Glaucoma
Glaucoma is a disease of the eye where high pressure inside the eye causes permanent and irreversible loss of vision. It requires early diagnosis and treatment to prevent worsening. Generally both eyes are involved, and it runs in family.
The pressure as well as the nourishment of the eye is maintained by secretion of Aqueous humor. This clear fluid flows across front part of the eye before draining out through a fine sieve like Trabecular meshwork. In those with glaucoma, this meshwork is partially or completely blocked causing the pressure to build up. This damages the ganglion & nerve cells in the retina and the optic nerve leading to slow vision loss. In early stages the vision loss occurs only in the side vision, keeping the front vision good till last stages. The vision loss caused by glaucoma is permanent and cannot be rectified.
The pressure as well as the nourishment of the eye is maintained by secretion of Aqueous humor. This clear fluid flows across front part of the eye before draining out through a fine sieve like Trabecular meshwork. In those with glaucoma, this meshwork is partially or completely blocked causing the pressure to build up. This damages the ganglion & nerve cells in the retina and the optic nerve leading to slow vision loss. In early stages the vision loss occurs only in the side vision, keeping the front vision good till last stages. The vision loss caused by glaucoma is permanent and cannot be rectified.
Pressure in the eye can also go up due to
- Too much fluid production
- Birth defects
- Injuries
- Eye diseases like cataract, iritis etc.
- Use of steroid containing drops, tablets or skin creams
Types of glaucoma
Open-angle glaucoma is a common form of glaucoma. In this type, the aqueous drainage is blocked at the trabecular meshwork.
Open-angle glaucoma is a common form of glaucoma. In this type, the aqueous drainage is blocked at the trabecular meshwork.
Acute angle-closure glaucoma Here the blockage is due to narrow angles between cornea & the iris. There is a sudden increase of intraocular pressure, which may cause:
- Intermittent blurring
- Severe eye pain & redness
- Headache & browache
- Rainbows like haloes around lights
- Nausea and vomiting
Secondary glaucoma is caused by blockage of drainage due to an injury or other eye disease. It can be either open angle or acute angle type. Common symptoms are redness, nausea with severe eye pain and visual disturbance especially in low light.
Developmental glaucoma is caused by an abnormality that is present since birth. Symptoms are large eyes in childhood, unable to see ordinary light, misty appearance of the eyes and jerky eye movements.
Signs & Symptoms of Glaucoma
Most often the Glaucoma is not detected in time. A routine eye check up is often the first time Glaucoma is detected. Many a time by than the disease is quite advanced, without the patient knowing about it. Hence it is recommended that everyone undergoes a glaucoma detection test once at the age of 40 years when Presbyopia sets in. A detailed eye check up is essential with an Eye doctor. Some of the symptoms of glaucoma are:
Most often the Glaucoma is not detected in time. A routine eye check up is often the first time Glaucoma is detected. Many a time by than the disease is quite advanced, without the patient knowing about it. Hence it is recommended that everyone undergoes a glaucoma detection test once at the age of 40 years when Presbyopia sets in. A detailed eye check up is essential with an Eye doctor. Some of the symptoms of glaucoma are:
- No symptoms
- Pain in the eyes
- Blurred vision
- Increased redness in the white areas of the eye
- Excessive watering of the eyes
- General sickness or vomiting
The same scene as viewed by a normal person & one with glaucoma
Glaucoma management
Damage caused by glaucoma cannot be reversed. Therefore, the goal in the management of glaucoma is to suspect & confirm the diagnosis at the earliest stage, quantify the damage & than reduce the intraocular pressure such that remaining healthy nerve cells & fibers maintain function.
Damage caused by glaucoma cannot be reversed. Therefore, the goal in the management of glaucoma is to suspect & confirm the diagnosis at the earliest stage, quantify the damage & than reduce the intraocular pressure such that remaining healthy nerve cells & fibers maintain function.
Diagnosis
Tonometry
Several tonometers including Goldman’s, Keelers non-contact, iCare rebound tonometer etc are available and are routinely used in the OPD and Glaucoma clinic at Karthik Netralaya. iCare tonometer do not need any anesthetic drops or dye, and is very popular amongst our doctors & patients.
Tonometry
Several tonometers including Goldman’s, Keelers non-contact, iCare rebound tonometer etc are available and are routinely used in the OPD and Glaucoma clinic at Karthik Netralaya. iCare tonometer do not need any anesthetic drops or dye, and is very popular amongst our doctors & patients.
Gonioscopy
4 mirror indentation gonioscopy is essential to visualize the angle of anterior chamber, and to viusalise abnormalities in Trabecular meshwork, including its occludability.
4 mirror indentation gonioscopy is essential to visualize the angle of anterior chamber, and to viusalise abnormalities in Trabecular meshwork, including its occludability.
Visual field analysis
Is the gold standard for analyzing the visual fields and quantify the area and extent of damage. The efficacy of control with the eye drops is also assessed by repeating the visual fields. Karthik Netralaya has several types of visual fields, including Zeiss projection perimetry & Flicker perimetry.
Zeiss Humphrey
visual field
analyser
Pachymetry
Is measuring the thickness of the cornea, and contributes to the calculation of target intraocular pressure. It is a routine now that Pachymetry is measured in every patient with glaucoma to titrate the dosage of eye drops.
Is measuring the thickness of the cornea, and contributes to the calculation of target intraocular pressure. It is a routine now that Pachymetry is measured in every patient with glaucoma to titrate the dosage of eye drops.
OCT for glaucoma
The leader in HD OCT, Optovue, at Karthik Netralaya is a modern spectral OCT equipment. It incorporates ocular coherence tomography technology. The Optovue OCT is the gold standard in vivo imaging device for glaucoma and offers proven reproducibility for diagnosis & follow ups. Very critical analysis of small changes in glaucoma damage is possible so that the treatment can be modulated. It has several unique objective glaucoma analysis modes. This includes RNFL thickness & TSNIT maps for nerve fiber layer analysis, GCC (Ganglion cell complex) mapping & analysis, and optic disc cup analysis. Optovue OCT at Karthik Netralaya has updated normative database to compare patients test results. GCC analysis, one of the most recent criteria that can detect glaucoma in very early stages is extensively used. The OCT provides real-time cross-sectional images and quantitative analysis of glaucoma damage, and optimizes the diagnosis and monitoring of glaucoma defects.
HRT III for glaucoma
Heidelberg retinal tomography at Karthik Netralaya is a latest equipment that combines a laser scanning camera and specialized software that evaluates the optic nerve. HRT & OCT may diagnose glaucoma years before symptoms become apparent to the patient. The tests are painless, non-invasive and dilation is usually not necessary. It has Moorefield’s analysis & normative database, which can diagnose glaucoma at an early stage. Optic cup shape analysis, TISNIT graphs and nerve fiber layer analysis is possible with this equipment.
Eye drops
is the first line of treatment and needs to be used life long. Depending on the severity, it may have to be instilled once or several times a day, sometimes in combinations. These medications decrease eye pressure, either by reducing the aqueous production or by improving the outflow at Trabecular meshwork. Recently several new medications are introduced which show great promise for more effective and convenient management of glaucoma. Some drops cannot be used if you have Asthma, cardiac ailments etc.
It is important to tell your doctors about the eye medications that you are using for glaucoma control. In order for these medications to work, you must take them regularly and continuously. Quite simply, the key to the success of medication is your compliance.
Laser surgery
If conventional therapy is not controlling the intraocular pressure (IOP) adequately, or if the disease is progressing inspite of regular treatment, or if patient is not taking their medicine according to schedule, Karthik Netralaya’s Glaucoma Laser surgery treatment may bean effective alternative or adjunct. The laser is usually used in one of two ways. In open-angle glaucoma, the laser is used to enlarge the drains (Laser Trabeculoplasty). However this treatment is not very popular as the effect is generally temporary, and after several months the high IOPs can return.
In angle-closure glaucoma, the laser is used to create a hole in the iris (Nd YAG iridotomy) to improve the flow of aqueous and gives adequate & permanent results. This is to be done generally in both the eyes.
Operative surgery
When a surgery is needed to control clinically non responsive glaucoma, or when it needs to be done along with Phaco IOL surgery, a new drainage channel is created through which the aqueous fluid can leave the eye. This lowers the IOP and effectively controles glaucoma in most of the patients. Apart from Trabeculetomy, the time honored surgery for glaucoma with Mitomycin modulation, several newer techniques like Deep sclerectomy, Canaliculostomy, ExPress X-200 shunts etc. are routinely performed at Karthik Netralaya. For neovascular & in very advanced and recurrent glaucoma, Ahmed glaucoma valve is implanted with excellent results. In congenital glaucoma a combined Trabeculectomy +Trabeculotomy is the procedure of choice. Repeated follow ups are needed for lifetime, as the new canal created for drainage can get closed in a large number of people over several years.
Tips for Glaucoma management
Heidelberg retinal tomography at Karthik Netralaya is a latest equipment that combines a laser scanning camera and specialized software that evaluates the optic nerve. HRT & OCT may diagnose glaucoma years before symptoms become apparent to the patient. The tests are painless, non-invasive and dilation is usually not necessary. It has Moorefield’s analysis & normative database, which can diagnose glaucoma at an early stage. Optic cup shape analysis, TISNIT graphs and nerve fiber layer analysis is possible with this equipment.Eye drops
is the first line of treatment and needs to be used life long. Depending on the severity, it may have to be instilled once or several times a day, sometimes in combinations. These medications decrease eye pressure, either by reducing the aqueous production or by improving the outflow at Trabecular meshwork. Recently several new medications are introduced which show great promise for more effective and convenient management of glaucoma. Some drops cannot be used if you have Asthma, cardiac ailments etc.It is important to tell your doctors about the eye medications that you are using for glaucoma control. In order for these medications to work, you must take them regularly and continuously. Quite simply, the key to the success of medication is your compliance.
Laser surgery
If conventional therapy is not controlling the intraocular pressure (IOP) adequately, or if the disease is progressing inspite of regular treatment, or if patient is not taking their medicine according to schedule, Karthik Netralaya’s Glaucoma Laser surgery treatment may bean effective alternative or adjunct. The laser is usually used in one of two ways. In open-angle glaucoma, the laser is used to enlarge the drains (Laser Trabeculoplasty). However this treatment is not very popular as the effect is generally temporary, and after several months the high IOPs can return. In angle-closure glaucoma, the laser is used to create a hole in the iris (Nd YAG iridotomy) to improve the flow of aqueous and gives adequate & permanent results. This is to be done generally in both the eyes.
Operative surgery
When a surgery is needed to control clinically non responsive glaucoma, or when it needs to be done along with Phaco IOL surgery, a new drainage channel is created through which the aqueous fluid can leave the eye. This lowers the IOP and effectively controles glaucoma in most of the patients. Apart from Trabeculetomy, the time honored surgery for glaucoma with Mitomycin modulation, several newer techniques like Deep sclerectomy, Canaliculostomy, ExPress X-200 shunts etc. are routinely performed at Karthik Netralaya. For neovascular & in very advanced and recurrent glaucoma, Ahmed glaucoma valve is implanted with excellent results. In congenital glaucoma a combined Trabeculectomy +Trabeculotomy is the procedure of choice. Repeated follow ups are needed for lifetime, as the new canal created for drainage can get closed in a large number of people over several years. Tips for Glaucoma management
- If you are diagnosed to have glaucoma, just do not worry. Continue your routine life style, with healthy modifications. Good diet, exercises, control of Diabetes, hypertension, weight & high cholesterol levels is important. Tell about your general health to the eye doctor and about your eye health to your physician.
- Strictly follow your eye doctors advice. Use the medications regularly. Don’t alter them on your own, at any cost.
- After putting one eye drop, press the inner corners of the closed eyes for 2 minutes.
- Keep the drops in the fridge or a cool place so that you can use the drops beyond 1 month of its opening, Don’t touch the nozzle tip.
- Use the drops as usual even on the day you visit Karthik Netralaya. Please don’t stop the drops, as the doctor needs to know the eye pressures while you are using the drops. Visit the doctor at different times so that the IOP gets checked around the clock. Usually the early morning IOP is the highest.
- Visual fields & OCT are of paramount importance in the follow ups. You need to get them done atleast once an year.
- Get your eye checked up before your birthday. It is the best way to remember your appointments. Avoid tight collars & neck tie. Avoid consuming large amount of fluids at any one time. Check if your skin ointment has any steroids.
- Remember, the key to controlling glaucoma is catching it early. The best way to prevent vision loss form glaucoma is to know your risk factors and to have eye examinations at appropriate intervals.
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