Glaucoma (Contd...)

Glaucoma Treatment

Glaucoma treatment (for any form) entails decreasing aqueous humor production, increasing fluid drainage or a combination of the two.
These treatments will not restore any vision already lost to glaucoma.

The best way to prevent vision loss from glaucoma is early diagnosis and treatment. See your eye care practitioner at least every two years for a complete examination, including an IOP check.

People at high risk for glaucoma due to high intraocular pressures, family history, ethnic background, age or abnormal nerve appearance may need more frequent visits to the eye doctor.

Glaucoma Assessment

Glaucoma assessment is critical, early diagnosis based on different criteria of evaluation needs to be precise, with a regular follow up strategy, to forestall progression of the disease

1.Intra Ocular Pressure Measurement.

• Applanation tonometers continues to be the gold standard of measurement. An IOP is termed 'abnormal’ based on associated clinical findings.
• An individual could be a glaucoma suspect needing frequent follow up to detect inception of disease.
• An individual could have raised intra ocular pressure without the disease labeled ‘Ocular Hypertensive’.
• An individual could have raised intra ocular pressure with all features of disease entity and progression
• Small infants with congenited glaucoma need evaluation under general anaesthesia.

2. Optic Disc Evaluation

Specific changes in the optic disc are indicative of glaucoma. The 78 – 90 D lenses at the slit lamp evaluation and the indirect ophthalmoscopic examination evaluate the disc changes.

3. Fundus Photography is an additional tool to evaluate the optic disc and for desired documentation to assess progression of the disease.

4. Visual Field Analysis: With the raised intra ocular pressure, permanent damage occurs in the multitudes of optic nerve fibres. These could present even before the other obvious changes of glaucoma present. An automated field perimetry is useful in mapping the central visual fields within 30 Degree and the peripheral losses which provides concrete information with the various indices, age matched studies and probability plots. The trend of the disease can also be analysed by the different strategies available in the computer.

5. Optical Coherence Tomography: This is a laser scanning interferometer, the latest acquisition at our centre which can quantify the retinal structure by measuring the retardations of the reflected light. The retinal nerve fibre thickness analysis, the macular thickness and the optic disc specific measurements clinch the disease entity at its earliest inception. 30 % of the retinal nerve fibre damage presents before the clinical presentation of glaucoma. Hence OCT is a great tool in early diagnosis of glaucoma.

Finally, the eye care practioner needs to correlate all the clinical findings with the imaging techniques and arrive at the diagnosis, management strategy and follow up.

Medication

Generally the first stage of glaucoma treatment is beta-blocker eye drops, which will lower fluid production in the eye. However,newer drugs with more promising results are now available.

Most cases of glaucoma can be controlled with a single drug or drug combinations, but some patients may require surgery.

Laser Surgery

During glaucoma surgery, a laser creates tiny holes where the cornea and iris meet, in a procedure called trabeculoplasty to increase aqueous humor drainage.

Another procedure called trabeculectomy creates an artificial drainage area in cases of advanced glaucoma when there is optic nerve damage and the IOP continues to soar.

A third option is a drainage device, which the surgeon implants in your eye to improve fluid drainage.

Yag Laser Iridotomy

• This is the Laser used to create an opening in the periphery of the iris.
• This is to provide pathway for drainage of fluid from the front part of the eye of patients who have angle closure Glaucoma

Is this a complicated procedure ?

• It is a simple out patient procedure
• It takes only about two minutes per eye
• There are no restrictions following the procedure
• This is not a painful procedure.

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