Glaucoma

• Symptoms: No warning signs or symptoms in the early stage. Symptoms in the later stage include severe headache, blurred vision, watery eyes, redness of the eye, pain in the eye.
• Causes: Optic nerve damage is usually due to increased eye pressure
• Risk Factors: Poor eyesight, eye pressure, age over 40 years, family history or genetics, diabetes, a recent eye injury or surgery, using corticosteroid medication
• Severity: Mild to severe
• Which doctor to consult: Optometrist or Ophthalmologist

Overview

Glaucoma is not a single disorder. It is a group of eye disorders that can often lead to blindness in individuals over 40 years of age. It is common among individuals of all ages, including children, but older adults are more at risk. Glaucoma is one of the most prominent eye diseases responsible for blindness.

The optic nerve consists of more than 1 million nerve fibres in the back of the eye. This nerve is connected to the brain and is responsible for visual messages, i.e., transmitting images to the brain. These nerves are the reason individuals can see, and any damage to them can lead to glaucoma.

This condition usually has no warning signs, and this is why it remains untreated in most cases until the problem becomes severe. Also, the effects are very gradual, and it is usually too late by the time individuals notice them.

There is no cure for this disease. Once it affects the eyes, the treatment may continue lifelong. However, if it is detected early, several treatments can prevent it from causing further damage to the eyes and save the vision. The only way to determine if a person has glaucoma is to go for regular eye check-ups.

Ophthalmologists check the eye pressure in a detailed examination which can reveal if an individual has risks of glaucoma.

So, individuals should go for regular eye check-ups and get examined by eye specialists.

When to Consult a Doctor?

Glaucoma symptoms vary with age. Although the symptoms take time to appear, any sign that resembles the risk of glaucoma should not be ignored. One should consult a doctor immediately to prevent further progression of the disease.

Here are a few symptoms of glaucoma that patients should look out for.

• Severe headache
• Blind spots in side vision
• Nausea 
• Decreased night vision
• Blurred vision
• Severe pain in the eye
• Colored rings around lights

Individuals should not wait for more than one symptom to appear before consulting an ophthalmologist. Whether a patient is getting a severe headache frequently, or experiencing nausea, he/she should consider getting a check-up.

Diagnosis:

Glaucoma can be detected with regular and comprehensive eye check-ups. A doctor cannot confirm glaucoma by checking only the eye pressure. The doctors has to consider several factors like change in vision, loss of nerve tissue, and damage to the nerve. All these are monitored over time through routine check-ups to confirm glaucoma.

The comprehensive eye check-up for glaucoma includes the following processes:

• Patient History

The doctor will check the family history of glaucoma or other eye problems the patient has experienced. Patients also have to share any previous eye or health problems like diabetes. After assessing this, the doctor will review all the symptoms that the patient is experiencing and also check his/her medications and run tests if required.

• Preliminary & Complementary Tests

Preliminary tests like tonometry, keratometry, pachymetry, and perimetry tests are commonly done to check different eye conditions. All these are important in glaucoma, and some are done as complementary tests to determine other eye problems. The doctor will also perform visual tests to check the vision.

• Lab Tests

1. Tonometry measures the pressure inside the eyes. This test is also used to assess the effectiveness of the glaucoma treatment.
2. Keratometry measures the corneal surface's curvature to check the extent of astigmatism. Astigmatism causes blurred vision.
3. Pachymetry measures the thickness of the cornea, and this test can determine the relationship between the intraocular pressure and the corneal thickness of the eyes.
4. Perimetry tests the function of the visual field and checks peripheral vision.
5. Gonioscopy helps in checking whether the eye’s drainage angle is blocked or open.

Treatment:

Glaucoma cannot be cured. But if it is detected early, doctors can slow down or prevent loss of vision with proper treatment. There are not many home remedies for glaucoma, and patients should not rely on them alone. But home remedies that support natural wellness can aid the medical treatment.

• Home Care

Patients who eat a balanced diet and maintain a healthy weight have shown better responses to the treatment of glaucoma. Individuals should consider eating food rich in antioxidants. This can prevent further damage to the optic nerve. A person should also take vitamins and minerals supplements if his/her diet is not rich in nutrients.

Patients with glaucoma should maintain healthy body weight. Moderate exercises that improve blood circulation and support weight loss are ideal. However, it is advisable to not go for intense workouts as it can lead to increased pressure in the eyes. Also, patients should avoid exercises involving downward or inverted positions like headstands, downward dog or other yoga postures.

Brisk walking or jogging suits most glaucoma patients. Walking at least 5,000 steps daily or jogging for a kilometre or two can help.

• Medication

The most common medicine for glaucoma is eye drops. Doctors prescribe eye drops to control eye pressure. There are different types of eye drops that are suitable for varying conditions. Some eye drops are prescribed to improve the drainage of the fluid, aqueous humour, while other types can reduce the amount of fluid formation.

Depending on the stage of glaucoma, the doctor may prescribe one or multiple eye drops. It is advisable for glaucoma patients to never stop or start a medication without consulting an ophthalmologist.

Patients with severe glaucoma may have to use eye drops daily. Additionally, there may be pills prescribed by the doctor.

• Surgical Treatment

When medications do not work, surgery may be the last option to prevent glaucoma from spreading further. Surgery cannot restore vision, but if it is detected early, doctors may perform surgery to reduce the pressure in the eye.

There are several different types of surgery to treat glaucoma. If the patient experiences mild glaucoma, the doctor will suggest a minimally invasive glaucoma surgery (MIGS). This is a simple surgery performed to lower eye pressure. This surgery is often done with cataract surgery, requiring minimum post-operative care.

A drainage valve implant is another option for patients with glaucoma. In this procedure, the surgeon inserts small silicon drainage tubes to drain the fluid and reduce the eye pressure.

Another surgery, called trabeculectomy, involves the surgeon creating an opening in the sclera (the white portion of the eye) to drain the fluid.

Patients opting for surgery have to go for regular follow-ups and post-operative care.

Laser treatment is becoming increasingly popular to treat glaucoma. Doctors suggest laser treatments and eye drops to reduce eye pressure. The laser treatment is usually done at the doctor's clinic. Using a laser, the doctor can improve the drainage of the fluid. There are two popular laser therapy; trabeculoplasty and iridotomy.

• Alternative Management

Herbal treatment is often used to treat glaucoma, but there has not been any significant research in this field. Another effective way to manage glaucoma is by reducing stress. Practice relaxation, meditation and other techniques to manage daily stress.

Risks & Complications if Left Untreated

• Complete Blindness

Glaucoma is a slow-progressing disease. The pressure inside the eyes builds up slowly; over time, it can permanently damage the optic nerves. If left untreated after the initial symptoms, it can lead to partial vision loss, seeing halos or coloured lights and finally, complete blindness.

Additional Information

There are four significant types of glaucoma that affect individuals.

• Primary Open-Angle Glaucoma

This is called the "silent thief of sight" and is the most common glaucoma affecting older adults. Doctors are not sure what causes this glaucoma, but most state that increased pressure in the eyes causes this glaucoma. The symptoms are often not noticeable until it's too late. This is why patients often develop signs like peripheral loss of vision and blindness.

• Angle-closure glaucoma

This is an acute form of glaucoma that leads to vision loss from the day of the onset of the disease. This is a rare form of glaucoma, which occurs when the drainage angle of the fluid becomes blocked. This form of glaucoma usually affects one eye.

• Secondary glaucoma

This type of glaucoma results from different medical conditions. Sometimes, individuals may show symptoms of this glaucoma after an eye surgery.

• Normal-tension glaucoma

This glaucoma occurs when the optic nerve is damaged. Usually, eye pressure does not play any significant role in this glaucoma and individuals with normal eye pressure also show symptoms of glaucoma.