Glaucoma Diagnosis and Management at Bhandari starlife eye hospital in ludhiana

Glaucoma is a group of progressive optic neuropathies characterised by damage to the optic nerve, often associated with raised intraocular pressure (IOP). It is one of the leading causes of irreversible blindness worldwide. The condition usually develops gradually and may remain asymptomatic until significant visual field loss has occurred. Early diagnosis and appropriate treatment are essential to preserve vision because the damage to the optic nerve is generally irreversible.

Types of Glaucoma

1. Primary Open-Angle Glaucoma (POAG): This is the most common form of glaucoma. The drainage angle remains open, but aqueous humour outflow is impaired, resulting in optic nerve damage. It usually progresses slowly and painlessly.

2. Primary Angle-Closure Glaucoma: This occurs when the drainage angle becomes obstructed, causing impaired aqueous outflow and a rapid rise in IOP in acute cases. Symptoms may include severe eye pain, redness, blurred vision, halos around lights, headache, nausea and vomiting. Acute angle closure is an ophthalmic emergency.

3. Normal-Tension Glaucoma: Optic nerve damage and characteristic visual field loss occur despite IOP measurements within the statistically normal range.

4. Secondary Glaucoma: This develops due to other conditions, such as ocular trauma, uveitis, steroid use, neovascularisation or previous eye surgery.

5. Congenital and Juvenile Glaucoma: These forms occur in infancy, childhood or early adulthood and require specialised assessment and management.

Risk Factors

Important risk factors include increasing age, family history, raised IOP, high myopia, thin central corneal thickness, diabetes and certain anatomical characteristics of the eye. Long-term corticosteroid use can also increase IOP in susceptible individuals.

Diagnosis

A comprehensive glaucoma evaluation includes:

Intraocular pressure measurement: Usually performed using Goldmann applanation tonometry.
Optic nerve examination: Assessment for increased cup-to-disc ratio, neuroretinal rim thinning, notching and retinal nerve fibre layer defects.
Visual field testing: Automated perimetry detects and monitors functional loss.
Optical coherence tomography (OCT): Evaluates retinal nerve fibre layer and ganglion cell complex thickness.
Gonioscopy: Determines whether the drainage angle is open, narrow or closed.
Central corneal thickness measurement: Helps interpret IOP measurements and assess risk.

A normal IOP reading alone does not exclude glaucoma; diagnosis depends on the combined clinical findings.

Management

The main objective of glaucoma treatment is to lower IOP sufficiently to slow or prevent further optic nerve damage. Treatment is individualised according to glaucoma type, disease severity, progression and the patient's overall health.

Medical treatment: Topical medications include prostaglandin analogues, beta-blockers, alpha-agonists, carbonic anhydrase inhibitors and other agents. Adherence and regular monitoring are essential.

Laser treatment: Selective laser trabeculoplasty (SLT) is an important treatment option for open-angle glaucoma. Laser peripheral iridotomy is commonly used in appropriate angle-closure conditions.

Surgery: Trabeculectomy, glaucoma drainage devices and minimally invasive glaucoma surgery (MIGS) may be considered when medication or laser treatment does not achieve adequate pressure control. The appropriate procedure depends on disease severity and individual circumstances.

Prevention and Follow-up