Glaucoma is Cluster of eye diseases, resulting in optic nerve damage. Main function of optic nerve is to carry images from the retina, which is the specialized light sensing tissue, to the brain for interpretation so we can visualize it. In many cases, we do not know exactly what causes glaucoma. However, increased eye pressure is the most common risk factor for developing the disease. The pressure comes when the clear fluid in the eye, called the aqueous humor, does not drain properly.

This fluid normally helps to nourish the eye, and flows in and out of the eye through a mesh-like channel. In people with high eye pressure, the fluid does not drain properly and pressure builds up in the eye.

Due to this eye pressure delicate nerve fibers of the optic nerve are damaged. Once these nerve fibers are damaged, blind spots develop in the field of vision. It’s a permanent loss, once nerve damage and visual loss occur. Most people don't notice these blind areas until much of the optic nerve damage has already occurred. Glaucoma is a leading cause of blindness in the world, especially in older people.

What are symptoms of Glaucoma?
Open-angle glaucoma is asymptomatic. It develops slowly and sometimes without noticeable sight loss for many years. Most people who have open-angle glaucoma feel fine because the initial loss of vision is of side or peripheral vision, and the visual acuity or sharpness of vision is maintained.

As open-angle glaucoma has few warning signs or symptoms before damage has occurred, it is recommended to see a doctor for regular eye examinations. In open-angle glaucoma, the angles in your eye are normal, but the eye’s drainage canals become clogged over time, causing an increase in internal eye pressure and subsequent damage to the optic nerve.

In Angle-closure glaucoma (also called narrow angle glaucoma) the angle is closed, causing increased eye pressure, which leads to optic nerve damage, and possible vision loss. There is an acute attack of angle closure leading to noticeable symptoms and damage occurs quickly. If you experience any of these symptoms, seek immediate care from an ophthalmologist.

Hazy or blurred vision
The appearance of rainbow-colored circles around bright lights
Severe eye and head pain
Sudden vision loss
Nausea or vomiting (accompanying severe eye pain)
Congenital glaucoma is glaucoma occurring in children, whether from birth or at a very early age. This usually happens from a physical defect in the eye that doesn’t allow it to function normally, but it can also come from some other medical issue.

Pigmentary glaucoma, or pigment dispersion, blocks the drain of your eye with tiny granules of the eye’s pigment, or the iris, after circulating through the fluid at the front of your eye.

Secondary glaucoma – Glaucoma with associated conditions like tumor, diabetes, an advanced cataract, or inflammation.

Who is at a higher risk?
Elderly people
Ethnic background – East Asians, African Americans, and those of Hispanic descent have a higher risk of developing glaucoma, compared with Caucasians.
Medical conditions – like diabetes or hypothyroidism.
Eye Trauma
Myopia (nearsightedness)
Eye surgery
Patients on long-term corticosteroids for systemic diseases or even long term use of eye drops containing corticosteroids.
How Is Glaucoma Diagnosed?
To diagnose glaucoma, Ophthalmologist needs to perform a comprehensive eye examination along with detailed medical family history of glaucoma. They’ll check for signs of deterioration, including loss of nerve tissue. They may also use one or more of the following tests and procedures:

Puff test – It is a basic glaucoma screening test to estimate eye pressure (normal range - 12 to 22 mmHg).
Tonometry – It measures inner eye pressure using eye numbing drops.
Pachymetry - People with thin corneas have an increased risk of developing glaucoma, so pachymetry test can be used to determine cornea thickness.
Ophthalmoscopy – It is used to look at the shape and color of your optic nerve
Perimetry - a visual field test that checks your peripheral and central vision.
Gonioscopy – It examines the angle in your eye where the iris and the cornea meet
Treatment
Glaucoma is a disease basically due to increased eye pressure so the main focus in early stages of glaucoma is to to reduce pressure in the eye somehow. Regular use of prescription eye drops is the first line of treatment. Some cases with associated medical conditions may require systemic medications, laser treatment, or other surgery. While there is not yet a cure for glaucoma, early diagnosis and continuing treatment can preserve eyesight.

Medications
Nowadays lot of medications is currently available to treat glaucoma. Typically, medications are used to reduce elevated pressure in the eye. A single medication or a combination of medications may be prescribed. The type of medication may change if it is not reducing pressure enough or if the patient is experiencing side effects.

Surgical Procedures
Surgical procedures include laser treatment, making a drainage flap in the eye, inserting a drainage valve, or destroying the tissue that creates the fluid in the eye. All procedures aim to reduce the pressure inside the eye when medication is not sufficient. Even though, Surgery cannot reverse vision loss.

Laser surgery
Although few treatments are temporary and need to be repeated but for patient comfort, Laser trabeculoplasty helps fluid drain out of the eye. A high-energy laser beam stimulates the structure that drains fluid from the eye (the trabecular meshwork) so that fluid drains more efficiently.

Conventional surgery
If all other treatments like eye drops and laser surgery aren't controlling eye pressure, the patient may need a trabeculectomy. This filtering microsurgery creates a drainage flap. Fluid can then percolate into the flap and later drain into the vascular system.

Drainage implants
Drainage valve implant surgery may be an option for adults with uncontrolled glaucoma or secondary glaucoma or for children with glaucoma. A small silicone tube is inserted in the eye to help drain fluid.

Treatment for acute angle-closure glaucoma
Acute angle-closure glaucoma is a medical emergency. Those affected can take medication to reduce eye pressure as quickly as possible. They will also likely undergo a laser procedure called laser peripheral iridotomy. In this procedure, a laser beam creates a small hole in the iris to allow fluid to flow more freely into the front chamber of the eye where it then can drain.

Prevention
There is no known way to prevent glaucoma, but catching it early means it can be treated more effectively and vision loss can be minimized. Because, often, there are no symptoms, getting your eyes regularly checked is important; especially for people with a greater risk. Moderate activity like walking or jogging on regular basis might help lower eye pressure. Use protective eyewear when playing sports, outdoor activities in sunny weather or working on home improvement projects.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.

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Author's Bio: 

Dr. Jatin Ashar is an Ophthalmologist / Eye Surgeon / Cornea Specialist / Eye Specialist in Ghatkopar East and West. Dr. Jatin Ashar is a Cataract, Cornea and Refractive surgery specialist In Ghatkopar, Mumbai. He performed corneal transplants even in infants as young as one month old.