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.

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.

Symtoms of this type of glaucoma

The symptoms of this type of glaucoma vary from patient to patient. Because the symptoms depend on the patient’s stage of the disease. In addition, some of the symptoms are those that can be seen only with the use of various instruments and there are many of the symptoms that are felt only by the patient; can not be measured by any instrument.

The symptoms perceived by patients

Thepatients with this type of glaucoma suffer from so severe discomfort that they are forced to see a doctor. Severe  eye pain, headache, vision loss, blurring, etc. are some of the symptoms that make it difficult for anyone to stay home. Consider it in detailed manner:

1. A patient who is still in the early stages of the disease may occasionally feel as if the head has become heavy for a short period of time. Sometimes there are mild episodes of headache, but after a while these symptoms go away automatically, or they can be cured by using a variety of magic tricks, some are relieved by a doctor’s pill or injection. Someone says I use some homeopathic or herbal medicine and I get better. Many associate this reief with some religious act. We can call this period of distress an attack. This stage is called prodromal stage. Apparently the attack relievs and the credits goes to various drugs and religious healers etc. but in fact it lays some permanent damage to the eyes, and the damage accummulates with each attack! The disease progresses gradually, just as termites grow inside the wood. Many patients are not diagnosed as glaucoma at this stage, although this is the stage in which glaucoma are 100% curable. The main reason for not being diagnosed is that patients do not go to an eye specialist. Or if goes to doctor, they miss to measure the IOP.
2. When the disease progresses, some blurring is also felt in front of the eyes during the attack, and colored circles also appear when looking at the bulb. This is actually pointing out that the obstruction in the aquous drainage has been increased considerably and the eye pressure has now begun to increase considerably leading to cprneal edema. The loss caused by each stroke increases the oveall damage.
3. At the next stage of glaucoma, the patient develops redness in addition to pain in the eyes during the attack. And in addition to some of the heaviness and redness of the eyes, there is a gradual decrease in vision; at this stage also many times eye specialists also make mistakes due to hurry and do not check eye pressure. They treat the patient as a patient of allergic or other conjunctivitis. This stage is called chronic congestive glaucoma.
4. If the treatment opportunity is wasted at this stage, then the notorious attack of glaucoma develops. This stage is called acute congestive glaucoma. It is the notorious form of the disease which is commonly called glaucoma in the popular sense. Following symptoms may occur during this visit:
   1. The patient has a severe headache.
   2. There is severe pain inside the eye.
   3. Many patients come and say that they have not been able to sleep for two or three days due to the severity of the pain.
   4. Severe vomiting occurs and cholera is being treated.
   5. There may be a state of intoxication.
   6. There is a sudden decrease in vision.

In such condition, the patient often has to be hospitalized.