Sooner or later, anyone diagnosed with glaucoma asks the ophthalmologist: can glaucoma be cured? The honest answer has two halves. The optic nerve fibres that have already been lost do not regenerate. But the disease can be slowed down, and in many people almost entirely halted, by lowering the pressure inside the eye.
It is on this point that the research of the past thirty years is most solid. According to a review published in The Lancet, progression usually stops when intraocular pressure falls by 30–50% from its starting value; to get there, eye drops, laser and, if those are not enough, surgery are used1.
In brief
- Glaucoma can be treated in the sense of being slowed down: damage that has already occurred to the optic nerve cannot be recovered1.
- In a large randomised trial, each millimetre of mercury of pressure reduction was associated with a risk of progression about 10% lower2.
- All the eye drops used as a first choice lower eye pressure; the differences between those of the same family are small4.
- As a first treatment, laser gave results comparable to eye drops and, at three years, allowed three people in four to do without them7,8.
- For minimally invasive surgical techniques the evidence is still partial and varies from device to device9.
In this article
Can glaucoma be cured? What it really means
To speak of a cure would be inaccurate. Glaucoma is a chronic disease, the leading cause of irreversible blindness worldwide1. The aim of treatment is to preserve for life the sight a person still has, by acting on the only target with solid evidence of effectiveness: intraocular pressure5, which depends on the balance between the fluid produced inside the eye, the aqueous humour, and the fluid that leaves it through a small filter called the trabecular meshwork.
That lowering it helps was shown by the Early Manifest Glaucoma Trial, a randomised trial of 255 people with early glaucoma: treatment halved the risk of progression compared with not treating straight away, and each millimetre of mercury (mmHg) of reduction from the starting value was associated with a risk about 10% lower2. We described the details in our article on what glaucoma is.
Eye drops: what the studies say
Drops are the most widely used treatment. There are several families of them: some reduce the production of aqueous humour, others help it to drain away.
The study
UKGTS: an eye drop against a placebo, with the visual field as the yardstick
In the UK, 516 people with open-angle glaucoma were randomly assigned either to an eye drop containing latanoprost, a prostaglandin analogue, or to a drop with no active ingredient. After 24 months, pressure had fallen by an average of 3.8 mmHg with the drug and 0.9 with the placebo. The visual field, that is, the extent of what a person can see, was preserved for longer in the treated group: the risk of progression was more than halved (a relative risk, expressed as a hazard ratio of 0.44). It was the first placebo-controlled trial to show this effect on sight with a pressure-lowering drug; none of the 18 serious adverse events recorded was attributed to the eye drop3.
Which drop, then? A systematic review with network meta-analysis, which pooled 114 randomised trials and more than 20,000 participants, compared the drugs used as a first choice in open-angle glaucoma. All of them lowered pressure more than placebo at three months. The three most potent active ingredients, all prostaglandin analogues, reduced it by an average of 4.8–5.6 mmHg; the others by between 1.9 and 4.5 mmHg4.
The authors warn, however, that the differences between drugs of the same family are small and perhaps of little relevance in practice, and that side effects, the person’s preferences and costs also matter in the choice4.
Side effects are not a detail. A 2023 paper, built on a systematic review with meta-analysis, points out that most people with glaucoma have dry eye, largely because of the drops, and focused on benzalkonium chloride, the most debated preservative: versions that do not contain it lower pressure just as well5.
Sticking to treatment matters as much as the drug
An eye drop works only if it is used, and poor adherence to treatment is one of the main difficulties in the care of glaucoma5: the disease causes no discomfort, and a forgotten dose cannot be felt.
A Cochrane review gathered 16 trials, with 1,565 participants, that had tried to make the use of drops more regular6. The more elaborate interventions, which combined information with tailored strategies (for example, linking the drops to a daily habit), seemed to help in three trials. But the trials differed from one another, were generally short (under six months) and were at risk of bias: in the authors’ view, the evidence is not enough to recommend any one of them in particular6.
Laser: selective laser trabeculoplasty
Selective laser trabeculoplasty is an outpatient treatment: a low-energy laser acts on the trabecular meshwork and helps fluid to drain through it.
The study
LiGHT: starting with laser instead of drops
The British LiGHT trial randomly assigned 718 people with open-angle glaucoma or with high eye pressure to start with trabeculoplasty or with eye drops, and followed them for three years. Quality of life was similar in the two groups. After 36 months, 74% of those who had started with laser did not need drops to keep their pressure at the agreed target; in the eye-drop group 11 people needed an operation, in the laser group none7. The limitation: the trial concerned first treatment, and its results do not automatically apply to people with advanced disease.
A 2024 meta-analysis, which pooled 14 randomised trials with 1,706 people, compared laser with drugs. At one month, pressure was lower with eye drops; from two to twelve months the differences disappeared, and the same was true of the visual field and quality of life. People who had had laser needed fewer operations and fewer drugs, and had fewer side effects in the eyes8.
Surgery, when it is needed
When pressure does not fall enough or the disease advances, the next step is surgery1. The classic operation, trabeculectomy, creates a new exit route for the aqueous humour; an alternative is a small drainage tube.
A 2026 review of the major recent trials summarises two results. In advanced glaucoma, the TAGS trial found better pressure control and less deterioration of the visual field with trabeculectomy as the first treatment. The PTVT trial, by contrast, considers both trabeculectomy and the tube appropriate as a first operation, to be chosen according to the starting pressure, the risks a person is willing to accept and their goals10.
In recent years, minimally invasive surgical techniques have become widespread, known by the abbreviation MIGS (minimally invasive glaucoma surgery): small devices, often implanted during cataract surgery. An overview of Cochrane reviews found moderate-certainty evidence that adding a certain microstent to cataract surgery makes it more likely that a person can do without drops (about 60% more likely) and lowers pressure by a further 2 mmHg in the long term. With a second stent the effect on pressure did not last; a third device was associated with a higher risk of loss of sight9. Minimally invasive, in other words, does not mean free of risk.
When to talk to an ophthalmologist
- If you find it hard to use your eye drops every day or notice that you often forget them: talking about it allows the alternatives, laser included, to be considered6,7.
- If the drops sting, irritate your eye or make it red5.
- If, between check-ups, you notice that you see less well, at the sides or in the centre.
- Immediately: severe pain, a red eye or a sudden drop in vision, especially in the days after a laser treatment or an operation. If you cannot reach your ophthalmologist, go to an emergency department (A&E) or call 112: you will find the other warning signs on our page about eye emergencies.
Frequently asked questions
If my eye pressure has returned to normal with the drops, is the glaucoma cured?
No: it means the treatment is working. Glaucoma remains a chronic disease and damage that has already occurred cannot be recovered1; that is why checks of the pressure, the optic nerve and the visual field continue over time.
Do I still need drops after laser?
It depends. In the LiGHT trial, at three years about three in four people treated with laser did not need them; the others did7.
Do glaucoma eye drops have side effects?
They can, starting with irritation and dryness of the surface of the eye5. The effects vary from drug to drug, and the review of first-choice eye drops names side effects among the criteria for deciding4.
Does glaucoma surgery restore sight?
No. Surgery, laser and eye drops have the same purpose: to lower pressure in order to halt or slow the damage, not to repair the optic nerve1. That is why noticing the disease early matters so much.
Glaucoma cannot be wiped out, but it can be managed. Eye drops, laser and surgery are backed by solid studies, each with its limits; the choice depends on the stage of the disease and on the person, and is made with the ophthalmologist. Consistency does the rest.
Sources
- Jonas JB, Aung T, Bourne RR, Bron AM, Ritch R, Panda-Jonas S. Glaucoma. Lancet. 2017;390(10108):2183-2193. doi:10.1016/S0140-6736(17)31469-1 · PubMed 28577860
- Leske MC, Heijl A, Hyman L, Bengtsson B, Komaroff E. Factors for progression and glaucoma treatment: the Early Manifest Glaucoma Trial. Curr Opin Ophthalmol. 2004;15(2):102-6. doi:10.1097/00055735-200404000-00008 · PubMed 15021220
- Garway-Heath DF, Crabb DP, Bunce C, Lascaratos G, Amalfitano F, Anand N, et al. Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial. Lancet. 2015;385(9975):1295-304. doi:10.1016/S0140-6736(14)62111-5 · PubMed 25533656
- Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, et al. Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis. Ophthalmology. 2016;123(1):129-40. doi:10.1016/j.ophtha.2015.09.005 · PubMed 26526633 · PMC
- Nagstrup AH. The use of benzalkonium chloride in topical glaucoma treatment: An investigation of the efficacy and safety of benzalkonium chloride-preserved intraocular pressure-lowering eye drops and their effect on conjunctival goblet cells. Acta Ophthalmol. 2023;101 Suppl 278:3-21. doi:10.1111/aos.15808 · PubMed 38037546
- Waterman H, Evans JR, Gray TA, Henson D, Harper R. Interventions for improving adherence to ocular hypotensive therapy. Cochrane Database Syst Rev. 2013;2013(4):CD006132. doi:10.1002/14651858.CD006132.pub3 · PubMed 23633333 · PMC
- Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393(10180):1505-1516. doi:10.1016/S0140-6736(18)32213-X · PubMed 30862377 · PMC
- Chavez MP, Guedes GB, Pasqualotto E, Lopes LM, Ferreira ROM, de Souza ESMV, et al. Selective Laser Trabeculoplasty Versus Medical Therapy for the Treatment of Open Angle Glaucoma or Ocular Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Glaucoma. 2024;33(12):973-986. doi:10.1097/IJG.0000000000002466 · PubMed 39018052
- Bicket AK, Le JT, Azuara-Blanco A, Gazzard G, Wormald R, Bunce C, et al. Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma: An Overview of Cochrane Systematic Reviews and Network Meta-analysis. JAMA Ophthalmol. 2021;139(9):983-989. doi:10.1001/jamaophthalmol.2021.2351 · PubMed 34264292 · PMC
- Taylor K, Mosenia A, Bowden EC. Glaucoma management reconsidered: insights from LiGHT, ZAP, TAGS, PTVT, and EAGLE. Curr Opin Ophthalmol. 2026;37(2):76-80. doi:10.1097/ICU.0000000000001192 · PubMed 41330523
Study titles are given in their original language of publication. The superscript numbers in the text refer to these sources; citation details come from PubMed (National Library of Medicine).
