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GLAUCOMA SURGERY

Glaucoma ( also known as Kala Motia) is essentially a group of related eye disorders that cause damage to the optic nerve of the eye. The optic nerve of the eye is responsible for transmitting images to the brain. Glaucoma, if not contained and treated can lead to severe damage as well as Total Permanent Blindness. Many a time, glaucoma causes no pain or discomfort until the vision loss starts. Hence, it is essential to do regular checkups in order to detect and contain eye diseases like glaucoma. Consult with Eyemantra, one of the best eye doctors across Delhi/ NCR providing with the best consultation and eye-care facilities.

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Glaucoma: What is it?

Glaucoma is generally associated with a buildup of pressure inside the eye (Intraocular Pressure{IOP}) because the fluid inside the eye aqueous humor, stops draining from the eye normally. The fluid in the eye drains out from the trabecular meshwork and in Glaucoma, this drainage gets blocked leading to pressure buildup. The fluid pressure buildup can be attributed to the intrinsic deterioration of the optic nerve as well as genetic factors.

Types Of Glaucoma

OPEN-ANGLE GLAUCOMA (OAG)

Primary Open-Angle Glaucoma(POAG), Normal Tension Glaucoma (NTG), Pigmentary Glaucoma, Pseudoexfoliation Glaucoma, Secondary Glaucoma

ANGLE-CLOSURE GLAUCOMA

The type of Glaucoma in which the fluid cannot access the drainage angle of the eye. The drain space between iris and cornea becomes
too small.

PRIMARY OPEN-ANGLE GLAUCOMA(POAG)

POAG is a very common type of glaucoma. In this type of eye defect, the peripheral vision of a person is diminished without presenting any other symptoms.

ACUTE ANGLE-CLOSURE GLAUCOMA

Acute Angle-Closure Glaucoma produces sudden symptoms such as eye pain, headaches, halos around bright lights, dilated pupils, red eyes, nausea etc.

NORMAL TENSION GLAUCOMA

Normal Tension Glaucoma(also called Low-pressure Glaucoma) is very similar to POAG, which leads to field vision loss as a result of
optic-nerve damage.

PIGMENTARY GLAUCOMA

This a rare form of Glaucoma and it is caused by the clogging of the drainage angle of the eye. Affects males in
the age group of 30-40 years of age.

SECONDARY GLAUCOMA

This is a type of glaucoma which could arise from factors other than natural factors and could be attributed to things like an eye injury or an infection, inflammation>

CONGENITAL GLAUCOMA

This is basically a type of glaucoma which has been inherited by a child at birth from their parents. These kids are born with a defect in the drainage system.

Who is at risk of Glaucoma?

  • People over the age of 40
  • Have a family history of Glaucoma Problems
  • People of Asian, Hispanic, African Heritage are more susceptible to having glaucoma.
  • Individuals having high eye-pressure
  • People who have far-sightedness(Myopia) and/or near-sightedness (Hyperopia)
  • People with serious Eye Injuries
  • People who have had long-term use of steroids or other medications
  • People with thin corneas in the center
  • Thinning of the Optic Nerve
  • People who immuno-deficiencies like diabetes, migraines, high blood pressure and have poor blood circulation

How to Reduce Glaucoma Risk

Glaucoma is not a condition that presents any noticeable symptoms until ill-effects begin. This disease can also not be fully treated it just needs to be managed, therefore, it is vital to understand how to reduce the risk of complete loss of vision. Here are some steps to reduce the risks of glaucoma.

Since there are no apparent symptoms at first it is advisable to get a comprehensive eye examination once every few weeks or at least 1 month.

  • Do not stop taking corrective eye-drops prescribed by the ophthalmologist even though they might be causing slight discomfort.
  • Informed management of the condition along with ongoing follow-up exams is pivotal to eliminate vision loss.
  • Many researchers have found that regular exercise, maintaining a fit and active lifestyle along with dropping bad habits like smoking and alcohol abuse could go a long way in preventing as well as managing glaucoma

Glaucoma Symptoms

Glaucoma has been deemed by many doctors as the ‘silent thief of vision ‘ as it presents next to none or very little symptoms and many symptoms present themselves only after significant damage has been done to your vision. However, based on what type of glaucoma you might have there are certain symptoms there might be for early detection and management of glaucoma.

Open-Angle Glaucoma

Sadly, this type of glaucoma presents no symptoms before there has been a significant loss of vision. It is advised that if you feel at risk of glaucoma due to family history, you should keep getting comprehensive eye examinations on a regular basis. This will help track, diagnose, and help manage this defect better.

Chronic Open-Angle Glaucoma (COAG)

This first sign of this type of glaucoma is a loss of side vision/ peripheral vision. However, the changes are subtle and hence can be tough to acknowledge.

Acute Closed-Angle Glaucoma

Many people have described this as “the most traumatic eye pain of my life”. This glaucoma type produces some of the most painful symptoms.

  • Throbbing eye pain
  • Eye Redness
  • Headaches
  • Blurry or Foggy Vision
  • Dilated Pupils
  • Nausea and Vomiting

Congenital Glaucoma

Congenital glaucoma occurs in kids since their birth and the symptoms for the same could pop up in the first few years itself. These include
Tearing, Sensitivity to light, along with eyelid spasms
Enlarged cornea and clouding of the transparent cornea
Habitual Rubbing of the eyes, squinting, or keeping eyelids close majority of the time.

Secondary Glaucoma and Others

Symptoms include

Inflammation inside the eyes can cause halos in the vision.
Light Sensitivity (Bright lights cause a problem in the eyes)

The symptoms for Glaucoma are very subtle and many times the symptoms for the same can get hidden by Eye injuries like Corneal Edema, Bleeding as well as retinal detachment.
In case you’ve had an injury to your eye, inflammation, or even an advanced cataract, there are chances for glaucoma and in most of these cases, your ophthalmologist will check whether or not you have glaucoma as well.

Surgical options for Glaucoma

Surgery has not been advised as the first solution to treat glaucoma however, it might be left as your last option if other treatment and management fail to produce the desired results.

Initially, your eye doctor will give you a prescription eyedrop or some form of oral medicine in order to ease the pressure on eyes. However, if these drugs do not produce any results, surgery will be required to avoid loss of vision.

Various Types of Surgical Procedures for treating Glaucoma are as follows

  • Laser Surgery: This is basically used to clear up the clogged tubes and relive the built-up fluid pressure. Laser surgical procedures for glaucoma are also of several types as listed below:
    • Argon Laser Trabeculoplasty (ALT)
    • Selective Laser Trabeculoplasty (SLT)
    • Laser Peripheral Iridotomy (LPI)
    • Cyclophotocoagulation
  • Trabeculectomy: In this procedure, the surgeon will make a small cut in the sclera (white part of the eye) and remove some mesh of tissue. This is supposed to help with the drainage of fluid in the eye and relive some IOP pressure.
  • Drainage Implant Surgery: Since in glaucoma, the drainage system of the eye starts faltering, one of the ways to drain the fluid from the eyes is to implant an artificial system with a tube to drain out the fluid.
  • Electrocautery: In this procedure, the surgeon uses a heating device called a Trabectome to make an incision in the eye’s drainage tube. This sends heat to the mesh of the tissue and helps relieve the fluid build up as well as the pressure.

Cost

  • The procedure of “Gonioscopy”, for the treatment of Glaucoma, will cost Rs.500.
  • The cost of “Humphrey Visual Field Test”, for a single eye will be Rs.1,000.
  • The procedure of “Corneal pachymetry”, will cost Rs. Rs.500.
  • The procedure of “Optical coherence tomography (OCT)”, will cost Rs.1500.
  • The cost of “Glaucoma testing” inclusive of “Fields+OCT+Pachy+Gonio”, will be Rs.3,000.

We also provide charitable services for the “underprivileged sections of society”. Because we believe in making the world a more happier place to live in.
So an individual who is in need of eye treatment, but is unable to afford the treatment expenses, can come to our hospital and his entire treatment will be done “free of cost or at a very nominal price”.

Post Operation Care

During the surgery, you will be feeling very drowsy as you will be given some medicines to numb your eye and also relax you.
Post the operation, it is advisable to rest for at least a minimum time period of 7 days.
Doctors advise not to participate in any of the following activities:

  • Driving
  • Reading
  • Bending Over
  • Lifting anything heavy for 4 weeks

Other Tips for Post-operation

  • Eyes may become red, sore, watery
  • Vision might be blurry for 6 weeks
  • Avoid Splashing or putting water in the eyes
  • Contact Lenses might not fit properly

Risks with Glaucoma Testing

No surgical procedure is free from complications and we at EyeMantra as doctors have the responsibility to inform you of all the risks, after effects, and complications involved in the surgery. Here are some of the risks and complications that can occur with surgical treatment for glaucoma.

  • Eye Pain or Redness
  • Too high or too low Eye pressure
  • Infection
  • Cataracts development later in life
  • Inflammation
  • Bleeding in the eye.

Though there will always be complications and risks involved with risky procedures for the eye, surgical treatment of these eye problems could lead to significant improvement in the quality of life.

Risks with Glaucoma Surgery

When testing for glaucoma, it is advisable to clear to the ophthalmologist if you’ve had refractive corrective surgery and whether or not you are taking any other eye medication, steroids, etc so as to best assess your condition.

For testing and detecting whether or not you have glaucoma, the Ophthalmologist will first dilate your pupils and numb the eyes and check whether or not the optic nerve muscles are working properly and whether or not the pressure (IOP) is at normal levels or not.

Applanation Tonometry

Tonometry is basically a test to measure the internal pressure of the eye. Tonometry basically measures the amount of force required to flatten the cornea.

Ophthalmoscopy

Ophthalmoscopy (also known as funduscopy) is a procedure that allows the eye care professional to see inside the fundus of the eye and other structures of the eye using an instrument known as the Ophthalmoscope. This procedure helps establish the proper working condition as well as the health of the retina, optic nerves, optic disc as well as the vitreous humor.

Perimetry

Since glaucoma is a disease that basically starts with a loss of peripheral vision it is important for eye doctors to check the visual field of the patient. Perimetry does exactly that by providing the map of the visual fields

Gonioscopy

Gonioscopy is essentially done to determine what type of glaucoma you might have. Gonioscopy describes the usage of goniolens (or a gonioscope) along with the help of a slit lamp or a microscope to determine the status of the iridocorneal angle or the angle between the cornea and the iris.

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Frequently Asked Questions

1. Does increased eye pressure mean that I have glaucoma?
2.Can I develop glaucoma if I have an increased eye pressure?
3. Can I develop glaucoma without an increase in my eye pressure?
4.When should I get my eyes tested for glaucoma?
5. What Does Glaucoma Suspect Mean?
6. What are the risk factors for Glaucoma?