HOW IS GLAUCOMA DIAGNOSED ?
WHAT ARE THE SYMPTOMS OF GLAUCOMA?
Most patients with glaucoma do not exhibit any symptoms until the advanced stages of the disease. This is because, nerve damage starts from the periphery field of vision and gradually progresses centrally. The most common symptom is gradual and progressive vision loss which can lead to blindness. Once, damaged, the nerve function and vision cannot be restored! Apart from vision loss, other symptoms depend on the type of glaucoma. A patient with an acute attack of angle-closure glaucoma will experience pain, red eye, headaches, vomiting, and decreased or cloudy vision.
Symptoms of the underlying cause are present in secondary glaucoma. A child with congenital glaucoma will have large appearing eyes, excessive tearing, sensitivity to light, and clouding of the cornea i.e the front of the eye. It is always a good idea to get your eyes checked once a year routinely above the age of 40 years.
IMPORTANCE OF EARLY DIAGNOSIS
- Glaucoma patients do not have any symptoms until advanced stages of the disease.
- Thus, over half the people in the world, who have glaucoma, don’t know they have it.
- A routine eye check-up at an optician, without a detailed retina examination, will not pick up the eye pressure or the optic nerve damage.
- By the time, the ophthalmologist or glaucoma specialist observes nerve changes in your eye, the damage is already done because these changes are reflected after more than 50% of the nerve fibers are damaged.
- Ancillary tests such as Pressure testing ( Tonometry), visual field testing (Perimetry), measuring the space in the eye (Gonioscopy), and Nerve fiber testing ( OCT) are required to identify and monitor the progression of glaucoma. Of these, OCT and Perimetry changes help to diagnose glaucoma even before visible damage to the optic nerve is observed.
- If diagnosed early, the progression of glaucoma can be arrested and delayed by starting appropriate treatment. Thus, preserving your vision for a longer time and preventing sight-threatening disease.
GLAUCOMA TESTING – WHAT DOES IT INCLUDE ?
Early detection, through regular and complete eye exams, is the key to protecting your vision from damage caused by glaucoma. The Glaucoma Clinic at REH is equipped with all the advanced diagnostics and highly experienced glaucoma specialists in Mumbai.
RECOMMENDED FREQUENCY OF EYE CHECKUPS
Between the age of 35 to 40 years: First Checkup
Between the age of 40 to 60 years: Once in every two to three years
After the age of 60 years: Once every year
These are rough guidelines. If you have any of the risk factors for developing glaucoma, you must visit a glaucoma specialist for advice on the follow-up.
WHAT IS BUPHTHALMOS AND HOW CAN IT BE TREATED
This essentially means a large eye as a result of stretching due to elevated IOP prior to the age of 3 years.
Primary congenital glaucoma:-
Is rare with an incidence of 1:10,000. Boys are more commonly affected. Involvement is usually bilateral but may be unilateral as well. It is classified as:-
- True congenital glaucoma.
- Infantile glaucoma (manifests before 3 years)
- Juvenile glaucoma ( between 3-16 years of age)
The child usually presents with watering photophobia and blepharospasm noticed by parents. The child is evaluated under short G.A. to check parameters like IOP, Anterior chamber evaluation, gonioscopy, optic disc evaluation, corneal diameter, Fundoscopy, and Retinoscopy.
Treatment:- Management is essentially surgical
- Goniotomy
- Trabeculotomy
- Trabeculectomy
- Tube shunt implantation
- Ciliary body ablative procedures
Long-term IOP monitoring with visual rehabilitation is a must to prevent Amblyopia.
Your Glaucoma work-up would include the following tests
Patient history: To know the symptoms experienced by the patient and identify risk factors.
Visual acuity assessment: To determine if vision is being affected.
Tonometry: To measure the intraocular pressure with a special instrument called applanation tonometer or a non-contact tonometer.
Pachymetry: To determine the thickness of the cornea. Patients with thin corneas are predisposed to developing glaucoma.
Ophthalmoscopy: To examine the inside of the eye, especially the optic nerve and detect signs of nerve damage.
Perimetry: Also called a visual field test. During this test, you will be asked to look straight ahead and then indicate when a moving light passes your peripheral (or side) vision. This helps draw a “map” of your vision.
Gonioscopy: Gonioscopy is a painless eye test that checks if the angle where the iris meets the cornea is open or closed, showing if either open-angle or closed-angle glaucoma is present. Gonioscopy is an essential part of glaucoma evaluation of a patient suspected to have glaucoma. Patients with narrow angles are surprisingly quite common in the Indian scenario. They may either have narrow angles with high Intraocular pressures or just maybe suspects. Primary Angle-closure responds extremely well to Yag Laser Iridotomy, done in the early stages before peripheral Anterior synechiae (PAS) set in. Once PAS sets in the patient can be treated by Topical medications or may also need Anti glaucoma surgery to protect the optic nerve. Doing a prophylactic Yag Iridotomy in the fellow eye is of utmost importance. This is usually done at the same sitting. It has proven benefits and may alleviate the need for drops altogether in this eye thereby preventing glaucoma. So Gonioscopy helps us to differentiate between Narrow Angles and Open Angles, which in turn helps us decide the correct modality of Treatment for Glaucoma i.e. Laser, Topical Medications, or Surgery.
OCT: Optical Coherence Tomography (OCT) creates images of the optic nerve by use of special beams of light. The OCT machine can map the optic nerve, optic cup, and measure the retinal nerve fiber thickness. It is very useful for early diagnosis and for monitoring
disease progression.
GLAUCOMA CLINIC IN MUMBAI AT REH
Our Glaucoma Clinic in Mumbai is equipped with advanced Glaucoma Diagnostic Equipment like Carl Zeiss Cirrus HD OCT for Optic nerve fiber analysis, Carl Zeiss Humphrey Visual field analyzer for Standard and SWAP Perimetry and Scheimpflug based corneal pachymetry on Oculus Pentacam.
