“Glaucoma” describes a whole group of diseases affecting the eye wherein owing to an unhealthy pressure within the eye, the intraocular pressure, direct damage to the optic nerve occurs. The intraocular pressure rises due to an alteration in the drainage system of the eye, which is either blocked or offers resistance to the normal drainage.
Symptoms of chronic or acute glaucoma include trouble focusing vision, sensation of a blind area (Scotoma), headaches associated with exercise, halos around light and even pain in the eye, particularly when associated with smoky vision. Very often there are no symptoms and hence a routine eye check up after the age of 40 is usually advisable to rule out glaucoma.
Glaucoma could be the open angle type which is usually without symptoms and hence gets diagnosed only in the late stages. In the angle closure type, the eye pressure rises acutely due to a sudden block in the drainage system. Glaucoma may also occur in children (congenital glaucoma) after trauma or with inflammation.
Glaucoma is most commonly managed with medications only. Surgical treatment is an option only in those who do not respond to these medications and in congenital glaucoma
We offer all the facilities required in the diagnosis and the management of glaucoma at our hospital.
Initial glaucoma workup involves the measurement of the intraocular pressure (IOP) with the help of a Goldmann’s Applanation tonometer, evaluation of the angle of the eye with a Goldmann goniolens , examination of the optic nerve head by slit lamp bio microscopy and the measurement of the central corneal thickness using a pachymeter. Ultrasound biomicroscopy helps us to further assess angle details and dimensions and actively intervene based on the findings. We offer all these facilities in our hospital.
Visual field monitoring is a very important part of glaucoma management. We have the Humphrey’s Field Analyzer strategy that allows us to monitor visual fields efficiently, assess progression if any and change our mode of approach.
Optical Coherence Tomography (OCT) is the latest in glaucoma diagnostics that gives us a quantitative measurement of the retinal nerve fibre layer, the part of the eye damaged in glaucoma. We offer this technology to you in the form of the Carl Zeiss Spectral Domain OCT.
Stereoscopic photographs of the disc for documentation of the changes in the optic disc can be taken on the the Zeiss VisuPac and FF450 plus fundus camera.
Although medications are the mainstay of glaucoma management, laser is required in certain types of glaucoma. We have the facility to do a laser iridotomy using the Zeiss YAG laser in cases of angle closure glaucoma. Another laser procedure in glaucoma, the laser trabeculoplasty is also done sometimes, for which we have the Diode laser.
Surgical procedures in glaucoma including trabeculectomy with and without antimetabolites, trabeculotomy and even glaucoma drainage valve implant placements are performed by qualified surgeons at our centre.
Anyone can develop glaucoma especially once over the age of 40 years. However, people with a family history or with diabetes or hypertension are at an increased risk of developing this condition.
Once glaucoma has been confirmed, your doctor prescribes medications best suited for your condition in order that your intraocular pressure is reduced. You must be very compliant with the application of these eye drops as these are essential in preventing further damage to your eye. In certain cases, laser may be required to create an alternate pathway for drainage of fluid from the eye.
No. It is a simple outpatient procedure that requires no injection and is pain free. It simply involves using the YAG laser to create another outflow channel in your eye that helps decrease the intraocular pressure.
Yes. Those with a family history of glaucoma have a greater risk of developing it once over the age of 40 years. If you have a family history then it is advised that you have a regular eye check up atleast annually after the age of 40 years.
During your visit to our hospital, you will first be taken through a routine check up of your refraction by a team of qualified optometrists. A routine glaucoma workup includes measurement of intraocular pressure, corneal thickness and angle evaluation. If the consultant thinks you need a prophylactic laser iridotomy, this may be advised and done on the same day. If not your pupils are dilated and the optic nerve is evaluated. Any suspicion of glaucoma may require the consultant to ask for more tests. Following dilatation, it maybe difficult to read or drive for several hours after the visit.
We sometimes advise a diurnal variation in which we record the intraocular pressure every two hours starting 7am. This helps us get a profile of the intraocular pressure throughout the day.
Ans: yes more common in consanguineous marriages. The child typically has an enlarged cornea, excessive lacrimation and photophobia. Diagnosis is my measuring the intraocular pressure and the management is surgical.
Ans: yes. Most of these medications are to be avoided in pregnancy and lactation unless the benefit exceeds the risk. They can cause ocular surface inflammation and dry eyes. Beta blockers one of the commonest medications used can have adverse effects on the airways and heart. Selective laser trabeculoplasty is a viable alternative to using topical medication.