Introduction Glaucoma is an eye condition in which the optic nerve is damaged progressively leading to gradual loss of vision. Good health of the optic nerve is required for maintaining good vision. Glaucoma is usually associated with an increase in the fluid inside the eye causing high pressure inside the eye. This increased pressure (called intraocular pressure) causes gradual damage to the optic nerve leading to a progressive decrease in vision, sometimes, total blindness, if not treated at an appropriate time. Glaucoma is a leading cause of permanent total blindness in the elderly beyond the age of 60 years. However, it can occur at any age. Although there is no cure for glaucoma, early diagnosis and its treatment can prevent damage and protect the optic nerve. Am I at Risk of getting Glaucoma? Certain individuals are at higher risk of developing glaucoma than others. These include Are of Asian heritage Are over 40 yrs Have family members with glaucoma Have high eye pressure Have diabetes, high blood pressure, poor blood circulation, Are near-sighted/far-sighted Have thinner cornea at the centre Have had an eye injury Have been on steroids for a long duration What are the symptoms of Glaucoma? Initially, there are no symptoms of glaucoma in almost all types of glaucoma. Only in the angle-closure type of glaucoma, the patient might experience sudden onset redness, blurring of vision, severe headache, watering and light sensitivity. At later stages, the patient might experience blind spots and loss of side (peripheral) vision. For this reason, glaucoma is also known as “sneak vision thief”. How can I get myself screened for glaucoma? If you have one or more of the above risk factors, you should get yourself evaluated by an ophthalmologist yearly. The ophthalmologist will do a complete eye exam including Vision assessment Checking your eye pressures Angles of your eye Examine the optic nerve to look for any damage (after putting in eye drops to widen your pupils) Measure your corneal thickness Do a vision field test Photographs to assess optic nerve at subsequent visits Treatment Once you are diagnosed with glaucoma, your doctor will advise you with one of the following measures Medicines – This is the first line of treatment your ophthalmologist will start. All the classes of medicines help in lowering your eye pressure and preventing further damage to your optic nerve. Laser therapy – These procedures usually help in increasing the outflow of fluid from the eye. They are simple procedures performed in the ophthalmologist’s office. a. Trabeculoplasty – In persons with open-angle glaucoma, the laser is used to further open up the drainage angle so that the fluid flows out more properly, thus lowering the eye pressure. This can work alone or in combination with eye medicines. b. Iridotomy- In persons with angle closure glaucoma, the laser is used to create an alternative passage in the peripheral iris for the fluid to drain out properly into the drainage angle. c. Laser photocoagulation- This procedure is done in the middle area of the eye to lower the formation of fluid inside the eye. Surgery – It is advised by the ophthalmologist if the desired eye pressure is not achieved by medicines or laser procedures. Sometimes, it may be advised as the first procedure. a. Trabeculectomy – In this procedure, a bypass is created so that fluid is diverted directly into a reservoir outside the eye, thus bypassing the drainage angle. This helps in lowering eye pressure. b. Glaucoma drainage devices – various microscopic drainage devices have been developed which are placed in the drainage angle to facilitate the egress of fluid from the eye. c. Cataract surgery – In some cases, cataract removal/ clear lens extraction with the placement of IOL can lower eye pressure by creating more space inside the eye.
