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Glaucoma

Glaucoma Diagnosis

Glaucoma, a leading cause of blindness in the world, especially for older people. However visual loss is preventable or stabilized with early diagnosis and treatment. Glaucoma is a condition of the eye where the optic nerve is damaged. The optic nerve carries images to the brain, which are then perceived as vision. Minute nerve fibres from various parts of the retina join to form the optic nerve. Glaucoma results when the pressure within the eye is high enough to be detrimental to the normal functioning of these nerve fibres, some of which stop functioning. Non-functional nerve fibres result in a loss of retinal function in the area from where they originate, leading to defects in the field of vision. The disease is called the ‘sneak thief of sight’ because it is painless, without symptoms and irreversible. Therefore, the person with glaucoma is usually unaware of it until much loss of vision has occurred. In fact, half of those suffering damage from glaucoma do not know it. Currently, damage from glaucoma cannot be reversed and if the entire nerve is damaged, blindness results. Early detection and regular treatment are the keys to preventing optic nerve damage and blindness from glaucoma.

WHAT CAUSES GLAUCOMA?

The aqueous humour is the clear fluid circulating within and nourishing some parts of the eye which have no blood supply. ‘Normal’ individuals have an equal production and drainage of this fluid resulting in a constant pressure within the eye. If the drainage is compromised due to any reason, there is a pressure build-up in the eye, which can damage the optic nerve.

WHAT ARE THE DIFFERENT TYPES OF GLAUCOMA?

  • Most common type of glaucoma.
  • The increase in IOP occurs slowly over time, pushing on the optic nerve and the retina at the back of the eye.
  • Painless, asymptomatic.
  • You are at a high risk if you have a parent or grandparent with open-angle glaucoma.
  • Children of the parents having glaucoma should be checked regularly after the age of 35 years, as glaucoma usually runs in family.
HOW IS GLAUCOMA DETECTED?

Regular eye examinations by the ophthalmologist leads to detection.
The complete and painless examination includes (among other tests):
- Tonometry – Measurement of intraocular pressure
- Gonioscopy – Inspection of drainage angle of the eye
- Ophthalmoscopy – Evaluation of optic nerve damage
- Perimetry – Testing the visual field of each eye
- GDXVCC – Retinal nerve fiber layer analyser
- OCT – Retinal nerve fiber thickness and optic cup–disc size

WHO IS AT RISK FOR GLAUCOMA?
  • Family history of glaucoma
  • Age over 45 years and not regular with eye exams
  • Near-sightedness (myopia)
  • Any injury to your eyes
  • Secondary to cataract, inflammation, tumours
  • Long-term cortisone medication
About Symptoms
  • Poor night vision
  • Sensation of blind area
  • Headaches in early morning or after dusk
  • Pain in eye, especially with smoky vision
  • Halos around lights
About Risk Factors

People with high pressures have greater risk. Advancing age, high myopia, family history, diabetes, past injuries, surgeries, anaemia, or shock increase risk. High risk with no optic nerve damage: monitored as 'glaucoma suspect.'

About Early Detection

Regular eye examination by an ophthalmologist is the best way to detect glaucoma. During a complete work up for glaucoma, your ophthalmologist will measure the intraocular pressure (tonometry), inspect the drainage angle of the eye (gonioscopy), evaluate for optic nerve damage (ophthalmoscopy), and test the visual field of each eye (perimetry). These tests must be repeated regularly to monitor the progress of disease.

Management

Glaucoma can't be cured, but can be controlled and further damage slowed/halted. Requires lifelong treatment and regular checkups.

  • Medical: Eye drops (sometimes pills) to reduce eye pressure, used regularly at prescribed intervals.
  • Possible side effects: Stinging, redness, blurring, headaches. Rare: pulse, heartbeat, breathing changes. Pills may cause tingling, drowsiness, loss of appetite, bowel/kidney issues.
  • Laser surgery: Trabeculoplasty (open angle); Iridotomy (angle-closure).
  • Surgery: Trabeculectomy (advanced cases), glaucoma valve implants (if other surgeries fail).
The goal is to lower the eye pressure to a safe level that prevents further optic nerve damage.
The success of your treatment depends entirely on teamwork between you and your ophthalmologist. It is therefore important to communicate with your doctor and keep all the follow-up appointments. If you don’t, glaucoma could be stealing your sight without your knowledge!

Suggested Glaucoma screening schedule in High Risk groups

  • People with high intra-ocular pressure (IOP): Regular visit to eye specialist for Tonometry, Fundus and Visual field aa a testing.
  • People over the age of forty years with no previous glaucoma: At least once every two years, specially whenever there is a change of reading glasses.
  • Family history of glaucoma: Regular screening from younger age for people with parents or close blood relatives a suffering from glaucoma.
  • People having minus or plus numbered glasses: Once a year.
  • Other high risk factors: Like diabetes, injury to eye, a major eye surgery, prolonged steroid use etc. need more frequent screening as advised by the treating physician.