Glaucoma Treatment Abroad: Surgery & Management Options in 2025

Understanding Glaucoma

Glaucoma is a group of eye conditions that damage the optic nerve — the vital connection between the eye and the brain — usually due to elevated intraocular pressure (IOP). The damage is progressive and irreversible: vision lost to glaucoma cannot be restored. This makes early detection and effective treatment critical for preserving sight. Glaucoma is often called the 'silent thief of sight' because it typically causes no symptoms until significant peripheral vision has been lost.

The primary goal of glaucoma treatment is to lower intraocular pressure to a level that slows or stops optic nerve damage. This is achieved through eye drops (first-line treatment), laser therapy (SLT), or surgery (trabeculectomy, tube shunts, MIGS). When medical therapy alone is insufficient — due to disease progression despite drops, medication intolerance, or patient non-compliance — surgery becomes necessary. Approximately 10-15% of glaucoma patients ultimately require surgical intervention.

For patients traveling abroad for glaucoma surgery, understanding the different types of glaucoma is essential for selecting the right treatment approach. Open-angle glaucoma — the most common form, accounting for approximately 70-90% of all glaucoma cases — develops slowly as the trabecular meshwork (the eye's drainage system) becomes gradually less efficient at draining aqueous humor. Angle-closure glaucoma occurs when the iris physically blocks the drainage angle, causing a sudden or gradual rise in IOP. Normal-tension glaucoma presents with optic nerve damage despite IOP readings within the statistically normal range, suggesting that optic nerve susceptibility — rather than absolute pressure level — is the primary pathological factor. Each type requires a different surgical strategy, and patients should ensure their chosen international clinic has fellowship-trained glaucoma specialists experienced in managing the specific variant of glaucoma they have. At Dünyagöz Eye Hospital, the dedicated glaucoma department manages all subtypes, including complex cases such as neovascular glaucoma, uveitic glaucoma, and pediatric glaucoma that require specialized surgical expertise.

The decision to proceed with glaucoma surgery is never taken lightly, and patients traveling abroad should understand what triggers the surgical recommendation. Ophthalmologists typically recommend surgery when intraocular pressure remains above the target level despite maximum tolerated medical therapy (usually two or three different eye drop classes), when visual field testing shows documented progression despite seemingly adequate pressure control, when the patient cannot tolerate or consistently comply with their medication regimen, or when the financial burden of long-term medication use becomes unsustainable. For patients in the US, where premium glaucoma drops can cost $200-$500 per month out of pocket, the economic argument for surgery is compelling — a single surgical procedure abroad that eliminates or significantly reduces medication dependence can produce substantial lifetime savings while simultaneously improving pressure control and protecting remaining vision.

The diagnostic workup for glaucoma has become remarkably sophisticated, and leading international clinics deploy the full range of modern diagnostic technology. Optical coherence tomography (OCT) provides high-resolution cross-sectional images of the optic nerve and retinal nerve fiber layer, detecting damage years before it becomes visible on standard examination. Automated visual field testing (Humphrey perimetry) maps the sensitivity of your peripheral and central vision, revealing the characteristic patterns of glaucomatous vision loss. Gonioscopy examines the drainage angle directly to classify the glaucoma type and guide surgical planning. Anterior segment OCT provides detailed imaging of the drainage angle anatomy without requiring a contact lens. Pachymetry (corneal thickness measurement) is essential because central corneal thickness influences IOP readings — thin corneas can cause falsely low IOP measurements, potentially masking dangerous pressure levels. At Dünyagöz Eye Hospital, the glaucoma department uses all of these diagnostic modalities to create a comprehensive baseline assessment before recommending any surgical intervention.

Surgical Options

Glaucoma surgery has evolved dramatically over the past two decades, with a growing range of procedures that offer different balances between efficacy, safety, and recovery. The choice of surgical technique depends on the type and severity of glaucoma, the target IOP, the patient's age and overall health, and whether the procedure will be combined with cataract surgery. Understanding the options empowers patients to have more productive discussions with their surgical team.

• Selective Laser Trabeculoplasty (SLT): A non-invasive laser treatment that targets the trabecular meshwork (the eye's drainage system) to improve fluid outflow. Takes 5-10 minutes, can be repeated, and typically reduces IOP by 20-30%. Often used as an early intervention before or alongside medication.
• Trabeculectomy: The gold standard glaucoma surgery. Creates a new drainage channel (bleb) in the sclera to allow fluid to drain from the eye. Highly effective at lowering IOP but requires careful post-operative management to prevent scarring. Anti-metabolites (mitomycin-C, 5-FU) are applied during surgery to improve long-term success.
• Tube Shunt Surgery (Ahmed/Baerveldt Valves): Implants a small tube and plate that creates an alternative drainage pathway. Used for complex or refractory glaucoma when trabeculectomy has failed or is unlikely to succeed. Highly effective for severe glaucoma.
• Minimally Invasive Glaucoma Surgery (MIGS): A newer category of procedures using micro-devices to improve drainage with minimal tissue disruption. Includes iStent, Hydrus Microstent, XEN Gel Stent, and Kahook Dual Blade. Lower risk profile than traditional surgery but generally produces more modest IOP reduction.
• Cyclophotocoagulation (CPC): A laser treatment that reduces aqueous humor production by treating the ciliary body. Micropulse CPC (MP-CPC) is a newer, gentler version that avoids the tissue destruction associated with traditional CPC. Used for refractory glaucoma when other surgeries have failed or are not feasible.
• Canaloplasty: A non-penetrating procedure that uses a microcatheter to dilate Schlemm's canal (the eye's natural drainage channel) and places a tension suture to keep it open. No bleb is created, reducing the risk of bleb-related complications. Particularly suitable for patients at high risk of scarring.

Cost Comparison

Glaucoma Surgery Cost Comparison 2025

Prices include surgeon fee, facility fee, anesthesia, implant device (where applicable), and standard post-operative care. Glaucoma medications post-surgery are additional. Follow-up monitoring is essential — plan for local ophthalmologist appointments after returning home.

Glaucoma surgery abroad offers significant savings, particularly for complex procedures like trabeculectomy and tube shunt implantation. In Turkey, comprehensive glaucoma surgical care is available at major eye centers including Dünyagöz Eye Hospital, which maintains dedicated glaucoma departments with fellowship-trained specialists, advanced diagnostic equipment (Heidelberg OCT, Humphrey visual field analyzers), and experience with both traditional and MIGS procedures.

For patients requiring complex glaucoma management — including combination cataract-glaucoma surgery, tube shunt revision, or treatment of neovascular or uveitic glaucoma — hospital-based ophthalmology departments at Memorial Şişli Hospital and Anadolu Medical Center provide the multi-disciplinary support and intensive post-operative monitoring that these complex cases require.

The financial burden of glaucoma extends far beyond surgery. In the US, the average glaucoma patient spends $1,500-$3,000 per year on medications alone, and many insurance plans impose significant copays for specialty glaucoma drops. Over a lifetime, the cumulative medication cost can exceed $50,000-$100,000. Successful glaucoma surgery that eliminates or reduces medication dependence therefore produces ongoing cost savings year after year. When evaluating the cost of glaucoma surgery abroad, patients should consider not just the immediate surgical savings but also the potential long-term reduction in medication expenses. A trabeculectomy in Turkey that costs $2,000-$3,000 and eliminates the need for $2,000/year in medications pays for itself within the first year — and continues saving money for decades.

The MIGS Revolution

Minimally Invasive Glaucoma Surgery (MIGS) has transformed the treatment landscape for mild-to-moderate glaucoma. These micro-scale procedures — performed through the same tiny incision used for cataract surgery — offer several advantages over traditional glaucoma surgery: faster recovery, fewer complications, less post-operative monitoring, and the ability to combine with cataract surgery in a single procedure. The trade-off is generally more modest IOP reduction compared to trabeculectomy.

Leading Turkish eye centers offer the full range of MIGS devices, including iStent inject W, Hydrus Microstent, XEN 45 Gel Stent, and the Kahook Dual Blade goniotomy. At Çağın Eye Hospital, glaucoma specialists evaluate each patient's disease severity, angle anatomy, and IOP target to recommend the most appropriate MIGS device or traditional surgical approach. The cost of MIGS in Turkey ($1,500-$3,000) is 50-60% less than US pricing, making it accessible to patients who might otherwise delay necessary intervention.

The combination of MIGS with cataract surgery is one of the most significant advances in glaucoma management. Because many glaucoma patients are also of cataract age, performing both procedures simultaneously — removing the cataract and implanting a MIGS device through the same tiny incision — avoids the need for a separate glaucoma surgery, reduces total recovery time, and often produces a synergistic IOP-lowering effect. The iStent inject W, Hydrus Microstent, and Kahook Dual Blade goniotomy are all designed to be performed in conjunction with cataract surgery. At Veni Vidi Eye Clinics, surgeons experienced in both cataract and glaucoma surgery offer these combined procedures, providing a comprehensive solution for patients dealing with both conditions simultaneously.

The XEN Gel Stent deserves special attention as a MIGS device that bridges the gap between traditional trabeculectomy and micro-scale MIGS. Unlike trabecular MIGS devices (iStent, Hydrus) that enhance the eye's natural drainage pathway, the XEN stent creates a new subconjunctival drainage route — similar in principle to trabeculectomy but through a minimally invasive, ab interno approach. The XEN stent can produce greater IOP reduction than trabecular MIGS devices, making it suitable for moderate-to-advanced glaucoma. However, like trabeculectomy, XEN stents can experience fibrosis and may require post-operative needling procedures to maintain function. Patients considering XEN stent implantation abroad should ensure the clinic has experience managing post-operative bleb care and needling, as these follow-up interventions are sometimes needed in the first few months after surgery.

Choosing a Destination

Glaucoma surgery requires more careful destination selection than routine LASIK or cataract surgery because post-operative monitoring is more intensive and complications (hypotony, bleb leak, infection) require prompt management. Choose a destination where you can stay for 1-2 weeks after surgery for initial monitoring, and ensure you have a glaucoma specialist in your home country who can manage long-term follow-up. Turkey, India, and Singapore are the top destinations for glaucoma surgery abroad.

Turkey offers the ideal combination of surgical expertise, diagnostic technology, and affordability for glaucoma patients. Istanbul's major eye hospitals employ fellowship-trained glaucoma specialists who have completed advanced training at leading glaucoma centers in the US and Europe. The city's well-developed medical tourism infrastructure — including international patient coordinators, comfortable hotel accommodations within walking distance of clinics, and reliable airport transfer services — makes the extended stay required for glaucoma surgery recovery as comfortable and convenient as possible. For patients from Europe and the Middle East, Istanbul's geographic accessibility (3-5 hour flights from most major cities) makes it particularly practical for the initial surgery and any follow-up visits that may be needed.

Establishing a continuity of care plan before traveling for glaucoma surgery is absolutely essential. Unlike LASIK, where a single post-operative visit confirms success and the patient is essentially discharged, glaucoma surgery requires ongoing monitoring for months to years. Before departing, identify a glaucoma specialist or experienced ophthalmologist in your home city who is willing to manage your post-operative care based on the surgical report and treatment plan provided by the operating surgeon. Many international clinics, including Memorial Şişli Hospital, provide detailed operative reports, baseline post-operative measurements, and medication schedules specifically designed to facilitate seamless handover to local ophthalmologists. Some clinics also offer virtual follow-up consultations, allowing the operating surgeon to review OCT scans and IOP data remotely and advise your local doctor on management adjustments.

What to Expect

Glaucoma surgery (trabeculectomy or tube shunt) takes 30-60 minutes under local anesthesia. You remain awake but feel no pain. Post-operatively, the eye is patched overnight and you begin a regimen of antibiotic and steroid eye drops. The first 2-4 weeks after surgery require close monitoring — the surgeon adjusts the balance between drainage and pressure through suture management and medication adjustments. Plan to stay near the clinic for at least 7-10 days after surgery for adequate initial monitoring.

The post-operative period after trabeculectomy is more dynamic than most surgical recoveries. In the first few weeks, the surgeon actively manages the healing process by adjusting releasable sutures (laser suture lysis or suture removal in the clinic) to fine-tune the amount of fluid draining through the bleb. Too much drainage causes hypotony (dangerously low eye pressure), while too little drainage means the surgery has not achieved its IOP target. This balance requires multiple clinic visits — typically every 2-3 days in the first two weeks — making it critical to remain near the surgical center during this period. Steroid drops are used aggressively (sometimes hourly) in the early post-operative period to prevent scarring of the drainage site, and the frequency is gradually tapered over 2-3 months. Your surgeon will provide a detailed tapering schedule, and adhering to it precisely is important for long-term surgical success.

My glaucoma was progressing despite three different eye drops. The trabeculectomy in Istanbul was my last option before losing significant vision. Six months later, my pressure is perfectly controlled with no medications, and my visual field has stabilized. I wish I had done it sooner.

William K., glaucoma surgery in Turkey