Tag: Glaucoma

Quality of Life concerns

  1. I have glaucoma. I am pregnant. What do I do?

Ideally, you should have discussed with your ophthalmologist that you were planning to have a baby. The doctor could have suggested alternate methods for lowering your eye pressures, since most eye drops can have a deleterious effect on your baby. The most common alternative is Selective Laser Trabeculoplasty, SLT.

Now, your doctor will carefully consider the potential dangers to the baby with the risk of worsening glaucoma in your eyes. These precautions hold true for your pregnancy, as well as during the time that you are breastfeeding, since the glaucoma medicines are found in both your bloodstream and breast milk.

In case eye drops are essential, you can minimize the absorption of the medication into your bloodstream, and that of the baby, by gently pressing on the inside corner of the eye (nasolacrimal occlusion).

See technique for putting eye drops.

  1. How will glaucoma medications affect my baby?

Any glaucoma medication may affect the baby, especially during the first three months of pregnancy. Please understand that all of the information we possess is from laboratory studies, conducted on animals, and may not be exactly true for human beings. That said, it is extremely important to stay vigilant about your glaucoma drops during both pregnancy, and lactation.

Carbonic anhydrase inhibitors should be used with caution in the first trimester because of reports of deformity of the embryo. Beta blockers get concentrated in breast milk, and should be avoided if possible by nursing mothers. Pilocarpine has shown no effects when used in early pregnancy, but can cause fits in the newborn. Prostaglandins may induce premature labour

  1. I have glaucoma. Can I go ahead with LASIK for spectacle removal?

Glaucoma is a not an absolute contraindication for LASIK. However, LASIK permanently alters the shape and properties of your cornea, making subsequent eye pressure recordings unreliable.

Also, the high pressure exerted on the eye during LASIK may injure the already compromised optic nerve. Steroid eye drops that are used post operatively may also result in pressure spikes in predisposed eyes.

Most doctors, therefore, prefer to rule out glaucoma before LASIK is planned, and deter patients with diagnosed from the procedure. A safer procedure would be femtosecond laser or photorefrative keratotomy, PRK, in case the patient’s visual needs are significant.

  1. I have had LASIK. Now my doctor says I have glaucoma. How is it possible?

Diagnosing and monitoring glaucoma in patients after LASIK is challenging for your eye doctor. Very often, since the cornea is thin after LASIK, the available devices underestimate eye pressures. The doctors rely heavily on optic nerve examination and visual fields to diagnose glaucoma.

In susceptible eyes, the brief but significant rise in eye pressures during LASIK can cause optic nerve damage. The use of steroids in the postoperative period can cause a steroid induced glaucoma. It is also possible that a diagnosis of glaucoma was missed before surgery, or you developed the disease recently.

  1. I have glaucoma. Can I drive?

Most glaucoma patients can go about their life without any functional impairment. However, in severe disease your doctor may ask you to restrict your driving, or stop it all together because of advanced field loss.

  1. I have glaucoma. Can I exercise?

Yes. Exercise is known to help maintain your general fitness and also is known to be an important stress buster. Yoga is known to help manage both physical fitness and stress as well. There is some evidence that the headstand or the shirshaasan may result in brief but significant rise in eye pressures, and so must be avoided in glaucoma patients.

  1. I have glaucoma? I also have cataract!

Both cataract and glaucoma are more common in the older age group, they often co-exist. Sometimes treatment for one can contribute to the development of the other.

Glaucoma typically has no symptoms, but the loss of vision due to it is irreversible. On the other hand, cataract results in clouding of vision which can be reversed by surgery.

Your doctor will therefore evaluate the severity of each before deciding on the treatment plan. Typically, most doctors would want your eye pressures to be controlled before cataract surgery. The usual exception to this rule is when your visual needs are such that waiting for eye pressure control is difficult. The second situation is in case of angle closure glaucoma, where your doctor might want to remove the cataract earlier to obviate the need for a laser peripheral iridotomy.

In case you are planning cataract surgery, please remember that multifocal IOLs (intraocular lenses) are to be used with caution in patients with moderate to severe glaucoma.

Treatment

  1. I have glaucoma. What are my treatment options?

Initially, your doctor will perform a test called gonioscopy to decide your glaucoma subtype: open angle or closed angle.

For open angles, you will be prescribed eye drops to be used as directed by your doctor. Your doctor will thereafter check their efficacy over time, adding or substituting eye drops as required. He/ she may also offer you a laser treatment called selective laser trabeculoplasty.

In case of closed angle glaucomas, you will be offered a laser procedure called laser peripheral iridotomy. In case your doctor believes that the laser alone is not enough, you will be prescribed eye drops subsequently like open angle glaucoma patients.

In case the above treatment modalities are not adequate, especially in advanced glaucomas and certain other complicated sub-types of glaucoma, your doctor will advise glaucoma surgery.

Eyedrops

  1. What are the common glaucoma medications?

The common glaucoma medications are listed in the table below, the list is by no means exhaustive.

Class Drug name Action Half life Dosage Brand names
Prostaglandin Analogues Latanoprost Outflow Long Once at bedtime Xalatan, Latoprost RT
Travoprost Outflow Long Once at bedtime Travatan
Bimatoprost Outflow Long Once at bedtime Lumigan
Beta blockers Timolol Inflow Moderate (longer in gel form) Twice a day Iotim, Glucomol, Timolol GFS
Levobunolol Inflow Moderate Twice a day Betagan
Betaxolol Inflow Moderate Twice a day Betoptic
Alpha-agonists Brimonidine Inflow/ Outflow Moderate Thrice a day Alphagan
Carbonic Anhydrase Inhibitors Acetazolamide (tablet) Inflow Short Thrice a day/ SOS Diamox, Iopar SR (sustained release)
Dorzolamide Inflow Shorter Thrice a day Dorzox
Brinzolamide Inflow Shorter Twice a day Azopt
Miotics Pilocarpine Outflow Short Thrice a day Pilocarpine

 

  1. My eye pressures are no longer high after medication. Why do I have to still take medication?

If you stop taking glaucoma medication, the eye pressure will go back up to what it was before treatment. It is absolutely necessary to continue your eye drops as prescribed. Glaucoma is a chronic disease like diabetes or high blood pressure, we can only control your eye pressures with medication, and not treat it once and for all.

  1. I have been prescribed eye drops. Can I switch to a generic medicine?

In general, we presume that the effectiveness of generic medication is the same as that of the branded product. Generics contain the same active ingredient, and in the same concentration and have been tested in laboratories to be the same chemically. However, the manufacturers of the generics are not required to prove the therapeutic effect of the drug.

Equivalence of eye drops is difficult to assess because blood levels cannot be monitored or considered to be an index of effectiveness.  Minor differences can affect absorption, and the comfort of the eye drop. Other concerns of importance include safety of packaging and drop size. In case the bottle dropper is such that the drop size is larger, the drug will prove to be more expensive per month.

That said, it will be erroneous to dismiss generics as unacceptable, and you must discuss with your doctor if you may use a generic product under supervision, provided your comfort is not compromised, and your doctor is assured of the product’s efficacy.

  1. I have been prescribed eye drops. What are the side effects?

Listed below are the most common side effects of the common anti glaucoma medication. You can develop a hypersensitive reaction, or allergy to any medication. Almost all medications can potentially cause dryness of the eyes. The specific side effects of the usual groups of prescribed medications include:

  • Prostaglandin Analogs: Change in eye color (especially for those with light eyes), pigmentation of eyelid skin, stinging, blurred vision, redness, itching, burning.
  • Beta Blockers: Reduced pulse rate, fatigue, shortness of breath (especially in asthmatics), reduced libido, depression.
  • Alpha Agonists: Stinging, fatigue, headache, drowsiness, dryness of the mouth and nose.
  • Carbonic Anhydrase Inhibitors:

Eye drop: stinging, altered taste

Oral tablet: tingling hands and feet, stomach upset, confusion, depression, metabolic imbalances

  1. I have been prescribed eye drops. How do I put them?

Remember to follow your doctor’s orders about dose and frequency. Please wash your hands before putting in your eye drops, and ensure that the tip of the dropper does not touch any part of your eye or hand.

If you have been prescribed more than one type of drop, make sure you wait five minutes before putting the next drop in.

Initially you may want to practice putting in your eye drops in front of a mirror. Tilt your head backward while sitting down. Fold a clean paper tissue into four and place it just below your lower lid. With your index finger gently pull down your lower lid to form a pocket.

Look up and squeeze one drop into the lower lid, and try and avoid blinking. Keep your eyes closed for two minutes and gently press on the inside corner of your closed eyes with your index finger. Blot around your eyes to remove any excess.

In case your hands shake, try approaching your eye from the side, while resting your hand on your face.

In case you are unable to grip or squeeze the eye drop bottle due to arthritis, ask your doctor for an assistive device.

  1. I keep forgetting to put in my eye drops. What can I do to help?

You are not alone; lots of patients struggle to remember. That said, it’s important to put your eye drops as advised. A recurrent alarm on the phone usually helps, provided you respond to it immediately.

Unless your eye drop requires refrigeration (Xalatan does but only until you open it and start using it), you can keep it on your bedside and link it to an activity like taking off your glasses at bedtime.

Your smart phone has several apps that you can download, which have reminder facilities.

For Ios phones-

https://itunes.apple.com/us/app/eyedrops/id525362921?mt=8

For Android phones –

https://play.google.com/store/apps/details?id=com.eyedropsfree&hl=en

You can do the same for your doctor visits. You can also ask a friend or relative to also help you remember or schedule doctor appointments.

Laser:

  1. I have been advised a laser iridotomy. What is that?

A laser peripheral iridotomy, or LPI, is advised by your doctor in order to make an alternate channel for drainage of the fluid in the eye, in case the drainage angles are compromised.

Your doctor will instil drops to make your pupil smaller, and thereafter a local anesthetic agent, so you feel no pain.

As in a gonioscopy, a lens will be placed in your eye so your doctor can see your iris better. You will be asked to focus on a red light, while the doctor will use the laser to make a small hole in the iris.

The process is slightly uncomfortable, and some patients report pain which is not intolerable. Your vision remains blurred for a maximum of three days after surgery, and your doctor will usually prescribe steroid drops for upto a week.

  1. I have been advised selective laser trabeculoplasty. What is SLT?

Selective laser trabeculoplasty or SLT is a laser procedure that helps in increasing the outflow from the drainage angle of the eye. The doctor applies a low energy laser to the drainage angle, and immune modulators within the eye increase the outflow through this channel. It is usually prescribed for open angle glaucomas.

The doctor will instil some eye drops to close the pupil up to three times, so as to increase the visibility of the drainage angle. A drop of eye pressure lowering agent may also be instilled an hour before the procedure.

Just before SLT, the doctor will instil a drop of local anaesthetic, which may sting a little. After this, the doctor will ask you to sit comfortably with your face close to the headrest, with your chin in chinrest of the laser machine. He/ She will then insert a lens in the eye, as for your gonioscopy. You will be asked to look at a blinking red light while the doctor adjusts the focus of the laser. You might feel the laser as a small brief twinge or stinging.

After the procedure, you will be advised either steroid drops or non-steroidal anti-inflammatory eye drops, as needed, for up to a week. You will also  be asked to continue your glaucoma medication as before, and the doctor will want to measure your eye pressures an hour after your procedure. Most doctors will ask for a review after one week..

Peak effects of SLT take up to one to three months, and often the effect of SLT is temporary. It is therefore extremely important to remain under constant follow up after the procedure.

See more: https://www.youtube.com/watch?v=ZPuzM19KiRY

Surgery:

  1. What is trabeculectomy? Why do I need trabeculectomy?

Trabeculectomy is a surgery performed to decrease the eye pressures. In case your doctor is not satisfied with the pressure control achieved in your eyes with drops, you will be advised a trabeculectomy.

Trabeculectomy involves creating a small pathway in the white part of the eye (sclera) so that the fluid inside the eye can drain out, under the conjunctiva. The drained fluid forms a bleb, a small elevation that you will be able to see just under your upper lid if you look into a mirror.

  1. What is an Ahmed Glaucoma Valve?

An Ahmed Glaucoma Valve is a small silicone valve that is implanted in the eye to promote drainage of fluid from inside your eye to the space under your conjunctiva. Your doctor might also implant a small piece of donated sclera (white part of eye) to cover the tube and stop it from extruding.

  1. Why am I getting an Ahmed Glaucoma Valve (AGV) implant and not a trabeculectomy?

Clinical trials all over the world have established that both procedures are equally effective and safe in the long term. If you have not had a previous surgery, your doctor can help you choose from either of the procedures, depending on what will suit you best.

In case you have had a failed trabeculectomy, your doctor will consider the Valve implantation, since the chances of success with a repeat trabeculectomy are lower.

In certain cases such as inflammatory, neovascular, and post VR surgery glaucomas, as also scarred corneas, the Valve implantation often has a better surgical result. Most doctors consider is prudent to use the Valve as a reserve procedure because of its higher cost.

  1. What do I feel during the surgery?

Typically you will be given an injection to make the eye numb, and another intravenous injection to bring down your  eye pressures.

You will be made to lie on your back in the operating room, and a drape will be placed over your face after cleaning the area to be operated.

In case you are asthmatic, or feel claustrophobic, do let your doctor know and the anaesthetist will provide you with oxygen piped under it. There will a clip placed in the eye to make sure you don’t blink during surgery. You will see a bright light of the microscope, and your vision will get blurred as the surgery progresses.

You might feel some discomfort during the procedure, most of which gets exaggerated due to apprehension, but the surgery is mostly painless.

The surgery can take between 45 minutes to an hour, and you should be back with your friends and family in a couple of hours, depending on hospital policy.

  1. What is recovery period like?

Most patients experience a drop in their central vision post-surgery, which slowly recovers back to normal. You might need a change of glasses, which your doctor will discuss with you.

You will be seen by your doctor on the day after your surgery; most doctors need you to wear an eye patch on the day of the surgery, to be opened on the morning after. Thereafter, depending on the status of your eye, you will be required to visit the doctor again after 3-7 days. Initially most doctors prefer to see you more frequently, and once your eye is stable, less regularly.

You will be required to use antibiotic drops, and steroid drops as prescribed by your doctor. You may also be asked to continue with some or all of your glaucoma medications during the early post-operative period.

  1. Do I need to restrict my activity after trabeculectomy or AGV implantation?

You can resume gentle exercise like walking soon after surgery, in fact your doctor will encourage you to take lots of oral fluids and walk around soon after surgery. You will be advised to wear an eye shield for up to a week after surgery, while sleeping.

You can resume work in about two weeks, but strenuous weight lifting should be avoided for at least a month. Swimming also should be avoided for this duration.

  1. What are risks of glaucoma surgery?

When your doctor has advised that you get your eyes operated for glaucoma, he has obviously considered the risks and benefits of surgery in your case, and decided that it is best to go ahead with surgery.

The important ones that you need to be aware of include:

Decreased Vision: The decrease in central vision may last for up to a few weeks due to inflammation, fluctuating eye pressures and bleeding within the eye.

Cataract: Your chances of getting cataract increase, and if you already have cataract the process might be accelerated.

Infection: There is an increased risk of infection, as after every surgery. With trabeculectomy, the increased risk is permanent.

Second surgery: There might be a need to perform an additional procedure or surgery to ensure optimal pressure control.

Types of Glaucoma, Clinical Spectrum of disease

  1. I have angle closure glaucoma. How is it different from open angle glaucoma?

Types of Glaucoma
Types of Glaucoma

In angle-closure glaucoma, the fluid within the eye cannot drain through the angle because the drainage angle is narrow, or closed in parts. This may result in a sudden increase in eye pressure, the symptoms of which include a red, painful blind eye. This is an eye emergency and you must seek immediate medical help.

The chronic form the disease is like open angle glaucoma with occasional coloured halos and headaches.

Typically, you doctor will offer you a laser peripheral iridotomy, a procedure that forms an alternate drainage pathway for the fluid inside the eye. Subsequent to this, you may or may not require lifelong anti glaucoma eye drops.

  1. I have glaucoma. But my eye pressures are normal without any medication.

It can be rather confusing at first, when your doctor tells you that despite normal eye pressures, you are suffering from glaucoma. About 10-25% of people with glaucoma do not exhibit higher than normal eye pressures.

The exact cause for this is not known, but it may be attributed to an unusually fragile optic nerve which is unable to withstand even the pressures that are considered normal for population (typically <21mmHg). Some researchers also believe that this may be due to a deranged blood supply to the optic nerve.

Associations of Normal Tension or Low Tension Glaucoma include:

  • Japanese ancestry
  • Family history of normal tension glaucoma
  • History of migraines and vasospastic disorders like Raynaud’s disease
  • Sleep apnoea
  • Alzheimer’s disease.

  1. My eye pressures are high. My doctor says I do not have glaucoma, only ocular hypertension.

In case your eye pressures are higher than normal, but your doctor sees no evidence of damage to the optic nerve or the visual field, you are said to have ocular hypertension (OHT).

OHT is known to be a precursor of glaucoma, as many people with high eye pressures subsequently develop optic nerve and visual field damage.

In case your doctor thinks it appropriate, you will be asked to take eye drops or in certain cases, selective laser trabeculoplasty.

Since most glaucoma treatments including eye drops have side effects, your doctor may advise you to not get any treatment for the OHT until optic nerve or field changes develop. You age, race, family history and corneal thickness will all determine your treatment plan.

In either scenario, you must remember that regular eye checks will be required to ensure that you do not develop significant visual field loss.

  1. I am a glaucoma suspect. I have no symptoms, and all my tests, including visual fields were normal last year. Still my doctor has advised tests this year.

A glaucoma or disc suspect is someone who has optic nerves that look like they are damaged from glaucoma. The doctor looks at the cup-disc ratio and determines if that is within the population normal (usually a C:D ratio of 0.5:1, may require subsequent testing). In case the doctor observes an asymmetry between the optic nerves (C:D ratio difference more than or equal to 20%), you will be advised tests.

In case your eye pressures are higher than the population normal, or in case there is a discrepancy between the eye pressures of the two eyes, your doctor might ask you to get annual eye exams to monitor any visual field loss.

These tests are usually repeated annually for a few years until your doctor is satisfied that there is no change from baseline, and then you might be asked to come for visual field testing once every two years.

  1. My baby has been diagnosed with glaucoma. How is that even possible?

Glaucoma can affect all age groups, though it is more common in the elderly. Children may be born with a congenital defect in the drainage angle of the eye, resulting in a congenital glaucoma. These children typically have cloudy eyes, sensitivity to light, and excessive tearing. Most mothers notice that the baby burrows his head into the pillow, trying to shield himself / herself from light.

Your eye doctor may initiate eye drops, but will eventually recommend surgery for the child. A timely surgical intervention can ensure that these children have good vision later on in life also.

Your child may have a coincident cataract or other eye abnormalities which must be managed. Your doctor may prescribe glasses, eye drops and /or subsequent surgeries, as required. Amblyopia or lazy eye therapy may also be recommended.

Please remember that children with glaucoma can lead fully functional lives, with a little support.  Even in cases where there has been a partial loss of vision, tailor made treatment protocols will ensure that the child can remain independent. It is important as a parent to remain optimistic and encourage the child to be independent and participate in all age appropriate activities

Diagnosis

  1. 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.

  1. I have been advised a gonioscopy. It sounds scary.

    This is what your doctor sees
    This is what your doctor sees

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.

Gonioscopy in progress
Gonioscopy in progress

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.

  1. 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.

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  1. 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.

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  1. 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.g2

Continuous eye pressure monitoring:

See more here

  1. 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.

  1. 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.g3

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.

  1. 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:

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Patient Information

  1. What is glaucoma? How can it be prevented?

Glaucoma consists of a group of eye diseases characterised by damage to the optic nerve due to high eye pressures, resulting in progressive and irreversible loss of vision. It is the second most common cause for blindness worldwide, and has no symptoms.

Glaucoma cannot be prevented; however, timely medical intervention can slow down its progression so as to prevent any functional impairment and blindness.

Since glaucoma has no symptoms, it is important to visit your eye doctor regularly, so that the disease may be detected early. The tests for glaucoma screening are painless, and your doctor will recommend a routine test for vision and eye pressures. If indicated a visual field examination may also be required. You may also be advised to get a test to determine the thickness of the nerve fibre layer called the Optical Coherence Tomogram (OCT), and a gonioscopy.

In case you are diagnosed with glaucoma, the frequency of your eye exams will be decided by your doctor depending on disease severity and progression.

  1. What puts me at risk for glaucoma?

Everyone above the age of 40 should get an annual eye check, and especially so in case of the following risk factors:

  • Family history of glaucoma
  • History of eye injury
  • Taking steroid medications for any disease
  • Diabetes, or thyroid disease
  • History of migraines and vasospastic disorders like Raynaud’s disease
  • Sleep apnea
  • Alzheimer’s disease.
  • Being nearsighted or far sighted (Hypermetropia and Myopia)
  • Symptoms like frequent change on power of glasses, coloured haloes, headaches and nausea, blurring of vision

It is important to remember that vision loss due to glaucoma is irreversible; you can’t get your vision back once it is lost. Therefore, regular eye exams are mandatory, at least every couple of years if you are over 40 or on the schedule recommended by your doctor.

See more: https://www.youtube.com/watch?v=03hsgEFqe-k

  1. What is a glaucoma check up like?

On the day of your appointment, you will need to bring all your previous records, eye drops and current prescription glasses. It is better to carry your entire medical file, and not only your eye records. Prior to your consultation with your Ophthalmologist, you will be seen by an Optometrist who will perform an initial assessment of vision and eye pressure. Thereafter your doctor will perform the preliminary eye test, including a retinal and optic nerve exam, and schedule further tests if required. These can include visual fields, water drinking test, OCT, pachymetry and a dilated eye exam.

Following these tests, the doctor will explain the results and discuss the further treatment plan with you.

It is better to not drive to the clinic as your eyes may be dilated which will blur your vision clearly for approximately three hours. Also you will not be able to read fine print for this duration. Please bring a pair of sunglasses with you so as to avoid glare on your way back from the hospital.

  1. I have glaucoma. Will I go blind? How effective is the treatment?

With proper medical care, glaucoma blindness can be avoided. In most cases, if you take your eye drops as told, and are regular with your eye exams, you should retain your vision for as long as you live.

In case your glaucoma has been detected late, or has progressed to an advanced stage, your doctor might advise surgery to prevent progression. In case your glaucoma has advanced to a stage that your visual field is severely constricted, you will be offered low vision aids which can aid mobility.

It is always advisable to discuss with your doctor the lifestyle changes that will help you cope with the disease better.

  1. I have glaucoma. How often should I see my doctor?

Doctors recommend an annual eye examination for everyone whereas an examination every alternate years is mandatory for those above 40 years of age. In case you are a glaucoma suspect, your doctor will schedule annual glaucoma tests, and more often in case he/she thinks that is more appropriate.

As for any other chronic disease, you will require lifelong follow up and treatment modification depending on the evolution of the disease process. The doctor will initially need to see you more often so as to determine both disease severity and response to treatment. The frequency of your visual field testing will also be dependent on the same factors.

Once your diagnosis and treatment regimen are sorted, your visits will largely be dependent on disease severity and eye pressure control.

More severe cases with poor control will require more frequent follow up, as compared to early glaucomas.

In case you need a glaucoma surgery, you will require early post-operative care which will be more intensive, and slowly the visits will become more infrequent. It is essential to remember that even after surgery you may require eye drops, and even if your eye pressures are well controlled, regular visits, as scheduled by your treating eye doctor, are mandatory.

  1. What can I do help my parent/partner who has glaucoma?

The diagnosis of glaucoma can be scary for most people because of the implied threat of blindness. It is therefore important for you as a partner/ child/ caregiver to reassure your loved one of the fact that with timely intervention, blindness is not an imminent threat. Emotional support from the family at the time of diagnosis, and thereafter, is essential to help the patient cope with the disease.

You can also help your parent or partner to establish a regular schedule of eye drops. Given that glaucoma is a chronic disease, which requires regular monitoring and lifelong use of eye drops, you can help by acting as a reminder service.

Helping the patient keep his/her scheduled appointments with the doctor is also important, you can drive him/her to the hospital and help schedule the visits as well.

In case the patient is already suffering from a visual loss that impairs his/her daily activity, then the support of the family becomes imperative. It is important to remember that assistance is available from other support groups as well, and you should discuss with your doctor the possibilities for visual rehabilitation and low vision aids.

  1. What does loss of vision due to glaucoma feel like?

Unfortunately for those who need to treat and diagnose glaucoma, the patient has no symptoms, and even advanced field defects may go unnoticed by the patient since the brain compensates for the peripheral loss. This sometimes means that patients do not take their field loss seriously, forgetting both their medication and doctor visits.

MSD pharmaceuticals, International Glaucoma Association (IGA) and Moorfields Eye Hospital have helped develop a free glaucoma Sim App for healthcare professionals and patients. The App helps you to simulate the effect of glaucoma on visual field over time. You can thus experience a simulation of the loss of vision that can be a result of glaucoma progression.

The App is available from the UK Apple Store. To download it, please search for ‘Glaucoma SIM’.

  1. How do I decide on a doctor? What about second opinions?

Choosing a doctor is often tricky, since you are apprehensive about your vision, and will be inundated with information from the internet and friends alike. Personal references are often a good source of information, and it is sensible to a background check about your doctors’ credentials online.

Find a doctor who listens and responds to your concerns and questions. Your doctor also must explain your treatment options, and should be available and accessible for frequent check ups. If you are not comfortable with your doctor, it is a good idea to seek a second opinion, especially in case surgery has been decided on as the way forward.

  1. What are the online resources I can check on for recent advances?

AllAboutVision.com

http://www.worldgpa.org/

American Academy Of Ophthalmology (AAO)

American Optometric Association

BioMedLib Search Engine

ClinicalTrials.gov

EyeHelp.co.uk

Foundation Fighting Blindness

MedscapeMerck Manuals – Eye Disorders

National Eye Institute

National Library Of Medicine