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.

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.

لیزر کی یہ قسم نیووسکولر گلوکوما کے علاج کیلئے استعمال کی جاتی رہی  ہے۔ اب جدید تحقیقات میں سفارشات کی جا رہی ہیں کی اس لیزر کو اوپن اینگل گلوکوما کے علاج کے لئے بھی استعمال کیا جانا چاہئے۔

مصنوعی رستہ بنانے کا طریقہ

مواد کی نکاسی کیلئے  مصنوعی بنانے کے مختلف طریقے ہیں جو رکاوٹ کی مختلف قسموں میں مختیار کئے جاتے ہیں۔ ان میں درج ذیل زیادہ مستعمل ہیں:

Trabeclectomy

Trabeculotomy