Can glaucoma be reversed?

No, and this is the point where we do not put it more kindly than it is. In glaucoma, nerve fibres in the optic nerve die off, and this tissue does not grow back. What is missing from the visual field is missing permanently — no drops, no laser and no operation bring it back. What treatment can achieve is something else, and by no means little: it lowers the intraocular pressure, and lowering the pressure is the only point at which the further course can be influenced at all. Being treated early and consistently therefore puts you in a considerably better position than someone who comes only once they notice something — because glaucoma is usually noticed late.

When does glaucoma have to be operated on?

Not at a fixed pressure reading and not after a waiting period, but when the treatment so far does not reach its goal. Three situations typically lead to this question: the individually set target pressure is not reached with drops and laser; the visual field or the cross-sectional scan of the optic nerve shows a deterioration despite treatment; or the drops cannot be kept up because of side effects, because of the number of bottles, or for practical reasons. A very far-advanced finding can also lead to surgery earlier, because there even small fluctuations in pressure cost a great deal. Operating on glaucoma is therefore not an escalation and not a failure but a switch to a method that lowers the pressure more strongly than the previous step. Which method comes into question is decided by the findings at the anterior chamber angle, by the stage and by your history so far — not by the wish to do something final.

How long do I have to use the eye drops?

As a rule permanently. Glaucoma is a chronic disease: the drops lower the pressure for as long as they are used, and the pressure rises again when they are left out. This is exactly where the commonest trap lies, and it is entirely understandable — the eye does not hurt, vision feels unchanged, so the daily routine looks like a measure against nothing. But the damage happens silently and over years. If you find the routine hard, please tell us instead of quietly stopping: often the schedule can be simplified, a combination preparation saves a bottle, a preservative-free preparation takes away the irritation — and in some situations a laser treatment is the more honest answer to a drop schedule that does not work in everyday life.

Does the SLT laser treatment hurt?

The treatment is done under local anaesthetic with eye drops, and most people describe it as easy enough to bear: short flashes of light are visible, and what is usually felt is slight pressure from the contact lens resting on the eye while it is done. We do not promise you that you will feel nothing — some people find the flashes unpleasant, and in the hours afterwards the eye can be irritated, sensitive to light or slightly aching. The procedure itself takes only minutes, is done as an outpatient and needs no general anaesthetic. Anyone prone to circulatory trouble or very tense should say so beforehand: more time is then planned in, and after the treatment the pressure is checked before anybody goes home. What does not belong to the normal course, by contrast: pain that increases instead of subsiding, an increasingly red eye, or markedly worse vision in the hours and days afterwards. Then call the same day — outside consulting hours the ophthalmic emergency service, or go directly to the emergency department of an eye hospital. A rise in pressure after the laser is rare, but it looks exactly like this, and it does not wait for the next appointment.

I see well — do I still need treatment?

Yes, if the findings call for it, and with glaucoma that is the normal case rather than the exception. The disease begins at the edge of the visual field, and the second eye fills in the gaps when you look — which is why people affected notice nothing for a long time, and why good visual acuity is no all-clear. Central visual acuity and the ability to read are often preserved into advanced stages. What we treat is not how your sight feels today but the measurable state of the optic nerve and the pressure it is under. The reverse holds just as much, though: not every raised pressure reading needs treatment straight away. If the optic nerve and the visual field show no damage, monitoring is sometimes the right decision — and then we say so.

Does health insurance pay for glaucoma treatment?

Assessing glaucoma, the follow-up checks and the pressure-lowering treatment are medical treatments and, where there is a medical indication, are billed through basic health insurance — that holds for the prescribed covered eye drops just as much as for lowering the pressure by laser or by surgery. Your deductible and co-payment apply as at any doctor's appointment, and for an inpatient or larger outpatient procedure the insurer's cost approval comes first: for a procedure we carry out ourselves, we obtain it; where you are referred on, the centre carrying it out takes on that part. What does not run through basic health insurance are comfort and optional services around a procedure, which are a matter for supplementary insurance, and food supplements and training offerings. What applies in your case we clear with you before treatment.

What is an acute attack of glaucoma — and how do I recognise it?

Ordinary glaucoma develops over years and is not an emergency. The acute attack of glaucoma is the opposite of it, and it looks completely different too: the drainage in the anterior chamber angle blocks suddenly, and the pressure rises sharply within hours. Typical are severe pain in the eye and in the head, a red eye that feels hard, rapidly worsening vision as though through fog, coloured rings around light sources, and nausea and vomiting — the last of these occasionally leads to the stomach being blamed first. This is an ophthalmic emergency and needs treating at once, not the next day: call us, outside consulting hours the ophthalmic emergency service, or go directly to the emergency department of an eye hospital. If a narrow anterior chamber angle has once been found in you, though, it does not stop at watchfulness: for that situation there is a preventive treatment, the laser iridotomy, which takes away the eye's ability to go into an attack at all. Raise it actively, instead of waiting for symptoms.

Glaucoma

Glaucoma: treatment means lowering the pressure, not bringing sight back

Anyone given a diagnosis of glaucoma wants to know one thing above all: what can treatment still save now? The honest answer is — what is still there today. Every treatment of glaucoma works through the same lever, the intraocular pressure: lowering it so that the optic nerve carries less load — and, with a narrow anterior chamber angle, preventing it from rising suddenly. Whatever visual field is already lost does not come back. Drops, laser and surgery are therefore not a repair but a brake — and that is exactly why it counts that treatment starts early and is then kept up.

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The aim of treatment: lower the pressure, halt the damage

In glaucoma, nerve fibres in the optic nerve die off — first at the edge of the visual field, where nobody notices, because the other eye fills the gap. This tissue does not grow back. That fixes the aim of every treatment before the first bottle is unscrewed: The point is to slow the further loss, not to bring back what is gone. What glaucoma actually is, the parent page describes in detail: how glaucoma arises and how it is detected. This page here starts after the diagnosis.

The only point at which the course of the disease can be influenced is the intraocular pressure. It arises from a balance: aqueous humour is produced continuously in the eye, and it drains away again through a fine meshwork in the anterior chamber angle. When that ratio no longer holds, the pressure rises, and the optic nerve head carries a load it cannot tolerate in the long run. Everything used in glaucoma treatment — drops, laser, surgery — acts at exactly one of two places: it improves the drainage or it reduces the production.

'Normal' pressure, though, is not a fixed number. What your eye tolerates depends on the starting pressure, on the state of the optic nerve, on the stage and on the corneal thickness, which influences the value measured. That is why we set an individual target pressure with you — the range in which your eye should stay stable — and measure the treatment against it. If it is not reached, or the findings get worse despite the target value being met, the target pressure is set lower and the treatment adjusted.

Not every raised reading has to be treated. A pressure above the statistical norm with no damage at all to the optic nerve and the visual field is called 'ocular hypertension', and it is a risk situation, not a disease. In that constellation, monitoring can be the right decision — and conversely a normal pressure reading does not rule glaucoma out: normal-tension glaucoma exists. Both are a reason to judge the findings as a whole rather than a single number.

The usual path goes in steps. First: Eye drops; if the effect fails to appear or everyday life is difficult, the SLT laser; and if neither of them reaches the goal, a surgical method. That order is a rule, not a law: with a far-advanced finding, surgery can make sense early, and the laser is used today as a first step as well, rather than only after the drops.

Eye drops: the first step — and the one that most often comes unstuck

For most people, pressure-lowering eye drops are where treatment starts. They work reliably, they are outpatient, and they are reversible — what does not suit can be changed. Their drawback lies not in the pharmacology but in everyday life: they work only on the days they are actually used, and an eye that does not hurt reminds nobody.

The drug classes and what they do

For the conversation in the consulting room, the name of the preparation matters less than the question of where a drop acts. Four groups are in regular use today, plus combination preparations, which unite two active substances in one bottle and so reduce the number of daily steps. Older active substances such as pilocarpine are rarely prescribed today but still occur in particular situations and in ongoing treatment — if you use a preparation of that kind, it belongs on the list you show us.

Prostaglandin analogues improve the drainage of aqueous humour through a second, natural route alongside the trabecular meshwork. They are usually applied once a day in the evening and are therefore often the first preparation.
Beta-blockers reduce the production of aqueous humour. They are long established — and they are the group where the rest of your diagnoses count most.
Carbonic anhydrase inhibitors as drops reduce production through a different mechanism and combine well with other groups.
Alpha-2 agonists work in two ways: less production and better drainage. They are often added when one preparation alone does not reach the target pressure.

Side effects that need discussing beforehand

No pressure-lowering drop is without an effect on the rest of the eye, and sometimes on the rest of the body. Knowing that beforehand means not being alarmed later and not stopping on your own initiative.

Prostaglandin analogues can make the lashes longer and darker, darken the iris, make the eye look red, and over years change the fat pads around the eye so that it appears more deeply set. Some of that is permanent — where they are used on one side only, the difference between the eyes is what is most likely to be noticed.
Beta-blockers reach the circulation through the mucous membrane and can slow the pulse and lower the blood pressure. With asthma and with certain heart rhythm disorders — a pulse that is too slow, a higher-grade conduction block — they are therefore out of the question altogether, and with chronic obstructive lung disease only after weighing it up. This is not a question of tolerability but a contraindication: tell us your heart, lung and blood pressure diagnoses and everything else you take, before a drop of this kind is prescribed.
Alpha-2 agonists lead, in some of the people who use them, to an allergic reaction with a red, itchy eye after months; tiredness and a dry mouth also occur. They are not suitable for babies and small children, and they do not go together with certain antidepressants from the group of MAO inhibitors.
Carbonic anhydrase inhibitors sting on instillation more often than other preparations; some people notice a bitter taste at the back of the throat. Chemically they belong to the sulfonamides — if you know of an allergy to sulfonamides, tell us before they are prescribed.

Preservatives are a subject of their own. Multi-dose bottles usually contain an additive that keeps the preparation germ-free — and that irritates the surface of the eye with daily use over years. Burning, a foreign-body sensation, red eyelid margins and a picture like the one that dry, irritated eyes produce are a common reason why drops get stopped — and one that can be put right: preservative-free preparations in single doses or in special bottles exist for most active substances. Tell us when putting the drops in becomes unpleasant, instead of enduring it or leaving it out.

Putting the drops in properly — and sticking with it

A large part of the effect that fails to appear is not a question of the active substance but of how the drops are used. These few points make the difference:

One drop is enough. Physically, no more than that fits in the conjunctival sac; the rest runs down the cheek and only costs you preparation.
Keep the eyes closed for about a minute after putting the drops in and press lightly on the inner corner of the lid towards the nose while you do. That keeps the active substance at the eye and reduces how much of it reaches the circulation through the tear ducts — with beta-blockers this is the single most important thing you can do.
Wait a few minutes between two different drops. One immediately after the other, the second washes the first out.
Tie it firmly to a habit. Brushing your teeth, coffee, the evening meal — an anchor in the day carries further than a good intention. An alarm on your phone helps on top of that.
A missed application is never doubled up. If you notice it the same day, make it up; if the next regular time is already close, leave it out and carry on from there. Two drops at once do not lower the pressure any further, they only irritate. And tell us honestly how often it happens.
Bring all your bottles to the check-up, including the ones prescribed by other doctors. That way we see what is actually in the bathroom cabinet.

When a schedule does not work in everyday life, that is not a character flaw but information. It leads to a different decision: one preparation fewer, a combination preparation, a preservative-free product — or the step to the laser, which can replace the daily routine.

Laser in glaucoma: SLT — and the iridotomy for the narrow angle

The selective laser trabeculoplasty, SLT for short, is directed at the trabecular meshwork in the anterior chamber angle — the structure through which the aqueous humour leaves the eye. Very short, low-energy pulses of light strike the pigmented cells there in a targeted way. What follows is not a mechanical opening but a biological response of the tissue, in the course of which drainage works better again. The laser does not cut and removes no tissue — that is what sets it apart from older laser techniques, and it is the reason a repeat treatment is possible in principle.

The process is unspectacular: the eye is numbed with drops, a contact lens is placed on the cornea so that the anterior chamber angle becomes visible, and the pulses are applied all the way round. It takes minutes, is done sitting at the device and needs no general anaesthetic. The pressure is checked afterwards, and the drops you have been using are continued for now — what changes is decided only at the check-up a few weeks later. An irritated eye that is sensitive to light in the hours afterwards is part of it. If pain or redness increases instead of subsiding, or vision becomes markedly worse, call the same day — a rise in pressure after the laser is rare, but it looks exactly like this, and it does not wait for the check-up you have booked.

When SLT comes up: as an alternative to starting with drops, if you would rather avoid a daily routine; as the next step, when the target pressure is not reached with drops; and whenever drops do work but are poorly tolerated or cannot be kept up in everyday life. The prerequisite is an open anterior chamber angle that can be seen into. If the angle is very narrow, SLT does not tackle the right problem — the iridotomy then comes to the fore, and it is described further down in this section.

And the limits are part of it: Not every eye responds to SLT. Where it does work, the effect can fade over the years, so that a repeat treatment or drops again become necessary. It does not replace the follow-up checks, and it is not a decision against later surgery but a step before it.

Whether SLT comes into question for your eye is decided by the look at the anterior chamber angle together with the target pressure, the stage and your treatment so far. We discuss that with you at the findings — including the question of where the procedure takes place and who carries it out.

The narrow anterior chamber angle: the iridotomy

Everything described so far concerns the common, insidious course with an open anterior chamber angle. If, by contrast, the angle is narrow, what threatens is not the slow wearing away but acute closure: the iris can lie across the drainage, and the pressure then rises within hours instead of over years. That is the acute attack of glaucoma — an emergency, and something entirely different from the glaucoma this page is otherwise about.

For exactly this anatomy there is a laser treatment of its own, the iridotomy. Under anaesthetic drops, a YAG laser makes a tiny opening in the iris through which the aqueous humour can bypass the bottleneck. It takes minutes, is done as an outpatient sitting at the device, and is often done on both eyes, because the anatomy is usually similar on both sides.

What it does — and what it does not. Unlike SLT, the iridotomy does not lower the pressure lastingly; it takes away the eye's ability to go into an attack. That is why it is placed preventively, before anything happens, and it is also the step that stabilises the situation after an attack that has already occurred. An existing glaucoma with an open angle is not treated by it: whoever has both needs both. Glare or a fine double-contour effect are possible afterwards, usually temporary, and the pressure is checked after the laser.

If a narrow anterior chamber angle has once been found in you, that is a reason to raise the subject actively — not only once symptoms appear. Whether an iridotomy makes sense is decided by the assessment of the angle; where it takes place and who carries it out we discuss with you beforehand, as with every procedure.

Surgical methods: when drops and laser are not enough

Operating on glaucoma is not a failure of the treatment so far but a switch to a method that lowers the pressure more strongly. This step comes up when the target pressure is not reached with drops and laser, when the visual field or the cross-sectional scan of the optic nerve gets worse despite treatment, or when the drug treatment cannot be kept up. With a very far-advanced finding it can come earlier, because there even small fluctuations in pressure cost a great deal.

What all the methods have in common: they lower the pressure. What none of them does: improve vision or bring back lost visual field. Anyone hoping to see better after an operation is confusing glaucoma with cataract — there, cataract surgery with an artificial lens is indeed a procedure that can improve visual acuity again.

Trabeculectomy

The filtering method that has been established for decades. In the upper part of the eye, covered by the lid, an additional drainage route is created from the anterior chamber under the conjunctiva; the aqueous humour collects there in a flat cushion, the so-called bleb, and is absorbed from it. So that this cushion does not scar closed again, a medicine that inhibits wound healing is usually applied to the tissue during the procedure. The procedure as a rule lowers the pressure considerably more than drops or laser, and it therefore comes into consideration above all with an advanced finding or with a low target pressure.

It does, however, demand intensive aftercare with closely spaced check-ups in the first weeks, often with anti-inflammatory drops and adjustments at the bleb; vision during this time is usually blurrier than before and takes weeks to settle. The possible courses include a pressure that is too low, scarring of the bleb with a fading effect and — permanently, even years later — a risk of infection at the bleb, which is why a red, painful eye after a trabeculectomy always needs looking at immediately. And in honesty one thing belongs here too, because it is very common: An eye with its own lens clouds over faster after filtering surgery — a cataract that later needs an operation of its own is, after this procedure, more the rule than the exception.

MIGS — minimally invasive glaucoma surgery

MIGS covers a range of newer methods. Most of them make the natural drainage route passable again: with tiny stents in the trabecular meshwork, with a targeted opening of it, or by widening the drainage canal. Individual methods in this group take a different route and create a new outflow under the conjunctiva through a very fine tube; they then form a bleb — as a trabeculectomy does — and its check-ups and its permanent risk of infection apply to them correspondingly.

What the group has in common is less tissue damage, a short procedure and simpler aftercare compared with classical filtering surgery. The price for that, with the angle-based methods, is as a rule a more moderate lowering of pressure — they address mild to moderately severe disease above all, not the end stage. They are often combined with cataract surgery that is planned anyway, because the access is the same and a second procedure is avoided. Which method in this group is meant therefore makes a difference: in the consent discussion, ask for its name and ask whether it creates a bleb.

Cyclophotocoagulation

Here the treatment acts not on the drainage but on the production: a laser acts from outside through the sclera on the ciliary body, which forms the aqueous humour, and reduces its output. The procedure is short, requires no opening of the eye and can be repeated. It is used above all when other routes are exhausted, when an eye is unsuitable for filtering surgery, or when in a badly damaged eye the aim is primarily to take away pressure and pain.

Do not confuse this with SLT. The anaesthetic here is not drops but an injection beside the eye, or a general anaesthetic. An inflammatory reaction is to be expected after the treatment and is treated accordingly. The possible courses also include a pressure that is too low and may persist, and in rare cases a worsening of vision extending to shrinkage of the eye. That is precisely why this method stands at the end of the sequence and not at the beginning — and why the balance falls differently for an eye that sees well than for a badly damaged one, where the point is above all to take away pressure and pain.

Method	Where it acts	Typical situation
Trabeculectomy	New drainage route under the conjunctiva	Advanced finding, low target pressure; intensive aftercare
MIGS	Usually the natural drainage in the anterior chamber angle; individual methods, by contrast, a new route under the conjunctiva	Mild to moderately severe disease, often together with cataract surgery
Cyclophotocoagulation	Less production of aqueous humour	When other routes are exhausted or the eye is unsuitable for filtering surgery

Which method we carry out ourselves and what we refer on for, we tell you in the consultation — before you agree to anything. If your findings belong in a specialist glaucoma surgery centre, we say so and arrange the referral rather than keeping the case. What we take on in every case is the assessment beforehand and the follow-up afterwards, close to home in Zurich, Wetzikon or Meilen. For colleagues who would like to send us a patient, the pathways for referring physicians are available.

After a procedure or a laser treatment on the eye. A slightly irritated eye that is sensitive to light is normal in the first few days. What is not normal is increasing pain, an increasingly red eye or markedly worse vision: then call the same day — +41 44 500 69 00, outside consulting hours the ophthalmic emergency service, or go directly to the emergency department of an eye hospital. That holds after every one of these procedures — and after a trabeculectomy for life, because the bleb can still become infected years later.

Cataract and glaucoma in the same eye. The two often occur together, and in selected cases both can be dealt with in one sitting. Whether that makes sense for you depends on the anterior chamber angle, on the stage and on how far the pressure needs to come down. Who carries out the combined procedure, and where, we discuss with you beforehand.

Aftercare and follow-up: how we see whether it is enough

Glaucoma treatment is never finished with the prescription, because whether it is enough cannot be read off how you feel — glaucoma causes no symptoms for as long as it is not very far advanced. The treatment is therefore judged on three findings, and none of them is enough on its own.

The intraocular pressure shows whether the treatment is taking hold at all. It fluctuates through the day, which is why a single good measurement does not yet prove good control — the time of the measurement is therefore noted with it.
The visual field (perimetry) measures how sensitive the eye is at each individual point. It shows the loss of function directly, but it is demanding and it scatters from examination to examination — a single poorer finding is not yet a trend; several in the same direction are.
The cross-sectional scan of the optic nerve (OCT) measures the thickness of the retinal nerve fibre layer around the optic nerve head. It often picks up changes in structure before they show in the visual field, and it compares well over time as long as the same device is used.

The value of these examinations lies in their repetition. A single measurement says where you stand today; only the series says whether anything is moving — and only that decides whether the treatment stays as it is or is changed. The rhythm of check-ups therefore has no fixed calendar: it follows the stage, the target pressure and the stability, tightens after every change of treatment, and can stretch out again when the course is quiet. How such a check-up works and what is measured at an ophthalmic monitoring check-up is set out in detail on its own page.

Two practical things improve how much the results tell us, more than you would suspect: where possible the same device and the same specialist, because comparability here is half the diagnosis — and appointments that actually happen. A missed check-up leaves no gap you can see later; it leaves a gap in the curve, at which nobody can afterwards say when the deterioration began. If an appointment does not suit, move it rather than let it lapse: Request a follow-up appointment online.

What you can influence yourself — and what you cannot

In glaucoma there are few adjusting screws in your own hands, and of all things the least spectacular are the most effective. There are two: using the treatment as prescribed and coming to the check-ups. Everything else is decided by the findings.

Do not stop because nothing hurts. The absence of symptoms in glaucoma is not a sign of improvement but the normal state of the disease. Leave the drops out and you notice nothing for months — and see the price only in the visual field.
Report side effects instead of putting up with them. Almost every intolerance can be solved with a change of preparation or a preservative-free one. Stopping quietly is the one option with no solution.
Tell every doctor about your eye drops, and tell us about the rest of your medicines. That applies particularly to heart, circulation and asthma medicines.
Report steroid-containing preparations — eye drops, ointments, nasal and asthma sprays, tablets. Steroids can drive the intraocular pressure up, and when we know about them we check at closer intervals instead of guessing.
Tell your first-degree relatives. Anyone with a parent or a sibling who has glaucoma carries a higher risk and should be examined earlier and more regularly — what is checked is set out under Screening examination: detecting glaucoma early. That is the only point on this list that helps somebody other than you.

And what honestly belongs here as well: For food supplements, eye training or a particular diet there is no evidence that they lower the intraocular pressure lastingly or halt the course of the disease. We are not advising you against living healthily — but we leave nobody believing that this replaces treatment. If somebody is selling you something different, that is the moment to ask us. With a very far-advanced finding, the conversation about aids, reading aids and the question of fitness to drive belongs here as well; we discuss that openly too, rather than going around it.

Costs & health insurance

What does the insurer pay for — and what not?

Glaucoma is an illness, and assessing it, monitoring it and treating it are medical treatments. Where there is a medical indication, that runs through basic health insurance (OKP); your deductible and co-payment apply as at any doctor's appointment. What is not included we tell you beforehand — not on the invoice.

Service	Coverage	What this means for you
Check-up with pressure measurement, visual field and cross-sectional scan (OCT)	Basic health insurance where indicated	With known glaucoma, with a noticeable finding or with a well-founded suspicion, the follow-up check is medically indicated and is covered. If you come without symptoms and without an indication, for a screening examination on its own, we clear the cost question with you beforehand.
Prescribed pressure-lowering eye drops	Basic insurance (OKP)	Covered preparations you collect at the pharmacy; what you pay towards them depends on your deductible and co-payment. Preservative-free versions are available for most active substances — which of them are covered by basic insurance we clarify when prescribing.
Laser treatment on the eye (SLT, iridotomy)	Basic health insurance where indicated	A pressure-lowering laser treatment for confirmed glaucoma or for a pressure that needs treating is medical treatment, as is a preventive iridotomy for a demonstrated narrow anterior chamber angle. Who carries it out, and where, we discuss with you beforehand — together with the question of whether it is the right step in your situation at all.
Surgical pressure lowering (trabeculectomy, MIGS, cyclophotocoagulation)	Basic health insurance where indicated	Where there is a medical indication, basic health insurance covers the procedure. Depending on the method and the setting, the insurer obtains cost approval beforehand: for a procedure we carry out ourselves, we see to that before an appointment is fixed. Where you are referred on, the centre carrying it out obtains the cost approval and bills its own part itself.
Comfort and optional services around a procedure	Subject to conditions	A free choice of doctor or hospital, semi-private or private accommodation and similar wishes are a matter for supplementary insurance, not for basic health insurance. Which of them are available at all depends on where the procedure takes place — where you are referred on, the conditions of the centre carrying it out apply. Whether your policy covers it is something your insurer tells you; ask beforehand, not afterwards.
Food supplements, eye training, vision training offerings	Not covered	No pressure-lowering or course-slowing effect has been demonstrated for these offerings; they are not a mandatory benefit and they do not replace treatment. We do not recommend them — and we would rather say so beforehand than afterwards.

Unsure whether your current treatment is still enough? Bring your previous findings and all your bottles, and we will judge it together. And if you would like a second opinion on a proposal, that is not an awkward request but a sensible one.

Related conditions

Glaucoma Eye examinations Eye screening

Medically reviewed by PD Dr. med. Andrea von Rückmann · Last reviewed 14 August 2026

Your ophthalmologistPD Dr. med. Andrea von RückmannView profile

Frequently asked questions

: No, and this is the point where we do not put it more kindly than it is. In glaucoma, nerve fibres in the optic nerve die off, and this tissue does not grow back. What is missing from the visual field is missing permanently — no drops, no laser and no operation bring it back. What treatment can achieve is something else, and by no means little: it lowers the intraocular pressure, and lowering the pressure is the only point at which the further course can be influenced at all. Being treated early and consistently therefore puts you in a considerably better position than someone who comes only once they notice something — because glaucoma is usually noticed late.
: Not at a fixed pressure reading and not after a waiting period, but when the treatment so far does not reach its goal. Three situations typically lead to this question: the individually set target pressure is not reached with drops and laser; the visual field or the cross-sectional scan of the optic nerve shows a deterioration despite treatment; or the drops cannot be kept up because of side effects, because of the number of bottles, or for practical reasons. A very far-advanced finding can also lead to surgery earlier, because there even small fluctuations in pressure cost a great deal. Operating on glaucoma is therefore not an escalation and not a failure but a switch to a method that lowers the pressure more strongly than the previous step. Which method comes into question is decided by the findings at the anterior chamber angle, by the stage and by your history so far — not by the wish to do something final.
: As a rule permanently. Glaucoma is a chronic disease: the drops lower the pressure for as long as they are used, and the pressure rises again when they are left out. This is exactly where the commonest trap lies, and it is entirely understandable — the eye does not hurt, vision feels unchanged, so the daily routine looks like a measure against nothing. But the damage happens silently and over years. If you find the routine hard, please tell us instead of quietly stopping: often the schedule can be simplified, a combination preparation saves a bottle, a preservative-free preparation takes away the irritation — and in some situations a laser treatment is the more honest answer to a drop schedule that does not work in everyday life.
: The treatment is done under local anaesthetic with eye drops, and most people describe it as easy enough to bear: short flashes of light are visible, and what is usually felt is slight pressure from the contact lens resting on the eye while it is done. We do not promise you that you will feel nothing — some people find the flashes unpleasant, and in the hours afterwards the eye can be irritated, sensitive to light or slightly aching. The procedure itself takes only minutes, is done as an outpatient and needs no general anaesthetic. Anyone prone to circulatory trouble or very tense should say so beforehand: more time is then planned in, and after the treatment the pressure is checked before anybody goes home. What does not belong to the normal course, by contrast: pain that increases instead of subsiding, an increasingly red eye, or markedly worse vision in the hours and days afterwards. Then call the same day — outside consulting hours the ophthalmic emergency service, or go directly to the emergency department of an eye hospital. A rise in pressure after the laser is rare, but it looks exactly like this, and it does not wait for the next appointment.
: Yes, if the findings call for it, and with glaucoma that is the normal case rather than the exception. The disease begins at the edge of the visual field, and the second eye fills in the gaps when you look — which is why people affected notice nothing for a long time, and why good visual acuity is no all-clear. Central visual acuity and the ability to read are often preserved into advanced stages. What we treat is not how your sight feels today but the measurable state of the optic nerve and the pressure it is under. The reverse holds just as much, though: not every raised pressure reading needs treatment straight away. If the optic nerve and the visual field show no damage, monitoring is sometimes the right decision — and then we say so.
: Assessing glaucoma, the follow-up checks and the pressure-lowering treatment are medical treatments and, where there is a medical indication, are billed through basic health insurance — that holds for the prescribed covered eye drops just as much as for lowering the pressure by laser or by surgery. Your deductible and co-payment apply as at any doctor's appointment, and for an inpatient or larger outpatient procedure the insurer's cost approval comes first: for a procedure we carry out ourselves, we obtain it; where you are referred on, the centre carrying it out takes on that part. What does not run through basic health insurance are comfort and optional services around a procedure, which are a matter for supplementary insurance, and food supplements and training offerings. What applies in your case we clear with you before treatment.
: Ordinary glaucoma develops over years and is not an emergency. The acute attack of glaucoma is the opposite of it, and it looks completely different too: the drainage in the anterior chamber angle blocks suddenly, and the pressure rises sharply within hours. Typical are severe pain in the eye and in the head, a red eye that feels hard, rapidly worsening vision as though through fog, coloured rings around light sources, and nausea and vomiting — the last of these occasionally leads to the stomach being blamed first. This is an ophthalmic emergency and needs treating at once, not the next day: call us, outside consulting hours the ophthalmic emergency service, or go directly to the emergency department of an eye hospital. If a narrow anterior chamber angle has once been found in you, though, it does not stop at watchfulness: for that situation there is a preventive treatment, the laser iridotomy, which takes away the eye's ability to go into an attack at all. Raise it actively, instead of waiting for symptoms.

Glaucoma treatment works only for as long as it is happening.

Whether drops, laser or surgery: the appointment that counts is the next one. Call if you are unsure whether your treatment is still enough — or if you would like a second opinion on a finding.

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