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