Treatments for glaucoma

There are different ways to operate on glaucoma, which are briefly described below:

Laser treatment

Laser rays are used in a variety of ways to treat cataracts.

Argon laser

This type of laser is used to open holes in the trabecular mesentery. This operation is called ALT and SLT operation. This method is useful for the treatment of open angle glaucoma.

Yag Laser

This type of laser is used to treat narrow angle glaucoma. It drills holes in the iris that act as an alternative drainage route.

Diode laser

This type of laser has been used to treat neovascular glaucoma. Modern research is now recommending that this laser can be used to treat open angle glaucoma.

Different surgical operation to create an an artificial route for drainage

There are different methods for creating artificial routes for drainage. These are used in different types of glaucoma. The following are the most commonly used:

• Trabeculectomy
• Trabeculotomy

How is open angle glaucoma treated?

The treatment of this disease depends on the stage at which the patient comes to the doctor.

Nowadays laser treatment is first choice treatment at early stage of the diseases. Most patients can be successfully treated with a laser. By application of laser we open the closed pores in the trabecular meshwork. This results into proper drainage of the liquid into the bloodstream and  thus lowering the intraocular pressure. In other words, most people’s glaucoma disappear almost permanently. However, many people are at risk of recurrence of the defect, so it is important that the patient be examined periodically.

Many patients have to use medication despite having a laser. However, the amount of medicine and potency medicines is reduced after laser treatment.

If the severity of the disease has increased, the chances of benefiting from the laser are less. ۔

If the damage continues despite the use of medication, then the disease is to be treated with surgical operation. The vision may not become completely normal, but in time surgery can prevent blindness.

If there are practical problems with the operation or if it is necessary to postpone the operation due to some other illness, then there is no other option but to use medicines.

How narrow angle glaucoma is treated?

When acute congested glaucoma has been developed, thetreatment becomes almost impossible to treat. There are very few lucky ones whose eyes can be saved at this stage. If proper treatment is not given at this stage, then the eye becomes permanently blind. This attack should be treated urgently. Even one minute is precious at this stage. Many people who are blind due to glaucoma, they actually developed this stage. Best treatment is to prevent development of this critical stage! prophylactic measures are the actual treament!

If both the doctor and the patient behave as responsible persons and deal with the symptoms and signs carefully at the early stage of the disease, the narrow angle glaucoma can easily be diagnosed and the patient can be prevented from the accident of becoming blind. But unfortunately the eyes of many people in our country get lost idue to missing of diagnosis at early stage! One narrow angle glaucoma has been diagnosed or has been suspected, the patients should not waste time. Doctors should listen carefully to symptoms of the patients and should not neglect to check the intraocular pressure.

Treatment methods

• The treatment of this disease depends on the stage at which the patient comes to the doctor.
• At the early stages of the disease, first priority treatment is laser treatment. Most patients can be treated with a laser. With the help of a laser machine, a thin hole is made inside the iris. This acts as alternative route of drainage in case of pupil blockage and prevents the development of the acute congestive stage. In other words, with this treatment at an early stage glaucoma can disappear almost permanently.
• But if the severity of the disease has increased, the chances of benefiting from the laser are less. In this case, surgery is necessary. The vision may not be recovered completely with surgery, but timely surgery can prevent blindness.
• If there are some operative risks or if it is necessary to postpone the operation due to some other illness, then the treatment with medicines can also be considered.

It is commonly said that glaucoma cannot be cured and even if it is treated, the treatment fails! Is this true?

There are actually many types of glaucoma, some of which are actually almost incurable. But the most important thing is at what stage of the disease the treatment was started!

If treament started at an early stage, it is 100% successful. and if treatment of glaucoma is initiated when the disease was much advanced, then it is very likely that the treatment will be of no use at all. The most important thing is that the damage that already has occurred at the time of initiation of the treatment will not recover! People come to us for treatment very late, rather most of the people come when the disease is at endstage! Due to this reason it has been misconcepted that the disease is incurable.

What is glaucoma?

Glaucoma is a disease which is a major cause of blindness in many people. Glaucoma damages the optic nerve which transmits visual signals to the brain. In fact, the nerves that carry information from the retina to the brain stop working. The most important mechanism of this damage to optic nerve is increase in intraocular pressure.

What is meant by internal pressure of the eye? And what should be the pressure of the eye normal?

Measurement of internal eye pressure is of great importance in the diagnosis and treatment of glaucoma. This is because the increase in pressure is an important sign of the disease and this can be controlled and hence in this way blindness can be prevented.. It is necessary to measure it repeatedly to assess the success of the treatment.

Allah Almighty has created a system for feeding the inner parts of the eye. A water-like liquid is formed from the blood and enters the eye. It provides food to the inner parts of the eye and goes back into the blood. In the glaucomatic eyes there is obstruction in the way to return to the bloodstream. The liquid slowly begins to accumulate inside the eye in larger amounts. As a result, the internal pressure of the eye becomes higher than normal

The internal pressure of the eye is usually below 21 but in case of glaucoma it goes up; maybe to 50, 40 and sometimes up to 100. This pressure can be measured in different ways as seen in the pictures below::

Why does this disease occur? What is wrong with the eye?

At the junction of both the cornea and the iris is formed a sieve called the trabecular meshwork. The picture below shows this sieve.

In different patients, due to various reasons, the holes of this sieve become closed, which obstructs the drainage of aqueous from the eye, and the pressure of the eye begins to increase and the optic nerve begins to be damaged.

What are the symptoms of this type of glaucoma?

This type of glaucoma is extremely dangerous. A large of patients are present in our society but most of them have not been diagnosed. The most dangerous aspect about this disease is that even though the disease has progressed considerably, the patient does not have any such symptoms that may compel  the patient to feel the diseaese and go to doctor. Another aspect is that many times it happens that 80% of the vision has been lost but still he feels himself normal and is not serious about treatment. Why?

The disease works like a termite. It secretly causes severe damage but is not detected at all.

The reason for this is that in this disease, the ability to see straight ahead persists till the end-stage of the disease, while the width of the visual field decreases significantly.

Symptoms that some patients may experience

1. This disease does not cause pain in eyes or headache. There may be only mild discomfort or heaviness.
2. In this disease, night vision gradually decreases.
3. Most patients go to the doctor to seek treatment for some other eye problem and it is the first time they are diagnosed with glaucoma.
4. Many people’s numbers for glasses start to change rapidly.

Signs that doctor examines

The most important thing in the early stages of the disease is the patient’s family history. Measuring the intraocular pressure of the eye is very important in diagnosing this disease. Two things are very important at the initial stage

• If there is a big difference between morning and evening pressure, it is very important even if the pressure in both eyes is normal.
• The other thing is that the difference between the two eyes is very large, even if the pressure in both eyes is normal.

An examination of the trabecular meshwork which is the site of obstruction is called  Gonioscopy.

The most important thing in this test is to check the C: D ratio. This examination is very important. The optic disc is usually pink in color, while the central part is white, and is called the optic cup. The ratio of the two is evaluated. If the size of white region one third and the rest is pink, this is normal. This is called 0.3. In this type of glaucoma, this ratio is not maintained and gradually the white region becomes larger and the pink part becomes smaller. When it is halved, it is called 0.5. When the pink part is only 10%, it is called 0.9. The picture below shows its different conditions.

C:D Ratio

There is a strong possibility of error in the diagnosis if two things are not taken into account during the examination of C:D ratio ratio.

• The first thing is to compare the proportions of the two sides. Whether the proportions of the two cupss are are symmetrical or asymmetrical.
• In this condition, C:D ratio is examined repeatedly for some time to find out whether it is stable or is increasing. If the same ratio is found on long-term examinations, then it is very unlikely that it is a sign of glaucoma.
• The other thing is that the size of the cup is constantly increasing or is table. If it is increasing in size, then it must be a sign of glaucoma.

VF test

• Visual field is examined by state-of-the-art automatic machines. VF test evaluates the extent of the damage.
• There are other special types of tests that make it possible to diagnose the disease at an early stage. Also they help to find out if the disease has stopped or is progressing.

OCT test

• The OCT test now has the potential to diagnose open angle glaucoma at a very early stage.

Why does this disease occur? What is wrong with the eye?

There is a filter at the junction of the cornea and the iris. It is forms a sieve which is called the trabecular meshwork. There is a system at this place that drains the material from the eye to the blood vessels. For various reasons, the cornea and the iris become so close to each other that the material does not reach the trabecular meshwork, so the drainage is blocked. The fluid accumulates inside the eye. This leads to rise in the pressure within the eye.

• The structure of the anterior chamber is abnormal in some patients, especially in younger patients. As a result of which the aqueous drainage system does not work properly, as a result the pressure in the eye rises. This raised intraocular pressure causes damage to the optic nerve.
• In many patients, the iris and the cornea come so close to each other that the aqueous cannot reach the sieve and accumulates within the eye. As a result, the pressure in the eye increases, which damages the optic nerve.
• In many patients, persistent inflammation develops membranes which covers the holes in the sieve, and thus closes the holes. As a result, the pressure in the eye increases, which damages the optic nerve.
• In many patients the cornea and iris become attached to each other and adhesions develop leading to permanent closure of the angle and hence permanent blockage of whole or some parts of the angle. As a result, the pressure in the eye increases, which damages the optic nerve.

The signs which are searched by doctor

When the disease is just beginning, it is very difficult to diagnose. In practice, careful listening to the patient’s grief story is the most important thing that can lead to a diagnosis. At this stage, special to the patient’s history is the basis of the diagnosis. If the patient’s symptoms are not listened to carefully or their details are not known carefully, it becomes impossible to diagnose, because at this stage no reliable test for diagnosis has yet been discovered.

The eye is examined with a slit-lamp biomicroscope. This is the machine that won Nobel Prize when it was first introduced. In addition to general inspections, the following examinations are performed:

1. Anterior chamber depth (AC Depth):
   1. In many people the anterior chamber is shallow sice birth. This is the distance between the cornea and the iris. It is measured with the help of a slit lamp.
   2. when iris and cornea come very close to each other, it results into blockage in the draianage of the aqueous humour leading to rise in intraocular pressure.
2. Eye pressure.
   1. Measuring of eye pressure is very important in diagnosing this disease.
   2. There is a special problem that at the early stages of the intraocular pressure usually remains norma, sol whenever checked. there are very brief episodes of rise which are missed during diagnosis or It rises only during the episode.
   3. Therefore, the best way is to check the pressure when the patient feels the condition of attack. When the disease is severe enough, then this increase in pressure becomes a reliable feature.
3. Gonioscopy
   1. this is performed with the help of a special lens called gonioscope.
   2. This test directly evaluates the drainage site (the trabecular meshwork).