Glaucoma Diagnosis & Treatment

What is Glaucoma?

Glaucoma is diagnosed when the optic nerve is damaged due to combination of various factors, but most commonly associated with high eye pressure. Optic nerve is the finest fibre optic cable which connects your eyes (camera) to your brain (monitor) where you see the image. If left untreated, glaucoma can cause irreversible visual loss leading to complete blindness. It is usually a slow process but can cause very fast progression if eye pressure goes very high very quickly.

Is Glaucoma curable?

Optic nerve damage and related visual loss cannot be reversed. Early detection and treatment is essential to maintain good quality vision. Regular monitoring is most essential to detect change if any and amend treatment accordingly. Most common cause of visual loss in glaucoma is poor adherence to treatment and inappropriate follow up on regular interval.

What are the signs and symptoms of Glaucoma?

Glaucoma is called silent thief of sight as there are usually no symptoms which you can identify its presence. Only regular eye examinations by your optometrist can allow early diagnosis. Your optometrist can either pick up high eye pressure or early changes in in your nerve appearance. Some of the optometrist can even check the visual field test to pick up changes to the function of your nerve.

What glaucoma treatments are currently available?

Correct diagnosis of the mechanism of your glaucoma is essential for correct treatment and best outcomes. Usually you are given some eye drops in the beginning. There are four main types of drugs which are available in different combination in various eye drops. In the beginning, you are given drops which are used once a day. Later on you may have to use these several times a day. If you are unable to use eye drops, you can choose laser surgery instead of eye drops. If drops / laser or combination of two does not control your eye pressure, there are several types of surgical interventions available. These include minimally invasive glaucoma surgery with I-stents, Trabcectome, Xen stent, Trabeculectomy surgery, glaucoma drainage tube implant surgery.

Will I become blind if diagnosed with glaucoma?

Glaucoma is usually a slowly progressive condition. With modern treatments, we should be able to prevent further visual loss at whichever state you are at. It is vital to get early diagnosis & treatment and regularly monitoring to keep your vision for longest.

What can I do to prevent glaucoma?

You cannot prevent development of glaucoma but you can reduce / minimise the impact of glaucoma related visual loss on your life. Usual principles of good healthy life style with healthy diet, exercise, controlling your weight, blood pressure and blood sugar along with some nutritional supplements are some of the things you can do but make sure that you see your optometrist on a regular basis.

What tests for glaucoma should I have?

After detailed medical history, your ophthalmologist will carry out a detailed eye examination with gonioscopy, pressure measurement and optic nerve assessment. The following tests are usually carried out:

  1. Pachymetry
    This is a method to measure the thickness of your cornea (front wall of your eye). This may indicate that your real eye pressure is different to what has been measured by traditional means.
  2. Visual field test
    This is the most common eye test in the world to monitor glaucoma. This test allows measurement of the sensitivity of your retina and gives a map of your field of vision. This map is compared on different visits to detect any change in your vision. This is recommended every six months in routine cases but may be repeated in four months as well in advance cases.
  3. Optic dis imaging with photograph / OCT
    It is very likely that you will undergo some form of photography. This is essential to compare the appearance of your nerve and detect early change. Newer imaging technique like Ocular Coherence tomography allows monitoring the thickness of your nerve fibre layer. These expansive tests are now routinely done as recommended by NICE for monitoring the change.

Does Nutrition and exercise affect glaucoma?

Aerobic exercise can lower intraocular pressure; other forms of exercise can increase pressure. It is useful to discuss this with your Ophthalmologist which exercises to avoid. There are certain nutritional deficiencies which can cause optic nerve damage e.g. B12 or Folate deficiencies. A healthy diet coupled with a daily routine of exercise is advisable for everyone.

Alternative/ Herbal therapies and Glaucoma

Many natural products have been shown to have positive protective effect on optic nerve, thus being used by some. The compounds which are being studied with most interest are Ginkgo Biloba, Curcumin ( a component of turmeric) and Omega-3 fatty acids. It is important to inform your doctor if you start taking any herbal medications as some of them can enhance the effect of Aspirin. Iron and calcium supplementation above a certain level may increase your risk of developing glaucoma.

Driving and Glaucoma

If you have glaucoma and have developed visual field defects in both eyes, it is your legal duty to inform the DVLA. It is best to discuss this with your glaucoma specialist if you are not sure. If you do not have visual field defect, you do not need to inform the DVLA.

Is it important to see a Glaucoma Specialist?

Most ophthalmologists claim that they can see all medical cases of glaucoma. While this is partly true, a general ophthalmologist can easily miss some subtle signs as they usually do not see glaucoma cases in such detail as a glaucoma specialist. In last 5 years glaucoma treatments have changes significantly, with many new modalities are now available. Our opinion is that the initial diagnosis and most of the treatment recommendations are best carried out by someone with specialised training in glaucoma.

Tarun Sharma

Tarun Sharma is a consultant ophthalmic surgeon who carries out his NHS work at Worcestershire Acute NHS Trust since his appointment in 2007.