Is there an order of priority between traditional surgery and laser treatment? Laser treatment is generally used as an option before traditional surgery because of its low cost, high safety and few side effects, and is often the treatment of choice, especially in primary closed-angle glaucoma. In primary open-angle glaucoma, it is often used as a treatment option when the results of drug therapy are unsatisfactory and conventional surgery is not considered for the time being, such as selective laser trabeculoplasty (SLT), which has the advantages of minimal trauma, repeatability, rapid recovery, and low cost. The disadvantages are that the decompression is small, the efficacy is not long-lasting, and it is not suitable for all patients. What types of glaucoma are laser treatments suitable for patients with? Primary closed-angle glaucoma is suitable for iris laser perforation or iris perimetry, depending on the atrial angle and iris morphology. Primary open-angle glaucoma is suitable for selective laser trabeculoplasty, which is the laser equivalent of unblocking the “fluid outflow channels” of the eye to reduce intraocular pressure. What are the effects of the different types of laser treatments? Will it stop recurring? The purpose of laser perforation of the iris is to bridge the atrial fluid in the anterior and posterior chambers of the eye and to balance the pressure in the front and back of the iris. It is equivalent to making a short circuit in the outflow pathway of the eye to reduce the resistance to outflow and balance the pressure in the front and back of the iris, thus preventing the iris from moving forward and completely blocking the outflow of atrial fluid and causing an acute attack of glaucoma. Early stage patients with closed-angle glaucoma who have not had an acute attack and have normal IOP can be prevented from having an acute attack in 93% of patients after iris laser perforation and can maintain normal IOP for years to decades without any treatment. However, in patients with closed-angle glaucoma who have had an acute attack and whose IOP is already elevated, acute attacks can be prevented in about 70% of cases, and IOP control is limited and often requires a combination of medications. Laser iridoplasty is often used in the treatment of chronic closed-angle glaucoma, where the iris often has a specific morphology, and the thermal effect of the laser causes it to contract, thereby increasing the width of the atrial angle and reducing the risk of atrial angle closure. It is similar to hardening and reinforcing the sewer opening to avoid blockage. However, this efficacy often diminishes over time as the lens thickens with age. Selective trabeculoplasty, on the other hand, uses laser energy to induce apoptosis of cells in the outflow channels to unblock the “sewer” and thereby reduce IOP. However, this effect is often diminished by the body’s compensatory repair function, so the effect is not long-lasting. Can I have laser treatment for both eyes at the same time? Both eyes can be treated with laser at the same time. Do I need laser treatment for the other eye when I have an acute attack in one eye? In primary angle-closure glaucoma, the disease is often in both eyes. Therefore, after an acute attack in one eye, there is also a factor of shallow anterior chamber and narrow atrial angle in the other eye, so laser perforation treatment is needed to prevent an acute attack of glaucoma. What are the conditions that may cause treatment failure? Is there a risk of blindness? Laser perforation can successfully penetrate the iris in 99% of patients, but there are a few patients who have a dense, tough iris stroma that cannot be penetrated by the laser and require routine surgery to remove the peripheral iris. In addition, in patients with uveitis or acute inflammation, the diameter of the laser hole is relatively small and therefore easily blocked by the inflammatory exudate. The laser procedure itself does not carry the risk of causing blindness. Do I still need long-term medication to lower my eye pressure after laser treatment? In early stage closed-angle glaucoma, the atrial angle is not yet closed and laser perforation removes an important causative factor, so the condition can be relieved for a long time without the need for any medication. In more advanced cases, where the atrial angle is already closed and the IOP is elevated, the laser itself does not reduce the IOP much and adjunctive medication is needed. Selective trabeculoplasty for open-angle glaucoma often requires continued use of antiglaucoma medications.