Glaucoma Surgery

What is Glaucoma?

Glaucoma is an eye condition that develops when too much fluid pressure builds up in the eye. The internal or intraocular pressure (IOP), if high, can damage the optic nerve, which transmits images from the retina to the brain. Glaucoma was discovered in the 17th century, but its importance as a cause of blindness has been known only since the 19th century. Initially in the Hippocratic Aphorisms, the word glaucoma was used to describe blindness.

How does it happen?

A fluid called aqueous humour (this fluid nourishes the cornea and the lens and gives the eye its shape) is produced in the eye, which is constantly drained out through a mesh like channel. This maintains a constant intraocular pressure around 10mm to 20mm Hg. When there is an obstruction to this circulation, fluid accumulates in the eye and pressure in the eye increases. Abnormally high levels of IOP can damage delicate visual structures like optic nerve head which can lead to gradual loss of visual field and finally to blindness, if untreated.

Glaucoma has been nicknamed the "Sneak thief of sight", because the loss of visual field normally occurs gradually over a period of time and is often only recognized when the disease is quite advanced. Once lost, this damaged visual field can never be recovered. Glaucoma is the leading cause of irreversible blindness in the world, where 60.5 million people had glaucoma in 2010. In India Glaucoma is the third leading cause of blindness, accounting for 13 percent of the country's blindness.

Glaucoma cannot be prevented but if it is diagnosed and treated early, the disease can be controlled. Less common causes of glaucoma include:

Development of Glaucoma

Types of Glaucoma

Glaucoma cannot be prevented but if it is diagnosed and treated early, the disease can be controlled. Less common causes of glaucoma include:

  • Congenital Glaucoma (Glaucoma affecting children between the ages of birth and 3 years)
  • Blunt or Chemical Injury
  • Corticosteroid Intake: Steroid-induced glaucoma results from the use of steroids
  • Blockage of Blood Vessels in the Eye
  • Inflammatory Condition and occasionally post-surgery
Glaucoma Stage 1

Normal Vision

Glaucoma Stage 2

Early Glaucoma

Glaucoma Stage 3

Advanced Glaucoma

Glaucoma Stage 4

Extreme Glaucoma

Note: if diagnosed early, can be controlled to a large extent with medication/laser/surgery. Successfully lowering the eye pressure can prevent further visual loss from glaucoma. However, if not detected early or with irregular treatment, patient can even become blind. Thus, it is imperative for the patient to understand the importance of this disease and also the value of regular follow-ups and compliance to medication.

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Can Glaucoma be prevented?

Glaucoma cannot be prevented but if it is diagnosed and treated early, the disease can be controlled. Less common causes of glaucoma include:

  • Congenital Glaucoma (Glaucoma affects children between the ages of birth and 3 years)
  • Blunt or Chemical Injury
  • Corticosteroid Intake: Steroid-induced glaucoma results from the use of steroids
  • Blockage of Blood Vessels in the Eye
  • Inflammatory Condition and occasionally post-surgery

Population at risk

Everyone is at risk of having glaucoma from newborns (1 in 10,000 babies born have glaucoma), infants, children, youngsters to elderly. The following are the population more at risk of obtaining glaucoma:-

  • People with family history of glaucoma
  • People having diabetes mellitus (especially, diabetes during pregnancy) /hypertension (high blood pressure)
  • People with high myopia (near sight) or high hypermetropia (farsightedness)
  • Those who take corticosteroid (anti-inflammatory) medications

Symptoms of Glaucoma

  • Frequent change of glasses
  • Painless progressive diminution of vision
  • Haloes around light
  • Narrowing of field of vision
  • Sudden onset of pain, redness of associated with headache and vomiting (Angle closure glaucoma)

Treatment

  • Medical Treatment - Eye Drops
  • Laser Therapy
  • Surgery in advanced cases or in those uncontrolled by medicine / laser

Follow up Measures
Once glaucoma is diagnosed, a lifelong care is required. It is important for patients to use the eye drops regularly and come for regular follow ups.

Facilities available
The following facilities are available at Manipal Eye Care for Glaucoma

Tests done

What does the test examine

How is the test done

Applanation Tonometry

IOP measurement & Check Inner eye pressure

The eye is numbed via eye drops. The examiner then uses a tonometer to measure the inner pressure of the eye through pressure applied by a puff of warm air / tiny tools

Gonioscopy

Using a special lens to look at the eye, where the iris meets the cornea

Eye drops are used to numb the eye. Then a hand-held contact lens with a mirror is placed gently on the eye to allow the examiner to see the angle between the cornea and the iris.

Ophthalmoscope

The shape & colour of optic nerve head

Eye drops are used to dilate the pupil. A small magnification device with a light on the end is used to examine the magnified optic nerve.

Perimetry:

Computerised Visual Field Analyser allows the examiner to map the patient's field of vision

The patient looks straight ahead and is asked to indicate when light passes the patients peripheral field of vision.

RNFL Analysis by OCT

Thickness of the nerve fiber layer & structural or anatomical changes in the retina are examined

Look at a yellow-green spot inside the machine and technology does the rest.

Pachymetry

Thickness of the cornea

The examiner places a pachymeter gently on the front of the eye to measure its thickness.

Fundus Photograph

   

YAG Laser

Effectively remedies haze or opacity of the capsule.

Creates an opening in the center of the cloudy capsule, removes the opacity from your line of sight, without making an incision/ touching the eye.

Argon Laser

Reduces the pressure in your eye and helps prevent further damage to optic nerve & vision loss.

Our doctor uses a laser to make more openings in the drainage pathways (the trabecular meshwork) in your eye

Note: Glaucoma, if diagnosed early, can be controlled to a large extent with medication/laser/surgery. Successfully lowering the eye pressure can prevent further visual loss from glaucoma. However, if not detected early or with irregular treatment, patient can even become blind. Thus, it is imperative for the patient to understand the importance of this disease and also the value of regular follow-ups and compliance to medication.

Read More

Myth Busters (Click on myth to know the fact)

Myth:People with good vision do not have Glaucoma.

Fact: Many people, who can read signs from a distance, believe they do not have glaucoma. But they do not realise that in a vast majority of cases Glaucoma affects peripheral vision first and then closes in, affecting central vision only in the later stages. By the time they notice deterioration in central vision, the disease may be very advanced and significant, permanent loss to your vision has already occurred.

Myth:Only people in their old age are affected by Glaucoma.
Myth:Delaying Glaucoma surgery is better.

Fact: This is false and treatment should be done immediately as any vision loss due to Glaucoma is permanent. The surgery and medical treatment for Glaucoma does not repair/regenerate the damage that has already happened to the eyes.

Trivia: World Glaucoma Week: 11th-17th March

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