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Glaucoma Management
The Optic Nerve
Normal Patient
Patient with Glaucoma

Clear vision | Vision with glaucoma.

 
Progressive loss of visual field
Glaucoma is a blinding disease, present in 5-8% of population, in which the Optic Nerve is damaged, usually due to high pressure inside the eye. This damage can lead to loss of vision which cannot be reversed after it has  occurred. However, early treatment can control this disease and prevent or delay blindness.

In most people it is symptom less, esp. in chronic type. So most patients are not diagnosed before extensive damage is done. Hence regular eye examination are important. 

Symptoms can be:
(a) Frequent change of glasses (none of which is satisfactory)
(b) Difficulty in dark adaptation.
(c)
Bumping into things at unfamiliar places.
(d) Blurred or foggy vision.
(e) Coloured halos (rainbow coloured rings) around lights.

Acute angle closure type presents with severe eye pain & vision loss
Early diagnosis, proper treatment & proper monitoring are very essential to p reserve vision till life span.
All people over 45 yrs age & all first relatives of known glaucoma patients must get themselves checked for glaucoma periodically.

The Optic Nerve
Normal Patient Patient with Glaucoma
The Visual Field
Normal Patient
Patient with Glaucoma

Glaucoma Services at NETRA
1) Early & appropriate diagnosis by judicious use of

Applanation Tonometry: Gold standard to measure Eye Pressure
Pachymetry : For corneal thickness influencing eye pressure check
Early morning Eye Pressure check to know pressure variations in a day
Stereoscopic Optic nerve examination & photography
Automated Perimetry: To detect visual field defects
Gonioscopy: To diagnose type of glaucoma- open angle or angle closure- which have different lines of treatment
Recently additional test like HRT or OCT are available and may be employed but their use is not mandatory or included in standard of care

2) Medical treatment with drops & optimal follow-ups to ensure stability, compliance, address adverse effects , detect progression if any .

3) Surgical/ LASER treatment by

Trabeculectomy : Fluid bypass for open angle type
Laser Peripheral Iridotomy : Fluid bypass for narrow angle type
Laser Trabeculoplasty: A stop gap treatment in place of medicines
Laser Cyclophotocoagulation: For blinded painful glaucoma eyes
Glaucoma Valve : In glaucoma not responding to usual treatment

LASER Peripheral iridotomy is a commonly performed preventive procedure. Hence some more information as under will be useful.

Laser Iridotomy
Laser iridotomy is a treatment for narrow-angle glaucoma. In laser iridotomy, a small hole is placed in the iris to create a hole for fluid to drain from the back of the eye to the front of the eye. Without this new channel through the iris, intra-ocular pressure can build rapidly causing damage to the delicate optic nerve, and permanent loss of vision. In most patients, the iridotomy is placed in the upper portion of the iris, under the upper eyelid, where it cannot be seen.

The purpose of an iridotomy is to preserve vision, not to improve it.
drops will be used to to make your pupil smaller. This stretches and thins your iris, which makes it easier for the laser to make the pinhole sized puncture; no injections or needles are used.

During the laser treatment, you may see a bright light, like a photographer's flash from a close distance. Also, you may feel a pinch-like sensation. Other than that, the treatment should be painless.
Everyone heals differently, but most people resume normal activities immediately following treatment, although you'll need to have someone drive you home after your procedure. For the next few days your eyes may be red, a little scratchy and sensitive to light.

Realistic expectations:
Serious complications with laser iridotomy are extremely rare, but like any medical procedure, it does have some risks. The chance of losing vision following a laser procedure is extremely small. The main risks of a laser iridotomy are that your iris might be difficult to penetrate, requiring more than one treatment session. Another risk is that the hole in your iris will close. This happens in less than one-third of the cases. Following your procedure, you may still require medications or other treatments to keep your eye pressure sufficiently low. This additional treatment will be necessary if there was damage to the trabecular meshwork prior to the iridotomy or if you also have another type of glaucoma in addition to the closed-angle type.

 

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