Glaucoma: the silent thief of sight

by Dr Gauri bhushan

Glaucoma is the leading cause of irreversible blindness worldwide and as per the National Programme for Control of Blindness it is the third leading cause of blindness in India. Glaucoma, popularly known as ‘kaala motiya ‘ is asymptomatic in early stages, leads to an insidious irreversible visual impairment and an early detection can halt the visual loss.

What is glaucoma?

A condition of the eye, where an increased eye pressure (unrelated to Blood Pressure) leads to damage of the Optic Nerve (nerve of the Eye). This damage is irreversible and the vision once lost cannot be restored by medication or by surgery.

The real challenge in the diagnosis of this disease is its symptomatology and its slow progression. Usually  asymptomatic in early stages, a patient may complain of increased problems with near vision, occasional headache, loss of peripheral vision. In India where majority of visual complaints are still managed by a shorter route of getting a new fancy pair of glasses from the nearest optical shop, a thorough eye examination is often missed. Diagnosis of Glaucoma, a condition which is usually picked up by an ophthalmologist in a routine eye examination gets delayed . Asymptomatic glaucoma thus is allowed to follow a relentless course towards severe visual loss before medical attention is sought. A patient may even ignore glaucoma induced blindness in one eye as long as the other eye remains functional not realising that the same fate is slowly unfolding in the better eye.

Do I have an increased risk of developing glaucoma?

There are various known risk factors for development of glaucoma, age being one of them. People over 40 are at a relatively higher risk of developing glaucoma. With a strong genetic linkage, a positive family history increases the risk of developing glaucoma by 10 times. If we have Glaucoma, we must get our blood relatives tested as well.

Apart from age and genetics, myopia, migraine, Diabetes, Hypertension, thyroid and trauma to eye also increase risk of developing glaucoma. 

Doctor told me I have glaucoma, what next?

Remember Glaucoma damage is permanent- it cannot be reversed. Once detected with glaucoma , the treating ophthalmologist  performs certain tests to quantify the visual impairment and to find the subtype of glaucoma. Subsequently patient is advised medications, laser therapy, surgery in advanced cases or a combination of these. The treatment given aims to halt the progression of disease by bringing down the eye pressure, it cannot reverse the visual loss which has already occurred.

Treating glaucoma successfully is a team effort between the treating doctor and the patient. It is imperative that the patient does not discontinue the medication without consulting the doctor. Compliance to medication is extremely important as any spike in eye pressure can have deleterious effect on a glaucomatous eye. 

The diagnosis of glaucoma is often shocking to the patient who perhaps came prepared only for prescription of new glasses.  The possibility of having a chronic potentially blinding disease is difficult for the patient to accept, hence the importance of communicating clearly for better understanding and to lay out a clear plan of action. Even when glaucoma has already delivered a harsh lesson of its damaging potential careful education is still needed to help the patient understand the nature of the disease, rationale for treatment and importance of complianceFor a patient affected by glaucoma, the impact can be profound which can include difficulty with mobility ,driving, employment and depression. A high level of awareness and knowledge of this silent killer of the eye is need of the hour. For public awareness there are various portals for patient education on websites of numerous ophthalmological societies across India. A timely diagnosis, initiation of treatment and compliance with treatment lifelong can conquer this potentially blinding disease. 

So next time you have any symptoms related to your eyes, book your appointment with an ophthalmologist without any delay and knock this devil out before it knocks you out.

The writer is Dr. Gauri Bhushan, Consultant Ophthalmologist, NKS Hospital, Delhi.