What is glaucoma?
Glaucoma is group of diseases where fluid pressure inside the eye is increased due to various reasons and if left untreated, it can permanently damage optic nerve behind and reduce field of vision.
Who are at risk of developing it?
Those with family history of glaucoma, any trauma, any previous eye surgery, prolonged steroid use, any other eye disease
How it is different from cataract? And can two coexist together?
Cataract is age related whiting of normal lens whereas glaucoma means just the raised fluid pressure than the normal. And yes both diseases can coexist.
How most patients present?
Generally, this glaucoma is asymptomatic and gets picked when visit to eye specialist is for any other visit esp. glasses change or cataract evaluation. Very few glaucoma are high pressure glaucoma which can have pain, redness, blurring of vision, color haloes around the light and vomiting in case of sudden increase in eye pressure.
How it is detected?
It needs thorough eye examination which includes eye pressure measurement, evaluation of drainage angle by gonioscopy, optic nerve examination with 90/78 D lens, perimetry, OPTIC nerve OCT for fine assessment of nerve damage, pachymetry and baseline disc photograph. All these investigations help us diagnose, stage the disease and decide on target eye pressure for that eye to slow down the disease progression.
How it is staged & treated?
Perimetry, OCT RNFL analysis and baseline disc photograph these tests helps us in staging the disease. As per stage of disease management plan gets formulated.
Glaucoma gets treated by medical management which includes eye drops & sometimes oral tablets, lasers and various surgeries.
When lasers are used?
Narrow angle glaucoma requires YAG laser iridotomy to address most important mechanism of glaucoma. Open angle glaucoma can be offered elective laser trabeculoplasty as per case basis, stage of disease, number of medications patient already on, any topical medication allergies, other co morbidities and preexisting systemic illness which reduce choice of medications given topically.
Is any surgery available for this disease?
Yes, various surgery options are now available. Trabeculectomy of drainage implant are commonly done procedures. Newer minimally invasive surgery options are also coming up but important thing is all these surgeries stabilize glaucoma and have no potential to reverse the already existing glaucoma damage.
Can we do anything once disease reaches end stage with complete blindness?
No. Unfortunately at this stage no sight restoring option is available. But treatment needs to be given so that eye does not go into painful blind eye phase.
Any subtypes which are very serious?
Narrow angle glaucoma, neovascular glaucoma, uveitic glaucoma, glaucoma after retina & cornea surgery these glaucoma are very aggressive subtypes of glaucoma.
How can one take care of eyes from Glaucoma?
As this disease is asymptomatic, be regular with your comprehensive eye checkup and follow your eye specialist’s instructions carefully. This will ensure timely detection of glaucoma & appropriate treatment of glaucoma.
Dr Pankaj Bendale
NIO Super Speciality Eye Care, Pune