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Glaucoma(Kala Motia)
The Silent Snathcher of Sight
Glaucoma

Glaucoma

About Optic Nerve
The Optic Nerve is the nerve for sight. It is like an electric cable with millions of wires, that carries electrical impulses from the light sensitive cells of retina to the brain. The earliest change in glaucoma is the damage to nerve fibers that leads to the formation of small non seeing areas in your field of vision. People do not notice these small blind areas until they enlarge and effect vision. Special tests (OCT and Automated Perimetry) are required to identify these early defects. When the entire nerve is destroyed, permanent blindness results. Early detection and treatment are the keys to prevent optic nerve damage and blindness from Glaucoma.
About Pressure
A clear fluid called the Aqueous humor circulates continuously within the eye. This liquid is not a part of the tears on the outer surface of the eye. Produced behind the iris, it flows forwards through the pupil and drains out of the eye through a meshwork of drainage channels. The amount of fluid produced inside the eye, balances the amount of fluid that flows out of the eye thereby keeping pressure within the safe range. A high pressure damages the optic nerve. This is Glaucoma.
Range of Normal Pressure
Average Intra-Ocular Pressure (IOP) in adults is 16mmHg. The range varies from 9mmHg to 21mmHg. If the pressure is consistently above 21mmHg, the chances of eye damage are probably around ten percent. When the pressure is above 26 mmHg, the likelihood increases to about fifty percent. If the IOP persists above 30 mmHg, the damage will definitely occur.
The Intraocular Pressure is different and independent of blood pressure. Don't confuse it to be related to tensions of day to day life.

TYPES OF GLAUCOMA

The drainage portion of the eye, called the “angle” is like a sieve and can get blocked in different ways.
  • It gets suddenly blocked by the iris closing off the angle. Eye pressure increases rapidly, resulting in sudden blurring of vision, severe eye pain, headache, rainbow halos around light, nausea and vomiting. It is an emergency and if not treated immediately leads to blindness. A small hole in iris with laser prevents attack of “Primary Angle Closure Glaucoma”.

  • In the second type of Glaucoma, the out flow sieves get slowly blocked. This leads to insidious rise in pressure, known as “Primary Open Angle Glaucoma”. It damages vision so gradually and painlessly that a person is unaware of the trouble until the optic nerve is badly damaged. It has no symptoms. This type of Glaucoma is much more common.

  • Glaucoma can also occur secondary to injury, inflammation of eye, drugs, cataract etc. Glaucoma may rarely be present at birth. The parents may notice their baby's eye enlarging and hazy(since a baby's eye is more elastic than an adult). The infant or child should be taken to an ophthalmologist immediately.

KEY FEATURES OF GLAUCOMA

There are three key features of Glaucoma:
Increased IOP:
The pressure inside the eye is measured with NCT (Non-Contact Tonometer) Goldmann applanation tonometer. A prism with blue lights touches the eye to accurately check IOP.
Cupping and atrophy of the Optic Nerve:
It is the drying up of the nerve of sight as it suffers damage due to high pressure inside the eye. It is assessed by examination of fundus of the eye.
Nerve fiber layer and Visual Field Defects:
The slow death of nerve fibers is the earliest change to occur in Glaucoma. This nerve fiber layer damage is picked by an instrument called OCT. Visual Field defects are missing as are in the field of sight, though the person may be seeing well otherwise. This is measured with an instrument called perimeter. The modern perimeter is computerized to evaluate, self analyze, compare and report the defects.

RISK FACTORS
People with high Intraocular Pressure have a higher risk of developing optic nerve damage. Other important risk factors include advancing age, high myopia (near sighted), family history of Glaucoma, presence of Diabetes, past injury to the eye, surgery, or history of severe anemia or shock. We will weigh all these factors before deciding whether you need treatment for Glaucoma or not. If your risk of developing Glaucoma is higher than normal but there is no damage as yet, you will be monitored periodically as a “Glaucoma Suspect”.
EARLY DETECTION
Regular eye examination at GEI is the best way to detect Glaucoma. During a complete work up for Glaucoma, we will measure the Intraocular Pressure (Tonometry), the central corneal thickness (Pachymetry), inspect the drainage angle of the eye (Gonioscopy), evaluate for optic nerve head damage (Ophthalmoscopy), test the visual field of each eye (Perimetry), evaluate for retinal nerve fibre layer OCT.
TREATMENT
Medical Treatment
Eye drops are the first line of treatment. They act to decrease eye pressure either by reducing the production of aqueous fluid within the eye or by improving the outflow through the drainage angle. Instill drops properly and regularly at prescribed timings. Tablets may be required at times.
Some medicines occasionally result in unwanted side effects. They may sting, redden the eye and cause blurring of vision or headaches. Such side effects usually disappear after a few days. Rare side effects may be changes in pulse rate and breathing. Medication should never be stopped or changed without consulting your ophthalmologist. Frequent eye examinations and tests are crucial to monitor any changes in your Glaucoma. Pills sometimes cause tingling sensation in fingers and toes, drowsiness, loss of apetite, bowel irregularities or kidney stones. Inform us immediately if you think you are experiencing side effects.
Laser Treatment
Laser surgery is effective for some types of Glaucoma. In chronic open angle Glaucoma, the drain itself is treated (trabeculoplasty), and the laser helps to reduce the medications to control the pressure. In angle-closure Glaucoma, a hole is made in the iris (Laser iridotomy) to restore the free flow of aqueous fluid.
Surgical Treatment
In advanced cases, surgery (trabeculectomy) is necessary to control Glaucoma. We use miniature instruments to create a new drainage channel for fluid to leave the eye, thus lowering the pressure in advanced cases. If surgery fails, special Glaucoma valves can be implanted. Fortunately, serious complications of modern Glaucoma surgery are rare. Surgery for Glaucoma would be recommended only if the medicines fail to prevent damage to the optic nerve. Whatever may be the approach, the objective of the treatment is to lower the eye pressure to a level at which optic nerve damage does not develop or worsen.
Please Note
The success of your treatment depends entirely on the team work put in by you and the GEI team. It is therefore important to communicate with us. Finally, remember to keep the follow-up appointments, if you don't, glaucoma can steal your sight silently.
About Optic Nerve
The Optic Nerve is the nerve for sight. It is like an electric cable with millions of wires, that carries electrical impulses from the light sensitive cells of retina to the brain. The earliest change in glaucoma is the damage to nerve fibers that leads to the formation of small non seeing areas in your field of vision. People do not notice these small blind areas until they enlarge and effect vision. Special tests (OCT and Automated Perimetry) are required to identify these early defects. When the entire nerve is destroyed, permanent blindness results. Early detection and treatment are the keys to prevent optic nerve damage and blindness from Glaucoma.
About Pressure
A clear fluid called the Aqueous humor circulates continuously within the eye. This liquid is not a part of the tears on the outer surface of the eye. Produced behind the iris, it flows forwards through the pupil and drains out of the eye through a meshwork of drainage channels. The amount of fluid produced inside the eye, balances the amount of fluid that flows out of the eye thereby keeping pressure within the safe range. A high pressure damages the optic nerve. This is Glaucoma.
Range of Normal Pressure
Average Intra-Ocular Pressure (IOP) in adults is 16mmHg. The range varies from 9mmHg to 21mmHg. If the pressure is consistently above 21mmHg, the chances of eye damage are probably around ten percent. When the pressure is above 26 mmHg, the likelihood increases to about fifty percent. If the IOP persists above 30 mmHg, the damage will definitely occur.
The Intraocular Pressure is different and independent of blood pressure. Don't confuse it to be related to tensions of day to day life.

SYMPTOMS

Unfortunately, there are no symptoms. Disease may effect 80% of the vision before a person realizes the effect on vision. A person with Chronic Glaucoma is usually unaware of the disease. It is a silent snatcher of vision. On the other hand, Acute Glaucoma, in which the pressure rises rapidly, causes severe symptoms that force the patient to consult a doctor.
Some symptoms suggestive of Glaucoma are:
  1. Poor night vision.
  2. Appreciation of a blind area.

  3. Headaches during dusk or dawn.

  4. Pain in the eyes, particularly when associated with smoky vision.

  5. Halos around light.

  6. Frequent change in number of reading glasses.
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