What is Glaucoma?

The optic nerve transmits the image of the object seen by the eye to the brain. It is made up of several     wire-like fibres. Glaucoma is a disease affecting the optic nerve. When raised intraocular pressure (IOP)      damages the optic nerve, dark spots     appear in the field of  vision. Initially, the affected  person does not notice these spots. One begins to notice them only when     substantial damage is already done to the optic nerve. When the optic nerve is completely damaged  it causes blindness. Early consultation with an ophthalmologist and starting of treatment helps prevent damage to the optic nerve and eventual blindness.

What causes Glaucoma?

A clear liquid, Aqueous Humor (not to be confused with tears), circulates in the front portion (anterior) of the eye. To maintain adequate pressure in the eye, aqueous humor is produced in a certain quantity and the same amount of liquid is drained out of the eye. If,  for some reasons, the drainage is obstructed then    adequate amount of liquid cannot be drained out of the eye resulting in raised IOP, damaging the optic nerve.

Are there different types of Glaucoma? 

Yes, mainly of two types.

1. Open Angle Glaucoma: The draining process in some people slows down with ageing. This results in gradual increase in IOP which  may  damage the  nerve.  The nerve  in  some patients is so sensitive that it cannot withstand even normal IOP and is at more risk of damage to the nerve. There are no symptoms at the beginning of this type of  Glaucoma and the vision is also not affected.        However, as the damage increases, dark spots appear in the field of vision. Most patients do not notice them initially, but as their size increases they affect the   central vision. By that time the nerve is  already    damaged considerably. If the nerve is totally damaged then blindness results. In short, in this type of glaucoma the patient is not aware till the field of vision is contracted considerably. So, examination at a regular interval by an ophthalmologist is necessary. The likelihood of such    Glaucoma increases with the age. It is known as ’sneak thief of sight’ as there are no timely symptoms.  

2. Closed Angle Glaucoma: The anterior segment in the eyes of some people is narrow which brings the iris (coloured portion in the middle) closer to the drainage area. This makes the way narrower than normal. It is usually associated with Hyperopia (+ numbers).  Sometimes the iris covers the drainage area completely which stops the outflow of humor. This in turn rapidly increases the IOP, causing an acute attack of glaucoma. The symptoms of such   attack of glaucoma are blurred vision, pain in the eye, headache, halos around light source, vomiting, etc. If a patient experiences any of these then he/she must immediately  consult the doctor  and start treatment. Failing this, one may suffer blindness. Sometimes an attack of low intensity may subside without any treatment, but the subsequent attack can be severe. Every time there is an attack, some fibres of optic nerve are permanently damaged.

Who can get Glaucoma?
  • People over 40 years
  • Those with family history of glaucoma
  • Those with high number of specs
  • Those with eye injury or surgery
  • Those with diabetes, migraine, etc.
  • Those on steroids medication
  • Those with one or more of these reasons have greater likelihood of being affected with glaucoma than normal people. Such persons must get their eyes checked at regular intervals. Timely diagnosis and treatment stops further damage to the nerves.
What are the symptoms of Glaucoma?

If a person has even one of the following symptoms then glaucoma can be suspected.
  • Blurred vision
  • Frequent change in numbers of specs  leading to boredom in activities like   reading.
  • Colourful halos around light sources
  • Pain in the eyes after activities done in dim light or exciting moments. 
How is Glaucoma diagnosed?

Regular check up is necessary for timely diagnosis of Glaucoma. The following are the tests to detect Glaucoma though every patient does not need to undergo all tests.
Measuring the IOP (Tonometry)
Checking whether any nerve is damaged (Ophthalmoscopy)
Checking the field of vision (Perimetry): To diagnose Glaucoma accurately. Also, whether the damage in the eye of a patient undergoing treatment has increased can be known.
Checking the drainage system of the humor (Gonioscopy)
Examination of nerve and its fibres through special computerized photography and analysis.

How is Glaucoma treated?
Glaucoma can be treated with eye drops, tablets, laser or surgery which may help in stopping further damage to the nerve. It is not possible to reverse the damage already done to the nerve. Remember, Glaucoma can not be cured completely. Those    diagnosed with glaucoma should regularly get their eyes checked to know the status of the optic nerve. In short, early detection and timely treatment      prevents further damage to the nerve.

Medicines:
Regular use of eye drops controls glaucoma by    controlling IOP.   Changing or stopping drops without the consent of the doctor can be dangerous.

Laser Treatment: 
Sometimes laser treatment is recommended to those with narrow anterior segment who are more likely to develop closed-angle glaucoma. It is suggested as a preventive measure to avoid acute attack of glaucoma. In this treatment a hole is made with  laser to make an alternative path to restore the flow of aqueous humor.

Surgery: 
When glaucoma can not be controlled by either medicines or laser treatment the patient is   advised surgery. Glaucoma surgery is done with modern micro instruments to create an alternative path to restore normal flow of aqueous humor.

What should the patient do?
Cooperation between the patient and the doctor is important for effective treatment of Glaucoma.  Medication as advised and regular check up help in controlling Glaucoma. This stops further damage to the nerve.

Guide for check up of eyes as suggested by American Academy of Ophthalmology:

About 2% of people over 40 years have Glaucoma.

Age Patient with family history  Others
20 to 29 Yrs Every  3 – 4 Years Once
30 to 39 Yrs Every  2 – 3 Years Every 5 Years
40 to 65 Yrs Every  1 – 2 Years Every 2 – 3 Years
More than 65 Yrs Every Year Every Year

However, more than half are not aware of it. Hence, regular check up is advised for them.

Glaucoma patients must remember: timely detection,  regular check up and treatment prevent blindness. Carelessness can be dangerous and lead to blindness.

Glaucoma Management

Diagnosis and Management of glaucoma at the earliest possible stage is very important for long term preservation of a patient’s sight.

Diagnosis of Glaucoma: 
We are fully equipped with all types of glaucoma assessment system including Non-Contact Tonometry, Applanation Tonometry, Fundus Photography, Perimetry, Gonioscopy and Pachymetry for best management of glaucoma. Those diagnosed with glaucoma should regularly get their eyes checked to know the status of the optic nerve. In short, early detection and timely treatment prevents further damage to the nerve.

We have the facility of Automated Perimetry test (Visual Field Examination) which is the diagnostic test for detecting and monitoring Glaucoma. It is also extremely important for evaluation of further damage (monitoring) in already diagnosed cases of Glaucoma.    

Examples of Automated Perimetry Reports


Management of Glaucoma: 
At BECC we provide comprehensive management for Glaucoma
1)  Medicines: Anti Glaucoma Medication (Eye drops, Oral medicines)
2)  Laser: It is advised in some cases to prevent attack of Glaucoma.
3)  Surgery: Surgery is advised in cases when medicines or Laser cannot control Glaucoma. We are well equipped for standard. Anti Glaucoma surgeries as well as surgeries using newer filtering devices such as valves and stents for Advanced Glaucoma.