Glaucoma Diagnosis in Gurgaon: What to expect
Glaucoma steals vision silently. Most patients feel no pain and notice no changes — until significant nerve damage has already occurred.
Early diagnosis changes everything. In, Gurgaon, Dr. Shibal Bhartiya offers a complete glaucoma diagnostic workup using advanced imaging and functional testing.
If you have a family history of glaucoma, are over 40, or have been told your eye pressure is high, this page explains exactly what your evaluation involves.
Why Early Glaucoma Detection Matters
Vision lost to glaucoma cannot come back. But when you catch it early, treatment halts further damage. That is why a thorough diagnostic evaluation is essential, not optional.
Early detection matters most if you have:
- A parent, sibling, or child with glaucoma (family history)
- Eye pressure above the normal range
- Thin corneas are a known risk factor
- Diabetes, high myopia, or a history of eye injury
- Age over 40, especially with South Asian ancestry
💡 Research shows that South Asians have a higher risk of angle-closure glaucoma. A screening examination can identify this risk before any symptoms appear.
5 Tests Used to Diagnose Glaucoma
Dr. Bhartiya uses a structured, evidence-based protocol. Each test answers a different question about the health of your optic nerve and visual system.
1. Intraocular Pressure (IOP) Measurement
High eye pressure is the most well-known glaucoma risk factor. Dr. Bhartiya measures IOP using Goldmann applanation tonometry, the gold-standard technique.
Normal IOP: 10–21 mmHg. Readings above this range trigger further evaluation. However, some patients develop glaucoma at normal pressures (normal-tension glaucoma), so IOP alone is never enough.
The test is quick and painless. It takes less than a minute per eye.
💡 IOP fluctuates through the day. Dr. Bhartiya may check your pressure at different times if she suspects normal-tension glaucoma.
2. OCT- Optic Nerve and RNFL Imaging
Optical Coherence Tomography (OCT) is the most important advance in modern glaucoma diagnosis. It gives Dr. Bhartiya a detailed cross-sectional scan of your optic nerve and retinal nerve fibre layer (RNFL).
OCT detects structural nerve damage up to 6 years before visual field loss becomes visible. This makes it the cornerstone of early detection.
OCT measures:
- RNFL thickness, thinning here signals glaucoma damage
- Optic nerve head parameters, including the cup-to-disc ratio
- Ganglion cell complex, a sensitive early marker of nerve loss
The scan is non-contact, takes about 5 minutes, and requires no eye drops in most cases.
💡 Dr. Bhartiya’s research background in optic nerve imaging means she reads OCT results with particular depth, looking beyond the machine’s colour codes and interpreting the raw data.
3. Visual Field Testing (Perimetry)
Glaucoma damages peripheral vision first. A visual field test maps exactly which parts of your vision are affected, and how severely.
Dr. Bhartiya uses automated Humphrey perimetry. You sit in front of a dome-shaped screen and press a button each time you see a light flash. The test takes 5–7 minutes per eye.
Visual field testing answers three questions:
- Is there functional vision loss, and where?
- How fast is the damage progressing?
- Is current treatment working?
Results compare against age-matched norms. Serial testing over time is especially important, a single test shows the current state; repeated tests reveal the trend.
💡 Reliable results require full concentration. Bhartiya’s team explains the test carefully so your first attempt is accurate. But if there are too many false positives or negatives, they will request a repeat!
4. Corneal Pachymetry
Pachymetry measures the thickness of your cornea. This single measurement significantly changes how Dr. Bhartiya interprets your eye pressure.
Here is why. IOP measurements are affected by corneal thickness. A thin cornea makes pressure read falsely low. A thick cornea makes it read falsely high.
Average corneal thickness: ~545 microns. Corneas below 500 microns carry a significantly higher risk of glaucoma progression, even when IOP appears normal.
The test is painless and takes under 2 minutes. A small probe touches the cornea gently after numbing drops.
💡 Pachymetry is especially important if glaucoma is progressing despite treatment, and for patients with borderline IOP readings.
5. Gonioscopy: Examining the Drainage Angle
Gonioscopy is the only way to directly examine the drainage angle of the eye — where fluid exits. This examination determines whether your glaucoma is open-angle or angle-closure. That distinction drives every treatment decision.
Dr. Bhartiya places a specialised mirrored lens gently on your eye (after numbing drops) to visualise structures that are otherwise invisible.
Gonioscopy reveals:
- Open-angle glaucoma: the drainage angle is open but not working efficiently
- Angle-closure glaucoma: the angle is narrow or blocked, often needing laser treatment
- Secondary causes: such as pigment dispersion, pseudoexfoliation, or neovascularisation
💡 Many patients in India have narrow drainage angles without knowing it. Gonioscopy at your first visit can prevent a potentially blinding acute angle-closure attack.
What to Expect at Your Glaucoma Evaluation
A complete glaucoma workup takes approximately 60–90 minutes. Here is the sequence:
- Brief history: symptoms, family history, current medications
- Visual acuity and refraction
- IOP measurement (both eyes)
- Pachymetry
- Gonioscopy
- Dilated fundus examination and optic nerve evaluation
- OCT imaging
- Visual field testing (where indicated)
- Detailed consultation: results, diagnosis, and treatment options
Dilation drops may be used during the examination. Your vision may be blurred for 3–4 hours afterwards. Plan not to drive yourself home.
Seeking a Second Opinion on Glaucoma?
Many patients come to Dr. Bhartiya after receiving a diagnosis elsewhere, unsure whether they need surgery, or concerned about a treatment recommendation.
A second opinion review includes a full re-evaluation of all existing tests, a fresh examination, and an honest, unhurried discussion of your options. Dr. Bhartiya brings her research expertise to every such case.
💡 Bring all previous reports, OCT scans, visual field printouts, and prescription history. The more information you bring, the more specific the guidance.
About Dr. Shibal Bhartiya
Dr. Shibal Bhartiya is a fellowship-trained glaucoma specialist and Clinical Director of Ophthalmology at Marengo Asia Hospitals, Gurgaon. She is a Research Collaborator at Mayo Clinic, Jacksonville, and has published extensively- PubMed-indexed papers on glaucoma, optic nerve imaging, and health equity.
These peer-reviewed article discussing glaucoma treatment are benchmarks for glaucoma surgeons globally, and can be accessed on PubMed and Google Scholar
She is Executive Editor of the Journal of Current Glaucoma Practice and a board member of the International Society of Glaucoma Surgery.
Her approach combines internationally trained clinical skills with a genuine commitment to patient education, so you leave every consultation understanding your condition clearly.
Book Your Glaucoma Diagnosis in Gurgaon
Do not wait for symptoms. Glaucoma gives no warning until significant damage is done.
Book a comprehensive glaucoma evaluation with Dr. Shibal Bhartiya at Gurgaon.
📞 Call or WhatsApp: +91 8882638735
🔗 Also read: Glaucoma Surgery in Gurgaon | Glaucoma Second Opinion | About Dr. Shibal Bhartiya
Frequently Asked Questions
Is glaucoma diagnosis painful?
No. All five tests are painless. IOP measurement, OCT, and visual field testing involve no contact with the eye. Pachymetry and gonioscopy use numbing drops first, so you feel minimal discomfort.
How often should I get screened?
If you have risk factors — family history, high eye pressure, thin corneas, or age over 40 — annual screening is advisable. For diagnosed patients, Dr. Bhartiya sets a personalised review schedule based on disease stage and stability.
My eye pressure is normal. Can I still have glaucoma?
Yes. Normal-tension glaucoma is well-recognised and common in Asian populations. Dr. Bhartiya evaluates optic nerve structure and visual function alongside IOP — because pressure alone does not tell the whole story.
Can glaucoma be detected before symptoms appear?
Yes, and this is the entire point of a diagnostic evaluation. OCT detects structural nerve damage years before you notice any visual change. Early detection is the single most important factor in protecting your long-term vision.
What is the difference between open-angle and angle-closure glaucoma?
Open-angle glaucoma develops slowly and painlessly as drainage channels lose efficiency over time. Angle-closure glaucoma occurs when the drainage angle narrows or blocks — it can cause sudden pain, redness, and rapid vision loss. Gonioscopy distinguishes between the two and guides treatment.
How long does the full diagnostic evaluation take?
Approximately 60–90 minutes for a first-visit comprehensive workup. Follow-up visits for monitoring are usually shorter — 30–45 minutes.
Some more FAQs :
I am going for my glaucoma tests. What should I do to prepare for them?
It is a good idea to read a little about glaucoma and carry a small cheat sheet with any questions/ apprehensions that you might have.
There are no specific instructions to be followed for your glaucoma investigations, but you should try and get a good night’s sleep before you go for your visual fields.
It is also advisable to have a light meal before you reach your doctor, since some tests can take time. You should also continue with all of your previously prescribed medications, unless advised otherwise.
In case your doctor has scheduled a water drinking test, you may want to carry a one litre bottle of water, flavoured or otherwise, if you do not want to use the drinking water available at the clinic.
In case a dilated retinal exam or an optic nerve photo has been scheduled, please do remember it will entail about forty five minutes of waiting and you may not be able to drive back alone from the hospital.
Glaucoma investigations are painless, but tiring and often time consuming. You will benefit from carrying something to read with you, as also your sense of humour.
I have been advised a gonioscopy. It sounds scary.
Your doctor must have noticed that the anterior compartment or anterior chamber
of your eyes is shallow. Alternatively, you would have been diagnosed with glaucoma, and your doctor needs the information in order to classify the disease, and decide on the future course of action.
In case you have a history of trauma to the eye, the doctor would be looking to see if the trauma has resulted in compromise of the drainage angle of the eye, called angle recession. In case you have diabetic changes on your retina, your doctor may look for new blood vessels in the angle of the eye.
Gonioscopy is a painless procedure, though it is known to be slightly uncomfortable.
Your doctor will put local anesthetic drops in both your eyes which might sting a bit. Thereafter,
you will feel no pain. He/ she will then place a lens in your eye and instruct you to look straight ahead, or towards a particular direction. You will need to keep both your eyes open and look in the direction instructed. The doctor will switch off the lights during the procedure for more accurate results.
Most people tolerate this procedure remarkably well, in some people it may stimulate one the nerves (Vagus) and result in a temporary syncope or giddiness.
I have to get a visual field. It isn’t an easy test, what are my options?
The visual field test is done to determine your peripheral vision, and is required to diagnose, and monitor glaucoma over time.
A spot that is repeatedly presented in different areas of your peripheral vision, and each time you see it, you are required to click a button. Your doctor will ask you to keep looking ahead at the fixation light, and not look at this moving light, and press the button even if you think you see it.
The visual field test will often frazzle and tire you. You will be tempted to click the button fast in order to finish the test. The result is counter-productive. In case you find yourself getting tired, feel free to tell the operator that you’d like a break.
In case you feel your eyes going dry, feel free to stop and blink, or even use your tear supplements before continuing with the test.
There is a learning curve for the visual field test, so your doctor may ask you to repeat the test to confirm your results. In case you are trigger-happy, or slow to react, the machine tells your doctor about more than acceptable false positives and false negatives, needing you to repeat the test.
In case of advanced glaucoma, your doctor might order a limited field exam for the central ten degree visual field in addition to your regular field test.
For now there isn’t an alternative to the visual field exam, and it remains the most important parameter for monitoring your glaucoma.
I have been asked to get an OCT. What is that?
The Optical Coherence Tomogram (OCT) takes a very high resolution picture of the optic nerve and the nerve fibres in its immediate vicinity.
You will be asked to keep looking at a bright green star, while the machine takes the high resolution image of your optic nerve. The machine has a database of normal population, specific to your age, gender and ethnicity, to which it compares your optic nerve pictures. The results are presented in a colour coded diagram where the green is good, yellow caution, and the red represents a nerve fibre loss that requires attention.
This is a useful tool for monitoring and diagnosing glaucoma, and is the most important in picking up early disease, as well as monitoring patients with advanced disease.
What is Diurnal Variation of Intraocular Pressure (IOP)? What are the alternatives available?
The pressure of your eyes undergoes a cyclical variation through the day and night, and this is called its diurnal variation. The peak eye pressures are typically recorded around 4 AM and doctors are worried that the eye pressures recorded during their office hours may miss the peak eye pressures in your eyes. They therefore advise a 24 hour eye pressure monitoring, where your eye pressures are monitored every two hours for a twenty four hour period. This is cumbersome and expensive, and so many doctors ask for a two hourly recording of your eye pressures during the time that their clinic is functioning.
An acceptable surrogate for diurnal variation is the Water Drinking Test. In this, your eye pressures are measured before you drink about 10ml/kg body weight of water over five minutes. Your eye pressures are thereafter recorded every fifteen minutes, for one hour. This gives an approximate idea about the peak eye pressures, fluctuation as well as the time taken for eye to regain the baseline eye pressures.
Continuous eye pressure monitoring:
See more here
What is my target eye pressure? How does my doctor determine the target?
Your target eye pressure is the acceptable range of eye pressures that will ensure that your glaucoma remains controlled so as to avoid any functional loss of visual field; without compromising your quality of life.
Your doctor keeps into account your baseline eye pressures, race, age, gender, comorbidities and disease severity when arriving at this number.
Typically, the target pressures depend on disease severity, broad guidelines are as follows:
- Severe glaucoma:
- Moderate glaucoma
- Early glaucoma
- Ocular hypertension
Your doctor may also monitor your diurnal variation of IOP and want to decrease the fluctuation of eye pressures, as also peak pressures.
How is the eye pressure measured?
The technical name for measurement of eye pressure is tonometry. Your doctor may instil local anaesthetic and a dye in the eye to measure your eye pressures with a contact process called Applanation Tonometry.
What your doctor sees during applanation tonometry:
Alternatively, the doctor may use a device called the air-puff or non-contact tonometer which uses a puff of air to measure your eye pressures.
Both processes are painless, and require you to cooperate with your doctor by keeping your eyes open, and not squeezing your eyes shut during the test.
How can the doctor see my optic nerve?
The doctor can visualise your optic nerve by either an ophthalmoscope or by slit lamp microscopy. The doctor may want to dilate the pupil so as to better examine the shape and color of the optic nerve using a magnifying device with a light source called the ophthalmoscope.
Alternatively, the doctor might use a hand held lens of a high power to visualize your optic nerve on the slit lamp in a process termed slit lamp biomicroscopy.
What your doctor sees when examining your optic nerve:
