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Glaucoma – “The sneak thief of sight”

This article is intended to increase awareness of Glaucoma, a potentially blinding eye condition, which is mostly symptomless and hence neglected.
The eye is the organ of sight, a nearly spherical hollow globe filled with fluids. The fluids in the eye are divided by the lens into the vitreous humour (behind the lens) and the aqueous humour (in front of the lens). The aqueous humour is being made behind the coloured part of the eye (the iris). It leaves the eye through channels in the front of the eye in an area called the anterior chamber angle, or simply the angle, which acts as a drain for the eye. This forming and draining of the fluid (aqueous) is a continuous process and also is a fine balance maintaining a certain pressure in the eye called intraocular pressure.

What is Glaucoma?

Anything that slows or blocks the flow of this fluid out of the eye will cause pressure to build up in the eye.
The increased pressure causes compression of the optic nerve which can eventually lead to nerve damage. Glaucoma can cause partial vision loss, with blindness as a possible eventual outcome.
Glaucoma refers to the condition of increased intraocular pressure causing nerve damage at the back of the eye which can be detected clinically and/or by a set of specialized investigations called Visual Fields and Retinal Nerve Fibre Analysis. Increased pressure alone does not constitute glaucoma but must raise an alarm, similarly normal pressure may also cause nerve damage.
This nerve loss causing VISION LOSS IS IRREVERSIBLE, hence the need to detect and arrest progression of nerve loss in the early stages.

Open-angle (chronic) glaucoma is the most common type of glaucoma. The cause is unknown. It is usually seen after the age of 40 years. An increase in eye pressure occurs slowly over time. The pressure pushes on the optic nerve. This type tends to run in families, so the risk is higher if one has a parent, a grandparent or a sibling with open- angle glaucoma.
This type of glaucoma is symptomless and is usually detected on routine examination.

Angle-closure (acute) glaucoma occurs when the exit of the aqueous humour fluid is suddenly blocked. This causes a quick, severe, and painful rise in the pressure in the eye. Acute angle-closure glaucoma is an emergency. This is very different from open-angle glaucoma, which painlessly and slowly damages vision. If you have had acute glaucoma in one eye, you are at risk for an attack in the second eye, and your doctor is likely to recommend preventive treatment in the form of laser in the second eye.
Often during routine examination the angles are noted to be narrow, in such cases the intraocular pressure may be normal and the patient is otherwise asymptomatic but is still advised to undergo a laser treatment called YAG PI(peripheral iridectomy). This laser forms an alternative route for the aqueous to flow should the angles suddenly close. This is a preventive treatment done in persons having narrow angles (angles are the natural drainage system in the eye). This is an outpatient procedure and both eyes are done in the same sitting. This does not mean they have glaucoma.

Congenital glaucoma is seen in babies. It often runs in families (is inherited).It is present at birth. It is caused by abnormal eye development.

Secondary glaucoma is caused by drugs such as corticosteroids, certain eye conditions like uveitis, systemic diseases and trauma.

Normal-tension glaucoma – A type of Glaucoma in which eye pressure can be normal, but the nerve may get damaged.

A comprehensive (complete) eye examination is needed to diagnose glaucoma. The examination will include vision, refraction, tonometry (eye pressure checkup), and evaluation of the nerve and retina after dilatation. Some of the other tests may include using a special lens to look at the angle (drain) of the eye (gonioscopy),visual field testing and scanning of the nerve with the help of specialized equipments(OCT).

The goal of treatment is to reduce eye pressure. Treatment depends on the type of glaucoma that one has. Most people can be treated successfully with eye drops. Most of the eye drops used today have fewer side effects than those used in the past. Tablets may also be given to lower pressure in the eye. Other treatments may involve Laser therapy. Eye surgery for glaucoma is reserved for those whose pressure doesn’t get controlled with drops or laser.

Expectations (prognosis)
Open-angle glaucoma cannot be cured. However, you can manage your symptoms by closely following your doctor's instructions. Regular check-ups are needed to prevent blindness. Angle-closure glaucoma is a medical emergency. You need treatment right away to save your vision. Babies with congenital glaucoma usually do well when surgery is done early. How well a person with secondary glaucoma does depends on the disease causing the condition.
With proper use of medications and regular follow up with the eye specialist most Glaucoma patients will be able to lead a life with good vision.

Prevention
All adults should have a complete eye exam from age 40 on a yearly basis, or sooner if you have risk factors for glaucoma or other eye problems. You are more likely to get glaucoma if have a family history of open-angle glaucoma, have diabetes or high blood pressure.
If you are at high risk for acute glaucoma, talk to your doctor about having eye surgery to prevent an attack.