Glaucoma

Overview

Glaucoma is not a single disorder. It is a group of eye disorders that can often lead to blindness in individuals over 40. Although it is common among individuals of all ages, including children, 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 often remains untreated until the problem becomes severe. Also, the effects are very gradual; it is usually too late for individuals to 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 someone 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 is at risk of glaucoma.

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

Types and symptoms of Glaucoma:

The symptoms can vary depending on the type and stage of glaucoma:

Open-angle glaucoma: Often asymptomatic in the early stages, it can gradually lead to patchy blind spots in peripheral vision and, in later stages, central vision.
Acute angle-closure glaucoma: This can present with severe headache, eye pain, nausea, blurred vision, halos around lights, and eye redness.
Normal-tension glaucoma: Similar to open-angle, it may start with no symptoms but can progress to blurred vision and loss of side vision.
Glaucoma in children: Symptoms can include a dull or cloudy eye, increased blinking, tears without crying, blurred vision, nearsightedness, and headache.
Pigmentary glaucoma: This may cause halos around lights, blurred vision with exercise, and gradual loss of side vision.
It’s crucial to have regular eye exams to detect glaucoma early, as it can lead to blindness if untreated. If you experience any sudden or severe symptoms, seek medical attention immediately.

Causes:

Glaucoma is primarily caused by damage to the optic nerve, which is often associated with increased pressure in the eye. This pressure can result from a buildup of fluid called aqueous humour, which flows throughout the inside of the eye. Normally, this fluid drains through a tissue at the angle where the iris and cornea meet, known as the trabecular meshwork. However, the fluid can accumulate if the drainage system isn’t working properly, leading to elevated eye pressure and optic nerve damage.

There are different types of glaucoma, and the specific cause can vary:

Open-angle glaucoma: The most common type, where the eye’s drainage system becomes less efficient over time, leading to gradual pressure buildup.
Angle-closure glaucoma: Occurs when the iris is too close to the drainage angle, potentially blocking it and causing a rapid increase in pressure.
It’s important to have regular eye exams to monitor eye pressure and optic nerve health, especially if you’re at higher risk for glaucoma. Early detection and treatment can help prevent vision loss. If you experience any sudden symptoms like severe headache or eye pain, seek immediate medical attention, as these could indicate an acute glaucoma attack.

Risk factors:

The risk factors for glaucoma include:

Age: Being over 60 years old increases the risk.
Ethnicity: There is a higher risk in people who are Black, Asian, or Hispanic.
Family history: A family history of glaucoma raises the risk.
Medical conditions: Diabetes, heart disease, high blood pressure, and sickle cell anaemia are associated with a higher risk.
Eye conditions: Thin corneas in the centre and extreme nearsightedness or farsightedness can be risk factors.
Eye pressure: High internal eye pressure (intraocular pressure) is a significant risk factor.
It’s important to have regular eye exams to monitor for glaucoma, especially if you have these risk factors. Early detection can help prevent vision loss. If you’re experiencing new, severe, or persistent symptoms, contact a healthcare provider immediately.

Possible Complications

The complications of glaucoma, if left untreated, can be serious and include:

Progressive vision loss starts with peripheral vision and potentially leads to blindness.
Tunnel vision: Only a small area of central vision remains in the advanced stages.
Headache: Due to increased pressure in the eye.
Eye pain: Can be severe in acute cases.
Nausea and vomiting: Often accompany severe eye pain.
Blind spots: Develop in the visual field.
It’s crucial to manage glaucoma properly to prevent these complications. Regular eye exams and following treatment plans can help maintain eye health and vision. If you experience any new or worsening symptoms, it’s important to seek medical attention promptly.

Prevention:

Preventing glaucoma involves a combination of regular eye exams and lifestyle choices. Here are some strategies that may help:

Regular Eye Exams: Early detection through comprehensive eye exams is crucial, especially if you’re at risk due to factors like age or family history.
Exercise: Moderate, regular exercise can help reduce eye pressure.
Eye Protection: Use protective eyewear to prevent eye injuries that could lead to glaucoma.
Healthy Diet: Consuming foods rich in vitamins and minerals can support overall eye health.
Avoid Steroids: Long-term or high-dose use of steroids can increase eye pressure. Consult with your doctor if you’re taking steroids.
Manage Other Health Conditions: Conditions like diabetes and high blood pressure can affect eye health, so keep them under control.
Remember, while some forms of glaucoma cannot be prevented, these measures can help maintain eye health and potentially slow the progression of the disease. Always consult with a healthcare provider for personalized advice and regular screenings.

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

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

• Preliminary & Complementary Tests

Preliminary tests like tonometry, keratometry, pachymetry, and perimetry are commonly done to check eye conditions. All these are important in glaucoma; 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 check whether the eye’s drainage angle is blocked or open.

Treatment:

Glaucoma cannot be cured. However, if it is detected early, doctors can slow down or prevent vision loss with proper treatment. There are not many home remedies for glaucoma, and patients should not rely on them alone. However, home remedies that support natural wellness can aid 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, which can prevent further damage to the optic nerve. If their diet is not rich in nutrients, they should also take vitamins and minerals supplements.

Patients with glaucoma should maintain a healthy body weight. Moderate exercises that improve blood circulation and support weight loss are ideal. However, intense workouts are not recommended, as they can lead to increased pressure in the eyes. Patients should also avoid exercises involving downward or inverted positions like headstands, downward dogs, 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

Glaucoma is treated with various types of medications that aim to lower intraocular pressure and prevent damage to the optic nerve. Here are some examples of medications used for glaucoma:

Prostaglandins such as Latanoprost, Travoprost, Tafluprost, and Bimatoprost.
Beta-Blockers such as Timolol, Betaxolol.
Alpha-Adrenergic Agonists such as Apraclonidine, Brimonidine.
Carbonic Anhydrase Inhibitors such as Dorzolamide, Brinzolamide.
Rho Kinase Inhibitors such as Netarsudil.
Miotic Agents such as Pilocarpine.
These medications can be eye drops or oral pills, and they work by either reducing fluid production in the eye or increasing fluid outflow.

It’s important to note that while these medications help manage glaucoma, they do not cure it and are typically a lifelong treatment to prevent vision loss. Always consult with a healthcare professional for personal medical advice.

• 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 therapies: trabeculoplasty and iridotomy.

• Alternative Management

Herbal treatment is often used to treat glaucoma, but no significant research has been done in this field. Another effective way to manage glaucoma is by reducing stress. Practice relaxation, meditation and other techniques to manage daily stress.