Glaucoma Lasers and Surgeries

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Glaucoma is the name given to a group of diseases in which the optic nerve at the back of eye is slowly destroyed. In most people this damage is due to an increased eye pressure – a result of blockage of the circulation of aqueous or its drainage. In other patients, the damage may be caused by poor blood supply to the vital optic nerve fibres, a weakness in the structure of the nerve and / or problem in the health of the nerve fibres themselves.

What are the symptoms of Glaucoma?
Chronic (primary open-angle) glaucoma is the commonest type. It has no symptoms until eye sight is lost at a later stage. Damage progresses very slowly and destroys vision gradually, starting with the side vision. One eye covers for the other and the person remains unaware of any of any problem until a majority of nerve fibres have been destroyed, and large part of vision has been destroyed. This damage is irreversible. It is progressive and relentless. Treatment cannot recover what has been lost. But it can arrest or at least, slow down the damage process. That is why it is so important to detect the problem as early as possible to start the the treatment with as little damage to the vision as possible.

Who is at risk?
Although any one can get glaucoma, some people have a higher risk, those with
• Family history
• Diabetes
• Migraine
• Short sightedness (myopia) and farsightedness (hyperopia)
• Eye injuries
• Blood pressure
• Past or present use of cortisone drugs (steroids)

People in these groups should have their first eye check no later than age of 35. For most people, it is recommended to have an eye check for glaucoma by the age of 40.

How is Glaucoma detected?
Regular eye examinations are the best way to detect glaucoma early.

Glaucoma tests usually include the following:-
• Optic nerve check
• Eye pressure check (Tonometry or ocular response analyzer)

• Visual field assessment if needed (to find out sensitivity of the peripheral vision, where glaucoma strikes first)
• Corneal thickness
• Optic nerve thickness (using Optical Coherence Tomography)

What are the some other forms of Glaucoma?
1. Chronic (primary open – angle) Glaucoma is the most common form of this disease

2. Acute (angle-closure) Glaucoma – Acute Glaucoma is when the pressure inside the eye rapidly increases due to iris blocking the drain. An attack of acute
Glaucoma is often severe. People suffer pain, nausea, blurred vision and redness of the eye. Immediate medical help should be sought. If treatment is delayed there can be permanent visual damage in a very short time. Usually, laser surgery performed promptly can clear the blockage and protect against visual impairment.

3. Secondary Glaucoma – These glaucomas can develop as a result of other disorders of the eye such as injuries, cataracts, eye inflammations and diabetes. In case of glaucoma in diabetes patient, surgery can be performed successfully by implanting valves (Ahmed Valve), which is now been used most commonly.

4. Congenital Glaucoma – This rare form of Glaucoma caused by abnormal drainage system. It can exist at birth or develop later. Parents may note that the child is sensitive to light, has enlarged and cloudy eyes and excessive watering. Surgery is usually needed.

5. Low tension or normal tension Glaucoma – occasionally optic nerve damage can occur in people with so-called normal eye pressure. This form of glaucoma is treated in same manner as open angle-glaucoma.

Treatments of Glaucoma:-
1. Eye drops – these are the most common form of treatment and must be used regularly. In some cases pills are prescribed.

2. Laser treatment (Peripheral Iridotomy).

3. Surgery (Trabeculectomy) – this is performed usually after eye drops and laser have failed to control the eye pressure. A new channel for the fluid to leave the eye is created. During surgery Mitomycin is used for successful outcome.

4. Ahmed valve implantation – this type of valve is used in complicated cases including diabetic cases.

5. In advanced cases special laser treatment called cyclo photocoagulation or cryo is used to reduce the eye pressure without need for surgical intervention.

NB: Treatment can save remaining vision but it does not improve vision.