Glaucoma Treatment: Types, Surgery & FAQ

Glaucoma (kala motia) is a disease that damages your eye's optic nerve. It usually happens when fluid builds up and increases pressure inside the eye.

On the basis of the available data, we estimate that there are approximately 11.2 million persons aged 40 years and older with glaucoma in India. Primary open-angle glaucoma is estimated to affect 6.48 million persons. The estimated number with primary angle-closure glaucoma is 2.54 million.

What is Glaucoma in Eye?

What is Glaucoma or ‘Kala Motia’?

Glaucoma (Kala Motia)

Glaucoma or ‘Kala Motia’ occurs when the eye pressure increases and damages the optic nerve leading to impairment of visual acuity. Of all the conditions prevailing in the human eye, glaucoma is one of the most threatening ones. Glaucoma is also known as a ‘silent thief of vision’ as it has often no symptoms and may go unnoticed in the early stages.

Types of Glaucoma (Kala Motia)

Glaucoma may be classified as open-angle or closed-angle or mixed/ secondary type of glaucoma.

Primary Open-angle Glaucoma

It is widely known as open-angle glaucoma and is the most common form of glaucoma. It is caused by increased eye pressure which slowly causes damage to the optic nerve and consequent vision loss. Classically the filtration angle (an area between the cornea and iris through which the aqueous humour filters out of the eye) is open. The patient may have high pressure or a vague feeling of heaviness. Associated features may include headaches or a decrease in vision. Often it is asymptomatic and the patient may not feel anything. 

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When you visit the eye doctor at the eye hospitals for these complaints the medical staff will take your history and record your vision and eye pressure. The doctor will then examine you and recommend tests if needed. Your eye pressure will be recorded by Applanation Tonometry and the optic disc (nerve of the eye) will be examined for any variation in size as compared to normal. A visual field test will be advised to evaluate the function of the optic nerve. An OCT may be advised to see the thickness of the optic nerve fibres. A corneal thickness measurement will be done. A gonioscopy will be performed to look at the angle. A colour picture of the optic nerve may be needed to document the size of the optic nerve. Depending on the condition of your eyes, the doctor may advise some or all of these tests for a detailed evaluation.

• Open-angle glaucoma treatment
  
  Once the patient has been investigated and the diagnosis of open-angle glaucoma is confirmed, efforts are made to lower the eye pressure using eye drops. There are various kinds of eye drops and the doctor will choose the best drop for you depending on associated conditions such as asthma, diabetes, inflammation in the eye etc. Sometimes additional medicines in the form of tablets, syrups and injections may be given for short term to improve the pressure control.
  
  Other options such as lasers, surgery and filtration devices can be considered for patients not responding or not controlled with eye drops alone.

Angle-closure glaucoma

Angle-closure glaucoma is a type of glaucoma in which the drainage area or angle is closed or narrow. Consequently the aqueous humour or fluid inside the eyes cannot drain out normally which leads to a rise in eye pressure. This may lead to pain in the eye, redness, decreased vision and coloured halos around light. Angle-closure glaucoma may have acute symptoms and need immediate attention in the form of medicines and lasers to relieve the acute attack. Some patients may have dull, low-grade pain in case of chronic angle-closure glaucoma

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When you visit the eye doctor he will examine your eyes as discussed above and recommend some tests based on your eye condition. He will assess whether you need any immediate treatment or a regular follow up.

• Closed-angle Glaucoma Treatment
  
  Routine, periodic eye checkups will help your doctor assess whether you are at risk of angle-closure glaucoma. Your doctor will perform some tests to see if you have any signs of closed-angle. In case the eye pressure is very high, medicines in the form of tablets/ syrups and eye drops will be given. A laser may be recommended to create an alternative opening to relieve the angle closure and allow fluid to pass through and open the blockade (YAG PI). Patients who do not respond to lasers and medicine will need surgery (glaucoma filtration surgery).

Secondary Glaucoma

Secondary glaucoma develops as a result of other eye conditions such as trauma or injury or complicated surgery, inflammation, use of certain drugs like steroids, etc. Sometimes it may be due to pigment release from the eye (pigmentary glaucoma) or due to deposition of flaky material (pseudo-exfoliative glaucoma) It will need treatment depending on the cause of glaucoma.

• Steroid-induced Glaucoma
  
  Excessive and prolonged use of steroids either locally in the eye or systemically for other conditions can lead to steroid-induced Glaucoma in vulnerable people. Patients with family history, myopia and diabetes etc. may be more at risk for developing this condition. Avoiding steroids for a long duration is essential. Treatment involves lowering the eye pressure and minimizing steroid use.
  
  
• Traumatic glaucoma
  
  Traumatic Glaucoma occurs due to direct or indirect injury to the eye. It may occur immediately after trauma or even years later. Sometimes it may be difficult to treat with medication alone and may need surgery to control the elevated intraocular pressure.

What is the Treatment for Glaucoma (Kala Motia)?

Glaucoma or ‘Kala Motia’ can be controlled with appropriate treatment. Eye Hospitals recommends disciplined and regular treatment to tackle glaucoma (Kala Motia). We have one of the best Glaucoma specialists to help you diagnose and manage this eye condition and treat it to the best extent possible.

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Glaucoma lasers and surgery

The most commonly performed laser for glaucoma is the YAG peripheral iridotomy (YAG PI). It is performed in patients with narrow or closed angles. It needs to be performed usually in both the eyes to prevent an acute rise in pressure or an ‘attack’ of glaucoma. The patient may or may not need additional medicines after a YAG PI.

Laser trabeculoplasty using an Argon or YAG laser may be performed at select places to improve pressure control.

Glaucoma surgery involves creating an alternative filtration channel to drain the aqueous and control the pressure. Trabeculectomy (or Trab as it is commonly called) is the standard glaucoma surgical procedure. In trabeculectomy, the surgeon creates an alternative filtration opening under a scleral and conjunctival flap to drain out the aqueous and control the pressure.

We also have several new techniques in Glaucoma surgery like implanting a valve or Glaucoma filtration device (for controlled filtration) and the use of sophisticated vitreoretinal methods to help to perform complicated Glaucoma procedures. These techniques of surgery provide tremendous hope to patients with advanced and uncontrolled Glaucoma.

Glaucoma - Frequently Asked Questions

What are the early signs of glaucoma?

Glaucoma (Kala Motia) is a silent disease. Most people will not have any significant symptoms. Occasionally someone may feel vague eye ache, especially in the evening and in dim light conditions. Other symptoms include redness, watering, coloured halos around light, and blurring of vision.

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What should glaucoma patients avoid?

Glaucoma patients should avoid taking steroids in any form and, if needed, must inform their doctor that they have glaucoma. Self-medication should be avoided at any cost. Besides, avoid excessive tea or coffee intake. Avoid consuming large quantities of water/fluids in one go.

How to get rid of eye pressure?

You need to get yourself examined by a Glaucoma specialist, who will perform a couple of tests to measure the eye pressure and check if it is elevated. Depending on the measurements, the glaucoma specialist might recommend a few eye tests followed by appropriate treatment. Laser treatment for Glaucoma is also one of the ways to treat Glaucoma and is done on an outpatient basis.

Can glaucoma medications produce side effects?

Yes, the side effects of Glaucoma medications can be seen in some people. The anti-glaucoma eye drops may cause an itching sensation, redness in the eyes, increased heartbeat, dry mouth, eyelash growth, noticeable change in eye colour and the skin around it, irritation etc.

How does Glaucoma medication affect the baby?

One should always keep in mind that glaucoma medications may have a high chance of affecting the fetus. Pregnant women with glaucoma should inform their doctor and take medicines only under supervision.

Does working on a computer or mobile worsen my Glaucoma or eye pressure?

No, it does not. As long as you’re putting your eye drops regularly and getting check-ups done as required, you are free to use digital screens as much as you comfortably can. It is a good idea to take a break between long hours of work to prevent eye muscle fatigue

Can glaucoma (Kala Motia) be cured completely?

Glaucoma can be controlled in more than 90% of cases. Just like many other chronic diseases, we can prevent Glaucoma from progressing further with medicines, but it needs regular monitoring. A combination of medicines, lasers and surgery where needed helps to provide relief to most patients.

Is coffee bad for Glaucoma?

Excessive coffee (more than 2-3 cups a day) is associated with elevated eye pressure and is best avoided.

Can you reverse Glaucoma?

Glaucoma (Kala Motia) cannot be reversed, but further damage can be stopped. Only in some cases like children, early intervention may sometimes reverse the damage and restore an improved visual field or optic nerve function.

Does exercise play any role in Glaucoma?

Doing exercise is healthy for the body. For a patient suffering from Glaucoma, there are a few aerobic exercises that can safely be done 3-4 times a week for a minimum of 25 minutes. These include swimming, jogging or walking or riding a bike. However, patients with advanced glaucoma should avoid exercises like weight lifting or push-ups which cause a lot of strain. Certain yogic postures like shirshasana (where the head is below the body) are also best avoided.

Can Glaucoma occur in a baby?

Glaucoma may be present at birth or may develop shortly after and is known as congenital glaucoma. Such children may have large eyes which may appear bluish, watering and a tendency to avoid light (photophobia). It is more common in families where marriages occur between relatives and cousins (consanguinity). It needs immediate attention to prevent permanent damage to eyesight.