Glaucoma

Glaucoma

Of all the conditions prevailing human eye, Glaucoma is the most threatening one. It is also known by the name of ‘Kala Motia’ or as ‘a silent thief of vision’ due to its painless nature. Clinically, it is a slowly manifesting disease distinguished by acute damage of optic nerves caused due to retinal ganglion cell loss.

Common symptoms to look out for here are -

  • Slow degradation of the side vision
  • Headaches accompanied by the redness & pain in eyes
  • Rapidly changing glass prescription
  • Reduced vision in low light conditions or at night
  • Seeing colorful halo rings around bulbs
  • Pain around eyes after coming into the light from the darkness

Anyone can have this disease, however, few people are more susceptible to it. They are the ones -

  • Aged above 40 years
  • With hypertension, migraine or diabetes
  • Having myopia (nearsightedness) of open-angle type or hyperopia (farsightedness) of close angle type
  • Having glaucoma family history

Types of Glaucoma

This malady is of 7 different types.

Primary Open Angle Glaucoma (POAG)

Primary Open Angle Glaucoma is a chronic disorder that needs lifelong monitoring as well as medicines for maximum control. There are no associated early stage symptoms to identify or diagnose POAG in patients. Few of them notice patchy area vision loss, delayed adjustment of eyes to dim lighting condition or something as vague as a minor headache. It is only through proper IOP evaluation by an eye specialist can diagnose it. Based on the findings, doctors recommend more tests to become sure about the diagnosis.

Angle Closure Glaucoma

It occurs in cases where the eye filtration angle is closed or narrow, resulting in blockage of aqueous outflow plus elevated IOP. This may be either primary or secondary to systemic or ocular causes.

Amongst the Indian population, Primary Angle Closure Glaucoma (PACG) is pretty common. Symptoms include nausea/vomiting, episodic eye ache, seeing colored halos, redness in the eye, blurred vision, and a general feeling of heaviness in the body. Elevated IOP and shallowness in the anterior chamber can be diagnosed upon examination.

Secondary Glaucoma

Glaucoma concerning other systemic or ocular cases is known as Secondary Glaucoma. Based on the position of obstruction with respect to the trabecular meshwork, it is further divided into three sub-categories:

  • Pre-trabecular
  • Trabecular
  • Post-trabecular

Pigmentary Glaucoma

This glaucoma is generally diagnosed in the eyes of young male patients accelerated many-a-times due to exercise. In this case, the iris rubs against zonules and releases pigment that subsequently blocks trabecular meshwork.

Pseudoexfoliative Glaucoma

Pseudoexfoliative Glaucoma can be related to zonal weakness and cataract. That is why it needs extra precaution at the time of surgery. Scientifically speaking, it is caused by amyloid-like white fibrillary substance deposition at trabecular meshwork that in turn clogs angles and elevates IOP.

Steroid-Induced Glaucoma

Typically seen in steroid sensitive (responders) people using systemic or topical steroids, it arises within weeks of usage. Risk factors further elevating the situation here are glaucoma family history, diabetes, and myopia. Treatment encompasses shifting to a medication of non-steroidal nature. Monitoring and caution are needed in the future too.

Traumatic Glaucoma

Any eye trauma that damages angle structure by scarring it, can cause this glaucoma. In these cases, treatment is very difficult. The first medication is tried and if it fails, surgery remains the only option.

Glaucoma Treatment at Sanjeev Netralaya

The damage done by Glaucoma cannot be reversed, however, timely intervention can prevent further progress of this malady. The Glaucoma treatment at Sanjeev Netralaya aims to preserve the remaining vision of the suffering patient by lowering IOP so that no more damage can take place. Three approaches taken by the specialists at the Sanjeev Netralaya to achieve it are - Medication, Laser & Surgery.

Medication

If manageable by medicines, the specialists prescribe eye drops, syrups, and injections to the patients to manage the condition.

Laser

Different laser procedures are performed to contain different situations of Glaucoma. Depending on the type of Glaucoma, the specialists choose the best-suited one for the patient. Four laser procedures are as follows:

This laser procedure is suggested to the patients diagnosed with closed or narrow angles to treat or prevent pupillary block glaucoma. The release of pigment accompanied by a gush of aqueous indicates completion of the procedure. After the operation, the patient may be recommended topical steroids. Probable complications, in this case, are elevated IOP, iritis, lens damage, corneal endothelial damage, and iris bleeding.

As the supplementary procedures to lower a patient’s IOP who is suffering from open-angle glaucoma, Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT) have gained popularity in recent years.

This laser surgery reduces aqueous production by the usage of a contact diode probe. The patients with poor vision potential and who have been unresponsive to medication plus deemed unfit for surgery are treated with this procedure.

During the postoperative stage, the selective suture-lysis is done using a diode or argon laser to improve aqueous outflow and control any possible IOP spike.

  • Peripheral Iridotomy (PI)
  • Laser Trabeculoplasty
  • Transscleral Diode Cyclophotocoagulation
  • Laser Suture Lysis

Surgery

Surgeries here are treated as last resort after a patient fails to respond to medication or lasers. Trabeculectomy surgery aims at providing the aqueous flow an alternative drainage channel to lower IOP. And if it fails too, doctors suggest taking the route of glaucoma drainage device. A bio-compatible drainage implant is placed in an eye, which allows the draining of aqueous.

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