Glaucoma is the second leading cause of IRREVERSIBLE blindness in India.It is estimated that there are more than 60 million cases of glaucoma worldwide and it will increase to 80 million by 2020. In India alone, it affects around 12 million people while still a majority remain undiagnosed.Early Diagnosis and treatment prevents blindness.
The word Glaucoma itself means SLOW THIEF OF SIGHT. It is a condition of the eye that is gradually progressive and hence the vision loss too is slow and progressive.It can lead to complete irreversible blindness. Glaucoma is a neuropathy.Here the pressure of the eye increases leading to pressure on the optic nerve (nerve of the eye) which in turn causes visual filed defects.As the disease progresses,the vision loss could be total. Primary glaucomas usually affect those over the age of forty,family history or with myopia.Babies could be born with glaucoma and so could children develop glaucoma. But these are the rarer kinds of glaucoma.
UNDERSTANDING MECHANICS OF IOP(INTRA OCULAR PRESSURE)
TYPES OF GLAUCOMA
Glaucomas can be broadly classified into two groups:
- PRIMARY & SECONDARY:Primary where it is usually hereditary,familial or because of ageing
Secondary: where the glaucoma is usually because of a secondary cause like any other eye disease,injuries,diabetes etc.
- OPEN ANGLE AND CLOSED ANGLE : Based upon whether the angle of drainage is open or narrow (closed) the glaucoma gets classified.
- Age: age 40 and above are at increased risk
- Family History: If anyone in your family has glaucoma,the risk increases.
- Associated Eye conditions: Myopes,history of eye injuries,people on steroids for various reasons,associated diabetic retinopathy are at more risk
- Co morbidities: Diabetes,thyroid disease,nephropathies,systemic steroid therapy,medication for hypertension,etc increase the risk factors
- Women are more prone for angle closure glaucoma than men.
DIAGNOSIS OF GLAUCOMA
Glaucoma is a disease without any symptoms in its early stages.Hence the diagnosis of glaucoma happens only on a visit to an ophthalmologist/eye doctor for a routine check.It is during a routine comprehensive eye check that the eye doctor may suspect that you may have glaucoma.He evaluates his examination and may then advise various tests that aid the confirmation of the suspicion of glaucoma.The tests done are:
Tonometry: This measures the IOP through various instruments.
Gonioscopy: this is a test to visualize and see the angle of the eye.
Dilated Fundoscopy: A dilated fundoscopy is a must towards making a diagnosis of glaucoma.I is the study and evaluation of the optic disc that helps make the diagnosis.
Visual Field Analysis: This test analyses the visual field (what and how wide you see)This test is a subjective test.It means that it depends upon the response given by the patient.Here the patients attention is actively required for mapping what he/she sees. VFA is advised first at the time of diagnosis and there after for recording the progression of damage or its stability.It may have to be done as frequently as every month if the glaucoma doesn’t remain under adequate control.It may have to be repeated frequently during the first two years of diagnosis to assess the rate of progression of glaucoma.This aids future management of the patient.
EARLY /Normal Visual Field CAN SOMETH
OCT: Optical Coherance Tomography
Anterior Segment OCT:This is a tomogram and studies the anterior segment and angle Lens iris complex
OCT Optic Disc: helps in studying the optic nerve,the retinal nerve fibre layer and its damage and progression.
UBM: Ultra Bio Microscopy of the anterior segment of the eye: this is a B scan sonography of the anterior segment of the eye .Again to study the Cornea lens iris angle complex.
MANAGEMENT OF GLAUCOMA
Glaucoma once diagnosed can only be managed or controlled by various means.Glaucoma cannot be treated (cured)
Medical Treatment: various types of eye drops are instilled to reduce the IOP
Surgical Treatment: a variety of surgeries mainly trabeculectomy helps control the IOP
Laser Treatment: various Laser procedures are used for treatment at various stages of management of glaucoma whether primary or secondary,open or closed angle.
Follow is the main stake of managing glaucoma and keeping it under control.Whatever the type of glaucoma, it is never cured and since it is a blinding disease,a regular follow up throughout ones life is advised.The usual follow up happens every 3-4 months or earlier as advised by the treating glaucoma physician.Follow up aids in assessing the appropriate IOP control,changes in the optic disc,tolerance od medication or slipping of control while on the same medication.
FOLLOW UP AS ADVISED BY YOUR EYE DOCTOR IS VERY IMPORTANT and has to be strictly adhered to.
What is Glaucoma?
Glaucoma is a condition of the eye where the optic nerve is damaged because of an increase in the eye pressure.
What Happens in Glaucoma?
The inside of the eye has a clear fluid that supplies nutrition to the inside of the eye.It is formed and drained from the eye in a continuous process.When the drainage reduces or is hampered or the formation exceeds drainage (this is a rare occurance)the pressure inside the eye(Intra Ocular Pressure: IOP) rises that causes damage to the optic nerve.
What changes happen in glaucoma?
Four things happen:
- Increased IOP
- Optic Nerve Changes: loss of nerve fibres
- Progressive, Patchy loss of vision (field defects)which corelates with the optic nerve damage
- Loss of vision ,changes in cornea happen in late stages
What are the symptoms of Glaucoma?
- People having glaucoma usually have no eye complaints
- Some have repeated episodes of headaches /pain in the eyes.
- Some may have nausea,vomiting,blurring of vision or haloes around light.
- There may be frequenting bumping into things/complaints by others of being ignored by the person.
How do I know I have glaucoma?
95% of people having glaucoma do not know that they have glaucoma.It is a slowly progressive blinding disease and hence aptly called as “thief of sight”.It is only diagnosed on a routine eye check by an eye doctor/ophthalmologist.
Q: Can glaucoma be prevented?
A: No it cannot be prevented. But it can be diagnosed early and managed in time. Everyone above 40 years should visit an eye specialist and not stop with a visit to an optician.
Q: What are the risk factors?
A: If you
- have blood relatives with glaucoma
- have diabetes mellitus, hypertension, or thyroid disease
- are near sighted
- are on treatment with steroids (in the form of tablets, skin ointments, inhalers, eye drops)
- are on treatment with certain psychiatric medication
- have a history of trauma/injury to the eye
You will need an early check up if you have any of the above symptoms.
Q: What are the tests for Glaucoma?
A: Tests help in finding out the presence of glaucoma and also its progression in the subsequent follow up visits.All tests are painfree and easy.
These tests include;
- Tonometry: To measure the pressure in the eye
- Gonioscopy: To assess the drainage angle
- Ophthalmoscopy: To view the optic nerve
- Pachymetry: To check the thickness of cornea
- Perimetry (Visual Field Analysis): To assess the field of vision
- OCT: to measure the Optic nerve health and status.
Q: What is OCT?
- A: OCT (Optical Coherance Tomography): This is a tomograph which measures the thickness of the nerve fibre layer in various quadrants of the optic nerve.Thinning suggests loss of nerves and progression.It may have to be repeated once a year or frequently if glaucoma is progressing rapidly inspite medication.
Q: What is the treatment of Glaucoma?
A: Most glaucomas are NOT TREATED but are managed/controlled so as to prevent damage or halt the process of damage, as the damage is not reversible. The Management includes medicines in the form of eye drops, laser or surgery either alone or in a combination depending upon the response and type of glaucoma.
Q: How do glaucoma medicines help to reduce the eye damage?
A:The medicines either decrease the production of the fluid or increase the drainage of the fluid so as to keep the eye pressure under control as determined by your doctor. The reduced IOP,takes the pressure off the optic nerve and helps reduce the damage caused by the increased eye pressure.
Q: How long do I have to continue the treatment of glaucoma?
A: Glaucoma is a progressive disease.It can only be controlled and never treated.You may need lifelong treatment as per the instructions and the supervision of the doctor.
Q: Can Lasers be used to treat glaucoma?
A: Yes.Lasers are used in the treatment of glaucoma to increase the flow of fluid. There are different procedures depending upon the type of glaucoma.
Q: What if the glaucoma remains uncontrolled inspite of medicines?
A:When Medical treatment fails,surgery may become necessary.
Q: What happens if I forget to instill the glaucoma medicines?
A: There is usually no immediate harm.Skipping a dose or two may not be harmful specially in the early stages.But try to not skip the dose if you have an advanced disease.One or two skipped doses can never make you blind if you are on home therapy.
Q: Can vision lost due to glaucoma be restored?
A: Treatment of glaucoma aims at preserving the existing vision; it does not restore the vision that is already lost.Therefore early detection and management are very important.
Q: How important are follow up visits to the doctor?
A: Glaucoma is not treated.It is always managed – either by medicines /Laser/Surgery.Therefore it becomes mandatory to follow up with the doctor at regular intervals as advised by your treating eye doctor.
Q: What is the frequency of visits for a glaucoma patient?
A: Usually every 3-4 months or as advised by your eye surgeon.This is to monitor the eye pressures, Check control and progression so that no further damage continues.
Q: What if I cannot keep up my regular appointment with my doctor?
A: Continue instilling the medication that has been advised.Reschedule your appointment at the earliest.If you are in another city and cannot visit your doctor,please see a local ophthalmologist and get a record of your IOP from him.s
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