GLAUCOMA (KALA MOTIA) - THE SILENT THIEF of SIGHT

WHAT IS GLAUCOMA

Glaucoma (KALA MOTIA) is a group of disorders wherein the fluid pressure inside the eye rises to such a level that it damages the delicate structures of the eye specially the nerve of sight (Optic Nerve). It is now understood to be a condition with compromised blood perfusion to the eye and it’s nerve wherein eye pressure is an important but not the only variable.This condition is very different from Cataract (Safed Motia) in which the natural lens of the eye becomes opaque and has to be removed.

Glaucoma is more dreaded than cataract because the loss of vision due to it can not be reversed as opposed to the vision loss in cataract which is easily restored by surgery. Cataract and Glaucoma can also occur simultaneously in the same eye.

Misty morning a lovely sight, but foggy vision a dreadful fright.

Progressive vision loss, visual field constriction in glaucoma.

WHY GLAUCOMA CARE AT GROVER EYE LASER HOSPITAL?

The Eye does not see what the Mind does not know. Our doctors are specially trained in the best institutions and coupled with vast experience in our hospital they diagnose glaucoma earlier & treat it earlier to save you from later problems.

Early Diagnosis of Glaucoma, Advanced Testing For Glaucoma, Early Start Of Treatment, Regular Monitoring, Proper Counseling, Individual Target Pressure calculations and Experienced Glaucoma Surgeons are all for the long term benefit for Glaucoma Patients

SUGGESTED HIGH RISK GLAUCOMA SCREENING

  • People with high intraocular pressure (I.O.P.): Regular visit to the eye specialist for Tonometry, Fundus test, Visual Field testing,OCT and Pachymetry etc,
  • People over the age of 40 years with no previous glaucoma, at least once every year, especially whenever there is a change of reading glasses.
  • Family history of Glaucoma: regular screening from younger age for people with parents or close blood relatives suffering from glaucoma.
  • People having high minus numbers or those having plus numbered glasses for distance also.
  • Other high risk factors like Diabetes, Injury to eye, following any major eye surgery, prolonged steroid use etc . need more frequent screening as advised by the treating physician.

Types of Glaucomas and their Symptoms

  • Open Angle Glaucoma
  • It causes a painless gradual diminution of vision. The patient does not even realize the problem till the disease is quite advanced. There may be frequent change of glasses numbers. Very few people may appreciate a feeling of a blind area / missing area in field of vision.
  • Many patients confuse this with vision loss due to cataract which also causes a painless gradual decrease in vision. But in this case delay in treatment causes permanent damage.
  • Narrow Angle / Angle Closure Glaucoma
  • The more common notion that 'Kala Motia' is accompanied by pain is at times seen in this variant. This type of glaucoma is more common in people needing plus numbered glasses for distance also (Hypermetropia). It may also be symptomless in initial stages. Some symptoms are as below
    • 1) At times mild to very severe pain may occur in this condition but initial stages or creeping angle closure variety can be painless. It may be accompanied by smoky vision during episodes of pain. Early stages usually have normal eye pressure (IOP , Intra Ocular Pressure) in between episodes of raised pressure.
    • 2) Colored halos (rainbow rings) around light.
    • 3) Frequent change of reading Glasses
    • 4) Headache during dusk and dawn
    • 5) Appreciation of a blind area in field of vision
    • 6) Nausea and vomiting

  • Secondary Glaucoma
  • Can be due to many reasons some of which are
    • i.) Prolonged use of steroids (prednisolone / cortisone etc.) as eye drops or at times as tablets or skin creams.
    • ii.) Hypermature or Intumescent Cataract (Over-ripe Safed Motia) in which surgery has not been done in time
    • iii.) Injury or bleeding inside the eye.
    • iv) Malignant glaucoma following certain eye surgeries etc.

  • Congenital Glaucoma
  • Due to various types of birth defects.

  • Normal or Low Tension Glaucoma (NTG / LTG), Ocular Hypertension
  • As the very name suggests, in this case the eye pressure (I.O.P.) alone may be misleading. In NTG / LTG Low Blood Pressure (Low diastolic B.P.) especially while sleeping at night greatly aggravates the eye damage due to improper blood supply (perfusion) to the eye repeatedly for some hours every night. This paradoxically can also occur in people with high BP during day but with low B.P. during sleep. Ocular Hypertension conversely means high I.O.P. without overt clinical signs of glaucoma (this may mean pre-glaucoma in some or just due to thick cornea in others).

Most common features of and the sequence of events in glaucoma are

  • (i) Increase of fluid pressure inside the eye resulting in
  • (ii) Damage to the Optic Nerve which is manifested as
  • (iii) Loss or constriction of field of vision
  • (iv) due to Retinal Nerve Fiber Layer (RNFL) thinning in the presence of
  • (v) Open or Narrow anterior Chamber Angles of fluid drainage with or without other associated anomalies.

This sequence forms the logic or basis of the various tests for a glaucoma patient as given below.

DIAGNOSTIC TESTS / INVESTIGATIONS in GLAUCOMA

  • 1.Tonometry / Intra-Ocular Pressure (I.O.P.)
  • To measure the fluid pressure inside the eye by various types of tonometers like Schiotz (metallic scale type), Goldmann Applanation (prism with blue light) or the Computerized Non Contact NCT type which measure pressure with a gentle puff of air without actually touching the eye.

  • 2. Ophthalmoscopy or Fundus Test
  • To check for the Cupping or Atrophy (damage) of the Optic Nerve due to the drying up of the nerve of sight it suffers damage due to high pressure inside the eye.

    FUNDUS : NORMAL OPTIC DISC
    ADVANCED GLAUCOMA CUPPING

  • 3.Visual field Analysis / Perimetry Test
  • The patient gets missing areas in the field of sight though he /she may be seeing well otherwise. This is due to some but not all fibers of the Optic Nerve being damaged at a point of time. The modern automated perimeters are computerized to measure and to a great extent self analyze, compare and report the defects. Visual Field / Perimetry test can also help to diagnose many other conditions like brain tumor, Pituitary tumor, drug toxicity, RP etc.

  • 4.Spectral OCT-SLO Test
  • Spectral Optical Coherence Tomography (OCT) with Scanning Laser Ophthalmoscope (SLO) is an advanced spectral laser scan of the anterior segment, retina and Optic Nerve. It tests the inner structures of the eye. The most advanced version of this machine is available at Grover Eye Laser Hospital.

  • 5.Gonioscopy test
  • To test the anterior chamber angle or the drainage points of the eye.

  • 6.Pachymetry Test
  • For Corneal thickness and to calculate individual Target I.O.P.

  • 7.Diurnal Variation test
  • To test for IOP & BP fluctuations over a 24 hour period. Usual time for such recordings is 10am, 2pm, 6pm, 10pm, 2am and 6am. So it is best done only in a hospital with facility for overnight admission.

MANAGEMENT of Glaucoma

As explained earlier optic nerve damage (Optic Atrophy) and consequent blindness due to glaucoma is irreversible, hence early detection with prompt and regular treatment are the keys to successful glaucoma management.

Glaucoma is said to be controlled not cured as treatment can at most halt further damage but generally cannot reverse damage already done.

The aim of treatment is to reduce and to maintain the fluid pressure (I.O.P.) inside the eye at a level at which further optic nerve damage does not occur. The generally accepted upper limit of I.O.P. is 20 mmHg. but levels below this are desirable though there may considerable individual variations.

TARGET I.O.P. for each patient is decided after detailed tests at our hospital. On long term follow up of an individual patient the eye surgeon can be sure of good glaucoma control when I.O.P. remains at an acceptable level at all times and further visual field loss on repeated perimetry (function test) and OCT-RNFL (retinal nerve fiber layer - structure test) does not occur.

TREATMENT of Glaucoma

  • Medicines
  • Anti-Glaucoma 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 fluid outflow through the drainage angle or other channels.

  • Laser Treatment
  • It is effective for some types of Glaucoma. In some cases the drain itself is treated (trabeculoplasty older ALT, later SLT and now PASCAL Pattern Laser Trabeculoplasty PLT), and the laser helps to either stop or reduce the medications to control the pressure.

In angle-closure Glaucoma, an opening is made in the iris (YAG Laser Iridotomy, LI) to restore the free flow of aqueous fluid and is the initial treatment of choice in these cases.

YAG LASER, TSCP, SLT LASER & PLT LASER for Glaucoma

  • i.) Advanced Q-Switched Nd-YAG Laser is used for LPI / LI - Laser Iridotomy in almost all Narrow Angle Glaucoma cases.
  • ii.) Selective Laser Trabeculoplasty (SLT) or the more advanced auto Pattern Laser Trabeculoplasty (PLT) with PASCAL Laser (available only at our hospital in the region) is helpful for some cases of Open Angle Glaucoma and also in some Narrow Angle Glaucoma cases after LI.
  • iii.) Trans-Scleral Cyclo-Photocoagulation (TSCP Laser), Diode Laser & Cryo Surgery are also available in our most advanced eye operation theatre of the region.

3. SURGERY

Various types of Glaucoma Filtering Surgery (trabeculectomy, trabeculotomy, goniotomy, deep sclerectomy, viscocanalostomy etc.)done . Surgery is done generally to create a filtering or fluid drainage channel to control the IOP in Glaucoma. We use miniature instruments to create a new drainage channel for fluid to leave the eye. If needed special adjuvants like 5FU or MMC are used or special Glaucoma shunts / implants / valves / setons may be used. Usually surgery for glaucoma recommended only if the medicines fail to prevent damage or some specific reason.

Since most of the damage due to glaucoma is not reversible, timely and regular treatment and follow-up is very important.

Early detection is the key to preventing progressive loss of sight from glaucoma. A target I.O.P. for a particular patient is determined as per the consultant's assessment.

Whatever may be the approach, the objective of the treatment is to lower the eye pressure to a level (Target I.O.P.) at which optic nerve damage does not develop or worsen.

Our hospital is best equipped for all advanced Glaucoma Tests, Lasers & Surgeries.

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