What is Glaucoma?
Glaucoma, a group of eye conditions, damages the optic nerve responsible for transmitting visual information to the brain. Typically associated with high eye pressure, glaucoma can also occur with normal pressure.
While it can affect individuals of any age, it’s more prevalent among older adults, often leading to blindness in those over 60. Many forms of glaucoma show no early warning signs, with vision changes becoming noticeable only in advanced stages.
Regular eye exams, including eye pressure measurements, are crucial for early detection. With timely recognition, vision loss from glaucoma can be slowed or prevented, necessitating lifelong treatment or monitoring for those affected.
Symptoms
Treatments
Precautions
Symptoms
- Early stages: Typically asymptomatic
- Progression: Gradual development of patchy blind spots in peripheral vision
- Advanced stages: Difficulty seeing objects in central vision
- Severe headache
- Intense eye pain
- Nausea or vomiting
- Blurred vision
- Halos or colored rings around lights
- Eye redness
- Early stages: Often symptomless
- Progression: Gradual onset of blurred vision
- Advanced stages: Loss of peripheral vision
- Infants: Dull or cloudy eye, increased blinking, tears without crying
- Older children: Blurred vision, worsening nearsightedness, headaches
- Halos around lights
- Blurred vision exacerbated by exercise
- Progressive loss of peripheral vision
Treatments
Treatments for Glaucoma
The damage caused by glaucoma can’t be reversed. However, treatment and regular check-ups can help slow or prevent vision loss, particularly when the disease is caught in its early stages.
Glaucoma is treated by lowering intraocular pressure. Treatment options include prescription eye drops, oral medicines, laser treatment, surgery or a combination of approaches.
Eyedrops
- Glaucoma treatment often starts with prescription eye drops. Some may decrease eye pressure by improving fluid drains from your eye. Others reduce the amount of fluid made by your eye. You may be prescribed multiple eye drops, depending on how low your required eye pressure level is.
Prescription eye drop medicines include
Prostaglandins
These increase the outflow of the fluid in your eye, helping to reduce eye pressure. Medicines in this category include Latanoprost (Xalatan), Travoprost (Travatan Z), Tafluprost (Zioptan), Bimatoprost (Lumigan), and Latanoprostene Bunod (Vyzulta).Possible side effects include mild reddening and stinging of the eyes, darkening of the iris, darkening of the pigment of the eyelashes or eyelid skin, and blurred vision. This class of drug is prescribed for once-a-day use.
Beta-blockers
These reduce fluid production in your eye, helping to lower eye pressure. Examples include Timolol (Betimol, Istalol, Timoptic) and Betaxolol (Betoptic S). Possible side effects include difficulty breathing, slowed heart rate, lower blood pressure, impotence and fatigue. This type of drug can be prescribed for use either once a day or twice a day, depending on your specific condition.
Alpha-adrenergic agonists
These reduce the fluid production that flows throughout the inside of your eye. They also increase the outflow of fluid in your eye. Examples include Apraclonidine (Iopidine) and Brimonidine (Alphagan P, Qoliana). Possible side effects include irregular heart rate, high blood pressure, fatigue, red, itchy or swollen eyes, and dry mouth. This type of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.
Carbonic anhydrase inhibitors
These medicines reduce the fluid production in your eye. Examples include Dorzolamide and Brinzolamide (Azopt). Possible side effects include a metallic taste, frequent urination, and tingling in the fingers and toes. This class of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.
Rho kinase inhibitor
This medicine lowers eye pressure by suppressing the Rho kinase enzymes responsible for fluid increase. It is available as Netarsudil (Rhopressa) and is prescribed for once-a-day use. Possible side effects include eye redness and eye discomfort.
Miotic or Cholinergic agents
These increase the outflow of fluid from your eye. An example is Pilocarpine (Isopto Carpine). Side effects include headache, eye ache, smaller pupils, possible blurred or dim vision, and nearsightedness. This class of medicine is usually prescribed to be used up to four times a day. Because of potential side effects and the need for frequent daily use, these medicines are not prescribed very often anymore. Because some eye drop medicine is absorbed into your bloodstream, you may experience side effects unrelated to your eyes. To minimise this absorption, close your eyes for 1 to 2 minutes after putting the drops in. You may press lightly at the corner of your eyes near your nose to close the tear duct for 1 or 2 minutes. Wipe off any unused drops from your eyelid. You may have been prescribed multiple eye drops or need to use artificial tears. Make sure you wait at least five minutes in between using different drops.
Oral medications
Eye drops alone may not bring your eye pressure down to the desired level. So your ophthalmologist may also prescribe oral medicine. This medicine is usually a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.
Surgery and other therapies
Other treatment options include laser therapy and surgery. The following techniques may help to drain fluid within the eye and lower eye pressure:
Laser therapy
Laser Trabeculoplasty offers an alternative for those who struggle with eye drops. It’s also considered when medications fail to halt disease progression. Your ophthalmologist might even suggest laser surgery before resorting to drops. This procedure is performed in-office, where a precise laser targets tissue at the angle where the iris and cornea meet, enhancing drainage. The full effects may take a few weeks to manifest.
Filtering surgery
This surgical procedure is known as a Trabeculectomy. During this operation, the eye surgeon makes an incision in the white part of the eye, known as the sclera. This incision creates an additional pathway for fluid to exit the eye. Drainage tubes. In this procedure, the eye surgeon inserts a small tube in your eye to drain excess fluid to lower eye pressure.
Minimally Invasive Glaucoma Surgery (MIGS)
Your ophthalmologist may suggest a MIGS procedure to lower your eye pressure. These procedures generally require less immediate post-operative care and have less risk than trabeculectomy or using a drainage device. They are often combined with cataract surgery. There are numerous MIGS techniques available, and your ophthalmologist will discuss which procedure may be right for you. After your procedure, you need to see your ophthalmologist for follow-up exams. You may eventually need to undergo additional procedures if your eye pressure increases or other changes occur in your eye.
Treating acute angle-closure glaucoma
Acute angle-closure glaucoma is a medical emergency. If you’re diagnosed with this condition, you’ll need urgent treatment to reduce the pressure in your eye. This generally will require treatment with medicine and laser or surgical procedures. You may have a procedure called a Laser Peripheral Iridotomy. The doctor creates a small hole in your iris using a laser, which allows fluid to flow through the iris. This aids in opening the eye’s drainage angle, relieving eye pressure.
Precautions
Precautions for Glaucoma
Get regular eye examinations
- Regular comprehensive eye exams can help detect glaucoma in its early stages before significant damage occurs. As a general rule, the American Academy of Ophthalmology recommends a thorough eye exam every 5 to 10 years if you’re under 40 years old; every 2 to 4 years if you’re 40 to 54 years old; every 1 to 3 years if you’re 55 to 64 years old; and every 1 to 2 years if you’re older than 65.
- If you’re at risk of glaucoma, you’ll need more frequent screening. Ask your healthcare provider to recommend the right screening schedule for you.
Know your family’s eye health history
- Glaucoma tends to run in families. If you’re at increased risk, you may need more frequent screening.
Wear eye protection
- Serious eye injuries can lead to glaucoma. Wear eye protection when using power tools or playing sports.
Take prescribed eye drops regularly
- Glaucoma eye drops can significantly reduce the risk of high eye pressure progressing to glaucoma. Use eye drops your healthcare provider prescribes even if you have no symptoms.
Types of Glaucoma
Before the Surgery
During the Surgery
After the Surgery
Before the Surgery
- To use glaucoma medication on the day of surgery until the procedure
- Head bath before surgery
- BP and DM medication to be continued; blood thinners to be stopped 4 days before surgery
- Doctor may advise IV Mannitol if needed to reduce eye pressure before surgery
During the Surgery
- Local anaesthesia is usually needed for glaucoma surgery; hence, the operated eye will be patched for one day after surgery
After the Surgery
- After certain procedures, vision will be blurred for a few weeks due to inflammation and medication use. Vision will recover slowly
- After invasive glaucoma procedures, the eye will be red and the patient will have a pricking sensation due to sutures (which will absorb in due course)
- Severe pain, redness, watering, or vision loss post-surgery needs immediate attention
- Avoid lifting heavy weights, bending forward, straining, breath holding for a few weeks
- Avoid head baths and face wash for 2 weeks
- Post-op regimen to be strictly followed.
Glaucoma FAQs