Glaucoma Service

Glaucoma is the leading causes of irreversible blindness worldwide. In India alone, it affects around 12 million people; India is projected to become the world capital of glaucoma by 2020. The sight loss caused by glaucoma is progressive and, unlike cataract, is irreversible. Fortunately, early diagnosis and treatment can prevent blindness.

What is glaucoma?

Glaucoma is a disease of the nerve for vision (optic nerve) caused by increased pressure in the eye.

How does glaucoma occur?

Glaucoma1The inside of the eye contains a fluid, which is being produced and drained out of the eye constantly. It is drained through a sieve like structure situated at the angle between the transparent cornea and the brown coloured iris. When the drainage mechanism becomes ineffective, the pressure in the eye (intra-ocular pressure) increases leading to optic nerve damage.

What are the effects of glaucoma?

Glaucoma can lead to permanent loss of vision. Initially, the loss of vision starts from periphery and progressively affects the central vision. The central visual acuity is affected only in the advanced stage.

Progressive loss of visual field with corresponding loss optic nerve damage

Progressive loss of visual field with corresponding loss optic nerve damage

Are all the Glaucomas same?

No, there are many types of glaucoma. Some of these are:

  • Open angle glaucoma, in which, despite of open drainage angle, the drainage does not occur
  • Angle closure (closed angle) glaucoma, in which, the angle itself is closed preventing fluid drainage
  • Secondary glaucoma, which occurs due to other eye disease or treatment

Glaucoma3

How do I know whether I have glaucoma?

95% patients with glaucoma do not have any sypmtoms. Glaucoma is a silent disease that cannot be detected or felt by the patient since central vision remains unaffected till the late stages of the disease. Hence it is rightly called as the ‘sneak thief of sight’. It is usually detected during a routine eye checkup.

When should I go for eye checkup?

Everyone over the age of 40 years should have a detailed eye check up, at least when one needs reading glasses. Hence it is advisable to not stop with visiting an optician alone.
Those who have additional risk factors should undergo an early evaluation.

What are the risk factors associated with glaucoma?

If you

  • have blood relatives with glaucoma
  • have diabetes mellitus, hypertension, or thyroid disease
  • are near sighted
  • are on treatment with steroids (in the form of tablets, skin ointments, inhalers, eye drops)
  • have a history of trauma

You will need an early check up if you have any of the above symptoms.

What are the tests I need to undergo?

Tests help in finding out the presence of glaucoma and also its progression in the subsequent follow ups.
These tests include;

  • Tonometry: To measure the pressure in the eye
  • Gonioscopy: To assess the drainage angle
  • Ophthalmoscopy: To view the optic nerve
  • Pachymetry: To check the thickness of cornea
  • Perimetry: To assess the field of vision

All these tests are painless.

What is the treatment?

Glaucoma is a treatable disease that needs early detection as the damage is not reversible. The treatment can include medications, laser or surgery.

  • MEDICAL TREATMENT – The medications either decrease the production of the fluid or increase the drainage of the fluid so as to keep the eye pressure under control as determined by your doctor.

The correct method to instil eye drops is being depicted:

FIG

You are advised to be compliant in using the eye drops and visit your doctor at regular intervals for eye-pressure check-up.

  • LASER TREATMENT – Lasers are used in the treatment of glaucoma to increase the outflow of fluid from the eye. The LASER treatment we offer include:
    • LASER PERIPHERAL IRIDOTOMY – It is the application of a laser beam to selectively make a small hole through the iris. This is done only for patients with angle closure glaucoma. It is a simple, outpatient procedure which takes about 10-15 minutes. However, eye drops need to be instilled prior to the procedure to make the pupil small. All regular activities may be resumed after the procedure. It will be necessary to use eye drops for about one week and re-visit your doctor after a week.
    • SELECTIVE LASER TRABECULOPLASTY – It is the application of a laser beam to areas of the trabecular meshwork (sieve like area through which the fluid drains out) to increase fluid outflow. This can be performed only to areas of the angle that are open.
  •  SURGICAL TREATMENT – It aims to increase the fluid outflow in the eye.  The surgeries most commonly performed include trabeculectomy and drainage device implantation surgeries. These procedures create a drainage channel from the anterior chamber to the external surface of the eye under the conjunctiva, aiming at lowering the pressure inside the eye.

Does treatment restore the lost vision?

Treatment of glaucoma aims at preserving the existing vision; it does not restore the vision that is already lost. Therefore, early detection and treatment are very important.

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Department of Glaucoma at Narayana Nethralaya is equipped with the latest diagnostic facilities including,

  • Perimeters – Humphrey Visual Field Analyser, VFA Octopus and Humphrey Matrix.
  • Retinal Nerve Fiber Layer Analysers
    – Spectral Domain Optical Coherence Tomography (SD-OCT)
    – GDX
    – Heidelberg Retinal Tomogram (HRT-3)
  • Ultrasound Pachymetry.
  • Ultrasound Biomicroscopy.
  • Anterior Segment OCT (AS-OCT).
  • Newer Tonometers – Tonopen, I-Care, Dynamic Contour Tonometer, ORA.

Doctors of Glaucoma Service

@Rajajinagar

Dr. Sathi Devi A.V
Dr. Ramgopal B
Dr. Dhanraj Rao A.S
Dr. Jayasree P.V
Dr. Zia S. Pradhan
Dr. Mahalakshmi Nair

@Narayana Health City

Dr. Sushma Tejwani
Dr Shoruba Dinakaran

@Castle street, Ashok Nagar

Dr. Ashwini Niranjan

@Bannerghatta Road

Dr. Harsha Rao
Dr. Narendra KP