A speciality clinic of H. V. Desai Eye Hospital, which deals with all types of Glaucoma including primary, secondary, paediatric and end stage diseases. Today, Glaucoma is the second most common cause of blindness. And it is more serious as it is irreversible loss of vision in contrast to cataract. So our main purpose is to preserve remaining vision and to avoid progression of blindness. We at H. V. Desai Eye Hospital are equipped with all latest modalities of diagnosis and treatment of glaucoma available in most modern healthcare centres.
What is Glaucoma?
Glaucoma is a disease of the eye in which pressure within the eye rises and which results in irreversible damage to Optic nerve which carries visual sensations to brain, resulting in blindness. Many times cause of rise in intra ocular pressure is not found while in some cases it may be secondary to some causes like trauma or use of few medications.
What are the different types of Glaucoma?
There are two main types of glaucoma, open angle and closed angle (angle closure) glaucoma. Normally fluid in eye flows from behind pupil , to place between iris and cornea called as angles of eyes involving sieve like structure called as trabecular meshwork.
Open Angle Glaucoma (OAG)
This is the most common type of glaucoma. This type of glaucoma is usually seen in old age. Mostly both the eyes of patient are involved in this type of glaucoma. Many times usually patient doesn’t come to know about this type of glaucoma till very advanced stage as there are not any obvious symptoms in early stages. This type of glaucoma usually has tendency of running in families i.e. hereditary. So it advisable to relatives of patients to go for regular check up to detect disease in early stages and to avoid its progression to blindness.
Closed Angle Glaucoma (acute angle-closure glaucoma)
Usually presents suddenly, with patient commonly presents with experiencing pain and rapid vision loss. Fortunately, the symptoms of pain and discomfort make the sufferer seek medical help, resulting in prompt treatment which usually prevents any permanent damage from occurring.
Signs and symptoms of closed angle glaucoma:
- Eye pain, usually severe
- Blurred vision
- Eye pain is often accompanied by nausea, and sometimes vomiting
- Lights appear to have extra halo-like glows around them
- Red eyes
- Sudden, unexpected vision problems, especially when lighting is poor
There are other types of glaucoma which involves significant number of cases glaucoma which include:Traumatic Glaucoma, Congenital Gluacoma, Drug Induced Glaucoma, Pseudoexfoliative glaucoma etc.
Who Gets Glaucoma or Who are at the High Risk of Glaucoma?
Glaucoma most often occurs in adults over age 40, but it can also occur in young adults, children, and even infants. Below are the cases having high risk of developing Glaucoma:
- People over the age of 40 years have a risk of developing the disease.
- People having family history of glaucoma
- East Asians, because of their shallower anterior chamber depth, have a higher risk of developing glaucoma compared to Caucasians.
- People with diabetes may have a higher chance of developing glaucoma.
- Some eye injuries, especially severe ones, can cause glaucoma.
- People with myopia (nearsightedness) have a higher risk of glaucoma.
- Patients on long-term corticosteroids, metabolic disorder have a raised risk of developing several different conditions, including glaucoma. The risk is even greater with eyedrops containing corticosteroids.
Tests to Diagnose Glaucoma
Normal routine eye check up by ophthalmologists is useful to find out cases of glaucoma and cases with possibility of glaucoma called as glaucoma suspects. In these patients following tests are useful to determine confirm diagnosis of glaucoma.
The doctor uses a tonometer (Applanation Tonometer), a device which measures intraocular pressure (pressure inside the eye). Some anaesthetic drop and a dye is placed in the cornea, and a blue light is held against the eye to measure pressure. This test can find out eyes with raised pressure ; a risk factor for open-angle glaucoma. The doctor also measures corneal thickness, because it affects how the pressure inside the eye is interpreted.
This test measures central corneal thickness. It is useful to determine corrected intraocular pressure which changes depending upon thickness of cornea.
This examines the area where the fluid drains out of the eye. It helps determine whether the angle between the cornea and the iris is open or blocked (closed). It also helps in observing narrow angle and open angle. It is performed routinely in all patients at our hospital.
Optic Nerve evaluation :
Detailed evaluation is done to identify damage to the nerve using special lenses.
It is also known as a visual field test. It determines which area of the patient's vision is missing. The patient is shown a sequence of light spots and asked to identify them. Some of the dots are located where the person's peripheral vision is; the part of vision that is initially affected by glaucoma. If the patient cannot see those peripheral dots, it means that some vision damage has already occurred. This test is gold standard in follow up of glaucoma patients. It has to be repeated regularly and check disease progress. We at H. V. Desai Eye hospital have Humphrey Field Analyser (perimeter) for visual field analysis.
This is one of the most advanced technology available for testing glaucoma. This test gives analysis of optic nerve and nerve fibre layers which are mainly involved in glaucoma.
Treatment for glaucoma?
Glaucoma Treatments involve either improving the flow of fluid inside the eye, reducing its production, and sometimes both. Damage caused by glaucoma is irreversible. Even the disease itself cannot be completely cured. However, regular check-ups and proper treatment can considerably slow down the progression of the disease, and even prevent further loss of eyesight.
In the majority of cases, initial treatment includes eyedrops. As glaucoma is disease of lifetime compliance for drugs by patient is vital for best results and to prevent undesirable side effects - this means following the doctor's instructions carefully.
If eyedrops are not effective enough, and the pressure is very high, some tablets may be given for a short period of time. Reglar check up, and regular use of the prescribed medicines(eye drops) are very important to control glaucoma, as vision lost due to glaucoma is difficult to get back.
YAG Laser surgery for angle-closure glaucoma
this laser procedure is usually carried out which creates a tiny hole in the iris, allowing fluids to pass into the trabecular meshwork - this procedure is called an iridotomy. Even if only one eye is affected, the doctor may decide to treat both, because this type of glaucoma often affects the other eye too.
SLT (Selective Laser Trabeculoplasty)
This laser is useful in cases of raised intra ocular pressure which are not controlled by multiple drugs and not feasible to undergo surgery because of other physical conditions or in not willing to undergo surgical procedures.
if drugs don't work, or if the patient cannot tolerate them, surgical intervention may become an option. The aim of surgery is usually to bring down the pressure inside the eye. Examples of surgery may include:
Trabeculectomy is the standard surgery for glaucoma. This surgery involves creating a opening in the eye wall in order to improve fluid outflow and decrease intraocular pressure. This would reduce the need for anti glaucoma eye drops. Success of this surgery may be improved by using an additional medicine called mitomicin C and Ologen implant
Trabeculectomy with ologen
a biodegradable porous collagen-glycosaminoglycan copolymer matrix implant (Ologen), has become available for glaucoma surgery. This implant is useful in preventing long term failure of trabeculectomy surgery maintaining controlled outflow of aqueous and IOP under normal levels.
Triple surgery in Glaucoma
It is advisable in patient having ataract with glaucoma. It is combination of cataract surgery (phaco emulsification) with intra ocular lens implantation with trabeculectomy.
Trabeculectomy with Trabeculetomy
This is a special type of surgery done in glaucoma seen in new born children or infants, in which early intervention needed to control intra ocular pressure and to avoid damage of optic nerve in early ages of life.
A team of two well qualified and experienced glaucoma consultants are available;
Dr. Vidya Chelerkar
Dr. Kalyani V.K.S.
There are two long term fellows available for patient examination and evaluation.
We have team of well trained optometrists for primary work up and to perform all the tests..
There are ancillary staff available for guiding patients at proper stations and maintaining order.