Tag: open angle glaucoma

Why Do I Need a Gonioscopy in Gurgaon?

You need gonioscopy when your doctor must see your eye’s drainage angle directly, to tell open-angle from angle-closure glaucoma. In Gurgaon, I do this five-minute test in a dimmed room, so a narrow angle is not missed.

Your doctor has said you need a gonioscopy. The name sounds alarming, and few people explain it well. It is a short, painless test. It answers one question: is your drainage angle open, narrow, or closed?

What is gonioscopy?

Your eye makes fluid all day. That fluid leaves through a narrow drainage angle between the iris and the cornea. Gonioscopy places a small mirrored lens on the eye’s surface and shows this angle directly. The angle stays hidden from the usual slit-lamp view.

Gonioscopy remains the gold standard for classifying glaucoma. It decides whether your treatment is drops, laser, or urgent care.

Why do you need a gonioscopy?

  • You have a shallow front chamber or a narrow angle. I need to check the angle directly.
  • You have glaucoma, or doctors suspect it. The test tells us whether your angle is open, narrow, or closed.
  • Angle closure runs in your family. Narrow angles often run in families.
  • You have had an eye injury. Trauma can scar the angle. This is called angle recession.
  • You have diabetic eye disease. New blood vessels can grow into the angle.
  • You are planning an ICL. A baseline gonioscopy comes before implant surgery.
  • You take medicines that can trigger angle closure. I may check your angle before you start or continue them.

How I do gonioscopy in Gurgaon

Technique changes the result. Two examiners can grade the same angle differently.

I dim the room lights. Bright light shrinks the pupil. A small pupil pulls the iris away from the angle. A narrow angle can then look falsely open. Dim light keeps the pupil near its natural size. This matches the conditions that trigger angle closure, such as a dark cinema or dusk.

I use dynamic (indentation) gonioscopy where needed. I press the lens gently to tell true closure from appositional closure. This decides whether you need a laser iridotomy, monitoring, or nothing.

I do the test myself. I perform gonioscopy on nearly every glaucoma or glaucoma-suspect patient I see.

What your angle finding means

Angle findingWhat it meansWhat usually happens next
OpenThe drainage channel is clear. If you have glaucoma, it is open-angle.Drops, laser, or surgery to lower pressure over time.
Narrow (occludable)The channel may close, even if it has not yet.Prevent an attack, often with a laser iridotomy.
ClosedThe channel is blocked. This needs prompt treatment.Treatment to protect your vision, planned by urgency.
Other findingsPigment, scarring (synechiae) or abnormal vessels.These point to pigment dispersion, past trauma or diabetic changes. Your plan changes.

I also grade your angle, for example with the Shaffer system. This lets us track changes over time.

Is gonioscopy painful, and what happens during the test?

No, gonioscopy is not painful, but you may feel a little pressure on the eye. Your eye is numbed with anaesthetic drops, so the test itself doesn’t hurt.

  1. I explain the test and answer your questions.
  2. Numbing drops go into your eyes.
  3. A little gel goes on the lens. It feels like ultrasound gel.
  4. I rest the lens gently on your eye.
  5. You look straight ahead, then in other directions.
  6. I view your angle through the microscope.
  7. I help you clean your eyes.

Your vision may stay blurry for 15 to 20 minutes. This clears on its own. Rarely, the test causes brief dizziness. It passes quickly.

Gonioscopy vs. Anterior Segment OCT (AS-OCT)

While Anterior Segment OCT (AS-OCT) offers an objective, non-contact, high-resolution cross-sectional scan of the anterior chamber angle—making it an excellent, non-invasive imaging tool for documentation and screening—gonioscopy remains the indispensable clinical gold standard for glaucoma diagnosis. AS-OCT captures a static image in dark or light conditions, but it cannot differentiate between appositional contact and true permanent scarring (peripheral anterior synechiae, or PAS), nor can it visualize critical pigmentary details, pseudoexfoliation deposits, neovascularization, or angle recession. Remember, AS-OCT is not the same as RNFL- OCT

Gonioscopy uniquely allows the clinician to perform dynamic indentation (compression), gently applying pressure through the mirrored lens to physically test whether a closed drainage angle can be reopened or is permanently scarred shut—a critical distinction that directly determines whether a patient requires preventive laser peripheral iridotomy (LPI), medical therapy, or surgical intervention.

How to prepare for gonioscopy in Gurgaon

You need very little preparation.

  • Continue your regular eye drops.
  • Remove contact lenses before your visit, if possible, or just before the test.
  • Bring earlier eye reports.
  • Bring someone to drive you, if you prefer.

When to see a doctor

See a doctor urgently

Go the same day if you have:

  • Sudden eye pain with a red eye
  • Halos around lights
  • Sudden blurred vision
  • Severe headache with nausea or vomiting

These can signal an acute angle-closure attack. Do not wait for an appointment.

See a doctor

Book a visit if you:

  • Have a shallow front chamber or a narrow angle on record
  • Have a family history of angle closure
  • Have glaucoma and have never had gonioscopy
  • Are planning ICL surgery
  • Have had an eye injury

What this means for you

Gonioscopy is a five-minute test, that just doesn’t just confirm glaucoma. It decides which kind you have, and that decision determines whether your treatment is drops, an elective laser, or urgent intervention.

Why is Gonioscopy Important?

Gonioscopy is an eye test that visualises the drainage angle of the eye. This drainage angle is responsible for maintaining the eye pressure. Gonioscopy determines if the glaucoma is open angle, or angle closure. It’s findings depend heavily on room lighting and examiner technique. A gonioscopy done under bright slit-lamp illumination can make a narrow angle look falsely open. This is because light constricts the pupil and pulls the iris away from the drainage angle. In Gurgaon, I perform gonioscopy in a dimmed room specifically to avoid this artifact. This way, the angle is graded at its true, physiologic width, not an artificially widened one.

Why Doing Gonioscopy in the Dark Matters

This is one of the most under-discussed variables in glaucoma diagnosis.

When light hits the eye, the pupil constricts. A smaller pupil pulls the peripheral iris away from the trabecular meshwork, which can open up an angle that is, in normal daily conditions, narrow or intermittently closing. If your gonioscopy is done in a bright room, an angle-closure risk can be missed — graded as open when it isn’t reliably open at all.

I do gonioscopy with the room lights dimmed, so the pupil stays closer to its natural size. This is closer to how your eye actually behaves when you walk out of a bright clinic into dim evening light, or sit in a dark cinema. These are the exact conditions in which angle closure is most likely to be triggered. Where indicated, I also use dynamic (indentation) gonioscopy. This involves gently pressing the lens to distinguish a truly closed angle from one that only appears closed (appositional closure). This distinction changes management directly. It decides whether you need a laser iridotomy, monitoring, or nothing at all.

Why Experience in This Specific Test Matters

Gonioscopy is a skill-dependent test — the same eye can be graded differently by two examiners. It takes practiced technique to hold the lens steady, avoid corneal compression that distorts the view, and read subtle angle structures consistently.

Gonioscopy is a routine part of my daily glaucoma practice, not an occasional add-on test. As a fellowship-trained glaucoma and neuro-ophthalmology specialist with over 25 years in the field, and as a research collaborator with Mayo Clinic, Jacksonville, my clinical work is built around glaucoma diagnosis and long-term angle monitoring. This means I perform gonioscopy, not delegate, on nearly every glaucoma or glaucoma-suspect patient I see.

Dr Shibal Bhartiya’s Published Research on Angle Closure

My angle-closure glaucoma work has been published in peer-reviewed journals and is indexed on PubMed, including:

You can view these and my other publications on PubMed and Google Scholar.

Frequently Asked Questions

Is gonioscopy painful?

No. Numbing drops remove the pain. You may feel mild pressure. Gonioscopy is very safe, and the lens touches the eye only briefly.

How long does gonioscopy take?

The test takes about five minutes. The full visit, with explanation, takes 20 to 30 minutes.

Will I need gonioscopy more than once?

Yes. Angles change with age, lens growth and after laser. I repeat the test when your glaucoma or narrow angle needs monitoring.

Does room lighting really change my result?

Yes. Bright light can make a narrow angle look falsely open. I do gonioscopy in a dimmed room for this reason. The bright light constricts the pupil and can pull the iris away from the drainage angle, making a narrow angle look artificially open.

Is gonioscopy available in Gurgaon?

Yes. I perform it routinely in Gurgaon, as part of every comprehensive glaucoma evaluation. I specifically do it in a dark room, and do the dynamic indentation where indicated.

What is dynamic (indentation) gonioscopy, and do I need it?

It’s a technique where gentle pressure is applied through the lens to see whether a closed-looking angle is truly closed or only appositionally closed. It’s used selectively, when the initial view suggests possible closure. This is because it changes whether you need a laser iridotomy or just monitoring.

How is this different from gonioscopy done elsewhere?

The test itself is standardised, but technique varies. Room lighting, indentation technique, and examiner experience all affect the reading. These are the specific variables I control for in every gonioscopy I perform.

How long will my vision stay blurry after a gonioscopy, and can I drive myself home?

The mild blurring and smudging you experience usually clear completely within 15 to 20 minutes. This temporary blurriness is not caused by long-acting dilation drops, but simply by the viscous lubricating gel placed on the diagnostic lens to protect your cornea during the examination. Once the gel washes away with natural blinking, your baseline vision returns to normal, and you can comfortably drive yourself home.

Can a gonioscopy test actually prevent an acute glaucoma attack?

Yes, indirectly—it is often the single test that saves a patient from a sudden, sight-threatening emergency. Acute angle-closure glaucoma happens when the eye’s drainage path suddenly blocks, triggering a rapid, agonizing spike in intraocular pressure. Gonioscopy is the only clinical examination that lets a specialist see an anatomically narrow or occludable angle long before symptoms appear. Detecting this early allows your doctor to perform a quick, preventive laser peripheral iridotomy (LPI) to keep the fluid pathway open permanently.

Book a Gonioscopy or Glaucoma Evaluation in Gurgaon

If you have a shallow anterior chamber, a family history of angle closure, or have simply never had your drainage angle formally assessed. A gonioscopy — done correctly — is a five-minute test that can prevent an acute angle-closure attack.

If you have been diagnosed with glaucoma, but have never had a gonioscopy, Request a Glaucoma Second Opinion.

Book an Appointment At my clinic in Gurgaon→

📍 Gurgaon 📞 +91 88826 38735 | 🌐 Contact Us | Second Opinion Form for teleconsults

Please also read about Comprehensive Eye Exam.

This article is part of the Glaucoma Diagnosis Hub. You may also want to read Eye Pressure Measurement, Why Do I Need a Visual Field Test? Understanding Your OCT Report in Glaucoma, Visual Field and OCT: Structure & Function Correlation, Gonioscopy, Glaucoma Progression: What It Means and How to Slow It, Do I Really Need All These Tests and Get a Glaucoma Second Opinion in Gurgaon

About the Author

This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine.

Dr Bhartiya has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes. She is also a committed patient advocate and mainstream medical columnist, translating complex ophthalmic evidence into actionable public health insights across leading national platforms including NDTV and OnlyMyHealth

As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery). Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.

1670+ Five Star Patient Reviews Google Business Profile

If you are unable to come to Dr Bhartiya’s clinic: Read more about teleconsultation

Read her research on PubMed | Google Scholar | ResearchGate | ORCID | Github | Wikidata

📋Upload your reports for a structured review.| 🌐 Contact Us| 📞 +91 88826 38735

⭐ Helped by this article? Leave a Google review — it helps other patients find reliable eye care.

Last Reviewed: October 2026

Common Myths About Glaucoma

Most common myth about glaucoma is that it causes pain or obvious vision loss, but early glaucoma is often silent and progresses slowly. Regular eye examinations are important because glaucoma damage can occur long before symptoms become noticeable. Patients who believe they would notice symptoms, that only older people are affected, or that treatment means surgery are the patients who present late. Here is what is true, explains Dr Shibal Bhartiya.

Glaucoma affects over 12 million people in India. The majority do not know they have it. Part of the reason is the disease itself: silent, slow, and peripheral. But part of the reason is misinformation that creates false reassurance at precisely the moment awareness matters most.

Dr Shibal Bhartiya is a fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term. Emphasis on early detection, risk assessment, and continuity of care. She is rated 5 stars across 1,500+ patient reviews on Google.

Eight Glaucoma Myths That Cost People Their Vision

MythWhat the Evidence Shows
Glaucoma only affects the elderly.While risk rises with age, glaucoma can occur at any age. Juvenile glaucoma affects teenagers. Primary open angle glaucoma is well documented in patients in their 30s and 40s, particularly in South Asian populations with high myopia or family history.
I would know if I had glaucoma — my vision is fine.Glaucoma destroys peripheral vision first. Central vision — what you use to read and recognise faces — is preserved until very late in the disease. The brain compensates for peripheral loss so effectively that patients can lose 40% of their optic nerve before noticing anything.
Glaucoma always causes high eye pressure.Normal tension glaucoma — where the optic nerve is damaged despite normal IOP — accounts for 30–40% of glaucoma in India. A normal pressure reading does not mean your optic nerve is safe.
Glaucoma means I will go blind.Glaucoma diagnosed and treated early is very unlikely to cause blindness. Most patients with well-managed glaucoma retain functional vision for life. The blindness associated with glaucoma is almost always the result of late detection or inadequate treatment.
Glaucoma treatment means surgery.The majority of glaucoma patients are managed with eye drops alone for many years. Laser procedures (SLT) are used when drops are insufficient or poorly tolerated. Surgery is reserved for cases where other treatments fail or where IOP needs to be lowered substantially.
Once I start glaucoma drops, I am on them forever.Treatment duration depends on the stage of disease, IOP response, and patient factors. Some patients transition from drops to laser. Some achieve adequate control with laser alone. Surgical treatment can reduce or eliminate drop dependence. Your specialist reviews this regularly.
Glaucoma runs in my family but I feel fine, so I must be fine.Family history of glaucoma increases your personal risk four to nine times. Feeling fine is expected — glaucoma is asymptomatic. A first-degree relative with glaucoma is the single strongest indication for annual specialist screening, regardless of how well you feel.
Glaucoma eye drops are just for reducing pressure — they have no other effect.Glaucoma drops significantly affect the eye surface, causing dry eye, redness, and allergic reactions in many patients. Some systemic drops affect heart rate and blood pressure. Your specialist needs to know your full medical history and all medications before prescribing.

To understand more, Please read Five Mistakes Glaucoma Patients Make

Please also read Cataract and Glaucoma

Frequently Asked Questions

Is There a Cure for Glaucoma?

There is no cure for glaucoma in the sense of restoring damaged nerve tissue. The optic nerve fibres lost to glaucoma do not regenerate. Treatment halts or slows progression — it does not reverse what has already been lost. This is why early detection is the single most important determinant of outcome.

Can I Check My Own Eye Pressure at Home?

Home tonometers are available and improving, but they are not a substitute for specialist monitoring. IOP is one variable in glaucoma management. Optic nerve appearance, visual field status, and nerve fibre layer thickness are equally or more important — none of which a home device measures. Home monitoring may have a role as a supplement to specialist care, not a replacement for it.

How Often Do I Need to See a Glaucoma Specialist?

This depends on your disease stage and stability. Newly diagnosed or unstable patients are typically reviewed every three to four months. Stable patients with well-controlled IOP and no progression may be reviewed every six to twelve months. Your schedule is set by your specialist and should not be deferred because you feel well.

Does Glaucoma Affect Both Eyes Equally?

Glaucoma is often asymmetric — it begins in one eye before the other and progresses at different rates. This asymmetry is one reason patients do not notice it. The better eye compensates for the worse eye. By the time both eyes are significantly affected, the window for prevention has often closed in the first eye.

Speak to a Glaucoma Specialist

If you have been diagnosed with glaucoma and are unsure whether your treatment is working, or if you have a family history and have never had a full nerve assessment, a second opinion is always appropriate. Early course correction protects what cannot be recovered.

Avoiding these common glaucoma mistakes can help protect your vision. Book a consultation with Dr. Shibal Bhartiya for a personalised glaucoma assessment, treatment review, or expert second opinion.

📍 Gurgaon 📞 +91 88826 38735 | 🌐 Contact Us | Second Opinion Form for teleconsults

This page is a part of the Glaucoma Hub. you may want to read about Glaucoma Progression, and Risk Stratification in Glaucoma. You may want to read more about OCT and Visual Field, Glaucoma Tests Explained, Normal OCT but Vision Symptoms and How to Understand Your OCT Better. Also of help could be Why Do I Need a Visual Field Test? Glaucoma Diagnosis in Gurgaon, Get a Glaucoma Second Opinion in Gurgaon and Get an Online Glaucoma Consult.

This article is a part of the Myths about Eyes Hub. Please also read Glaucoma Myths Debunked, Can Palming or Eye Exercises Cure Glaucoma, Complementary and Alternate Medication for Glaucoma, and Marijuana for Glaucoma.

About the Author

This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine.

She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.

As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.

1500+ Five Star Patient Reviews Google Business Profile

If you are unable to come to Dr Bhartiya’s clinic: Read more about teleconsultation for glaucoma

Read her research on PubMed | Google Scholar | ResearchGate | ORCID

Upload your reports for a structured review.| www.drshibalbhartiya.com | +91 88826 38735

Leave a review on Google

Related Reading
Get an Online Glaucoma Consult
Visual Field and OCT: Structure & Function Correlation
Glaucoma Diagnosis in Gurgaon
Risk Stratification in Glaucoma
Glaucoma Progression: What It Means and How to Slow It
Glaucoma treatment in Gurgaon
All About Glaucoma Medication
Glaucoma Lasers: SLT & LPI
Glaucoma surgery in Gurgaon
MIGS in Gurgaon
Get a Glaucoma Second Opinion in Gurgaon

Glaucoma Suspect

Posted on by Shibal Bhartiya

A glaucoma suspect is someone who has a risk of developing glaucoma. This includes higher pressure in the eye, evidence of optic nerve damage or vision loss. Glaucoma can cause irreversible vision loss, and usually has no early symptoms.

Types of Glaucoma: Open Angle, Closed Angle, Normal Tension, and More

Types of Glaucoma: Open Angle, Closed Angle, Normal Tension, and More, explained by Dr Shibal Bhartiya, glaucoma specialist in Gurgaon.

Glaucoma is not a single disease. It is a family of conditions, each with different causes, risk factors, and treatment approaches. What they share is a common outcome: damage to the optic nerve, leading to progressive and irreversible vision loss if untreated.

Understanding which type of glaucoma you have helps you ask better questions and follow your treatment plan with more confidence. This page explains the main types, from the most common to the less well known, written for patients rather than clinicians.

Dr Shibal Bhartiya is a fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term. Emphasis on early detection, risk assessment, and continuity of care. She is rated 5 stars across 1,500+ patient reviews on Google.

Not all glaucomas behave the same way, and the treatment that is right for open-angle glaucoma may be wrong for angle-closure or normal tension glaucoma. Getting the diagnosis right, and the type right, is where good glaucoma care begins.

If you are uncertain about your diagnosis, a structured second opinion can bring clarity.

THE TWO MAIN TYPES OF GLAUCOMA

Q1. What is the difference between open-angle and closed-angle glaucoma?

Most glaucomas fall into one of two broad categories, determined by the anatomy of the drainage angle of the eye.

Open-angle glaucoma is by far the more common type of glaucoma. The drainage angle is open and appears normal, but fluid drains too slowly, causing pressure to build gradually over months and years. It has no symptoms in the early stages. Patients typically lose peripheral vision first, and the brain compensates so well that many people do not notice the loss until the disease is advanced. This is why regular screening is essential, particularly for those with risk factors.

Closed-angle glaucoma occurs when the drainage angle is narrow or blocked, preventing fluid from draining. It can occur suddenly (acute angle closure) or gradually (chronic angle closure). The acute form is a medical emergency with symptoms including severe eye pain, redness, blurred vision, and nausea. The chronic form is subtler and may mimic open-angle glaucoma.

Note: The distinction between the two types of glaucoma (open and closed angle) is made using a test called gonioscopy. This single test shapes all subsequent treatment decisions.

CLOSED-ANGLE GLAUCOMA

Q2. I have been diagnosed with angle-closure glaucoma. What does that mean for me?

In angle-closure glaucoma, the iris (the coloured part of the eye) is too close to the drainage angle, narrowing or blocking it. When the angle closes, fluid cannot drain and eye pressure rises sharply.

The acute form causes a sudden, severe rise in pressure. Symptoms include a red, painful eye with blurred vision, coloured halos around lights, headache, and nausea. This is an eye emergency; seek immediate medical help if this happens.

The chronic form builds more slowly, with few symptoms other than occasional coloured halos and mild headaches. It can go undetected for years without a formal eye examination.

Treatment for angle-closure glaucoma starts with a laser procedure called laser peripheral iridotomy (LPI). This creates a small opening in the iris to provide an alternative drainage pathway. After LPI, some patients require no further treatment; others need long-term eye drops. Your doctor will monitor your pressure and angle anatomy over time.

Note: Family members of patients with angle-closure glaucoma have a higher risk of the same condition. Preventive laser iridotomy can be offered to at-risk relatives before any acute episode occurs.

NORMAL TENSION GLAUCOMA

Q3. My doctor says I have glaucoma, but my eye pressures are normal. How is that possible?

This is understandably confusing. Between 10 and 25 percent of people with glaucoma have eye pressures that fall within the normal range (below 21 mmHg). This is called normal tension glaucoma (NTG), or low tension glaucoma.

The exact cause is not fully understood. Two leading theories are that the optic nerve is unusually sensitive to pressure and sustains damage even at pressures that would be harmless in most people, or that the blood supply to the optic nerve is compromised, making it vulnerable to damage independent of pressure. Of all the types of glaucoma, this is perhaps the most confusing for patients.

Conditions associated with normal tension glaucoma include:

  • Japanese ancestry (NTG is significantly more common in East Asian populations)
  • A family history of normal tension glaucoma
  • Migraines and vasospastic disorders such as Raynaud’s disease
  • Sleep apnoea
  • Alzheimer’s disease

Treatment still focuses on lowering eye pressure, like all other types of glaucoma. Even when eye pressure is within the normal range to start with, clinical trials have shown this slows progression. Eye drops, laser, or surgery may be used depending on the rate of progression and individual risk factors.

Note: Normal tension glaucoma often progresses more slowly than high-pressure glaucoma, but regular monitoring is still essential. Missing follow-up appointments is the most common reason for avoidable vision loss.

OCULAR HYPERTENSION

Q4. My eye pressures are high but my doctor says I do not have glaucoma. What is ocular hypertension?

If your eye pressure is above the normal range but your optic nerve and visual field show no signs of damage, you have ocular hypertension (OHT). It is not glaucoma, but it is a significant risk factor for developing glaucoma.

Not everyone with high eye pressure will develop glaucoma. Your individual risk depends on your age, ethnicity, family history, and corneal thickness (thicker corneas can give falsely high pressure readings).

Your doctor will weigh your risk profile before deciding whether to treat. Options include eye drops or selective laser trabeculoplasty (SLT). In lower-risk patients, careful monitoring without treatment is often appropriate, since all glaucoma medications carry some side effect burden.

Whether or not you receive treatment, regular eye checks are essential. The goal is to detect any optic nerve or visual field changes before significant vision is lost. Knowing your risk early is one of the best things you can do for your vision.

GLAUCOMA SUSPECT

Q5. My doctor says I am a glaucoma suspect. My tests were normal. Why do I still need annual monitoring?

A glaucoma suspect is someone whose optic nerve appearance raises concern, even when eye pressure and visual field tests are currently normal.

The most common reason is a larger than average cup-to-disc ratio (the proportion of the optic nerve head occupied by the central cup). A ratio above 0.5, or a difference of 20 percent or more between the two eyes, warrants closer monitoring. Other reasons include borderline eye pressures or a strong family history of glaucoma.

This does not mean you have glaucoma. It means your doctor wants a baseline record to compare against over time. If the optic nerve or visual field changes, that change can be detected early and treatment started before significant vision is lost.

Most glaucoma suspects are asked to return for annual or biannual testing. Once several years of stable results have been recorded, the interval between visits may be extended.

Note: The value of being labelled a glaucoma suspect is that it keeps you in the system. Early detection is the single most powerful tool for preventing glaucoma blindness.

SECONDARY GLAUCOMA

Q6. What is secondary glaucoma, and what causes it?

Secondary glaucoma is glaucoma caused by another identifiable condition or event, rather than arising on its own. It is managed in the same way as primary glaucoma (eye drops, laser, or surgery), but the underlying cause must also be addressed.

The most common secondary types of glaucoma include:

  • Pseudoexfoliation glaucoma: A protein-like material deposits on the lens and drainage structures of the eye, blocking outflow. This is one of the most common secondary glaucomas in India and tends to cause higher pressures and faster progression than primary open-angle glaucoma. It requires close monitoring and often more aggressive treatment.
  • Pigmentary glaucoma: Pigment granules shed from the back of the iris clog the drainage angle. It typically affects younger, myopic (short-sighted) patients and is often missed because these patients are not in the standard high-risk age group for glaucoma screening.
  • Steroid-induced glaucoma: Long-term use of steroid eye drops, nasal sprays, skin creams, or oral steroids can raise eye pressure in susceptible individuals. If you are on any form of steroid medication for any condition, ask your doctor whether your eye pressure has been checked.
  • Traumatic glaucoma: An injury to the eye can damage the drainage angle and cause pressure to rise, sometimes years after the original injury. Any history of significant eye trauma should be disclosed to your eye doctor.
  • Neovascular glaucoma: New, abnormal blood vessels grow over the drainage angle, blocking outflow. It is most commonly associated with poorly controlled diabetes and retinal vein occlusion. It is one of the more difficult types to manage and often requires surgery.

Note: If you have a systemic condition such as diabetes, or are on long-term steroid medication, make sure your eye doctor is aware. These are glaucoma risk factors that are often overlooked.

CONGENITAL AND CHILDHOOD GLAUCOMA

Q7. My child has been diagnosed with glaucoma. How is that possible, and what should I expect?

Glaucoma can affect any age group, though it is most common in adults over 40. In children, the most common cause is a structural defect in the drainage angle that is present from birth; this is called congenital glaucoma or primary infantile glaucoma.

Signs that parents typically notice first include:

  • Cloudy or hazy eyes
  • Unusual sensitivity to light; the child may turn away from bright light or bury their face
  • Excessive tearing
  • Eyes that appear larger than normal (because raised pressure causes the infant eye to expand)

Eye drops may be started initially to control pressure, but surgery is almost always required for congenital glaucoma. Early surgical intervention gives the best chance of preserving good vision throughout the child’s life.

Some children also have a co-existing cataract or other eye abnormality that needs to be managed alongside the glaucoma. Glasses, patching therapy for amblyopia (lazy eye), and follow-up surgeries may all be part of the long-term plan.

Children with glaucoma can lead fully independent lives. Even where some vision has been lost, tailored rehabilitation and visual aids allow children to participate in all age-appropriate activities. As a parent, remaining engaged with the care team and encouraging the child’s independence are the most important things you can do.

Note: Congenital glaucoma is rare. If your child has been diagnosed, seek care from a specialist with specific paediatric glaucoma experience. Early and consistent follow-up is critical.

Read the research articles

This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. This article was edited in April 2026.

She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.

As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.

Available on Pubmed and Google Scholar

Dr Shibal Bhartiya
Glaucoma • Second Opinion • Advanced Care

www.drshibalbhartiya.com
+91 88826 38735

Patient reviews Google Business Profile

Upload your reports for a structured review.