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Glaucoma

Glaucoma
The Silent Thief of Sight

 An early diagnosis can preserve your vision for life.

Glaucoma is one name given to a group of eye diseases that share one sign i.e damage to the optic nerve head. This nerve gives us vision, colour vision and side vision; it is the latter that decreases slowly, so patients are unaware of the early symptoms. That is why it is referred to as the ‘silent thief of sight’. This progresses from the sides and till the very late stage, central vision remains intact. The damage to the optic nerve head is permanent and irreversible. The end result is irrecoverable blindness.

Contrary to popular belief, it can occur at any age, even in a new-born. However, the commoner types usually occur after the age of 40.

Understanding the Condition

Causes and Risk Factors

Glaucoma occurs when there is an imbalance between fluid (aqueous) production in the eye and improper functioning/obstruction of the eye’s natural drainage. This causes fluid buildup and increased pressure that damages the optic nerve. However, in the majority of patients, glaucoma occurs with no known cause. That is why it is termed ‘primary’. Some glaucomas can occur after ANY surgery to the eye, or due to another disease of the eye – these are called ‘secondary’ glaucoma. There is one characteristic that is shared by most primary glaucomas – it presents unequally i.e one eye is usually in a more advanced stage than the other.

You may be at higher risk if you:

  • Are over the age of 40: advancing age is the single largest risk factor for the commoner varieties of glaucoma
  • Have high eye pressure (intraocular pressure - IOP): this is one of the other major risk factor, but, it may not be high in Normal Pressure Glaucoma. In some susceptible individuals, the eye pressure may not be high, but if specific signs of glaucoma damage are present, then reducing the eye pressure can arrest the disease.
  • Have a family history of glaucoma: every individual above the age of 40 has a risk of developing glaucoma, but this risk increases 6-10 times when there is a family history of glaucoma. Therefore, first degree relatives (parents, siblings and off-spring) of a known case primary glaucoma should undergo annual examination so that if it were to occur, not only would it be detected earlier, but also treated earlier, preventing permanent blindness.
  • Are extreme short-sighted (POAG commoner in high myopia) or long-sighted (PACG commoner in high hyperopia)
  • Are diabetic
  • Have had long-term steroid use
  • Have a history of trauma

Types of Glaucoma

Primary Open-Angle Glaucoma

The most common form, it is slow and painless in onset. It may be associated with high or low pressure (latter is called Normal Pressure Glaucoma and usually occurs in the elderly). Paradoxically, many individuals only have high IOP without damage to the optic nerve head. They are called Ocular Hypertensives – and some may go on to develop glaucoma with advancement in age.

Primary Angle-Closure Glaucoma

this usually occurs in small eyes (long-sightedness or hyperopia) when there is a slow closure of the drainage angle – initially it is openable, but in advanced cases it closes permanently. That is why this type of glaucoma exists in a spectrum and it is the ONLY type of glaucoma in which damage to the optic nerve head may be preventable, if it is detected early with gonioscopic examination, with timely performance of Laser peripheral iridotomy (LPI).

In this type of glaucoma – one may even experience a sudden blockage of fluid drainage causing an acute attack; this is a medical emergency as patients experience extreme eye and head pain, redness, nausea, vomiting and sudden drop in vision. Such patients also require LPI, in an emergency, to abort the attack, or else blindness is permament. However, performing an LPI in an acute situation is very challenging and surgical option/s may have to be explored.

This type of glaucoma is also very closely associated with the lens of the eye, which grows in thickness, usually due to age and cataract. Such a lens occupies space in an already crowded area in the front of the eye, adding to the closure of the drainage angle. Early lens extraction is recommended in PACG.

Primary Congenital Glaucoma

Present at birth or in early childhood. This occurs due to poor development of the drainage angle and usually responds to early surgery.

Juvenile Open Angle Glaucoma

JOAG occurs up to the age of 40. It usually presents with very high IOP and has a very high incidence of presence in one sibling or the other.

Secondary Glaucomas

Caused by innumerable other eye conditions, trauma or even other surgeries to the eye.

Symptoms You Should not Ignore

In its early stages, glaucoma usually has no noticeable symptoms. This happens not only because the side-vision damage due to the disease is slow and chronic, but also because the better coompensates for the eye that has more advanced disease.
As the disease progresses, patients may experience:

Regular eye examinations are the only reliable way to detect glaucoma before vision loss occurs.

  • Gradual loss of peripheral (side) vision
  • Difficulty adjusting to dim lighting, bumping into objects in a dark room
  • In an acute attack of angle closure glaucoma - intermittent halos around lights precede eye pain, nausea, vomiting, redness and drop in vision
  • Loss of vision in one eye

Regular eye examinations are the only reliable way to detect glaucoma before vision loss occurs.

                       Advanced side vision loss in Glaucoma                        Central vision is intact till the last stage

How Is Glaucoma Diagnosed

Dr. Pathak Ray uses extensive clinical experience and advanced diagnostic technology to evaluate the optic nerve head accurately.

Common Clinical Tests Include:

  • Tonometry: Measures intraocular pressure (IOP).
  • Gonioscopy: Examines the angle where eye fluid drains.
  • Fundoscopy: Detailed examination of the optic nerve head (also known as the optic disc) to look for specific features of glaucomatous damage. Ideally, this should be done in dilated pupils; however, if gonioscopy has revealed angle closure, then Laser Peripheral Iridotomy is done first, as dilatation of the pupils under such circumstances can precipitate an acute attack.

Common Diagnostic Tests Include:

  • OCT (Optical Coherence Tomography): Captures cross-sectional images of the optic nerve.
  • Visual Field Testing: Maps peripheral vision loss.
  • Pachymetry: Measures corneal thickness, which affects IOP readings.
  • Optic disc photographs

Managing Glaucoma: A Lifelong Partnership

There is no cure for glaucoma – like other chronic diseases (diabetes, hypertension etc.) it can only be controlled. However, glaucoma may progress even on treatment. Therefore, not only is the treatment lifelong, but also follow-up has to be at regular intervals, determined by the stage, severity and type of glaucoma.
Treatment aims to reduce intraocular pressure and prevent further optic nerve damage – in other words, the treatment aims to maintain whatever vision the patient has, as recovery of what is lost is not possible. 

Dr. Pathak-Ray recommends individualised plans based on the stage and type of glaucoma.

  1. Medications: Prescription eye drops lower eye pressure by reducing fluid production or enhancing drainage. They are relatively safe, but many individuals experience problems with eyedrops – with constant red, watery and/or irritable eyes. Dry eyes are very common with eyedrops, and some also develop allergies to these medicines. Since these medications cannot be done lifelong by such individuals, the option of surgery has to be explored. Surgery is also considered when the disease is not under control.

Certain systemic diseases also (asthma, heart disease) limit the type of eyedrops we can use.

  1. Laser Therapy: Laser Iridotomy: Opens a new pathway for fluid in angle-closure glaucoma.
  1. Surgery: When medications or laser treatments aren’t enough, traditional surgical options like Trabeculectomy or Glaucoma Drainage Devices (commonly called Tubes) are performed. These are major surgeries and usually reserved for advanced glaucomas – pros and cons of each will be discussed by her.

    Dr. Pathak-Ray also specializes in the modern Minimally Invasive Glaucoma Surgery (MIGS) — procedures like iStent, Kahook Dual Blade, Hydrus, and ECP, that are much safer and offer effective pressure control with much faster recovery as compared to the traditional options.

Common MIGS procedures:

  • iStent Inject: the smallest device known to mankind (0.3mm) that overcomes resistance to drainage, the Trabecular meshwork (TM)
  • Hydrus: shaped like a comma, it is one of the newest stenting device to overcome resistance of the drainage which has been introduced in India recently.
  • Kahook Dual Blade: precisely excises a part of the drainage tissue (TM)
  • Endoscopic Cyclophotocoagulation: a laser delivered via a state-of-the-art camera to reduce the fluid inside the eye.

Surgery is also only a means of controlling the disease, and is not a cure. Follow-up has to be maintained lifelong even if one undergoes surgery. Generally, about 50-60% can be off glaucoma medications after traditional surgery, but usually in advanced cases, this is not possible and patient may have to continue eyedrops, though in reduced numbers. However, in MIGS, up to 90% of patients can be off eyedrops.

Surgery too, does not help to recover what is lost; it only helps maintain what is left. Traditional surgery is not without risks, so it is usually not offered as first-line management. But MIGS has been a game-changer, as it is safer and can be offered much earlier in the disease, usually when cataract surgery is undertaken.

Dr. Pathak-Ray is equally adept at performing traditional and modern surgery, in adults and in children.

There is no cure for glaucoma – like other chronic diseases (diabetes, hypertension etc.) it can only be controlled. However, glaucoma may progress even on treatment. Therefore, not only is the treatment lifelong, but also follow-up has to be at regular intervals, determined by the stage, severity and type of glaucoma.
Treatment aims to reduce intraocular pressure and prevent further optic nerve damage – in other words, the treatment aims to maintain whatever vision the patient has, as recovery of what is lost is not possible. 

Dr. Pathak-Ray recommends individualised plans based on the stage and type of glaucoma.

Living Well with Glaucoma

Glaucoma doesn’t have to mean vision loss. With early detection, appropriate management, and regular follow-ups, most patients maintain good sight and quality of life.

Dr. Pathak-Ray’s Recommendations

  • Never skip eye eyedrop doses or appointments.
  • Inform your doctor about any side effects.
  • Maintain healthy habits — balanced diet, regular cardio exercise
  • Avoid any exercise where there is pressure on the abdomen (bhrastika, excessive weight-lifting etc.) and also those where the head is below the body (sirshasana etc).
  • Try and sleep with 1 pillow if you use none, or 2 pillows if you use one - to try and keep your head above your body during sleep.
  • Avoid drinking more than 3 glasses of water (total 750 ml) at a time (minimum 2 litres or more in 24 hours is mandatory for bodily functions)
  • Protect your eyes from injury and avoid self-medication.

She encourages patients to see glaucoma management as a partnership, where awareness and consistency make all the difference.

Understand Your Condition Better

Dr. Pathak-Ray has prepared easy-to-understand educational materials on glaucoma care, including downloadable guides and instructional videos.
These resources empower patients to manage their treatment effectively and stay informed about long-term care.

Explore Patient Resources

Book a Consultation

If you have a family history of glaucoma or experience any visual changes, schedule an appointment for a comprehensive eye examination. Early detection is the most powerful tool to preserve sight.

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