Glaucoma

Glaucoma is an eye disease that causes loss of sight by damaging a part of the eye called the optic nerve. This nerve sends information from your eyes to your brain. When glaucoma damages your optic nerve, you begin to lose patches of vision, usually side vision (peripheral vision). Over time, glaucoma may also damage straight ahead (central) vision. You may not notice a loss of side vision until you have lost a great deal of your sight. When checking for glaucoma, eye doctors usually look for damage to the optic nerve and any loss of side vision. They may also check your eye pressure. Glaucoma is often called the ‘silent killer’ because people usually do not notice any signs of the disease until they have already lost significant vision. Once lost, vision cannot be restored.

• Chronic (Open Angle) Glaucoma:

  This is the most common type. In open-angle glaucoma, aqueous fluid drains too slowly and pressure inside the eye builds up. It usually results from aging of the drainage channel, which doesn't work as well over time. However, younger people can also get this type of glaucoma.

• Normal Tension Glaucoma:

  This is a form of open-angle glaucoma not related to high pressure. People with normal tension glaucoma may be unusually sensitive to normal levels of pressure. Reduced blood supply to the optic nerve may also play a role in normal tension glaucoma.

• Acute (Angle Closure) Glaucoma:

  Less than 10 percent of people have this form, but It causes a sudden rise in pressure, requiring immediate, emergency medical care. The signs are usually serious and may include blurred vision, severe headaches, eye pain, nausea, vomiting or seeing rainbow-like halos around lights. Occasionally, the condition may be without symptoms; similar to open angle.

• Secondary Glaucoma:

  Another 10 percent of glaucoma cases come from certain diseases and conditions that damage the eye's drainage system. These include diabetes, leukemia, and sickle-cell anemia also some forms of arthritis, cataracts, eye injuries or inflammation of the eye plus steroid drug use and growth of unhealthy blood vessels.

• Post-Surgical Glaucoma:

  which happen due to some surgeries, such as retinal reattachments increase the chance of getting glaucoma.

Your eye produces a watery fluid (aqueous humor), which goes into the eye and drains out. When your eye is healthy, the fluid drains through a mesh-like pathway and into the bloodstream. Aqueous fluid is produced by the ciliary body. It flows through the pupil and behind the clear cornea. Finally, it drains away through the trabecular meshwork. For some people, fluid can't drain properly because of a faulty drainage system. Drainage that once worked well may gradually slow down as you get older. A sink that becomes clogged backs up with water. When there is no place for excess fluid to go, a pressure inside the eye builds up. This increased eye pressure may damage the optic nerve over time. Slowly, the nerve fibers that are essential for vision die. For others, glaucoma damages the optic nerve without increased pressure. These people may be unusually sensitive even to normal levels of pressure. Their glaucoma may also be related to problems with blood flow in the eye. Different people experience glaucoma differently. Usually, glaucoma affects side vision (peripheral vision) first. Late in the disease, glaucoma may cause "tunnel vision." In this condition, the person can only see straight ahead. That's why someone with glaucoma can have good straight ahead (central) vision. However, even central vision can be seriously damaged.

All the above tests will be done at the time of diagnosis and a systematic document would be made that would help the doctor treat you in the best possible way. Some of the above tests need periodic repetition that has a specific scientific logic. Please ask your doctor and understand the details and the logic behind such a routine. This will greatly enhance the way you understand your disease.

Some people may need eye surgery to control their glaucoma. Lasers are very useful for treating glaucoma because they avoid cutting and have a lower chance of complications (compared to glaucoma surgery).

Creates a new path through the eye's tissues to let fluid drain from the eye. In the most common filtering surgery, called a trabeculectomy, the surgeon makes a small opening in the white part of the eye (the sclera) to create a new outflow path. The fluid then flows through the new opening and creates a bleb, which is like a small bubble or reservoir on the surface of the eye. The bleb holds the fluid while it is slowly absorbed into the surrounding tissue. The upper eyelid usually hides the bleb, so it's not noticeable to you or others. Most people who have this procedure no longer need medicine after surgery. Some people treated still need medicine, but they have better pressure control after the surgery. About 15 percent do not benefit from filtering surgery.

Drainage implant surgery is sometimes performed when a person is not suited for filtering surgery or when filtering surgery has failed. Depending on the kind of implant used, the surgery is called a valve, shunt or seton surgery. In these procedures, the surgeon inserts a tiny tube through the sclera into the front part of the eye behind the iris. This tube becomes a path for fluid to drain away. The other end of the tube is attached to a tiny reservoir that acts like the bleb (described on page 19) to hold fluid until it is absorbed into the surrounding tissue. The reservoir is placed on the surface of the eye, back between the eye muscles, so it is not visible.

Please ask your doctor regarding the risks and benefits of undergoing a procedure , Options that are available and be well-informed before you give your consent for any operative intervention

Even if surgery or drugs lower pressure in your eye, it's still possible to lose vision. Therefore you and your doctor must carefully monitor the disease. Communicate with your doctor any difficulties in compliance with the drug Regimen such as cost, difficulty in installation, lack of social support and inability to come for frequent follow-ups; so that the doctor can address these appropriately

Since you will be visiting your eye doctor regularly, take time and care in choosing a person who you are comfortable with. Your doctor should understand that your questions and concerns are important. A doctor who is willing to work with you, listen to your concerns and provide the best treatment plays a large part in your success against glaucoma. Also, you as a patient must be aware and adhere to the patient's responsibilities in glaucoma treatment such as regular follow-ups honest feedback on drug installation And updating about the occurrence of a new medical problem during the course of treatment

You may need medicines every day for the rest of your life. Find support and encouragement from your family, friends, and others. Sometimes it helps to talk to people who have experienced the same thing. It can help you to discuss side effects, share ways to remember your medicines and New medicines are being developed and other treatments may soon become available. Promising scientific discoveries will help you look forward to a bright future.