Glaucoma is a group of disorders characterized by progressive optic neuropathy resulting in a characteristic app: of optic disc with a specific pattern of irreversible visual field defects that are associated frequently but not invariably with raised Intraocular pressure (IOP). This elevated pressure is caused by a backup of fluid in the eye. Over time, it causes damage to the optic nerve. Through early detection, diagnosis and treatment, you and your doctor can help to preserve your vision.
— Primary Glaucoma- Open angle/Closed angle/Normal tension glaucoma.
— Congenital Glaucoma.
— Secondary Glaucoma- has a identifiable disease process:-
— Trauma – Head injury
— Long term use of topical Steroids.(nearsightedness).
At first, open-angle glaucoma has no symptoms. It causes no pain. Vision stays normal. Glaucoma can develop in one or both eyes. Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. They seem to be looking through a tunnel. Over time, straight-ahead (central) vision may decrease until no vision remains.
Many people may know of the “air puff” test or other tests used to measure eye pressure in an eye examination. But, this test alone cannot detect glaucoma. Glaucoma is found most often during an eye examination through dilated pupils. This means drops are put into the eyes during the exam to enlarge the pupils. This allows the eye care professional to see more of the inside of the eye to check for signs of glaucoma.
There are mainly 3 types of glaucoma:
Open angle glaucoma: About half of patients with this type of glaucoma remain asymptomatic. This common type of glaucoma gradually reduces your peripheral vision without other symptoms. By the time you notice it, permanent damage already has occurred. If your IOP remains high, the destruction caused by POAG can progress until tunnel vision develops, and you will be able to see only objects that are straight ahead.
Closed Angle Glaucoma: Angle-closure or narrow-angle glaucoma produces sudden symptoms such as eye pain, headaches, and halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting. These signs may last for a few hours, and then return again for another round. Each attack takes with it part of your field of vision.
Secondary glaucoma: Symptoms of chronic glaucoma following an eye injury could indicate secondary glaucoma, which also may develop with presence of eye infection, inflammation, a tumor or an enlarged cataract.
No. There is no cure for glaucoma. Vision lost from the disease cannot be restored. With treatment, further visual loss can be prevented.
To be safe and accurate, five factors should be checked before making a glaucoma diagnosis:
— Tonometry – Measuring IOP
— Dilated fundoscopy
— Gonioscopy – The angle in the eye where the iris meets the cornea
— Pachymetry – Thickness of the cornea
Computerised Visual Field Analysis:
A visual field test is an examination that may be performed to analyze a patient’s visual field. The test assesses patient’s response to a flash of light. This test can be completed anywhere from about 10-30 min depending on the patients co-operation.
Gonioscopy is an eye examination to look at the angle of anterior chamber of our eyes between the cornea and the iris. Gonioscopy is a painless examination to see whether the area where fluid drains out of your eye (called the drainage angle) is open or closed. It is often done during a regular eye examination, depending on your age and whether you are at high risk for developing glaucoma. A special lens is placed lightly on the front of your eye, and a narrow beam of bright light is pointed into your eye. Your doctor looks through the slit lamp at the width of the drainage angle.
A Pachymeter is a medical device used to measure the thickness of the eye’s cornea. It is useful in screening for patients suspected of developing glaucoma among other uses. Pachymetry can help your diagnosis, because corneal thickness has the potential to influence eye pressure readings. With this measurement, your doctor can better understand your IOP reading and develop a treatment plan that is right for you.
Diagnosing glaucoma is not always easy, and careful evaluation of the optic nerve continues to be essential to diagnosis and treatment. The most important concern is protecting your sight. Doctors look at many factors before making decisions about your treatment. If your condition is particularly difficult to diagnose or treat, you may be referred to a glaucoma specialist. A second opinion is always wise if you or your doctor become concerned about your diagnosis or your progress.
— State of art MEDICAL line of management
— Filtering Surgeries like Trabeculectomy with Antimetabolites implant(Mitomycin, Ologen)
— Trabeculectomy combined with phacoemulsification and iol implantation
— Deep sclerectomy
— Cyclodestructive procedures