Glaucoma Care

Glaucoma is often referred to as "silent thief of vision" as it can strike without any symptoms. However, some glaucoma patients may suffer symptoms like:

• Severe eye pain in case of angle closure glaucoma
• Blurred vision
• Frequent changes of reading glasses
• Difficulty in seeing side vision

Everyone is at risk of getting affected by Glaucoma. But certain risk factors for the disease are:

• High intraocular pressure
• Age - risk increases with age, especially those beyond 40 years of age
• Heredity - Primary open angle glaucoma risk is high if there is a family history of glaucoma
• Ethnicity - Glaucoma is common among Asians, Africans, Americans and Hispanics.
• Traumatic eye injury - in such cases, glaucoma can occur immediately after the injury or even in later years
• High myopia (nearsightedness)
• Diabetes
• Thyroid disease
• Hypertension
• Steroids intake

Periodic eye check-up is the best way to detect Glaucoma early. Glaucoma can be detected using following basic tests:

• Visual acuity test
• Tonometry, to measure the eye pressure
• Gonioscopy, to assess angle of anterior chamber
• Evaluation of optic disc damage by fundoscopy
• Perimetry Test for visual field examination
• OCT RNFL test to measure the thickness of the nerve fiber layer.

Glaucoma can be of two types. In open angle glaucoma, the drainage pathway is wide open, still there is increased eye pressure due to increased formation of aqueous humour (fluid of eye). In closed angle glaucoma, eye pressure is raised due to blockage in the drainage pathway of the fluid due to narrow or closed angle of the eye. Apart from this, some people also have secondary glaucoma, i.e developing glaucoma as a result of some other disease in the eye eg diabetic retinopathy, venous occlusion in the retina, after trauma etc.

Glaucoma cannot be cured, but it can be controlled. As damage to nerve caused by glaucoma cannot be reversed, the aim of the treatment is to prevent or reduce further damage to the optic nerve. The first step to do that is to lower the eye pressure. The three modalities of treatment are:-

Medical treatment:

• Your doctor will prescribe you certain medication (Eye drops and tablets) so as to lower your eye pressure. You must use the medicines regularly as directed by your ophthalmologist.
• You should not stop medicines even if you do not have symptoms.
• A regular follow up, as advised by your doctor, is mandatory.

Laser treatment:
A laser peripheral iridotomy (PI) is required for patients with angle closure glaucoma to open up the drainage area for the fluid of the eye (aqueous humour). It is a simple outpatient procedure which can protect the eye from developing attacks of angle closure attack in the future.

Surgery (Glaucoma Filtering Microsurgery or "By-pass" surgery of eye - Trabeculectomy)

Operation for glaucoma is suggested for patients in whom the eye pressure is not controlled with medication or laser. It is also the treatment of choice in non-compliant patients, and in infants and children with glaucoma. Filtering microsurgery involves creating a drainage pathway with the use of a small surgical tool, to bypass the blockage in the eye’s trabecular meshwork (the eye’s drainage system). This opening helps increase the flow of fluid out of the eye and thereby reduce the eye pressure.

Glaucoma surgery is a major surgery, and it requires regular checkup even after surgery. The surgery is performed under local anesthesia (injection), hence the patient does not feel any pain during the surgery. It is important to remember that life long checkup is mandatory even after surgery, and sometimes a patient may require medicines to control eye pressure after surgery.

Things to remember about Glaucoma:

• Glaucoma, like diabetes, cannot be cured only controlled
• Vision lost due to glaucoma cannot be recovered
• Early detection and treatment of glaucoma will prevent further loss of sight and blindness
• It is essential that people above the age of 40 and those with family history of glaucoma should have their eye examined periodically to detect glaucoma early
• Once diagnosed as having glaucoma, the patient should be committed for life-long treatment and periodic eye check-up.
• Drugs prescribed by the doctor should be regularly used at the specified time to ensure round the clock pressure control.