Glaucoma is a disease that principally affects the elderly and as such does not usually manifest itself in people before their 50s to 60s. There may be a family history of glaucoma but this is not necessarily so.
There are two main kinds of glaucoma: angle closure glaucoma and primary glaucoma. Acute Angle Closure Glaucoma starts quite suddenly, is very painful and causes blurring of vision. If someone has one-sided eye pain with a same-sided headache and blurring of vision in that eye, which perhaps occurs for a day and then stops and occurs again on another day, then it may be evidence that acute angle closure glaucoma is occurring. An eye surgeon can check this eye to confirm the diagnosis of angle closure glaucoma.
Primary glaucoma is chronic, slow and painless. People with this condition often do not notice they have the disease until vision is very badly affected. Peripheral vision is lost early and central vision is lost at the end of the disease. The best way of diagnosing this problem is to have your eye pressure checked and the optic nerve examined when there is any visual loss, to make sure that both are normal. It is sometimes difficult to detect chronic glaucoma early due to its relative lack of symptoms. Anytime that an eye is painful, red and aching, there is always the possibility that there is raised pressure causing glaucoma. If the symptoms persist, they should be reviewed for evaluation by an eye surgeon.
How do we manage glaucoma ?
When a patient has been diagnosed to have raised pressure in the eye, the doctor must determine whether it is due to angle closure glaucoma or chronic glaucoma. If the raised pressure is due to acute angle closure glaucoma, where there is pain and redness, the treatment is to reduce the pressure quickly with medicine and then to proceed as soon as possible to a simple, non-surgical laser therapy to reestablish the appropriate flow of fluid out of the eye. Laser therapy is a well-established procedure and the outcome is now over 90% successful.
In chronic glaucoma and other non-painful causes of raised eye pressure, the surgeon will usually check the visual fields — the peripheral vision of the eye — to determine how severe the glaucoma is. This is the most important test in chronic glaucoma as it indicates how much pressure control the patient needs. Regular, expert visual field checks are compulsory. The surgeon will also look at the optic nerve and the angles of the eye and take the pressure to ensure that the eye is safe and stable.
Eye drops, the main treatment of glaucoma, are used to control intraocular pressure. Should eye drops be insufficient to control intraocular pressure, surgery may be necessary to help fluid flow out of the eye. Surgical treatments often work well and can be performed as a day surgery procedure.
Finally, it must be remembered that glaucoma is a long-term, slowly progressive disease. Damage from glaucoma is permanent. The objective of glaucoma management is to prevent further damage. We cannot reverse the damage that has already happened, hence early diagnosis is critical and strict and careful control is the only solution to long-term success. Well-controlled glaucoma patients retain their vision and live normal and happy lives. Glaucoma is not a blinding disease if managed correctly.