Glaucoma is aptly called the ‘Silent Thief of Sight’ because most of the times, when the person realizes any symptoms,the disease is advanced. moreover the visual loss is permanent and irreversible.
Our goal is to “Act before Glaucoma strikes”. Our strategy is to screen each and every patient in the OPD for this Silent thief of sight – Glaucoma and identify the Glaucoma suspects. We then proceed for the detailed Glaucoma work- up of these high risks – Glaucoma suspects
Glaucoma diagnosis includes
Thorough slit lamp examination under high magnification.
. Non-contact Tonometry and Applanation Tonometry.
Gonioscopy - To measure and document the crucial findings of the angle structures in the eye.
Optic Disc Head Evaluation - We at Balaji ENT and EYE hospital, use the high magnification stereoscopic disc evaluation using 90D and 78D lenses.
Perimetry - It is a subjective test to evaluate and quantify and document the extent of vision loss. In this test, each eye is separately shown about 250 points of light at varying intensity and the patient has to press the buzzer whenever he/she perceives the light. At the end, we get a printed report that describes:
a. Which points were not seen?
b. Which points were seen?
c. What was the intensity of light at which the points were seen?
This data is then compared with that from normal age and sex matched population. This also acts as the baseline test to compare against the future tests. We, at Balaji ENT and EYE hospital are equipped with the MEDMONT Perimeter (Australia) which is a very patient friendly interactive system.
OCT -We, at Balaji ENT and EYE hospital use the Optical Coherence Tomography (OCT) from Zeiss Germany to evaluate the details of the optic nerve head. This high end scanning system gives us excellent scans of the optic nerve head in a few seconds.
OCT is important because of:
Quantitative documentation of baseline
Helps in progression analysis of Glaucoma
Thorough history and comprehensive eye and systemic evaluation is followed by detailed counseling of the patient and the family about:-
Nature of disease
Need for life long follow up
Management of co-morbidities like HTN, DM
Treatment options include:-control of systemic factors like Hypertension, Diabetes
Medications: mostly eye drops, sometimes oral tablets, and rarely injections
Lasers (YAG Peripheral Iridotomy)
Yag PI is recommended by World Glaucoma Consensus for prophylaxis in eyes with occludable angles and established narrow angle disease. It is a simple OPD procedure, non- invasive, no hospitalization. SLT - Selective Laser Trabeculoplasty is an option in some patients.
For patients who are not adequately controlled on maximum possible medications we have options of:
Trabeculectomy as a stand-alone procedure.
Trabeculectomy with Mitomycin C application
Trabeculectomy with Ologen
Ahmed Glaucoma valve surgery
Family Screening Program
Siblings and children of a person with Glaucoma have 15-20 times higher risk of Glaucoma. So we advise for thorough screening of the family members yearly.