Glaucoma Diagnosis and Treatment - Dr. Rajesh Mishra Dr Agarwals Eye Hospital

WHAT IS GLAUCOMA?

Glaucoma is an eye disorder which leads to progressive damage of the optic nerve in a characteristic pattern. The optic nerve is involved in carrying the visual impulse from the retina to the brain enabling us to see this impulse as vision. Glaucoma is generally but not always caused due to increase in the eyeball or intraocular pressure; in few glaucoma may be caused with normal eye pressure.


There is no set elevated value of intraocular pressure (IOP) which definitely leads to glaucoma; also there is no lower limit which eliminates the risk of glaucoma. Hence early diagnosis and treatment is absolutely essential.


According to WHO, glaucoma is the second leading cause of blindness worldwide after cataracts.


HOW IS GLAUCOMA DIAGNOSED?
Several tests are available to help the ophthalmologist detect the glaucoma. These tests include:


1. Tonometry: It measures the tone or the firmness of the eye. The eye is numbed and the tonometer is placed on the cornea of the eye. Greater the firmness, higher is the pressure.
2. Pachymeter: It is used to measure the thickness of the cornea, as too thick cornea can give false reading on tonometry.
3. Opthalmoscopy: The eye is dilated with eye drops and the ophthalmologist uses this scope with light at one end to look at the back of the eye and examine the optic nerve and the fundus for any changes like cupping or indentation of optic nerve head or paleness due to increased IOP.
4. Perimetry: This is used to examine and map the peripheral field of vision as glaucoma initially affects only peripheral field, which at most times is unnoticed. The patient looks straight ahead and asked to indicate when the light passes in his peripheral field of vision.
5. Gonioscopy – Used to visualise and measure the drainage angle between the cornea and iris using a lens based device. Helps identify angle closure glaucoma.


Other methods of monitoring glaucoma involve the use of sophisticated imaging technology — such as scanning laser polarimetry (SLP), optical coherence tomography (OCT) and confocal scanning laser ophthalmoscopy — to create baseline images and measurements of the eye's optic nerve and internal structures.


HOW IS GLAUCOMA TREATED?
Glaucoma is treated by either medications or surgery.


Eye drops medications are first used to lower IOP by decreasing the production or increasing the outflow of aqueous humor via trabecular meshwork. These include beta blockers, prostaglandin analogues, carbonic anhydrase inhibitors etc.


Laser treatment includes laser iridotomy which creates a hole in the iris to allow for drainage by bypassing the pupil and relieving the pressure, commonly used in angle closure glaucoma. Laser trabeculoplasty is used in open angle variety to remove the blockage at the trabecular meshwork.


Surgical correction like the trabeculectomy is used to remove the clogged trabecular meshwork and create a new drainage pathway. If successful it is the most effective way of lowering IOP.

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