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Glaucoma

Glaucoma is a condition that causes damage to your eye's optic nerve and gets worse over time. It's often linked to a build up of pressure inside your eye. The first sign is often a loss of peripheral, or side, vision. That can go unnoticed until late in the disease. That's why glaucoma is often called the "sneak thief of vision."


    Symptoms of Glaucoma:

  • Seeing halos around lights
  • Vision loss
  • Redness in the eye
  • Eye that looks hazy (particularly in infants)
  • Nausea or vomiting
  • Eye pain
  • Narrowed vision (tunnel vision)

1) Why is it important to know about glaucoma?
Damage due to glaucoma is preventable, not curable. It is therefore necessary that the disease should be detected and treated at its earliest stage to prevent blindness.

2) Which age does glaucoma affect?
Although glaucoma is most common above the age of 40 years, it may affect any age group. A special type of glaucoma called Congenital Glaucoma may affect even a newborn or a child. Any eye that appears bigger than normal in a child should be shown to an eye specialist.

3) Who all are at high risk of developing glaucoma?
• Presence of glaucoma in other family members
• Increasing age – above 40 years
• Thyroid disease o Patients who are on long term steroid therapy for other diseases such as asthma, arthritis etc.
• Previous eye injury or surgery o Hypermetropia (farsightedness)
Damage due to glaucoma may be more severe in those patients who have associated diabetes, widely fluctuating blood pressure and myopia.

4) How often should one get an eye check up?
• After the age of 40 years, one should get an eye check up for glaucoma every 3 to 4 years even if there are no symptoms.
• If a family member has glaucoma, if you have diabetes, if you are on long term systemic steroids for some other disease, or if you have suffered a blunt eye injury in the past, you must get your eyes checked every 1 to 2 years.

5)My vision is good, then why do you say I have glaucoma?
In glaucoma the central vision is not lost till the very late stages. It starts with damage to your peripheral vision and gradually comes to the centre. When the central vision is affected it is too late and nothing can be done to restore vision. In a way, a good vision is misleading as far as severity of glaucoma and extent of damage is concerned.

6) What is the normal pressure for an eye?
Normal pressure for an eye is one which does not cause any damage to the optic nerve. In most normal people the eye pressure is around 17 to 20 mm of mercury. Some people have higher pressure than this, but that does not cause damage to the nerve for years. However, such patients need careful monitoring so that damage to the nerve is detected at its earliest stage. On the other hand some patients have a much lower eye pressure, say 12 or 14 mm Hg, but this low pressure is not tolerated by the eye and the nerve is damaged. This is a special type of glaucoma and needs more careful monitoring and treatment.

7) How serious is my glaucoma problem?
It depends upon the amount of optic nerve damage that has already been caused. The damage can be measured by visual field analysis (VFA) and GDx (which measures the thickness of nerve). As the damage is permanent, appropriate measures are taken to prevent or slow down further damage.

8) Is glaucoma preventable?
Yes, damage due to glaucoma is preventable, not curable. Whatever damage that is already there cannot be restored, however further damage can be arrested or at least slowed down by appropriate treatment. It is a life-long treatment and needs regular followup.

9) Is Glaucoma hereditary?
Yes, blood related family members of glaucoma patients are likely to develop glaucoma more often than the general population. It is advisable that family members of glaucoma patients should get their eyes review to rule out glaucoma.

10) Can I get back my side vision after treatment?
Unfortunately the vision loss caused by glaucoma is permanent and cannot be regained.

11) What precaution must one take?
One must remember that glaucoma treatment is life long, and one should use the medicines regularly and should come for follow-up as and when advised. Persons who are at the risk of developing glaucoma (as listed previously) should undergo regular eye examinations. Diabetics should ensure good control of blood sugar levels Avoid smoking Avoid drinking 2-3 glasses of water at a time.

12) Do I need to come for follow up after laser / surgery?
Treatment of glaucoma is life-long. Even after laser or surgery one may need additional medication and a lifetime of follow up to monitor the progress of the disease.

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More About Glaucoma

» High fluid pressure inside your eye
» Inherited
» Blunt or chemical injury to your eye
» Severe eye infection, blocked blood vessels inside the eye
» Inflammatory conditions

Chronic Glaucoma or Open-angle Glaucoma: Your doctor may also call it wide-angle glaucoma. The drain structure in your eye -- it's called the trabecular meshwork -- looks normal, but fluid doesn't flow out like it should.
Acute Glaucoma or Closed-angle Glaucoma: Your eye doesn't drain right because the angle between your iris and cornea is too narrow. Your iris is in the way. This can cause a sudden buildup of pressure in your eye. It's also linked to farsightedness and cataracts, a clouding of the lens inside your eye.
Secondary glaucoma which develops due to systemic diseases like prolonged diabetes, complicated high blood pressure, thyroid disease, bleeding disorders etc. It may also occur as a complication of associated eye disorders such as vascular blocks, bleeding inside the eye, uveitis, swollen lens, blunt injury to the eye, etc.

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 (Eye drops and tablets) Laser treatment Surgery

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: –

If glaucoma is not controlled with the help of medicines, if the side effects of the medicines are not well tolerated and the patient is non compliant, or cannot afford the cost of the medicines, the second option is LASER TREATMENT. There are various types of lasers that are used in the treatment of glaucoma.
They are: –

YAG Laser Peripheral Iridotomy
A small opening is made in the iris so that the stagnant fluid finds a way to the anterior chamber, the front portion of the eye, and subsequently drained off. This is an OPD procedure, done under local anesthetic drops and takes only a few minutes to be completed. After the laser, you can wash your eye with water and can lead a normal life.
Operative procedures (Glaucoma Filtering Microsurgery or "By-pass" surgery of eye)
Operation for glaucoma is the only option left 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 hole 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.