Glaucoma is a complex eye disease that causes gradual, irreversible damage to the optic nerve, leading to progressive vision loss. It is the second most common cause of blindness worldwide.
What is Glaucoma?
Glaucoma refers to a group of eye disorders where the main risk factor is increased fluid pressure within the eye. This elevated pressure can damage the optic nerve, which is responsible for transmitting visual information from the eye to the brain. If detected early and managed properly, the progression of glaucoma can often be slowed or controlled.
Under normal conditions, the eye produces and drains fluid continuously. When the drainage channels become blocked or function poorly, fluid begins to build up, increasing the intraocular pressure. This heightened pressure gradually damages the delicate nerve fibers at the back of the eye.
As glaucoma progresses, it typically begins with a loss of peripheral (side) vision, and if left untreated, may eventually lead to complete vision loss, including central vision. Unfortunately, any vision lost due to glaucoma is permanent and cannot be restored, making early diagnosis and consistent treatment essential.
What Causes Glaucoma?
Glaucoma occurs when the optic nerve is damaged, often due to increased pressure inside the eye. This damage may result from mechanical compression or reduced blood flow to the optic nerve. Although high intraocular pressure is a major risk factor, glaucoma can also develop in individuals with normal eye pressure.
Warning Signs of Glaucoma
Glaucoma is often called the “silent thief of sight” because it typically progresses without early symptoms. However, some possible warning signs include:
- Difficulty adjusting to darkness
- Blurry vision at near or far distances
- Sensitivity to light or glare
- Change in the color of the iris
- Red, swollen, or crusty eyelids
- Recurring eye pain or discomfort
- Double vision
- Dark spots in the center of vision
- Distorted or wavy lines
- Excessive tearing or watery eyes
- Dry eyes with itching or burning
- Seeing floating spots or ghost-like images
If you experience any of these symptoms, consult an eye specialist promptly.
Surgical Options for Glaucoma Treatment
Operative Surgery
When medications or laser treatments are not effective, your ophthalmologist may recommend traditional surgery. This procedure involves creating a new drainage pathway for the eye fluid to reduce intraocular pressure. Surgery is considered when the benefits outweigh the potential risks and further optic nerve damage is likely without intervention.
Laser Surgery for Glaucoma
Laser surgery is increasingly used as a step between medication and traditional surgery. It is quick, minimally invasive, and usually done on an outpatient basis.
Trabeculoplasty (for open-angle glaucoma)
This is the most common laser procedure and includes:
- Argon Laser Trabeculoplasty (ALT): Targets the trabecular meshwork to improve fluid drainage. Usually, half of the drainage angle is treated first, and the rest can be addressed later if needed. It has a success rate of around 75%, but can only be repeated 2–3 times per eye in a lifetime.
- Selective Laser Trabeculoplasty (SLT): A newer technique using lower energy levels. It selectively treats parts of the trabecular meshwork, allowing for safe repeat treatments. SLT is effective even when performed after ALT or as a second treatment.
Laser Peripheral Iridotomy (LPI) (for angle-closure glaucoma)
LPI creates a small opening in the iris, allowing aqueous fluid to flow freely and relieve pressure buildup behind the iris. It is commonly used to prevent or treat angle-closure glaucoma caused by anatomical narrowing of the drainage angle.
Cycloablation (Cyclophotocoagulation)
Used in severe or treatment-resistant cases, this procedure reduces fluid production by destroying part of the ciliary body, the structure that produces aqueous humor.
- Transscleral Cyclophotocoagulation: Uses a laser directed through the outer white layer of the eye (sclera) to reach the ciliary body without damaging the outer tissue.
- Endoscopic Cyclophotocoagulation (ECP): Performed inside the eye through a surgical incision, delivering laser energy directly to the ciliary body.
Cycloablation is typically reserved for eyes that have not responded to other treatments or when traditional surgery isn’t viable due to the eye’s structure.
FAQs
1. What is Glaucoma?
Glaucoma is a disease that affects the optic nerve, often caused by an increase in intraocular (eye) pressure. Over time, this elevated pressure can damage the optic nerve, leading to irreversible vision loss if not treated promptly.
2. What Are the Symptoms of Glaucoma?
Common symptoms include difficulty with near vision, trouble seeing in dim or low light, frequent headaches, and a gradual loss of peripheral (side) vision.
3. What Tests Are Used to Diagnose Glaucoma?
Initially, vision and eye pressure are checked. If the doctor finds any signs of glaucoma during the clinical examination, further tests such as OCT RNFL (Optical Coherence Tomography of the Retinal Nerve Fiber Layer), Visual Field test, and Central Corneal Thickness measurement are performed to confirm the diagnosis. These tests also help in assessing the severity of glaucoma.
4. What Is the Success Rate of Glaucoma Treatment?
Glaucoma is a chronic condition, and any damage caused to the eye cannot be reversed. The primary goal of treatment is to prevent further damage and preserve the patient’s remaining vision.
Conclusion
Glaucoma management involves a combination of medications, laser procedures, and sometimes surgery. Early detection and consistent follow-up with your eye specialist are crucial in preventing vision loss and preserving eye health.