Glaucoma

What is Glaucoma?

Glaucomas are a group of diseases having in common gradual loss of retinal nerve fibers leading to characteristic excavated appearance (called glaucomatous cupping) of the starting point (head) of the optic nerve (nerve responsible for carrying visual senses from eye to the brain). Neglected, this fell disease gradually devours your field of vision from the periphery and ultimately leads to complete blindness. That is why it is called the ‘silent killer of sight’ and at present, the second leading cause of blindness world-wide. High intra-ocular pressure, as opposed to our previous belief, is no longer considered an essential pre-requisite for occurrence of glaucomatous damage, though lowering eye pressure still remains the mainstay of its treatment.

What is intra-ocular pressure (IOP)?

  • • It is the pressure inside the eye needed to maintain the shape of the globe, as well as the normal function of the eyeball.
  • • It is maintained by the balance between formation and drainage of an intraocular fluid called aqueous humor, which bathes and nourishes different structures of the eye and maintains its shape. Normally the fluid drains out of the eye through a ‘drainage channel’ located at the ‘angle’ between cornea and iris.
  • • Obstruction to these very drainage channels causes subsequent rise of eye pressure. Although infants and children can be affected rarely, glaucoma is more common in the adult population.

Causes & types of Glaucoma

The cause of optic nerve head damage in glaucoma is not yet fully known. In most glaucoma patients, it is linked to rise in IOP which can causes lowly progressing irreversible damage to the optic nerve and can result in permanent loss of vision.
Also, patients with high IOP may never have glaucoma, and also patients with normal IOP can develop severe glaucoma.

Types of glaucoma:–

    Open angle glaucoma– the angle is structurally open but the filter beyond is blocked. Can be of two types

  • • Primary – Not associated with any other eye diseases
  • • Secondary – Associated with other eye diseases
    Angle closure glaucoma– the angle is structurally closed. Can be of two types

  • • Primary – Not associated with any other eye diseases
  • • Secondary – Associated with other eye diseases

Signs & Symptoms

  • • No symptoms at all. The most common. Found in open angle glaucoma. In the early stages, there is loss of peripheral vision (which patients usually do not detect by themselves, and this is the phase where we can halt the deterioration further) and in the later stages, the central vision is affected and finally the patient becomes completely and incurably blind

  • • Haloes around light source in the evening – symptom of early angle closure
  • • Sudden severe pain and severe loss of vision – symptom of complete angle closure

Investigations

  • Tonometry – to measure eye pressure
  • Gonioscopy – to assess the drainage angle
  • Automated perimetry – to assess visual field damage
  • Optical Coherence Tomography
  • Treatment

    Glaucoma cannot be cured or reversed. It can only be controlled reasonably by reducing eye pressure by –

    • • Medicines
    • • Lasers – peripheral iridotomy – creating an alternate channel in angle closure
    • • Surgery –trabeculectomy, valves and shunts – by creating an alternate path in open angle as well as angle closure glaucoma

    Risk factors for developing glaucoma

    – Family History – parent or sibling
    – Age above 40 years
    – Myopia, hypermetropia
    – Diabetes mellitus
    – Hypertension, hypotension
    – Hypothyroidism
    – Eye inflammation, trauma, neglected cataract
    – Long term use of steroid medicines (drops or tablets)

    Glaucoma consultants in Susrut

    • Dr. Nilay Kumar Majumdar

      Dr. Nilay Kumar Majumdar,Head, Glaucoma Services

      MBBS, DO

      Specialization : Glaucoma and Cataract
      Dr. Nilay Kumar Majumdar is the senior glaucoma consultant of Susrut Eye Foundation & Research Centre. He did his MBBS from Calcutta National Medical College & Hospital in 1989 and Diploma in Ophthalmology from Regional Institute of Ophthalmology (RIO), Kolkata in 1993. He has also worked as Research Associate in the ICMR glaucoma project in RIO, Kolkata. He has several papers and presentations at national & international levels. His special interest is in spreading glaucoma awareness as well as in painting.

    • Dr. Navajyoti Goswami

      Dr. Navajyoti Goswami

      MBBS, MS

      Specialization :Glaucoma, Cataract and Refractive
      Dr.Navajyoti Goswami has done his MBBS from Gauhati University, and MS from Assam University, Silchar in the year 2005.

    • Dr. Sutapa Roy

      MBBS , DNB

      Specialization :Glaucoma
      She has done MBBS from NRS Medical College, Kolkata. DNB completed in 2010. Her main areas of interest are glaucoma, phacoemulsification.

    • Dr. Anuradha Chandra

      MBBS, MS, FAICO

      Specialization :Cataract, Glaucoma, Paediatric and Squint
      Dr. A. Chandra completed MBBS & MS (Opthalmology) from Medical College Kolkata in 2009. She has completed her Senior Residency in Pediatric Opthalmology, Strabismus & Pediatric Glaucoma from Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi in 2012. She has numerous papers dealing with glaucoma, strabismus and neurophthalmology in national & international journals.

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      Dr. Dhananjay Giri

      MBBS, MS, Fellowship (Glaucoma & Cataract)

      Specialization :Cataract and Glaucoma
      Dr. Dhananjay Giri completed MBBS & MS from Kolkata. He did fellowship in Comprehensive Ophthalmology & Glaucoma from SNC, Chitrakoot (one of the largest surgery centres in India).

    • Dr. Hari Shanker Nag

      MBBS, MS, FAEH

      Specialization :Cataract, Anterior Segment and Glaucoma
      Dr. Hari Shanker Nag completed his MBBS from VSS Medical College (Sambalpur University) and MS from Rajendra Institute of Medical Sciences (Ranchi University). He has done fellowship in IOL Microsurgery and Phacoemulsification from Arvind Eye Hospital, Madurai.

    • Dr. Amit Budrukkar

      Dr. Amit Budrukkar

      MBBS, DNB, FSEFRC (Glaucoma), FICO

      Specialization :Glaucoma and Cataract
      Dr. Amit Budrukkar has done his MBBS from Maharashtra University of Health Sciences. He has completed his DNB from New Delhi in 2016. He has done his specialization in medical and surgical glaucoma. He has presented papers in national and international conferences.

    • Dr. Abhisek Mondal

      Dr. Abhisek Mondal

      MBBS, MS,FSEFRC (Glaucoma)

      Specialization :Cataract and Glaucoma
      Dr. Abhisek Mondal has done MBBS in 2010 and MS (Ophthalmology) in 2014 from Banaras Hindu University. He has done long term fellowship in Medical and Surgical Glaucoma from Susrut Eye Foundation & Research Centre in 2017-2018.

    • Dr. Sumit Banerjee

      MBBS, DO, MS

      Specialization :Cataract & Anterior Segment
      Being a member of Medicos 1978, completed House-staffship in 1985, started journey as ophthalmologist after doing Diploma in Ophthalmology in the year 1987. Completed MS in1993. After doing private practice for few years, started “Megha Eye Centre”. Joined hands with “Susrut Eye Hospital and Research Centre”. An anterior segment surgeon with special interest in the segment of glaucoma.