When I Recommend Glaucoma Surgery & When I Don’t, Dr Shibal Bhartiya, fellowship trained glaucoma specialist in Gurgaon, explains her treatment protocols.
Being advised surgery, for any eye condition, raises immediate questions. Is this really necessary? Is there another option? Am I being rushed? These are reasonable questions. This page explains how I think about surgery recommendations in glaucoma, and what criteria guide that decision in both directions.
Glaucoma surgery can be life-changing when done at the right time, for the right reason. It can also create new problems when done too early, too routinely, or without fully understanding the long-term implications.
If I recommend not rushing to surgery, it is not because:
- Your condition is being ignored
- Your concerns are not serious
- Nothing needs to be done
It is because:
- There may be safer ways to stabilise the condition first
- The risks of surgery currently outweigh the benefits
- Careful monitoring may protect your vision just as effectively, with fewer lifelong consequences
In chronic eye diseases, surgery is often irreversible.
That makes timing as important as technique.
When surgery is the best option, I will explain:
- Why now is the right time
- What problem surgery is solving
- What it can and cannot achieve
- What lifelong follow-up will still be required
The goal is never to delay necessary treatment.
The goal is to ensure that when we intervene, we do so with confidence, clarity, and foresight.
I recommend surgery when not intervening carries a higher long-term risk than intervening. This decision is never based on urgency alone.
It is based on thresholds, clinical, functional, and temporal, being crossed.
I recommend surgery when:
- There is evidence that the disease is progressing despite appropriate medical care
- The risk of irreversible vision loss is increasing
- The window where surgery can be most protective is beginning to close
- Continuing to wait would limit future options or outcomes
In other words, surgery becomes the most conservative option when observation or medication is no longer sufficient to protect long-term vision.
When I advise surgery, it is because:
- The problem is now structural, not just numerical
- The cost of delay is greater than the cost of intervention
- Acting earlier offers a better chance of stability than acting later
This does not mean surgery guarantees perfect vision.
It means surgery offers the best available path to preserving function going forward.
Before proceeding, I will always explain:
- What has changed since earlier discussions
- Why surgery now makes sense in the long arc of the disease
- What surgery is realistically expected to achieve
- What it will not undo or reverse
- How care continues after surgery- because surgery is a step, not an endpoint
Recommending surgery is not a departure from careful thinking.
It is the result of it.
The aim is the same as always: to intervene once, thoughtfully, at the moment where it protects you most from future loss. Good glaucoma care starts with understanding, not alarm.
If you’ve been advised treatment, surgery, or long-term monitoring and would like to understand the reasoning, including what happens if you wait, I’m happy to walk you through it.
What surgery does not change
Surgery in glaucoma controls pressure. It does not restore vision already lost. Neither does it eliminate the need for monitoring. It does not mean the disease is over.
After glaucoma surgery, patients still need regular OCT scans, visual field tests, and pressure checks. Some patients need ongoing drops even after a successful procedure. The optic nerve remains vulnerable to any future pressure rise.
Surgery is a powerful step in glaucoma management. It is not a full stop. Understanding this before surgery makes the follow-up period easier to navigate — and reduces the disappointment that comes when patients expect surgery to mean they are “fixed.”
Frequently Asked Questions: Glaucoma Surgery — When It Is Recommended and When It Is Not
When is glaucoma surgery actually necessary?
Surgery is recommended when glaucoma continues to progress despite appropriate medical treatment, when the optic nerve is sustaining ongoing structural damage, when pressure cannot be brought to a safe level with drops or laser, or when the window for effective intervention is beginning to close. At that point, surgery is not an aggressive decision — it is the most conservative option available for protecting remaining vision.
Why might a glaucoma specialist advise against surgery right now?
There are several legitimate reasons to defer surgery. Drops or laser may still be providing adequate pressure control. The risk of surgical complications may currently outweigh the benefit. Observation with structured monitoring may be protecting the nerve just as effectively. In chronic eye disease, surgery is often irreversible — which makes timing as important as technique. Not recommending surgery yet is not the same as ignoring the problem.
Does glaucoma surgery cure the disease?
No. Glaucoma surgery controls eye pressure. It does not restore vision already lost, and it does not stop the disease permanently in all cases. After surgery, monitoring continues — OCT scans, visual field tests, pressure checks — and some patients require ongoing drops even after a successful procedure. Surgery is a significant step in glaucoma management. It is not a full stop.
What are the risks of having glaucoma surgery too early?
Operating before it is necessary can reduce future treatment options, introduce lifelong surgical risks before they are warranted, and solve a short-term pressure problem at the cost of long-term flexibility. Glaucoma surgery changes the anatomy of the eye permanently. That change needs to be justified by the clinical situation — not by pressure alone or by patient or surgeon anxiety.
What are the risks of delaying glaucoma surgery too long?
Waiting too long allows progressive optic nerve damage to accumulate. By the time surgery becomes unavoidable, the functional reserve may be smaller, the disease harder to control, and the outcomes less predictable. The ideal timing for surgery is before crisis — when it can be planned carefully, performed under optimal conditions, and expected to achieve meaningful long-term pressure reduction.
Should I get a second opinion before agreeing to glaucoma surgery?
Yes — if you have any uncertainty. A second opinion before an irreversible procedure is not a sign of distrust. It is a sign of good judgement. A structured glaucoma second opinion can confirm whether surgery is indicated, whether the timing is right, and whether the proposed procedure is the most appropriate one for your specific anatomy, disease stage, and long-term goals. Bring all previous reports, scans, and pressure records.
What should my surgeon explain before recommending glaucoma surgery?
Before agreeing to surgery, you should understand: what has changed since your last assessment that makes surgery appropriate now, what specific problem surgery is expected to solve, what pressure target the surgery aims to achieve, what realistic outcomes look like, what the surgery cannot reverse or undo, and what monitoring and care will be required afterward. If any of these have not been clearly explained, ask — or seek a second opinion.
Read the research articles
This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. This article was edited in April 2026.
She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.
Available on Pubmed and Google Scholar
Dr Shibal Bhartiya
Glaucoma • Second Opinion • Advanced Care
www.drshibalbhartiya.com
+91 88826 38735
