Kerala Kaumudi Online
Thursday, 09 April 2020 12.26 AM IST

What is Glaucoma?


Glaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for good vision.

It is one of the leading causes of blindness for people over 60 yrs, 37 million worldwide are blind of which 15 million are in India.

In India glaucoma is one of the leading causes of irreversible blindness with at least 12 million affected and 1.2 million blind. More than 90% cases of glaucoma remain undiagnosed.

The number of cases is projected to rise significantly as the population ages

What is Glaucoma?
Glaucoma is a disease affecting the optic nerve (nerve connecting the eye to the brain) mostly due to too much fluid pressure (aqueous humour) in the front part of the eye.

How does it happen?
The inside of the eye contains fluid that is constantly flowing into and being drained out of the eye. The fluid is not the same as tears which are found on the outside.

Think of the eye as a sink with a tap that is always open. Water flows through if the drainage mechanism is working alright. The trouble arises when the drainage is blocked and the water begins to collect.

When the drainage mechanism in the eye gets blocked, it results in the fluid accumulating in the eye. As the fluid builds up it begins to exert pressure inside the eye. The pressure is referred to as intraocular pressure (IOP) a term all are familiar with. When there is no problem with the drainage the IOP is maintained at a fairly normal level. It may vary slightly but stays within a safe range. Just as abnormally high blood pressure affects the body adversely, IOP which build up to abnormally high level can harm the eye

Over a period of time, this high pressure (IOP) can damage delicate visual structures like the optic nerve head. Left untreated, it can lead to blindness.

How to identify glaucoma?
Early stages of the disease can’t be seen or felt. Can only identify it during routine eye check when IOP is high and more detail testing are done

Damage can be as loss of field or visual changes. Initially the central vision will be spared and only peripheral vision is affected.

Reasons why it is undetected

Glaucoma can be painless, and will have no discomfort.

Early vision loss is in the periphery so goes undetected.

Often affects one eye more in severity

Usual vision tests only check central vision like vision charts

Often associated with aging so accepted as part of aging

Professional eye care is difficult to obtain and beyond their financial reach

Awareness and knowledge about glaucoma is unknown at community level

Glaucoma can be classified and sub classified into various types depending on various factors.

In all types of glaucoma the optic nerve is damaged usually due to high eye pressure.

The most common type of glaucoma is open angle type often has no symptom other than slow vision loss.

Angle closure glaucoma although rare, is a medical emergency and its symptoms include eye pain with sudden vision disturbance

Risks for glaucoma
Age above 55 yrs
Family history of glaucoma
Injury to the eye
On topical or oral steroid use
High refractive error
Once diagnosed as a glaucoma patient constant and life long treatment is important. Earlier diagnosis of glaucoma is better in preventing visual loss

How to treat
Glaucoma can be successfully treated with eye drops, laser. The most common treatment of choice is eye drops. Medication can work in two ways, one is to increase the drainage of fluid in the eye, while the other is to decrease the production of fluid in the eye

If IOP is not controlled with eye drops then surgery will be required.

Will glaucoma cause blindness?
If neglected glaucoma will cause irreversible blindness in both eyes

All you need to do is give your eyes the right kind of attention by putting your eye drops at the right time and consulting your Doctor at regular intervals. This will play a crucial role in controlling glaucoma and preventing blindness

Helping your doctor help you

Having diagnosed and knowing you have glaucoma puts you one step ahead of the disease. You can, together with your doctor work towards protecting your vision in the years ahead.

If you are newly diagnosed glaucoma patient, you may need to have your IOP levels checked every week or month until they are under control. Even when your IOP is at a safe level, you need to see the doctor several times a year for regular checkups.

It is also important that you discuss with your doctor yours concerns and questions and get more information on your treatment options. Make it a point to talk to your doctor about doubts.

Care for your eyes
Try to keep your eyes clean and free of irritants like avoid exposure to heat, dust and smoke as far as possible.

Avoid rubbing eyes even though some eye drops might make your eyes feel itchy or blurry.

Take home message
It is recommended that everyone should have their IOP checked at around 35 yrs.

For successful treatment correct timing of medications and periodic checkup is important.

Maintaining healthy life style with proper treatment for systemic illness also is essential.

Dr Asgar Abbas
Consultant Ophthalmologist
KIMS Hospital

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