Preserving the vision you count on
Fellowship-trained glaucoma specialists — from SLT laser and MIGS surgery to advanced glaucoma management, helping you preserve your vision for the long term.
What is glaucoma?
Glaucoma is a group of eye conditions characterized by damage to the optic nerve, usually associated with elevated intraocular pressure (IOP) — the fluid pressure inside the eye.
Glaucoma is a leading cause of irreversible vision loss worldwide. But here’s the good news: with early detection and proper treatment, the vast majority of patients can preserve useful vision throughout their lifetime.
The challenge with glaucoma is that it typically causes no symptoms. Optic nerve damage happens gradually and painlessly. Most people don’t notice any change in their vision until significant damage has already occurred — which is why regular screening is critical. By the time a patient notices vision loss, considerable irreversible damage may have already happened.
This is why the Canadian Ophthalmological Society recommends comprehensive eye examinations starting at age 40, even if you feel your vision is perfect. Early detection transforms outcomes.
Whether you have been told your eye pressure is elevated, have a family history of glaucoma, or have been recently diagnosed with open-angle glaucoma, angle-closure glaucoma, or normal-tension glaucoma — our glaucoma service provides specialist-level care across multiple locations.
Our glaucoma service is led by three fellowship-trained specialists with training from the University of Sydney, University of Toronto, and McGill University — with active research programs in SLT outcomes, MIGS devices, and next-generation glaucoma implants, and published work in the Journal of Glaucoma, Ophthalmology Glaucoma, and Clinical Ophthalmology.
Types of glaucoma and who is at risk
Glaucoma is not one disease — it is a group of conditions with different causes and progression patterns. Understanding your type of glaucoma helps guide your treatment plan.
Open-angle glaucoma
The most common form, accounting for about 90% of cases. Optic nerve damage develops gradually without noticeable symptoms. The drainage angle remains open but becomes less efficient at removing fluid. Often called “the silent thief of sight.”
Angle-closure glaucoma
Less common but more urgent. The drainage angle physically closes, preventing fluid from leaving the eye. Can occur gradually (chronic) or suddenly (acute angle-closure), which is an eye emergency requiring immediate treatment.
Normal-tension glaucoma
Optic nerve damage occurs despite normal eye pressure readings. Accounts for about 15% of cases and may involve reduced blood flow to the optic nerve rather than elevated pressure alone.
Secondary glaucoma
Develops as a result of another eye condition or injury — previous eye trauma, inflammation, or certain medications such as prolonged corticosteroid use.
Who is at risk?
Your risk of developing glaucoma increases significantly with:
- Age over 40 — risk increases steadily with each decade
- Family history of glaucoma — one of the strongest risk factors; if a parent or sibling has glaucoma, your risk is 4 to 9 times higher than the general population. We recommend screening for all first-degree relatives
- African, Caribbean, or Asian ancestry — higher prevalence and more aggressive disease patterns
- High myopia (nearsightedness)
- Diabetes — diabetic patients have higher glaucoma risk
- Prolonged corticosteroid use — including inhalers and topical steroids
- Previous eye injury or trauma
- Thin corneas — affects how eye pressure is measured and monitored
Even if you don’t have obvious risk factors, the Canadian Ophthalmological Society recommends regular eye examinations starting at age 40. Early detection saves sight.
How we diagnose glaucoma
Glaucoma diagnosis requires more than just measuring eye pressure. Our glaucoma specialists use a comprehensive diagnostic workup to detect even the earliest signs of optic nerve damage.
OHIP-covered diagnostics
| Test | What it measures |
|---|---|
| Tonometry | Fluid pressure inside the eye. We track pressure over time, as glaucoma damage is related to cumulative pressure exposure. |
| Gonioscopy | Drainage angle examination to determine open-angle vs. angle-closure glaucoma. Shapes the entire treatment plan. |
| OCT (retinal nerve fibre layer) | Detects structural thinning of the nerve fibre layer — the earliest detectable sign of glaucoma damage, often before functional vision loss occurs. |
| Visual field testing | Maps areas of vision affected by glaucoma damage. Early loss is often peripheral, which is why you may not notice it. |
| Pachymetry | Measures corneal thickness, which affects how eye pressure readings are interpreted. |
Advanced diagnostics (nominal fee applies)
| Test | What it measures |
|---|---|
| Corneal hysteresis | Biomechanical properties of the cornea — an independent risk factor for glaucoma progression. Helps interpret eye pressure more accurately than corneal thickness alone. |
| HRT (optic nerve mapping) | 3D maps of the optic nerve head. Provides complementary structural information to OCT for monitoring subtle changes over time. |
| Anterior segment OCT (AS-OCT) | High-resolution imaging of the drainage angle and anterior chamber. Used to assess angle anatomy before and after YAG peripheral iridotomy to confirm effectiveness of the procedure. |
| Fundus autofluorescence (FAF) | Captures natural fluorescence of the retinal pigment layer, detecting metabolic changes not visible on standard examination. |
Why early detection matters: Structural changes detected on OCT and HRT often precede functional vision loss by years. This window is where treatment is most effective.
In-office glaucoma laser procedures
Several glaucoma treatments are performed right in the clinic — no hospital visit or operating room required. These procedures are quick, effective, and well-tolerated, with most patients returning to normal activities the same day.
Selective laser trabeculoplasty (SLT)
The most effective in-office treatment for open-angle glaucoma — and increasingly used as a first-line alternative to daily eye drops. The landmark LiGHT trial showed SLT is comparable to drops for initial treatment, without the burden of daily medication. Low-energy laser pulses stimulate the trabecular meshwork to drain more efficiently. Takes 5–10 minutes, minimal discomfort, and can be repeated if the effect diminishes over time. Typical IOP reduction of 20–30% within 3–6 weeks.
Covered by OHIP
YAG laser peripheral iridotomy (PI)
Standard treatment for angle-closure glaucoma. Creates a tiny opening in the iris to relieve pressure when the drainage angle is narrow or blocked. Takes 5–10 minutes. The opening is permanent and typically does not need to be repeated. Often performed preventively before an acute episode occurs.
Covered by OHIP
Research-led care: Dr. Michaelov’s award-winning randomized controlled trial comparing 180° and 360° SLT found that 360° treatment was more effective at lowering IOP with a similar safety profile — research that earned the COS 1st Place Award for Excellence in Ophthalmic Research and directly informs how we tailor SLT for each patient (Michaelov et al., Journal of Glaucoma, 2023).
Glaucoma treatment options
The goal of glaucoma treatment is to lower intraocular pressure to a level that prevents further optic nerve damage. Treatment is highly individualized — your glaucoma specialist will recommend a step-wise approach, starting with the least invasive effective option.
| Treatment | How it works | Best for |
|---|---|---|
| Medicated eye drops | Reduce fluid production or improve drainage. Convenient, effective first-line therapy. | Most newly diagnosed patients |
| SLT laser | Stimulates the trabecular meshwork to drain more efficiently. Repeatable. | Open-angle glaucoma, first-line or adjunct to drops |
| YAG peripheral iridotomy | Creates a tiny iris opening to relieve angle-closure pressure. | Narrow or closed drainage angles |
| Micropulse (MP-TSCPC) | Modulates fluid production via gentle laser — without tissue destruction. Dr. Yuen’s published 5-year outcomes research demonstrated sustained IOP reduction with an excellent safety profile. | Patients not responding to drops, SLT, or iridotomy |
| MIGS (XEN, iStent, Ex-PRESS) | Creates new drainage pathways with minimal tissue trauma. Dr. Yuen specializes in multiple MIGS platforms — XEN gel stent, iStent, Ex-PRESS mini shunt, and MicroPulse Cyclo G6 — and selects the optimal device based on your anatomy and disease stage. | Combined with cataract surgery or standalone for inadequate control |
| Trabeculectomy / tube shunt | Traditional surgery creating a drainage channel or placing a drainage device. | Advanced glaucoma not controlled by other methods |
Research-led treatment: Dr. Yuen’s published research on micropulse cyclophotocoagulation demonstrated sustained IOP reduction over five years with no patients experiencing persistent inflammation or vision-threatening complications (Ophthalmology Glaucoma, 2020; Clinical Ophthalmology, 2024). Dr. Yuen is also the Canadian Principal Investigator for the ARTEMIS 2 clinical trial evaluating a next-generation bimatoprost sustained-release implant for glaucoma.
Your glaucoma specialist will discuss all available options during your consultation, explain the benefits and risks of each approach, and recommend a personalized plan based on your type and severity of glaucoma, your current eye pressure, and your overall health.
What to expect at your appointment
| 1 | Getting referredMost patients are referred by their optometrist or family doctor. Ask for a referral to Uptown Eye Specialists. We also accept self-referrals. |
| 2 | Your first appointmentIncludes a comprehensive eye examination, tonometry, corneal hysteresis testing, gonioscopy, OCT imaging, HRT optic nerve mapping, visual field testing, pachymetry, and a detailed discussion of your findings and personalized treatment plan. |
| 3 | Follow-up visitsEach follow-up cycle typically involves two visits. First, a diagnostic-only visit where testing is completed. Then a specialist visit to review results, assess treatment, and adjust the plan if needed. This structure ensures your specialist has all the latest data in hand. If you experience sudden eye pain, redness, halos around lights, or sudden vision loss — signs of acute angle-closure — seek immediate emergency care. |
| 4 | Ongoing coordinationWe coordinate care with your referring optometrist, and when needed, with other UVG specialists. If you need cataract surgery and have glaucoma, your surgeon can combine it with a MIGS procedure in a single visit to U Surgical Centre. If glaucoma drops are causing dry eye symptoms, we can refer you to the U Dry Eye Institute (UDEI) for coordinated care. You benefit from UVG’s integrated ecosystem at every step. |
OHIP coverage: Your specialist consultation, eye examination, tonometry, gonioscopy, visual field testing, SLT laser, YAG PI, and medically necessary glaucoma surgery are all covered by OHIP. Some advanced tests (HRT, corneal hysteresis, AS-OCT, FAF) have a nominal fee — your specialist will explain any costs before ordering.
Common questions about glaucoma
Our glaucoma specialists
Dr. Kay Lam
MD, FRCSC
Brampton · Vaughan
Dr. Evan Michaelov
MD, FRCSC
Brampton · Etobicoke · Vaughan · Scarborough
Dr. Darana Yuen
MD, FRCSC
Brampton
Concerned about glaucoma?
Whether you’ve been recently diagnosed, need a second opinion, or want to explore your treatment options, our glaucoma specialists are here to help. Most patients are referred by their optometrist or family doctor — ask for a referral to Uptown Eye Specialists.
We see patients across multiple locations throughout the Greater Toronto Area.