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Glaucoma and ELIOS: Implant-Free Laser Treatment During Cataract Surgery

Glaucoma, ELIOS, Laser Vision

Glaucoma rarely announces itself. In its most common form there is no pain, no redness and no obvious change to your vision until the damage is already done. That is why it is often called the silent thief of sight.
The good news is that glaucoma can be controlled, and treatment has moved on a long way. At Laser Vision, part of Prema, our surgeons can now offer ELIOS, an implant-free laser procedure that lowers eye pressure by restoring the eye’s own drainage. For many patients it can be carried out at the same time as cataract surgery, treating two conditions in one visit.

What is glaucoma?

Glaucoma is a group of eye conditions that damage the optic nerve, the cable that carries visual information from your eye to your brain. It is usually linked to pressure inside the eye, known as intraocular pressure (IOP), although damage can occur at normal pressures too.
Your eye constantly produces a clear fluid that drains away through a channel where the iris meets the cornea, called the drainage angle. If that fluid cannot drain properly, pressure builds and the optic nerve is gradually harmed.
There are two main types:

  • Open-angle glaucoma is the most common. The drainage angle looks open, but fluid drains too slowly over time. Vision loss starts at the edges and creeps inwards so gradually that most people do not notice it.
  • Angle-closure glaucoma happens when the iris sits too close to the drainage angle and blocks it. It can develop slowly, or suddenly as an acute attack with severe eye pain, headache, blurred vision, haloes around lights and nausea.

An acute attack is a medical emergency.
Lost vision cannot be restored, but treatment with eye drops, laser or surgery can slow or stop further damage. Early detection is everything.

Who is at risk of Glaucoma?

Anyone can develop glaucoma, but your risk is higher if you:

  • are over 40, with risk rising further with age
  • have a close family member with glaucoma
  • are of African, Caribbean or Asian heritage
  • are significantly short-sighted (more linked to open-angle) or long-sighted (more linked to angle-closure)
  • have diabetes or high blood pressure
  • have used steroid medication for long periods
  • have had a previous eye injury

If any of these apply to you, regular, thorough eye examinations are the single most useful thing you can do to protect your sight.

What is ELIOS?

ELIOS stands for excimer laser trabeculostomy. It is a type of minimally invasive glaucoma surgery (MIGS), now part of the Bausch + Lomb portfolio, and has been registered for use in the UK since 2023.
In open-angle glaucoma, the eye’s natural drainage tissue, called the trabecular meshwork, becomes less efficient over time. Fluid backs up and pressure rises. ELIOS uses a fine laser probe to create ten tiny microchannels, each around 0.2mm across, through this tissue. These open up a direct route for fluid to leave the eye, lowering pressure using the eye’s own drainage system.

Two things set ELIOS apart:

  • No implant. Many other MIGS procedures place a permanent stent inside the eye. ELIOS leaves nothing behind.
  • A cool laser. The excimer laser removes tissue without generating heat, which minimises the healing response and scarring that can cause drainage channels to close up again. It is the same family of laser used in laser vision correction.

Who is ELIOS suitable for?

ELIOS is designed for adults with mild to moderate open-angle glaucoma, or raised eye pressure (ocular hypertension). It may be a good option if you:

  • need cataract surgery and also have glaucoma or raised eye pressure
  • rely on one or more glaucoma eye drops and would like to reduce that burden
  • find drops difficult to use, or experience side effects from them
  • have glaucoma that is not well controlled by drops or SLT laser alone

The combination is more common than you might think. Up to one in five people having cataract surgery also have glaucoma or raised eye pressure, which makes cataract surgery an ideal opportunity to address both.
ELIOS can also be performed as a standalone procedure. It is not suitable for every type of glaucoma, so your surgeon will assess your eyes in detail before recommending it.

How the procedure works

When combined with cataract surgery, ELIOS adds only a few minutes to the operation:
1. Your eye is numbed with anaesthetic drops, and you are awake but comfortable throughout.
2. Your surgeon carries out cataract surgery in the usual way, through a tiny incision.
3. Through the same incision, a fine laser probe is guided to the drainage angle.
4. Ten microchannels are created in the trabecular meshwork, one pulse at a time.
5. The probe is removed, leaving no implant inside the eye.

No extra incisions are needed, and you go home the same day.

What does the evidence show?

  • ELIOS has been used across Europe for more than a decade, so there is long-term data behind it.
  • Lasting results. An eight-year study followed 161 eyes treated with ELIOS alongside cataract surgery. Eye pressure remained well controlled, and only 3.7% of patients needed further glaucoma surgery over the whole eight years.
  • Fewer drops. Two-year results from a large trial of 318 patients, presented at the ESCRS Congress in London in September 2026, showed sustained pressure reduction, with most patients no longer needing glaucoma medication.
  • A strong safety record. In clinical studies, side effects after ELIOS combined with cataract surgery have been in line with those seen after cataract surgery alone, which is one of the safest operations performed.
  • Results vary from person to person, and your surgeon will discuss what you can realistically expect.

Recovery and aftercare

Because ELIOS adds so little to cataract surgery, recovery is very similar. Most people notice their vision improving within days as the cataract is cleared, and return to normal daily activities quickly.
You will use eye drops for a few weeks after surgery to help your eye heal. Your surgeon will check your eye pressure at follow-up appointments and advise whether any of your existing glaucoma drops can be reduced or stopped. Please never stop glaucoma medication without your surgeon’s advice.

It is important to know that ELIOS does not cure glaucoma or reverse sight already lost. Glaucoma is a lifelong condition, so regular monitoring remains essential. What ELIOS offers is better pressure control, often with less reliance on daily drops.

Is ELIOS right for you?

If you have glaucoma or raised eye pressure, and especially if you are also thinking about cataract surgery, ELIOS could help you manage both in a single, implant-free procedure.

Book a consultation with Laser Vision, part of Prema, to find out whether ELIOS is suitable for you. Our consultant ophthalmic surgeons will carry out a thorough assessment and talk you through every option.

If you experience sudden eye pain, blurred vision, haloes around lights, headache or nausea, seek urgent medical attention at your nearest A&E or eye casualty department.

Sources

Reviews

 
 
 
 
 
 
 
  
 
 
 
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 Colin D. profile picture 
 
 
 Colin D. 
 
 
 
 Google star 1Google star 2Google star 3Google star 4Google star 5Trustindex verifies that the original source of the review is Google. 
I was initially going to write a brief review, but thought it might be beneficial to anyone considering using LaserVision Prema, if I gave a more detailed account of my personal experience? After 10 years of my eyesight gradually deteriorating due to age, wearing glasses became a necessity for all distances, which constantly frustrated me after having had perfect vision for most of my life. I'd heard of lens replacement surgery, so looked deeper into it and due to their positive reviews, settled on LaserVision Prema for an initial consultation to discuss options. From the outset, the experience has been amazing. The staff are friendly, making patients feel very welcome and at ease, there's no pressure to agree to have anything done and any concerns you have will be addressed, including any negative points you may need to consider? During the initial consultation, my eyes were thoroughly examined using a variety of methods and equipment, which gave me confidence the results would be accurate. Following this, I met with Rakesh, who performs the operations, to discuss the different options available based on the results. Fortunately, my eyes were suitable for any of the procedures. Rakesh took the time to make sure I knew exactly what the pros and cons of each lens type were, he also ensured I was aware that although my vision would likely be much better, nothing available at the present time will give me perfect sight back? In the end, I decided to opt for lenses which would improve vision at all distances. On the day of the operation, staff do everything to relax patients, and nothing feels rushed. The whole experience was easy and completely painless, taking approximately 15-20 minutes per eye. Throughout the procedure Rakesh will ensure you're fine. Although you can see enough to walk immediately afterwards, your vision is initially very much reduced, so you won't be able to drive. I'd booked a room in the Travelodge opposite in case I wasn't able to travel after the operation and walked to it without assistance. LaserVision Prema provide you with various eye drops, required to be used several times a day for a couple of months to ensure your eyes properly heal. I used these as prescribed and didn't experience any problems. As the day went on my vision started slowly improving, to the point where I could watch a film on my iPad, without it being too blurry. Later in the evening, I looked out the window and was immediately aware of a massive improvement to my distance vision, being able to see things clearly at distances I previously would have needed glasses for. The only discomfort in the entire process was in the evening after I'd had the operation, my eyes felt like they were gritty and began to water for two or three hours. Although it was quite annoying and noticeable, it was manageable. After a few hours my eyes stopped watering and the grittiness was at the point where I no longer thought about it. Rakesh called me late in the evening, in his own time, to ask how I was getting on and make sure I was ok? This is the level of care LaserVision provide. The morning after the operation, the improvement to my near, intermediate and far distance sight was incredible. This was done in December 2025 and since then, I haven't needed to ever wear glasses again for anything, at any distance - I don't even own a pair now! To give an idea, I can read unaided N4 size words on a reading chart. As Rakesh pointed out, it hasn't given me totally pin sharp eyesight back, but it really isn't far off and seven months later, I'm still amazed at what LaserVision Prema was able to achieve. The operation itself isn't the end of the process, you will also receive an aftercare service of follow up visits to check everything is as expected and to ensure you are happy with your progress. As mentioned, the results in how much your eyesight can be improved differs from person to person. This review is purely to highlight how impressed I am with LaserVision Prema, their professionalism and level of care provided to patients.
  
 
  
 
 
 
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 Fab Smith profile picture 
 
 
 Fab Smith 
 
 
 
 Google star 1Google star 2Google star 3Google star 4Google star 5Trustindex verifies that the original source of the review is Google. 
Tim Ford literally gave me my vision back — life-changing care! For years I’ve struggled with contact lenses, feeling frustrated and limited by my keratoconus. But from the moment I met Tim Ford, everything changed. He didn’t rush; he truly listened to my challenges, understood exactly what I’d been going through, and carefully created a personalised plan that finally works for me. His expertise, patience, and kindness are incredible — he didn’t just treat my eyes, he cared about restoring my quality of life. I can’t believe the difference; it feels like he has truly given me my vision back. If you’re looking for an optometrist who goes above and beyond, especially for complex eye health, Tim is absolutely amazing. Thank you so much for everything! 🙏✨
  
 
  
 
 
 
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 Nigel Steward profile picture 
 
 
 Nigel Steward 
 
 
 
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Excellent professional care.
  
 
  
 
 
 
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 Darren Toomer profile picture 
 
 
 Darren Toomer 
 
 
 
 Google star 1Google star 2Google star 3Google star 4Google star 5Trustindex verifies that the original source of the review is Google. 
I have been delighted with the level of care provided by Rakesh and his team during my eye lens replacement surgery. The results of the surgery have been nothing less than life-changing. I shall always remain extremely grateful to the gift of 20:20 sight given to me.
  
 
  
 
 
 
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 Peter Dixon profile picture 
 
 
 Peter Dixon 
 
 
 
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Excellent, could not have asked for more.
  
 
  
 
 
 
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 ros summers profile picture 
 
 
 ros summers 
 
 
 
 Google star 1Google star 2Google star 3Google star 4Google star 5Trustindex verifies that the original source of the review is Google. 
Excellent service, very friendly approachable staff. My eye condition was identified quickly & medication prescribed. So pleased I decided to book my initial appointment. Highly recommended
  
 
  
 
 
 
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 Janey Power profile picture 
 
 
 Janey Power 
 
 
 
 Google star 1Google star 2Google star 3Google star 4Google star 5Trustindex verifies that the original source of the review is Google. 
Absolutely incredible service so far. The most attentive staff that greet me by name and make me feel so valued. My Ophthalmic Surgeon, Mr Rakesh Jayaswal has made everything understandable and couldn’t be a nicer, more relatable gentleman than he is. The professionalism from all staff especially Vicky, Tracey, Jane and Rakesh, has made me feel so secure and I know I’m in safe hands. The lens replacement surgery was a bit strange but painless and over quickly. Now just looking forward to my recovery. My sincere thanks to all involved . It is now 5 months post surgery and I cannot believe the quality of the aftercare that I have received from Vicky and Rakesh. My biggest concern was that after paying for surgery, I would just be left then to get on with things but they have seen me regularly and given me the most incredible service. Nothing was too much trouble and they have checked and checked my vision every step of the way. I have been made to feel like an important guest and their warmth and concern has made me feel so special. For anyone considering Prema, please take my word for the most incredible experience and I can read, see and do jigsaws with NO GLASSES. Words are not enough to thank them for what they have given me. 5 stars are not enough!!!
  
 
  
 
 
 
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 Alison Philp profile picture 
 
 
 Alison Philp 
 
 
 
 Google star 1Google star 2Google star 3Google star 4Google star 5Trustindex verifies that the original source of the review is Google. 
Caring, empathetic staff with a lovely atmosphere in the clinic. The time taken to make sure I was happy with the treatment was never rushed & the whole procedure was so much more relaxed than I would have thought possible. Amazing.
  
 
  
 
 
 
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 Robert James profile picture 
 
 
 Robert James 
 
 
 
 Google star 1Google star 2Google star 3Google star 4Google star 5Trustindex verifies that the original source of the review is Google. 
Very well looked after by Mr Tapper at his Nuffield Woking clinic today, following a capsulotomy by him 6 weeks ago. I now have greatly improved vision in the affected eye. The LaserVision support team are also excellent. I would not hesitate to recommend this clinic to others.
  
 
  
 
 
 
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 Lynette Marshall profile picture 
 
 
 Lynette Marshall 
 
 
 
 Google star 1Google star 2Google star 3Google star 4Google star 5Trustindex verifies that the original source of the review is Google. 
If you are nervous about eye surgery, I highly recommend LaserVision Prema in Portsmouth. They looked after me so well from start to finish. Mr. Rakesh Jayaswal is a true gentleman whose calm manner and precision made me feel completely comfortable. The team is professional, kind, and happy to answer any questions. A five-star experience!
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