GLAUCOMA-The Silent Vision Stealer of the Middle-aged & Elderly: Symptoms, Causes, Treatment & Care -Contributed by Dr B Revathi MBBS, DNB (Ophthal)


Close up photo of the eye showing the iris and pupil
                                             Photograph by Paula Neumeyer from Pexels

What is Glaucoma?

Glaucoma is an eye disorder in which the pressure inside the eye (intraocular pressure) is high. This raised pressure causes damage to the optic nerve which is responsible for carrying the visual sensations to the brain. The field of vision (both central and side vision) is gradually lost corresponding to the extent of optic nerve damage.

According to the International Agency for Prevention of Blindness (IAPB), Glaucoma accounts for 20% of blindness worldwide. The overall presence of Glaucoma in India is said to be 3.9% in all age groups and 4.4% in adults over 35 years. Glaucoma is one of the leading causes of blindness in India next to cataract and corneal blindness

According to the Mayo Clinic, “Glaucoma is a leading cause of irreversible blindness worldwide. It affects more than 2.7 million individuals age 40 or older in the United States — approximately 1.9 percent of this population. Glaucoma is the second-leading cause of blindness among blacks, after cataract, and the third-leading cause of blindness in whites, after age-related macular degeneration and cataract.”

Why does the pressure inside the eye increase

Aqueous Humor (watery liquid) is produced behind the Iris and passes through the pupil to drain into the bloodstream through a band of sieve-like structure at the corner of the eye.

The pressure inside the eye goes up either due to clogging in the sieve-like structure in the eye or due to inefficiency in allowing the fluid to exit the eye

There are different types of glaucoma but two main types are

Open Angle Glaucoma –where the drain is open but inefficient

Angle Closure Glaucoma – where the drains are closed by the Iris

What are the symptoms of glaucoma?

Open Angle Glaucoma may be free of symptoms until the late stages when the patient has tubal or tunnel vision or has completely lost sight.

Angle-closure Glaucoma may have symptoms like colored halos (rings) around a light, mild eye ache, brow ache along redness of eyes in the early stages. It may sometimes present more dramatically with an extremely painful red eye with a severe decrease in vision

Are there other types of Glaucoma? Yes Glaucoma can occur following inflammation or any other problem in the eye which affects the drainage of fluid from the eye through the drainage channels

At What age does Glaucoma occur? The two common types of glaucoma usually occur after middle age

In India, 4% of the population above 35 years of age is affected by either of the 2 common types of Glaucoma ie Angle Closure and Open Angle Glaucoma. Sadly many of those affected with glaucoma are not aware since symptoms are absent until the late stage.

Is Glaucoma hereditary? Yes, close blood relatives of patients with glaucoma have a higher risk of getting glaucoma. The condition is likely to be detected earlier if the individuals at higher risk are subject to routine eye examinations to detect glaucoma

How is Glaucoma detected?- Glaucoma is detected with the help of tests to measure the eye pressure, followed by an examination of the drainage channels. The optic nerve is examined with an instrument called the Ophthalmoscope. Finally, the Side and Central Visual Fields are analyzed to arrive at a diagnosis

Can Glaucoma be successfully treated?- The aim of the treatment is to reduce the eye pressure to a level that is safe for the individual. This would prevent further damage and save the existing vision. If the pressure is controlled the treatment is a success. However, the patient has to be followed up every 3 to 6 months for the rest of his life to check if the glaucoma is satisfactorily controlled.

Will I have to live with glaucoma for the rest of my life or will it ever go away? – Usually, the glaucoma tendency is always present and requires treatment throughout life. An operation may make subsequent treatment unnecessary. Glaucoma can only be kept in control by treatment. It can never be cured.

Could I go blind?  There is little risk to sight if treatment is regularly given and adjusted to requirements, especially if treated early. However advanced cases may be difficult to arrest and require energetic treatment and close supervision

Will Glasses help? Glasses do not directly help glaucoma but may well be necessary to obtain clear vision

Can glaucoma patients do yoga, play games, and drive? Yoga can be done except for prolonged exercises involving the head being lower than the body. You can play games, swim, and drive provided you satisfy the statutory standard of vision.

Safety should be considered for driving if the field of vision (side vision) is severely restricted.

How is Glaucoma treated? – The best treatment for every individual with glaucoma is decided by the doctor depending on the type of glaucoma, severity of the disease, and the risks and benefits.

The following options are available for glaucoma treatment:

-          Medicines

-          Laser Therapy

-          Surgery

When will I be advised of Surgery for Glaucoma? The following are the common indications for Glaucoma Surgery :

a)  If the pressure is uncontrolled, with the maximum number of tolerated drugs

b)  If the eye pressure is on borderline control with drugs, but the optic nerve is weak

c)   If the patient is unable to comply with the medication schedule (due to various reasons including the cost of medicines and frequent checkups)

d)  Need for other surgeries in the eye e.g. Cataract Surgery or Corneal Surgery

Concluding Note - Glaucoma is usually a chronic disease and affects both eyes but few symptoms show up until the sufferer becomes aware of serious restrictions in the field of vision or even vision in the worse eye. Hence early detection and appropriate treatment can control glaucoma with appropriate medical, laser, and surgical techniques and prevent permanent vision loss due to this serious eye disease

The long-term prognosis with proper treatment is very good if the patient complies with the treatment and comes for regular checkups.

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