Glaucoma

Glaucoma is a kind of progressive optic neuropathy which is often associated with rise in Intra ocular pressure. Most of the people affected by glaucoma may not even aware of it because it is symptom less in most of the cases.

It mainly affects the field of vision secondary to damage of the optic nerve. Traditionally it is believed that high pressure within the eye, also known as intraocular pressure or IOP, is the main cause of this optic nerve damage. IOP is clearly a risk factor people with normal IOP may also suffer from Glaucoma.

Can I have Glaucoma ?
Unfortunately glaucoma is a disease which starts & progress without any symptom most of the time. Most often it is detected during routine eye examination. The mistake that most people commonly make is getting only their glass numbers checked by an Optician ignoring the need for a detailed eye examination by a qualified.

Ophthalmologist.
Sometimes the patient presents with complaints of mild headache or seeing rainbow colours around lights due to raised IOP.

  • Age: Glaucoma is much more common among older people. You are six times more likely to get glaucoma if you are over 40 years old.
  • Family History Of Glaucoma: The most common type of glaucoma, primary open angle glaucoma, is hereditary. If members of your immediate family have glaucoma, you are at a much higher risk than the rest of the population. Family history of glaucoma increases the risk of glaucoma four to nine times.
  • Indiscriminate use of Steroids: Studies indicate Steroids increase intraocular pressure. These could be in the form of Oral medications, Steroid Inhalers and Steroid Eye Drops used for long periods of time.
  • Injury to Eye: Injury to the eye may cause secondary open angle glaucoma. This type of glaucoma can occur immediately after the injury or years later.
  • Diabetes & Hypertension

Other possible risk factors:

  • High myopia (nearsightedness)
  • Central corneal thickness less than 500 microns.

It important to get an Eye Check up routinely above the age of 40 years.

Types of Glaucoma?
Adult glaucoma falls into two categories
  • Open Angle glaucoma
  • Closed Angle glaucoma

These are marked by increase of intra ocular pressure ( IOP ), or pressure inside the eye.

Open Angle Glaucoma
This is the most common form of glaucoma. Think of the eye as a sink with a tap that is always open. The water flows through if the drainage mechanism is working all right. The trouble arises when the drainage is clogged and the water begins to collect.

In the same way, the inside of the eye  contains fluid that is constantly flowing and is drained out of the eye.  Glaucoma happens when the eye’s drainage canals become clogged. The pressure inside the eye (also called intraocular pressure or IOP) rises because the correct amount of fluid can’t drain out of the eye.  This results in the fluid accumulating in the eye and over a period of time it leads o increased intra ocular pressure . Over a period of time, this high pressure inside the eye (IOP) can damage  the optic nerve ( or nerve of the eye )

Most people have no symptoms and no early warning signs. If open angle glaucoma is not diagnosed and treated, it can cause a gradual loss of vision. This type of glaucoma develops slowly and sometimes without noticeable sight loss for many years. It usually responds well to medication, especially if caught early and treated.


Angle Closure Glaucoma
This type of glaucoma is also known as acute glaucoma or narrow angle glaucoma. It is  very different from open angle glaucoma in that the eye pressure usually rises very quickly.

This happens when the drainage canals get blocked or covered over, like a sink with something covering the drain.

With angle closure glaucoma, the iris is not as wide and open as it should be. The outer edge of the iris bunches up over the drainage canals, when the pupil enlarges too much or too quickly. This can happen when entering a dark room.

Treatment of angle closure glaucoma usually involves surgery to remove a small portion of the outer edge of the iris. This helps unblock the drainage canals so that the extra fluid can drain. Usually surgery is successful and long lasting. However, you should still receive regular check-ups.

Symptoms of angle closure glaucoma : include headaches, eye pain, nausea, rainbows around lights at night, and very blurred vision.

Glaucoma evaluation:

Early detection, through regular and complete eye exams, is the key to protecting your vision from damage caused by glaucoma.
Regular eye check up helps us to diagnose Glaucoma. Prasad eye hospital and laser center has one of the most modern and sophisticated Glaucoma Clinic.


The following table gives us, how regularly eye check up should be done. 

Between age of 35 to 40 years:    First Check up
     
 Between age of 40 to 60 years:    Once in every two to three years
   
 After age of 60 years:    Once every year


Anyone with high risk factors, should be tested every year or two after age 35.


Routine Tests for Glaucoma:
Regular glaucoma check-ups include two routine eye tests: tonometry and ophthalmoscopy.

  1. Tonometry: The tonometry test measures the inner pressure of the eye or intraocular pressure with a special instrument 
    called applanation tonometer.
  2. Ophthalmoscopy: Ophthalmoscopy is used to examine the inside of the eye, especially the optic nerve. 
    If the pressure in the eye is not in the normal range, or if the optic nerve looks unusual, then  full glaucoma evaluation is advised. 
    Full Glaucoma Evaluation consists of tests  called perimetry, gonioscopy, pachymetry, optic disc photography and OCT (optical coherence tomography  or laser imaging of the nerve of the eye).
  3. Perimetry: The perimetry test is also called a visual field test. During this test, you will be asked to look straight ahead and 
    then indicate when a moving light passes your peripheral (or side) vision. This helps draw a “map” of your vision.
  4. Gonioscopy: Gonioscopy is a painless eye test that checks if the angle where the iris meets the cornea is open or closed, 
    showing if either open angle or closed angle glaucoma is present.
  5. OCT: The OCT instrument utilizes a technique called optical coherence tomography which creates images by use of special beams of light. The OCT machine can create a contour map of the optic nerve, optic cup and measure the retinal nerve fiber thickness. Over time this  machine can detect loss of optic nerve fibers.
  6. Pachymetry: Simple , quick and painless test to Determine Corneal Thickness

Why is Corneal Thickness Important ?
Corneal thickness is important because it can mask an accurate reading of eye pressure. Actual IOP may be underestimated in patients with thinner cornea and overestimated in patients with thicker cornea.


Truth & Facts about Glaucoma
Once diagnosed as a glaucoma patient, you require constant and lifelong care. If detected early, it can be controlled immediately and there by prevent any vision loss.  Although glaucoma can be controlled, any damage that has already occurred cannot be reversed. 
Glaucoma can be successfully controlled with eye drops, Pills or surgical operations.  This prevents further damage and thus preserves vision.  Often, people tend to think that once their IOP has been brought down to safe levels they have been cured of glaucoma.  Even when medication has successfully controlled glaucoma it is important to constantly monitor the condition by checking IOP levels regularly & use medications regularly.  Periodic eye examinations are vital in controlling glaucoma.  Glaucoma can worsen without your being aware of it and your treatment may need to be changed over time. 
We hope the following information is helpful to you.


Few Facts about Glaucoma 

  • Glaucoma is a leading cause of blindness. Estimates put the total number of suspected cases of glaucoma at around million.
  • Glaucoma can cause blindness if it is left untreated. And unfortunately approximately 10% of people with glaucoma who receive proper treatment still experience loss of vision.
  • There is no permanent cure (yet) for glaucoma.
  • Glaucoma is not curable, and vision lost cannot be regained. With medication and/or surgery, it is possible to halt further loss of vision. Since glaucoma is a chronic condition, it must be monitored for life.
  • Diagnosis is the first step to preserving your vision.
  • Everyone is at risk for glaucoma from babies to senior citizens. Yes, older people are at a higher risk for glaucoma but babies can be born with glaucoma (approximately 1 out of every 10,000 babies born in the world).Young adults can get glaucoma, too.
  • Estimates put the total number of suspected cases of glaucoma at around 65 million worldwide.

Symptoms of Glaucoma 

With open angle glaucoma, the most common form, there are virtually no symptoms. Usually, no pain is associated with increased eye pressure.
Vision loss begins with peripheral or side vision. You may compensate for this unconsciously by turning your head to the side, and may not notice anything until significant vision is lost. The best way to protect your sight from glaucoma is to get tested. If you have glaucoma, treatment can begin immediately. 

 

 

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