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What is Glaucoma

What is Glaucoma ?

Glaucoma is one of the leading causes of irreversible blindness in the world. Eye Solutions is one of the best hospitals for glaucoma in India having many years of glaucoma management experience.   Glaucoma is also known as Kach bindu or Kala Pani in Hindi. Visual loss in glaucoma is preventable or stabilized with early diagnosis and treatment. Glaucoma is a disease which causes damage to the optic nerve leads to progressive. This damage causes irreversible vision loss. This damage occurs because of increased eye pressure. Here will talk about the Glaucoma symptoms and treatment, how to prevent glaucoma and some forms of secondary glaucoma like Steroid induced glaucoma.

The optic nerve connects the retina to your brain, where visual or light signals get interpreted as the images you see. In the healthy eye, a clear fluid called aqueous humor circulates inside the front part of your eye. To maintain a constant healthy eye pressure, your eye produces a small amount of aqueous humor while an equal amount of this fluid flows out of your eye. In glaucoma, the aqueous humor does not flow out of the eye . Fluid pressure in the eye builds up and, over time, causes damage to the optic nerve fibers.

The disease is painless, symptom-less and irreversible. Thus, the person with glaucoma is usually unaware of it until much loss of vision has occurred. Early detection and regular treatment are the keys to preventing glaucoma and associated optic nerve damage and blindness.

TYPES OF GLAUCOMA 

 Primary glaucoma: Glaucoma without any associated eye condition.             

Secondary glaucoma: Glaucoma due to an associated eye condition.

These can be sub categorized as follows 

Primary open angle glaucoma

In this type of glaucoma drainage channel of the eye is open and large enough for drainage to occur. Yet the drainage does not occur as there is a problem in the drainage system of the eye. It is similar to having a broad pipe which gets blocked internally and thus not allowing fluid to flow through. This type is very common in India and affects people after the age of 50. Thus, it is very important to get your eye pressure and optic nerve examined regularly after 50. In certain conditions it may occur earlier than the age of 50 years. These conditions refer to predisposing conditions.

Some of the predisposing conditions:

  1. Diabetes 

  2. Family history where in one or more 1st or 2nd degree family members suffers from a similar condition.

  3. High Myopia or very high number for distance vision. 

This condition is usually treated medically by eye drops which help lower the eye pressure by increasing drainage of fluid out of the eye. In certain advanced cases glaucoma surgery becomes necessary to lower eye pressure.

You can read more about primary open angle glaucoma.

Primary closed angle glaucoma

In this type of glaucoma the drainage channel of the eye is narrow due to which fluid does not exit the eye. This is similar to having a narrow pipe which doesn’t allow fluid to flow through it. This type of glaucoma is commonly seen in India. It occurs more commonly in females. This glaucoma commonly happens at the age of 40 years. 

Some of the predisposing conditions:

  1. Family history where in one or more 1st or 2nd degree family members suffers from a similar condition.

  2. High Hyperopia – Which is a high plus number in your glasses

This condition in most cases is easily treated by a laser procedure which broadens the drainage channel. This is know as laser iridotomy. In some more advanced cases medications or surgery may be the line of management.

In patients with a cataract, removal of the cataract also helps broaden the drainage channel. 

Secondary glaucoma

These are conditions that cause the pressure in the eye to increase indirectly and hence cause glaucoma. It can do so by damaging the drainage channel or blocking it.  

Some common examples are:

  1. Bleeding in the eye due to trauma. The drainage channel gets blocked due to trauma 

  2. Blunt trauma to the eye. This causes direct damage to the drainage channel of the eye 

  3. Inflammation in the eye or uveitis. Inflammatory cells block the drainage channel

  4. Mature cataract. When cataract advances to a level where it matures it swells in size and blocks the drainage channel.

  5. Steroid Induced Glaucoma : Long term use of steroids causes a rise in eye pressure.  Sometimes this raised eye pressure does not reduce even after stopping the steroids.   One may also need surgery to treat the glaucoma. Either a trabeculectomy or even a tube shunt glaucoma surgery.

WHAT HAPPENS WHEN A PERSON HAS GLAUCOMA?

The optic nerve of the eye is like a large electric cable. It contains many tiny wires inside it known as nerve fibres. These nerve fibres pick up information from all the parts of the retina. All the nerve fibre signals together help in giving a complete field of vision. 

Now what happens when the eye pressure increases. The increased pressure presses upon these delicate nerve fibres and kills them. The longer the eye pressure high the more nerve fibres die. As each nerve fibre handles a part of the visual field when they die that part of the field of vision gets lost. When 90 percent or more nerve fibres get damaged it hampers a patient’s central vision. 

This combination of raised eye pressure, optic nerve damage and reduced field of vision is glaucoma.

WHO IS AT RISK OF DEVELOPING GLAUCOMA?

As mentioned earlier some of the risk factors of glaucoma are:

  1. People with family history of glaucoma. Anyone with 1st or 2nd degree family members with  glaucoma should get checked for the condition.

  2. Patients with diabetes. Diabetic patients can lead to primary  open angle glaucoma. 

  3. Patients with high spectacle power. High myopia and high hyperopia both cause glaucoma.

  4. Anyone with a history of trauma 

  5. Anyone with a recent surgery in the eye. Any eye surgery can cause a disturbance in the fluid drainage of the eye and cause eye pressure to increase.

  6. People with advanced cataracts. As the cataract can swell and block the drainage channel of the eye.  

WHAT DOES A PERSON WITH GLAUCOMA FEEL ? WHAT ARE GLAUCOMA SYMPTOMS ?

Glaucoma is silent disease. Many of our patients don’t realise that they have glaucoma till the very end where their central vision starts getting affected. Unfortunately not much can helped to revive vision at that point.

In glaucoma patients. there is peripheral field of vision. The visual field goes on  becoming smaller and smaller as the damage to the nerve increases. In the advanced stages the patients have tunnel like vision. This is like the view we get when we look out when driving through a tunnel.

This is a disease that remains silent in the early part of the condition. Hence,  we council all people who are in predisposed group or are in the high risk group of having the disease to get a thorough glaucoma evaluation. Nothing is more important than detecting it early. 

In cases where the eye pressure becomes very high patients may feel pain or pressure over the eye and forehead. Some may even have red eyes. 

Some patients may complain of decreased vision in dim light.

Freqyently Asked Questions ?

What is Glaucoma ?
Glaucoma means that the eye pressures are high. The front of the eye filled with a fluid called aqueous. This fluid develops in the eye by a structure called the ciliary body and flows out of the eye from a structure called the trabecular meshwork or the drainage angle of the eye.

If there is an imbalance between the production and drainage of aqueous then the pressure of the eye goes up. This high pressure damages the delicate optic nerve fibres which are responsible for vision. This damage of the nerve fibers results in gradual vision loss and this vision loss is irreversible.

What is open angle glaucoma ?
When the trabecular meshwork or the part of the eye where the fluid is being drained from is open then its called as Open Angle glaucoma. These types of glaucomas may respond to eye drops to reduce the eye pressure.

What is narrow / closed angle glaucoma ?
When the area from where the fluid in the eye drains out, the angle ( space between the back surface of the cornea and the front surface of the iris), is very narrow, called as narrow angle glaucoma. In other words the area for fluid to leave the eye has reduced.

Eye drops are also used to treat this condition but there is another procedure which can be advisable to reduce the pressure called Yag Peripheral iridotomy

What is normal tension glaucoma ?
Glaucoma happens when the eye pressure is more than 21mm of Mercury, when there is evidence of nerve damage. Sometimes however the pressure is below 21mm of mercury and there is still evidence of nerve damage and that is when we call it Normal Tension Glaucoma. Treatment is like open angle glaucoma.

What is Ocular Hypertension ?
Just like Normal tension glaucoma is when glaucoma is diagnosed inspite of low pressures, ocular hypertension is when the eye pressures are high but the patient does not have glaucoma.

How is Glaucoma diagnosed ?
Diagnosis of glaucoma can happen in clinic examination and certain investigations. We check the pressure by applanation tonometry and measure the central corneal thickness termed as pachymetry. We also perform certain tests like the visual field test and OCT.

Read more about a glaucoma consultation.

Who are at risk of getting glaucoma ?
Glaucoma can occur in anyone but genetic factors play a very important role in glaucoma. If certain family members have glaucoma it becomes very important to check yourself for this eye condition.

Ofcourse other conditions like uveitis and trauma can also lead to what is know as “secondary glaucoma.”

What is Glaucoma Treatment ?
At first drops gets prescribed to treat glaucoma medically . These drops help enhance flow of the fluid out of the eye or decrease manufacture of the fluid in the eye. In closed angle glaucoma a laser iridotomy is the main treatment. In case the medicines are not adequate a glaucoma surgery may be essential. Read more about trabeculectomy.

Is Glaucoma a permanant disease ?
Most primary glaucomas are permanent as mentioned above. Life long treatment plan plays important role to prevent damage to the optic nerve. Certain secondary causes of glaucoma are treatable temporarily. once the condition causing increased pressure is taken care of we can stop the glaucoma treatment

How to prevent Glaucoma ?
If you have read the text above you would realize that glaucoma is unpreventable. However what is preventable is vision loss due to glaucoma. This is possible by getting ealy and regular eye examinations by a glaucoma specialist. Eye Solutions can be considered as one of the best hospitals for glaucoma in india and we possess all the equipment necessary to investigate someone who has glaucoma. These are Visuals fields, OCT, Pachymentry and IOP eye test.

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