Glaucoma - What About It?

Glaucoma is a blinding disease, estimated to be present in about 8% of population, in which the Optic Nerve is damaged, usually due to high pressure inside the eye( but can also happen with normal Eye Pressure). This damage can lead to loss of vision which cannot be reversed after it has occurred. However, early treatment can control this disease and prevent or delay blindness.

In most people it is without any symptoms, esp. in Chronic type. So most patients are not diagnosed before extensive damage is done. Hence regular eye examination are important.

Symptoms can be: (a) Frequent change in reading glasses (b) Difficulty in dark adaptation. (c) Bumping into things at unfamiliar places.(d) Blurred or foggy vision. (e) Coloured halos (rainbow coloured rings) around lights. (f) Acute type may present with severe eye pain, vomiting, & vision loss.

Hence, Early diagnosis, proper treatment & proper monitoring are very essential to preserve vision till life span. All people over 45 yrs age & all first relatives of known glaucoma patients must get themselves checked for Eye Pressure and Glaucoma periodically.

Early & appropriate diagnosis is done by judicious use of

1. Applanation Tonometry: Gold standard to measure Eye Pressure
2. Pachymetry: For corneal thickness influencing eye pressure check
3. Early morning: Eye Pressure check to know pressure variations in a day
4. Stereoscopic: Optic nerve examination & photography
5. Automated Perimetry: To detect visual field defects
6. Gonioscopy: To diagnose type of glaucoma- open angle or angle closure- which have different lines of treatment

In present days, OCT(Ocular Coherence Tomography) is used to image the optic nerve but its use is supportive and still not considered a standard of care.

Medical treatment with eye drops & regular follow-ups to ensure pressure control, compliance, address adverse effects , detect progression if any , can help to maintain the vision for a long time

Those patients who are not regular in using drops or who do not follow up as advised or are not controlled by maximum tolerated medical treatment or have narrow angle type of glaucoma may be treated by Surgical/ LASER treatment as under,

1. Trabeculectomy: Fluid bypass for open angle type
2. Laser Peripheral Iridotomy: Fluid bypass for narrow angle type
3. Laser Trabeculoplasty: A stop gap treatment in place of medicines
4. Laser Cyclophotocoagulation: For blinded painful glaucoma eyes
5. Glaucoma Valve: In glaucoma not responding to usual surgical treatment. If you wish to discuss about any specific problem, you can consult an Ophthalmologist.