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What is glaucoma?


Everything you need to know about glaucoma


Glaucoma is a condition which can affect your sight. It often affects both eyes to varying degrees. One eye may develop glaucoma quicker than the other.

How common is glaucoma?

In England and Wales, it’s estimated more than 500,000 people have glaucoma, but many more people may not know they have the condition.

Chronic open-angle glaucoma affects up to two in every 100 people over 40 years old and around five in every 100 people over 80 years old.

You are also at increased risk of developing open-angle glaucoma if you are of black-African or black-Caribbean origin.

Some types of glaucoma, such as acute angle-closure glaucoma, are much less common. However, people of Asian origin are more at risk of getting this type of glaucoma compared with those from other ethnic groups.

The leading cause of glaucoma is a build-up of pressure within the eye.

The eyeball contains a fluid called aqueous humour which is continuously produced by the eye, with any excess drained through special tubes. Glaucoma develops when the fluid cannot drain properly, and pressure, known as the intraocular pressure, builds up. This can damage the optic nerve ( the part of the eye which connects the eye to the brain) and the nerve fibres from the retina (the light-sensitive nerve tissue that lines the back of the eye).

Glaucoma symptoms and lifestyle impacts

Different types of glaucoma have varying symptoms.

Chronic open-angle glaucoma

In cases of chronic glaucoma, there are usually no noticeable symptoms because the condition develops very slowly. People don’t often realise their sight is being damaged because the first part of the eye to be affected is the outer field of vision (peripheral vision). Vision is lost from the outer rim of the eye, slowly working inwards towards the centre.

Changes in vision are often linked to getting older, which is why it is so important to have your eyes checked regularly. You should have an eye test at least every two years unless you are advised by your optometrist to return more frequently.

Acute angle-closure glaucoma

Acute angle-closure glaucoma develops rapidly. Symptoms are often severe. They include:

  • Intense pain
  • Redness of the eye
  • Headache
  • Tender eye area
  • Seeing halos or ‘rainbow-like’ rings around lights
  • Misty vision
  • Loss of vision in one or both eyes that progresses very quickly

As a result of these symptoms, some people may feel sick or be sick.

Symptoms of acute glaucoma are not constant. They can last for one or two hours before disappearing again. However, each time the symptoms occur, your vision is damaged a little more. This is an emergency, and you should seek urgent advice.

It’s essential to seek professional help straight away if you have any of the above symptoms because early treatment can prevent further damage occurring. 

Secondary glaucoma

Secondary glaucoma is caused by other conditions, such as uveitis (inflammation of the middle layer of the eye). It can also be caused by eye injuries and certain treatments, such as medication or operations.

The symptoms of glaucoma can be confused with the symptoms of other conditions. For example, uveitis often causes painful eyes and headaches.

Glaucoma may also cause misty vision and rings or halos around lights.

Developmental glaucoma

Recognising the symptoms of developmental glaucoma (also known as congenital glaucoma) can be difficult due to the young age of the baby or child. However, your child may display symptoms, such as:

  • Large eyes due to the pressure in the eyes causing them to expand
  • Sensitive to light (photophobia)
  • Having a cloudy appearance to their eyes
  • Watery eyes
  • Jerky movements of the eyes
  • A squint, which is an eye condition that causes one of the eyes to turn inwards, outwards or upwards, while the other eye looks forward

Early diagnosis is important because any damage to the eyes cannot be reversed. If left untreated, glaucoma can cause visual impairment.

To diagnose glaucoma, we will review your medical history and conduct a comprehensive eye examination where we perform several tests, including:

  • Measuring intraocular pressure 
  • Testing for optic nerve damage with a dilated eye examination and imaging tests
  • Checking for areas of vision loss
  • Measuring corneal thickness 
  • Inspecting the drainage angle

Treatment aims to control the condition and minimise future damage by reducing the pressure in the affected eye. We can treat glaucoma with eye drops, laser treatment or surgery.

Eye drops

Chronic open-angle glaucoma is often treated using eye drops. There are several different types of eye drops available; the type prescribed may depend on:

  • How your condition is progressing
  • Whether you have other medical conditions
  • Whether you are taking any other medications
  • Whether the eye drops cause side effects when you use them

Other treatments

If the use of eye drops does not improve your symptoms, we may recommend a different type of treatment, such as laser treatment or surgery. 

Selective Laser Trabeculoplasty (SLT)

Selective Laser Trabeculoplasty (SLT) is one type of Laser Trabeculoplasties and helps to reduce the intraocular pressure in patients with glaucoma. It works by Applying a cold laser to the drainage tissue inside the eye. There is a combination of biological changes and chemical transformation in the tissue allowing Enhancement of the drainage of fluids from the eye. The results might take up to 3 months to show. SLT laser uses very low heat energy which mean that it is less likely to cause damage to the tissue and the pain is very minimal.

Selective laser trabeculoplasty or SLT is becoming the first line treatment for patients with a primary or secondary open angle glaucoma. There is a growing evidence to support that SLT laser is effective as a first-line therapy as well as being safe and well tolerated by patients. It allows for no or less need for topical eyedrops to control the glaucoma.

SLT laser has potential to lower the eye pressure by more than 30%. This is far more powerful than the most commonly used topical eyedrops. The effect of high-pressure control can last up to 5 years. There are cases where there is no or little benefit from the laser. This is usually known by monitoring the eye pressure for 6 to 12 months after the treatment. If the effect of the SLT laser has worn off often after several years then it would be advisable to repeat the treatment.

More and more surgeons are choosing SLT as a first line treatment for their patience. It will save the patients from installing too many drops in their eyes for life. The use of SLT laser has transformed the management of glaucoma for the better.

Selective Laser Trabeculoplasty (SLT) laser should not be confused with other types of laser treatments such as Argon laser trabeculoplasty (ALT) and micropulse laser trabeculoplasty (MLT). Finally, an alternative to laser trabeculoplasty is cyclodiode laser treatment. This involves destroying some of the tissue in the eye that produces aqueous humour. It creates less fluid in the eye, which reduces the intraocular pressure.

SLT laser can be used as sole therapy or as additional therapy to help other anti-glaucoma medications.

How is it done?

The treatment is painless and easy to do. We will place anaesthetic eye drops into your eye and place a special lens in front of your eye. The laser will be shone through the lens and will be focused on the trabecular meshwork. This allows more fluid to drain out of your eye and reduces the intraocular pressure.

Laser treatments are usually quick and painless, although, during the procedure, you may feel a brief twinge of pain or heat. You may still need to use eye drops after having laser treatment.


A trabeculectomy is the most common type of glaucoma surgery. It involves removing part of the trabecular meshwork to allow fluid to flow through the eye’s drainage system. The procedure will be carried out under local anaesthetic or general anaesthetic.

Other types of surgery include:

  • A viscocanalostomy – this operation removes part of the sclera (the white outer covering of the eyeball), enabling the fluid to filter out of your eye and into your body.
  • A deep sclerectomy operation – this operation involves implanting a tiny device inside your eye to widen the trabecular meshwork.
  • An aqueous shunt implant – this operation involves placing a tube device into your eye to increase the drainage of fluid out of your eye.

If you are having surgery, your Eye Clinic London surgeon may choose to use anti-scarring medicine. These can improve the success of the operation by preventing scar tissue forming as your eye heals.

Minimally Invasive Glaucoma Devices (MIGS)

MIGS procedures work by using microscopic-sized equipment and tiny incisions.

The MIGS group of operations are divided into several categories:

  • Miniaturized versions of trabeculectomy
  • Trabecular bypass operations
  • Totally internal or suprachoroidal shunts
  • Milder, gentler versions of laser photocoagulation

Acute angle-closure glaucoma

As acute glaucoma develops rapidly, we need to treat the condition quickly. The most common forms of treatment for this type of glaucoma include:

  • Eye drops – see above for further details
  • Systemic medicines – these are injected into your bloodstream to reduce the pressure in your eye quickly
  • Laser treatment (called laser iridotomy) – this uses high-energy beams of light to create holes in your iris (coloured part of the eye) to open the angle and enable fluid to flow. Both eyes may need to be treated, even if only one has acute angle-closure glaucoma. This is because this form of glaucoma may develop in both eyes at some point.
  • Surgery – a trabeculectomy (surgery to remove part of the drainage tubes) is the most common form of surgery for acute glaucoma.

If you also have a cataract (a cloudy patch in the lens of your eye), removing it may open the angle in your eye and control the intraocular pressure.


We can also treat acute angle-closure with a medication called a miotic, such as pilocarpine. Miotics work by opening up the blocked trabecular meshwork, which should improve the drainage of aqueous humour out of your eye. You may need to use these eye drops for up to four times a day.

Miotics can also cause side effects, such as:

  • Headaches, which may be severe during the first two to four weeks of treatment
  • Burning or itchy eyes
  • Blurred vision, which may affect your ability to drive

Treating other types of glaucoma

For other types of glaucoma, we usually recommend eye drops, laser treatment or surgery. Your treatment will depend on the type of glaucoma you have and how advanced it is.

Monitoring your condition

If you are diagnosed with glaucoma, your condition will be closely monitored to check for further damage to your vision.

Depending on how your glaucoma is progressing, you may need further appointments every one to four months, or up to 12-24 months apart with an experienced member of the team.

Samer Hamada and Eye Clinic London enable Londoners to experience relief from their eye problems so they can focus on what matters most.

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Happy patients from London and East Grinstead


Annabel Giles

“As soon as I met Mr Hamada, I knew I was in safe hands. He is an expert in his field, and very reassuring. His work was impeccable, and I would thoroughly recommend him to anyone wanting a professional, kindly, expert service.”

Tareq Kasshout

“I came all the way from the US to be evaluated by Mr. Samer Hamada who provided me with a world class experience. I was treated with technology that doesn’t exist in the United States. My vision improved significantly since the surgery. Mr. Samer Hamada is definitely a Keratoconus expert.”

Timothy Thompson

“Mr Hamada’s Eye Clinic London and his team are a delight. Nothing was too much trouble and the help, support, advice and guidance before during and after the surgery was all world class. I have worn glasses since the age of 13 years and had the onset of cataracts for the last five so it has all been very much a life changing experience to be free from glasses once more.”

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“As soon as I met Mr Hamada, I knew I was in safe hands. He is an expert in his field, and very reassuring. His work was impeccable, and I would thoroughly recommend him to anyone wanting a professional, kindly, expert service.”

Annabel Giles, Lens replacement

“I came all the way from the US to be evaluated by Mr. Samer Hamada who provided me with a world-class experience. I was treated with technology that doesn’t exist in the United States. My vision improved significantly since the surgery. Mr. Samer Hamada is definitely a Keratoconus expert.”

Tareq Kass Hout, Keratoconus
“I am glad to be with Mr Hamada. I am glad to be examined by Mr Hamada who acts responsibly and professionally. I never had this experience before from a previous ophthalmologist. I am thankful to Mr Hamada for the successful diagnosis and treatment of my case.”
Ghiath Sumainah

“What a Consultant. Dr. Hamada is a man who was born for this profession. As soon as we walked into the room you felt that you had met a man who was gentle and kind. His demeanour was of a man who knew his trade. He speaks in a way that you will understand. He explains exactly what is wrong and the way he will help fix it for you.”

Sam Brock

“My eyes got really sore, tired and gritty feeling this year. It kept getting worse for about 6 months and every time I thought about it, I kept thinking it would eventually go away, but it just didn’t budge. So I want to say a big thank you to eye doctor Mr Samer Hamada who finally sorted me out! Apart from the eye tests I expected, he also took a really personal approach. I appreciate that he asked questions about my whole diet and lifestyle which helped him to quickly figure out why my eye surface was inflamed. I now have simple steps I can take to reduce the inflammation through diet and lifestyle changes which I’ve now been doing for 2 weeks. I also have been using the special non-preservative eye drops and gels that Mr Hamada provided. My eyes are already feeling so much better and I’m so relieved to have had help to sort this out. If you’ve been noticing your eyes getting dry – don’t wait to sort it out as it keeps getting continually worse and you can find relief very quickly with the right help.”

Laura Livesey, Dry eye

“Mr Hamada’s London Eye Care and his team are a delight. Nothing was too much trouble and the help, support, advice and guidance before during and after the surgery was all world class. I have worn glasses since the age of 13 years and had the onset of cataracts for the last five so it has all been very much a life changing experience to be free from glasses once more.”

Timothy Thompson

“We saw Mr Hamada after our 14-year-old son was diagnosed with keratoconus by another specialist. Mr Hamada talked us through the pros and cons of the cxl epi off and epi on procedures, he answered all our many and detailed questions without rushing us and as openly and honestly as possible. We opted to go ahead with cxl epi off with Mr Hamada. Our experience with Mr Hamada and his team, from his incredibly informative and supportive Secretary Joanna, nurse Mimi and Mr Hamada himself who was incredibly reassuring and put us and our son at ease both before, during and after the procedure, and at each follow-on appointment, has been the best possible. I would go so far as to say that he and his team are by far the best medical team I have ever experienced. I recommend him highly and would be happy to speak to anyone considering an expert in this field.”

Lisa & George, Keratoconus

“I would not hesitate to recommend Dr Hamada and his team. From the first call to inquire about booking an appointment to booking it, I was so impressed with his wonderful secretary Joanna- she really is worth her weight in gold, her lovely manner and care made me decide to go for this clinic. Dr Hamada was a lovely man with a very kind and thorougher way about him – he put my 4-year-old daughter at ease. The appointment was lengthy but at no point were we rushed and able to ask as many questions- things were explained so well. I would have no hesitation at all to recommend anyone to use Dr Hamada and his team- I have already recommended to some other parents.”


“Mr Hamada, his assistant Joanna and his ophthalmic technicians provide a caring, efficient and high quality service. From the admin through to the surgical aftercare we were very well looked after and we had a high degree of confidence in Mr Hamada’s abilities. Our daughter’s cataracts have been corrected (under general anaesthetic) and her quality of life has improved substantially. You also feel well cared for throughout – the human touch is vital in healthcare, but not always delivered, so well done and thanks to all of the team.”

Nat & Rich
“We were referred to Dr.Hamada by one of the UK experts. The expert himself admitted that Dr.Hamada was better than him!! We were not disappointed at all. Dr. Hamada was excellent with my child. His communication skills and knowledge were exemplary. He gave us clear management plan and would not hesitate to recommend him.”
V Nama
“Dr Hamada is an excellent, highly competent doctor with a very kind and sympathetic manner. His reputation for successfully treating dry eye patients seems unparalleled. His team are all extremely friendly and helpful, especially Dr Hamada’s PA Joanna, making the overall experience better than anywhere else I’ve been!”
Isla Cully, Dry eye
“Appointment setting and follow-up were very efficient and well managed. Mr Hamada was kind, reassuring, knowledgeable and had a very warm manner with my young son, making him instantly feel at ease. I feel that we can trust him and that he will finally be able to solve my son’s long-term eye problems that have stumped other eye doctors.”
“A real care provider – true in letter and spirit. After having seen few other consultants we were lucky to see Mr. Hamada. He treated my mother’s eyes and the prolonged inflammation finally went away. My mother went on to receive a corneal graft. Mr. Hamada and his clinic are simply wonderful. Their response is immediate every time even if it’s the weekend. Mr. Hamada puts a lot of personal attention answering every question very patiently and alleviating any fears. His manner is so kind that puts his patients completely at ease. This caring trait continues in the rest of his staff especially his assistant Joanna. I really can’t thank them enough. I thoroughly recommend anyone with eye problems to go to Mr. Hamada. You couldn’t be in better hands. He has treated my mother who is a long sufferer of eye problems. I am grateful always to Mr. Hamada and Joanna for all the support they have provided throughout.”
Charmaine Ghafur

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About the expert

Mr Samer Hamada | Consultant Ophthalmologist and Corneal Surgeon

MD, MSc, DO (hons), FRCSEd, FRCOphth I am Samer Hamada, founder and consultant ophthalmic surgeon with over 20 years’ experience in ophthalmology. I am a world-renowned specialist in cornea, cataract and refractive surgery. I’m not only a leading surgeon but also the only dual fellowship trained in corneal diseases in children from reputable institutions in the UK. At Eye Clinic London I work closely with other consultant ophthalmologists, optometrists and orthoptists to achieve the best outcomes for our patients. Our main aim is to make sure our patients get the safest and best treatments available to them. We put your safety before anything else so you can rest assured that if you choose us you will be in the best and safest hands.

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