Glaucoma

Call for an Appointment 919-681-3937

Glaucoma is a progressive eye disease that requires early diagnosis and treatment to prevent optic nerve damage and vision loss. Our specialists have advanced training in managing all types of glaucoma, including open-angle glaucoma, narrow-angle (also known as closed-angle) glaucoma, and neovascular glaucoma -- which may affect people with diabetes.

Duke's glaucoma experts use the latest diagnostic advances and are skilled in advanced laser and surgical procedures to slow glaucoma progression. We routinely provide care for people who are at high risk for glaucoma, have been diagnosed with glaucoma, or haven't had success with glaucoma treatments. Our goal is to lower your eye pressure, minimize the damage to your optic nerve, and preserve your vision.

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Treatments

Medical Management

Several medications may be prescribed as eyedrops or medicines you take by mouth. Depending on your needs, we may recommend one or a combination of medications to help you reduce eye pressure, reduce the fluid that builds in the eye and causes increased pressure, and minimize damage to your optic nerve. There are now also medications that can be safely injected into the eye to reduce the number of eye drops you have to take.

Selective Laser Trabeculoplasty (SLT)

SLT uses a laser with low levels of energy to target select cells within the eye's drainage system while leaving the rest of it intact. This procedure is used to treat open-angle glaucoma. Unlike some laser procedures, it may be safely repeated.

Laser Peripheral Iridotomy

When the angle between the iris and the cornea is too small, a laser is used to make a small hole in the iris, which helps fluid drain and lowers eye pressure.

Trabeculectomy

This treatment relieves eye pressure by surgically creating a tiny drainage hole near the top of the eye through which fluid can drain. This outpatient surgical procedure is also known as filtration surgery. A shunt may be implanted as part of the trabeculectomy surgery.

Jullia Rosdahl, MD, PhD, a glaucoma specialist at Duke Health, shares what you need to know about glaucoma and what you can do to lower your risk for vision loss and blindness.

Tube Shunt Surgery

This drainage device is a synthetic tube that is inserted through a tiny hole created in the white portion of the eye. The tube allows fluid from inside the eye to drain out of the eye safely. This surgical approach may be recommended if your eye has scarring related to previous eye surgery.

Laser Cyclophotocoagulation

Laser energy is used to decrease the eye’s ability to make the fluid that causes increased eye pressure. This procedure, which is performed in an operating room, may be done with a camera (endoscopic cyclophotocoagulation, or ECP) to help view the area of the eye that produces fluid and to direct the laser energy. The procedure may reduce or eliminate your need for eyedrops.

Minimally Invasive Glaucoma Surgery

Some types of glaucoma surgery can be performed with minimally invasive techniques, which use tiny instruments and require smaller incisions. The goal of these procedures is to reduce elevated eye pressure and minimize the need for topical medications. The less invasive approach poses fewer risks for complications and may lead to a faster recover but results in more modest pressure-lowering than traditional glaucoma surgery. Minimally invasive glaucoma surgery is appropriate for people with mild-to-moderate glaucoma.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

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Tests for Glaucoma

Your glaucoma doctor will conduct a thorough examination of your eyes, including structural and functional testing of the optic nerve, using a variety of imaging devices. Additional tests are necessary to measure intraocular pressure, the extent of damage, and possible vision loss.

Tonometry

Measures the inner pressure of your eye using a tiny device that applies pressure to the eye.

Perimetry

Measures your peripheral or side visual field in each eye. During the test, you look straight ahead while lights flash at various levels of brightness in your side vision. The test allows doctors to detect defects in your visual field. It is used to diagnose and determine the progression of glaucoma.

Gonioscopy

A microscope known as a slit lamp and a special mirrored lens placed in front of your eye are used to look at the portion of your eye between your cornea and your iris. This “angle” is where the drain of the eye is located; the fluid drains back into your bloodstream. The test is used to determine whether the angle is open or narrow.

Optical Coherence Tomography

OCT is a computer-guided imaging device that creates a 3D image map of the optic nerve and the macula of the retina. It detects changes in the thickness of the macula and neural tissue and looks for small defects that may be difficult to identify during a visual field test. OCT of the front part of the eye may be useful in identifying angle-closure glaucoma and in imaging abnormalities such as iris cysts.

Pachymetry

Ultrasound waves measure the thickness of the cornea. Thinner corneas are a risk factor for developing glaucoma.

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919-681-3937

Experts in Comprehensive Glaucoma Care

Respected Leaders
Our board-certified, fellowship-trained glaucoma specialists travel the world to lecture and teach courses on the latest glaucoma research and treatments. Our extensive experience and knowledge mean you receive your care from some of the nation’s most respected glaucoma specialists.

Treatment Options for Complex Cases
We use the latest advances to treat people who have complex glaucoma, whose glaucoma has not responded to medical therapy, or who have had previous glaucoma procedures that failed.

Care for Multiple Eye Concerns
If you have eye concerns -- such as cataracts or retinal disease -- in addition to glaucoma, we can coordinate your visits and work closely with your corneal surgeon or retinal specialist, if needed. We also have the experience and expertise to combine complicated surgeries to ensure that you receive the most comprehensive care.

Promising Research
Our scientists are working on new treatments for glaucoma, ways to make medical management easier, and new drug delivery devices. We are also conducting studies that may ultimately lead to ways to protect the optic nerve. Our goal is to prevent blindness and minimize the damage caused by glaucoma.

Compassionate, Supportive Environment
We offer patient support services, including educational materials and programs, a vision rehabilitation program, and a dedicated social worker to help you and your loved ones manage your condition and maximize your quality of life.

Best Eye Hospital in North Carolina

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our ophthalmology program is ranked seventh in the nation and is the highest-ranked program in North Carolina, according to U.S. News & World Report for 2024–2025.

This page was medically reviewed on 07/22/2024 by

Leon W. Herndon Jr., MD | Glaucoma Specialist