Nitin Kumar
World Health Organization estimates that about two billion people worldwide are either blind or have some form of visual impairment. Glaucoma is one of the leading causes of blindness and visual disability. In fact, the visual loss secondary to glaucoma is irreversible. As far as the scenario in our country is concerned, an estimated 12 million patients are suffering from glaucoma. An estimated, 40 million people in the age group forty and above are either having glaucoma or are susceptible to develop the disease. These numbers are alarming; also a high proportion of the population has undetected disease.
In developing countries, about 90 % of the cases are undetected. About 50 % of patients detected to have glaucoma have never had an eye examination in the past. This is due to the fact that the disease has almost no symptoms and the awareness about the regular eye examinations is lacking. As most of the patients remain asymptomatic even up to the late stages of the disease, glaucoma is known as a “Sneak thief of sight.” A low level of awareness among the masses is a major cause that such huge numbers of patients have an undetected disease. The need of the hour is to make people aware about the disease, its early detection in populations and timely initiation of treatment. World Glaucoma Week is being celebrated in the month of march, every year, to raise awareness about the disease and motivate the people to get their eyes checked for the disease. The Theme for the World Glaucoma Day 2023 is “The World is Bright, Save your Sight”.
What is Glaucoma? Glaucoma is an eye disease characterized by chronic, progressive damage to the optic nerve secondary to an increase of the intra-ocular pressure (IOP), leading to the loss of vision. The normal IOP is in the range of 10-21 mm Hg and varies from person to person. The two major sub-types of glaucoma are Primary-open angle glaucoma and Primary angle closure glaucoma, these two can be differentiated by performing a gonioscopy test by an ophthalmologist. Also, certain glaucomas can develop in patients with lower pressures also due to increased susceptibility of the optic nerve. The angle closure type of glaucoma can present with an acute intense pain with redness of the eye, blurred vision, high IOP nausea and vomiting. In such a case, immediate attention should be sought from an ophthalmologist. Certain forms of glaucoma can present in conjunction with other eye diseases like cataracts, diabetic retinopathy and systemic diseases. A special mention of congenital glaucomas is pertinent which presents with the newborn children having watering from eyes, a large appearing eye and cloudiness of the front part of eye. These cases require emergent care to protect the vision of these newborns.
Screening: Glaucoma does not produce any symptoms and most of the patients present late with advanced visual loss and visual disability. So, it is imperative to screen patients who at risk, as to detect the patients early. Risk factors for glaucoma include age more than 40 years, significant family history of glaucoma, high refractive errors, and use of certain drugs like steroids.
How will your doctor screen you for Glaucoma: A comprehensive eye examination including IOP measurement, dilated examination of the optic nerve can help to detect glaucoma? Specialized tests like gonioscopy and visual field examination can help to make specific diagnosis.
Treatment: Unfortunately, there is no cure for glaucoma, but early treatment can preserve vision. The treatment if started in time can stop the progression of the disease and prevent further damage to vision. The treatment strategies include pressure lowering drops, laser therapy and surgery in advanced cases. The drops used for glaucoma bring the IOP down in a range which can be tolerated by the optic nerve, the laser treatment is commonly used for the angle closure type of glaucoma, while surgery is resorted to in cases where drug and laser therapy fails to control the eye pressure.
Importance of Celebrating Glaucoma Week: Celebrating glaucoma week gives us an opportunity to disseminate knowledge and make people aware about this dreaded disease. The promotion of, at least, one yearly comprehensive eye examination by an ophthalmologist can go a long way in helping to preserve the vision of our patients. Also, motivating family members of the patients with glaucoma to undergo eye examination is important, as the disease may run in families. Timely diagnosis and initiation of treatment will help us to prevent the irreversible blindness caused by Glaucoma.
(The author is an Associate
Professor, Department of
Ophthalmology, at AIIMS Jammu.)
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