Glaucoma treatment options in the UK: drops vs SLT vs MIGS surgery

Fast answer: which glaucoma treatment is right for you?

There is no single best glaucoma treatment — the right choice depends on the type of glaucoma, how advanced it is, and how well you tolerate drops. The 2026 UK treatment ladder, in order of escalation:

Eye drops: the long-standing first-line treatment

Pressure-lowering eye drops have been the default first-line treatment for primary open-angle glaucoma for decades. They reduce intraocular pressure (IOP) by either decreasing aqueous humour production or increasing its outflow. They’re effective when used correctly, but UK adherence studies suggest up to half of patients miss doses regularly, which is one reason SLT has overtaken drops as a preferred first step in many patients.

The five main classes of glaucoma drops used in the UK

Patients on multiple drops are commonly switched to combination products (such as Cosopt — dorzolamide+timolol; Ganfort — bimatoprost+timolol; DuoTrav — travoprost+timolol; Simbrinza — brinzolamide+brimonidine) to simplify the regimen. Preservative-free options are widely used in the UK to reduce ocular surface side-effects, particularly for patients on long-term therapy.

SLT laser: NICE-recommended first-line treatment

Selective Laser Trabeculoplasty (SLT) is a quick outpatient laser procedure that lowers eye pressure by stimulating the trabecular meshwork (the eye’s natural drainage system). It uses a low-energy, short-pulse laser that targets pigmented cells in the meshwork without causing thermal damage — hence “selective”. The procedure takes around 5–10 minutes per eye and is done with anaesthetic drops only.

Why SLT moved to first-line in the UK

The landmark LiGHT trial (Laser in Glaucoma and Ocular Hypertension), published in The Lancet in 2019, randomised UK patients with newly diagnosed open-angle glaucoma to either drops first or SLT first. At three years:

• 78% of SLT-first patients remained drug-free
• SLT-first patients had better quality-of-life scores than drop-first patients
• Glaucoma surgery rates were significantly lower in the SLT-first group
• SLT was found to be more cost-effective than drops over six years

On the back of this evidence, NICE guidance NG81 was updated in 2022 to recommend SLT as a first-line treatment for primary open-angle glaucoma and ocular hypertension when the IOP target requires treatment. It is now offered as the initial intervention by most UK NHS and private glaucoma services where the eye anatomy is suitable.

What to expect from an SLT appointment

1. Anaesthetic drops are placed in the eye to numb the surface.
2. A goniolens is placed gently on the eye to view the drainage angle.
3. The laser delivers around 100 short, low-energy pulses around the trabecular meshwork (typically 360 degrees in modern UK practice).
4. The lens is removed; the procedure typically takes 5–10 minutes per eye.
5. Mild anti-inflammatory drops are used for a few days afterwards.
6. Pressure is rechecked at 4–6 weeks; the maximum effect is usually seen by 8–12 weeks.

SLT is repeatable: if pressure rises again after a few years, a second treatment can be performed with similar outcomes. Most patients have no significant side-effects beyond a brief pressure spike and mild inflammation, both of which are treatable.

MIGS surgery: minimally invasive glaucoma surgery

MIGS is an umbrella term for a group of minimally invasive devices and procedures that lower eye pressure with a far better safety profile than conventional trabeculectomy. They are typically performed at the same time as cataract surgery (so-called “phaco-MIGS”) and are particularly useful in mild-to-moderate open-angle glaucoma where the patient also has a visually significant cataract.

Common MIGS devices and procedures used in the UK

Who MIGS is best suited for

• Mild-to-moderate primary open-angle glaucoma, particularly when cataract surgery is also indicated
• Patients struggling with drop adherence or experiencing significant ocular surface side-effects
• Patients who want a chance of being drop-free without the risks of trabeculectomy
• Patients who have responded poorly to SLT or for whom SLT was not enough

Trabeculectomy and tube shunts: the gold standard for advanced glaucoma

When IOP cannot be controlled by drops, SLT or MIGS — or when glaucoma is already advanced — conventional drainage surgery is the gold standard. Trabeculectomy creates a controlled drainage channel from the front of the eye to a small reservoir (a “bleb”) under the eyelid. Tube shunts (such as Baerveldt or Ahmed valves) are silicone tubes that drain to a plate at the back of the eye and are used in eyes where trabeculectomy has failed or scarring is likely.

Outcomes and trade-offs

• Largest IOP reduction of any glaucoma procedure; can achieve target pressures in the single digits
• Most patients become drop-free or near drop-free, at least initially
• Higher risk profile than MIGS — bleb leak, hypotony, infection, scarring, vision loss
• Requires close follow-up in the first 3 months; intensive post-op drops
• Recovery to full activity can take 4–6 weeks

For patients with very advanced visual field loss, where any further damage would seriously affect daily living, the larger pressure reduction of trabeculectomy or a tube shunt is usually the right call despite the higher complication rate.

Drops vs SLT vs MIGS vs trabeculectomy at a glance

A side-by-side summary of the four main UK glaucoma treatment options in 2026, focused on what most patients actually want to know:

In real practice, most UK glaucoma patients will move through more than one step on the ladder over their lifetime. The order is decided by your consultant based on disease type, IOP target, lens status (cataract or not), and how you respond to each treatment.

UK private glaucoma treatment prices in 2026

All prices below are typical UK self-pay guide prices in 2026 for private glaucoma care, per eye, including the consultation, the treatment and standard post-procedure review. Final quotes are confirmed after a face-to-face consultation. Most insurers cover medically necessary glaucoma surgery, with the same standard-vs-premium device distinction discussed above for cataract surgery.

FAQs: glaucoma treatment options (UK, 2026)

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