucoma is common, and many people who have it do not know it. More than 3 million Americans have glaucoma, and only about half are aware of it. Your risk rises after age 60 and if you have a family history of glaucoma, diabetes, or high blood pressure. Because nerve damage is permanent, treatment focuses on stopping glaucoma before it takes more of your vision.
What Are the Different Types of Glaucoma?
You are most likely to hear about three types:
- Open-angle glaucoma: This is the most common type. The drain stays open but slowly clogs, like a sink that empties more and more slowly. Pressure rises gradually and causes no pain.
- Angle-closure glaucoma: The iris crowds the drain and blocks it. This can build slowly or happen all at once. A sudden attack causes eye pain, nausea, headache, and blurred vision, and needs same-day care.
- Normal-tension glaucoma: The optic nerve is damaged even though eye pressure reads normal. This is why a pressure check alone cannot rule out glaucoma.
Symptoms of Glaucoma
In its early stages, open-angle glaucoma has no noticeable symptoms—this is why regular eye exams and glaucoma screenings are so important. Once vision changes from glaucoma are noticeable, such as blind spots, the optic nerve has been permanently damaged and it is too late to regain any vision that has been lost. The lack of warning signs is one reason that glaucoma is a leading cause of blindness worldwide.3 However, regular dilated eye exams allow you and your eye doctor to detect glaucoma early and help prevent optic nerve damage.
How Do I Know If I Have Glaucoma?
Often, you do not, and that is what makes glaucoma so risky. Early open-angle glaucoma causes no pain and no blurry vision. By the time you notice blind spots, damage has already happened.
The best way to catch glaucoma early is a comprehensive eye exam. If we suspect glaucoma, we use a few painless tests to confirm it and see how far along it is:
- Eye pressure check: A quick measurement of the pressure inside your eye.
- Optic nerve exam: We dilate your pupils to look closely at the nerve for signs of damage.
- Gonioscopy: A special lens lets us see whether your eye’s drain is open or narrow.
- OCT scan: This imaging scan measures the nerve fibers and can spot thinning before you notice any change.
- Visual field test: This maps your side vision to find early blind spots.
We repeat these tests over time. Changes from one visit to the next tell us more than any single result.
What Are My Glaucoma Treatment Options?
Every glaucoma treatment works toward the same goal: lowering the pressure inside your eye. The right option depends on your type of glaucoma, how advanced it is, and your daily routine.
Glaucoma Eye Drops
Drops are usually the first step. Some help your eye make less fluid, and others help fluid drain out. Most are used once or twice a day. Drops work well when you use them as prescribed. If daily drops are hard to keep up with or irritate your eyes, other options can help.
Glaucoma Laser Treatment
Laser treatment is done in our office and takes only a few minutes.
- Selective laser trabeculoplasty (SLT): Gentle laser energy helps your eye’s natural drain work better. A large clinical trial showed SLT works well as a first treatment, not only as a backup to drops.
- Direct selective laser trabeculoplasty (DSLT): This delivers a similar treatment from outside the eye, with no lens touching your eye.
- Laser peripheral iridotomy (LPI): This creates a tiny opening in the iris so fluid can flow in eyes with narrow or closed drains.
Minimally Invasive Glaucoma Surgery (MIGS)
When drops and laser are not enough, or when you also have cataracts, MIGS is often the next step.
What Is Minimally Invasive Glaucoma Surgery (MIGS)?
MIGS surgery uses tiny instruments and a very small incision to open or bypass your eye’s natural drain. Traditional glaucoma surgery, called trabeculectomy, builds a new drain on the outside of the eye. MIGS works from inside the eye instead, so it is gentler and recovery is usually faster.
MIGS is most helpful in earlier stages of glaucoma and can reduce your need for daily drops. It is often combined with cataract surgery, so both conditions are treated in one visit. We offer five MIGS techniques, each described below.
OMNI® Surgical System
The OMNI® Surgical System opens your eye’s natural drain along its full length, without leaving an implant behind. It first gently widens the drainage canal, then opens the clogged filter tissue. In real-world data from 230 eyes, OMNI used on its own lowered eye pressure for up to three years. This procedure is a form of canaloplasty.
iTrack® Microcatheter
The iTrack® is a hair-thin, lighted tube that your surgeon threads all the way around your eye’s drainage canal. It then releases a gel to stretch the canal open, a bit like clearing a clogged pipe. Nothing stays in your eye afterward. This procedure is called canaloplasty. In one 12-month study, 40 percent of treated eyes no longer needed glaucoma drops.
iStent®
The iStent® is a tiny titanium implant, smaller than a grain of rice. It creates a permanent bypass through the clogged filter so fluid can drain freely. It is usually placed during cataract surgery. Five years of follow-up from its main clinical trial found no device-related complications.
Hydrus® Microstent
The Hydrus® Microstent is a flexible scaffold about the length of an eyelash. It holds open a long stretch of your eye’s drainage canal so fluid can flow out. In a large five-year trial, 66 percent of patients who had Hydrus with cataract surgery were off glaucoma drops. That compares with 46 percent of patients who had cataract surgery alone.
Kahook Dual Blade®
The Kahook Dual Blade® removes a small strip of the clogged filter tissue so fluid can reach the drainage canal directly. No implant stays in your eye. In a multicenter study, combining it with cataract surgery lowered average eye pressure by about 26 percent at one year.
Which MIGS Procedure Is Right for Me?
There is no single best MIGS procedure. The right choice depends on:
- How much your eye pressure needs to come down
- Where the blockage in your eye’s drain is
- Whether you still have your natural lens or have already had cataract surgery
- How your drain looks during gonioscopy
Stents like iStent and Hydrus often suit mild to moderate glaucoma when the goal is steady control with fewer drops. OMNI and iTrack, both forms of canaloplasty, open the drain along its full length and can be done without cataract surgery. The Kahook Dual Blade removes the clogged tissue itself, which can help when that tissue is the main problem. Dr. Wong and Dr. Tran walk you through each option, including what it can and cannot do for your eyes.
Am I a Good Candidate for MIGS?
You may be a good candidate for MIGS if:
- You have mild to moderate open-angle glaucoma
- Your eye pressure is still too high on your current drops
- Your drops cause stinging, redness, or other side effects
- You also have cataracts that affect your vision
MIGS may not be the best choice if your glaucoma is advanced and your eye pressure needs to come down more than MIGS can usually achieve. It is also not usually the first step for angle-closure glaucoma or for eyes with heavy scarring in the drain. In those cases, traditional glaucoma surgery, such as trabeculectomy or a small drainage tube, may protect your vision better.
What is Trabeculectomy?
Trabeculectomy, also called glaucoma filtration surgery, is the traditional surgical option for glaucoma. We may recommend it when drops, laser, or MIGS cannot lower your eye pressure enough.
Your surgeon creates a tiny flap in the white of your eye. Fluid drains through it into a small pocket called a bleb. The bleb usually sits hidden under your upper eyelid, and your body absorbs the fluid naturally. Surgery takes less than an hour, and you go home the same day.
Recovery takes longer than with MIGS. Your vision may be blurry for several weeks, and you will use medicated drops to prevent infection and scarring. You will also need frequent follow-up visits early on. Because the bleb is permanent, your risk of eye infection stays higher for life. Call us right away if your eye becomes red or painful.
What Is Aqueous Shunt Surgery?
An aqueous shunt, also called a tube shunt or glaucoma drainage implant, is another traditional surgical option. It is generally used for more advanced glaucoma, or when drops and laser have not lowered your eye pressure enough.
The shunt is a soft, thin tube attached to a small, curved plate. Your surgeon places the plate on the white of your eye, under its clear outer layer. The tube goes into the front of your eye. Fluid flows out through the tube, and your body absorbs it naturally. Surgery takes about an hour or less, and you go home the same day.
Recovery is similar to trabeculectomy. Your vision may be blurry for a few days to a few weeks, and you will use medicated drops for several weeks. Most patients still use some glaucoma drops after surgery to keep their eye pressure where it needs to be.
What Is Recovery Like After Glaucoma Surgery?
MIGS is an outpatient procedure, so you go home the same day. You will need someone to drive you. Here is what to expect:
- Your vision may be hazy at first and usually clears over the following week.
- You will use anti-inflammatory eye drops for a few weeks.
- Many patients return to desk work, reading, and light activity within a few days.
- You will pause heavy lifting and swimming for a short time.
- We check your eye pressure the day after surgery and at several visits over the next few months.
Why Choose San Francisco Eye Institute for Glaucoma Care?
Glaucoma care is a long-term partnership, not a one-time visit. Our two glaucoma specialists bring complementary strengths.
Dr. Cassandra Tran
Dr. Cassandra Tran is a fellowship-trained glaucoma specialist with expertise in the latest MIGS techniques. She completed her ophthalmology residency at Tulane University and her glaucoma fellowship at UCSF. She continues to teach surgery to UCSF ophthalmology residents at San Francisco General Hospital. Dr. Tran has presented her research on glaucoma surgical outcomes at the American Glaucoma Society. She believes in shared decision-making, so you leave your visit understanding your options, not just a recommendation.
Dr. Patricia Wong
Dr. Patricia Wong is a board-certified ophthalmologist specializing in glaucoma treatment and surgery. She has been in private practice since 1993. She earned her medical degree at the University of Chicago Pritzker School of Medicine. She completed her ophthalmology residency at Hahnemann University and her glaucoma fellowship at Northwestern University. Dr. Wong has served as a clinical instructor in ophthalmology at the University of California, San Francisco (UCSF) and California Pacific Medical Center. She is a member of the American Glaucoma Society and the American Academy of Ophthalmology. She has published on glaucoma treatment techniques and is fluent in Cantonese. She believes in making treatment decisions with the patient: addressing each patient’s concerns, considering lifestyle and overall health.
Both doctors work alongside our full eye care team. Monitoring, imaging, and surgery all happen under one roof.
Frequently Asked Questions About Glaucoma
What is the success rate of glaucoma surgery?
Success depends on the procedure and how advanced your glaucoma is. With glaucoma surgery, success means keeping your eye pressure low enough to protect your optic nerve. It does not mean restoring vision that is already lost. Many patients use fewer drops after MIGS, and some stop entirely. Others still need one drop, and that is a successful result too.
Can glaucoma be cured with laser treatment?
No. There is no cure for glaucoma, including laser treatment. Laser lowers your eye pressure to help protect the vision you have. If the effect fades over time, laser treatment can sometimes be repeated.
Is glaucoma surgery safe?
Every surgery carries some risk, and we review yours with you before any procedure. MIGS is designed to be gentler than traditional glaucoma surgery because it works through a very small incision. Most patients feel little to no pain. We use numbing drops and relaxing medication to keep you comfortable.
How should I sleep after glaucoma surgery?
We may ask you to wear a protective eye shield while you sleep for the first several nights. Try not to sleep on the side of the eye that had surgery.
Does Medicare cover glaucoma surgery?
Medicare and many commercial plans cover glaucoma surgery, including MIGS, when it is medically necessary. Coverage rules can vary by device and by whether MIGS is done alone or with cataract surgery. Our team checks your insurance benefits before your procedure is scheduled.
Can you have cataract surgery if you have glaucoma?
Yes. Having glaucoma does not rule out cataract surgery. In fact, cataract surgery is a good time to add MIGS, so both conditions are treated in one procedure. If you have already had cataract surgery, some MIGS options, including OMNI and iTrack, can be done on their own.
What Do Patients Say About Their Glaucoma Care?
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Schedule a Glaucoma Consultation in San Francisco
Contact UsMaybe you just learned your eye pressure is high, or your drops are no longer enough. Either way, our glaucoma specialists in San Francisco can explain where you stand and walk you through every option. Contact San Francisco Eye Institute to schedule a consultation with Dr. Wong or Dr. Tran.
Sources1 Centers for Disease Control and Prevention. Current Glaucoma Programs. Vision and Eye Health. May 15, 2024. https://www.cdc.gov/vision-health/php/glaucoma-programs/index.html
2 Fahy ET, Montesano G, Garg A, Vickerstaff V, Konstantakopoulou E, Gazzard G; LiGHT Trial Study Group. The Impact of Baseline Intraocular Pressure on Initial Treatment Response in the LiGHT Trial: Selective Laser Trabeculoplasty versus Medication. Ophthalmology. 2024;131(12):1366-1376. https://doi.org/10.1016/j.ophtha.2024.06.022
3 Otárola F, Pooley F. Minimally invasive glaucoma surgery (MIGS) devices: risks, benefits and suitability. Community Eye Health. 2021;34(112):59. https://pmc.ncbi.nlm.nih.gov/articles/PMC8862621/
4 Radcliffe NM, Harris J, Garcia K, Zwick E, Chang RT, Mbagwu M. Standalone Canaloplasty and Trabeculotomy Using the OMNI Surgical System in Eyes with Primary Open-Angle Glaucoma: A 36-Month Analysis from the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight). Am J Ophthalmol. 2025;271:436-444. https://doi.org/10.1016/j.ajo.2024.12.015
5 Khaimi MA, Koerber N, Ondrejka S, Gallardo MJ. Consistency in Standalone Canaloplasty Outcomes Using the iTrack Microcatheter. Clin Ophthalmol. 2024;18:173-183. https://doi.org/10.2147/OPTH.S441113
6 Ahmed IIK, Sheybani A, De Francesco T, Lass JH, Benetz BA, Samuelson TW, Usner D, Katz LJ. Long-Term Endothelial Safety Profile With iStent Inject in Patients With Open-Angle Glaucoma. Am J Ophthalmol. 2023;252:17-25. https://doi.org/10.1016/j.ajo.2023.02.014
7 Ahmed IIK, De Francesco T, Rhee D, et al; HORIZON Investigators. Long-term Outcomes from the HORIZON Randomized Trial for a Schlemm’s Canal Microstent in Combination Cataract and Glaucoma Surgery. Ophthalmology. 2022;129(7):742-751. https://doi.org/10.1016/j.ophtha.2022.02.021
8 Dorairaj SK, et al. 12-Month Outcomes of Goniotomy Performed Using the Kahook Dual Blade Combined with Cataract Surgery in Eyes with Medically Treated Glaucoma. Adv Ther. 2018;35(9):1460-1469. https://doi.org/10.1007/s12325-018-0755-4
9 Boyd K. Trabeculectomy. American Academy of Ophthalmology EyeSmart. Reviewed by Anju Goyal, MD. January 21, 2026. https://www.aao.org/eye-health/diseases/trabeculectomy-12
10 Boyd K. What Is a Glaucoma Drainage Implant? American Academy of Ophthalmology EyeSmart. Reviewed by Anju Goyal, MD. June 25, 2026. https://www.aao.org/eye-health/drugs/glaucoma-drainage-implants
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The doctors at San Francisco Eye Institute have either authored or reviewed and approved this content.
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