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Shroff Eye Hospital

Shroff Eye Hospital is India's First Eye Hospital accredited by the Joint Commission International (USA) since 2006. Shroff Eye is also India's first and only Wavelight Concerto 500 Hz LASIK center. Shroff Eye has stood for excellence in eye care since 1919. A firm commitment to quality is at the heart of all services provided at our centers at Bandra(W) and Marine Drive, Mumbai.

What is glaucoma

Introduction

Glaucoma is one of the leading causes of irreversible blindness in the world, especially for older people. However visual loss is preventable or stabilized with early diagnosis and treatment. Glaucoma is a condition of the eye where the optic nerve is damaged. The optic nerve carries images to the brain, which are then perceived as vision. Minute nerve fibres from various parts of the retina join to form the optic nerve. Glaucoma results when the pressure within the eye is high enough to be detrimental to the normal functioning of these nerve fibres, some of which stop functioning. Non-functional nerve fibres result in a loss of retinal function in the area from where they originate, leading to defects in the field of vision.

The disease is called the `sneak thief of sight´ because it is painless, symptomless and irreversible. Therefore, the person with glaucoma is usually unaware of it until much loss of vision has occurred. In fact, half of those suffering damage from glaucoma do not know it. Currently, damage from glaucoma cannot be reversed and if the entire nerve is damaged, blindness results. Early detection and regular treatment are the keys to preventing optic nerve damage and blindness from glaucoma.

Causes of Glaucoma

The aqueous humour is the clear fluid circulating within and nourishing some parts of the eye which have no blood supply. ‘Normal’ individuals have an equal production and drainage of this fluid resulting in a constant pressure within the eye. If the drainage is compromised due to any reason, there is a pressure build-up in the eye, which can damage the optic nerve.

The different types of glaucoma are

  • Chronic open-angle glaucoma

    It is the most common type of glaucoma; damages vision gradually and painlessly. The pressure is rarely high enough to be symptomatic.

  • Angle-closure glaucoma

    An acute attack of glaucoma caused by sudden blockage of the drainage channels leads to a sharp rise in pressure within the eye causing blurred vision, severe eye pain, nausea and vomiting, headache, rainbow haloes around lights, pain around your eyes after watching TV or after leaving a dark theatre and red eyes.

    An acute attack requires the immediate attention of an eye doctor.

Detection

Regular eye examinations by the ophthalmologist leads to detection.

The complete and painless examination includes among other tests:

  • Tonometry – Measurement of the intraocular pressure [tension]
  • Gonioscopy – Inspection of the drainage angle of the eye
  • Ophthalmoscopy – Evaluation of optic nerve damage
  • Perimetry – Testing the visual field of each eye

‘Suspect’ cases with a family history of glaucoma may be required to additionally undergo a highly sensitive form of visual field analysis called short wavelength automated perimetry [SWAP], which detects changes well before the optic nerve shows the effects of glaucoma. It is also useful to monitor the early progress of the condition.

Who is at risk for glaucoma?

Everyone should be concerned about glaucoma and its effects. It is important for each of us, from infants to senior citizens, to have our eyes checked regularly, because early detection and treatment of glaucoma are the only ways to prevent vision impairment and blindness. There are a few conditions related to this disease that tend to put some people at greater risk. This may apply to you if:

  • Someone in your family has a history of glaucoma, though not always necessary that it could be hereditary.
  • If you are over 40 {could be earlier if you have a family member suffering from glaucoma} and have not had your eyes examined regularly by an ophthalmologist [eye doctor], not in an optical shop.
  • Any injury to your eyes
  • Secondary to other ocular conditions (cataract, inflammations in the eye, tumours etc.}
  • Long term medication {cortisone}. This holds for those who use eye drops injudiciously, particularly Pyrimon and other steroids, and repeat their prescription for red eye treatment with their chemists without consulting doctors. It is therefore, very important that youngsters who have contact lens-induced and other allergies, and those who repeatedly suffer from red eyes, to be very careful with their use of eye drops. They must visit the ophthalmologist urgently.

Treatment

The main treatment for chronic glaucoma aims at reducing the pressure in your eye. Damage already caused by glaucoma cannot be reversed. Eye drops, tablets, laser and surgical operations are used to prevent or slow further damage from occurring. With any type of glaucoma periodic examinations are very important to prevent loss of vision. Because glaucoma can irreversibly worsen without your being aware of it, your treatment may need to be changed from time to time during the periodic examination.

Medical treatment

  • Eye drops

    When taken regularly and continuously as prescribed, they control the eye pressure either by slowing the formation of aqueous fluid within the eye or by increasing the flow at the drainage area.

  • Tablets

    These are sometimes combined with the eye drops to decrease higher levels of eye pressure. They are occasionally known to cause tingling of fingers and toes, bowel irregularities, and in the very long term, kidney stones.

    Why a drug causes side effects in some persons and not others is not fully understood.

  • Laser surgery

    Lasers of different typesare usually used in one of three ways:

    In open-angle glaucoma the draining area itself is enlarged to control eye pressure.

    In angle-closure glaucoma the laser creates a hole in the iris to open up and improve the flow of aqueous fluid to the drain.

    In painful late-stage glaucoma medication or surgery do not control the pressure. The laser closes some aqueous fluid-producing areas in the eye and lowers the eye pressure.

  • Operative surgery

    A new drainage channel is created for the aqueous fluid to leave the eye. Sometimes a tube drains the fluid in very resistant cases.

    Surgery is recommended when your doctor feels that it is safer to operate than to allow optic nerve damage to continue.

    The best treatment for you should be decided after a thorough examination and discussion with your Glaucoma specialist.

    Key points to remember to minimize the risk of glaucoma

    • Glaucoma detection needs regular follow-up since the condition can cause asymptomatic and irreversible loss of vision if poorly treated or neglected. Have a routine eye check every 18 – 24 months if you are age 39 years or over. Every 12 months if a family member has glaucoma, if you have had a serious eye injury in the past, or if you are taking steroid medication [tablets or eye drops].
    • For glaucoma patients the effect of treatment on the eye pressure may not always be constant and needs to be regularly measured by the glaucoma specialist
    • Maintaining records of your eye condition for comparison on following visits is very important.
    • The prescription must never be altered or stopped without consulting your doctor.
    • ‘Suspect’ cases with a family history of glaucoma may be required to additionally undergo a highly sensitive form of visual field analysis called short wavelength automated perimetry [SWAP], which detects changes in your eye well before the optic nerve shows the effects of glaucoma.
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