Glaucoma controlled with a timely Yag Laser treatment
Mrs. Sonali Gholap*, a 60 years old lady came with complaints of severe pain, redness, and watering in her left eye associated with nausea and headache. She had a history of decreased vision in her left eye. When she was examined in detail, her visual acuity was found to be 6/9 in the right eye and 6/36 in the left. (This means that she could see at 6 metres what a person with normal vision can see at 9 and 36 metres respectively!)
Detailed examination with a Slit lamp revealed cataract in the right eye. The left eye showed that her conjunctiva (the transparent outermost layer) was congested and cornea (the clear outer dome of the eye) slightly hazy.
The front portion (or Anterior Chamber) had become shallow, pupil (the hole in the centre of the coloured part of the eye) was oval and fixed, while the lens showed early cataract. Mrs Gholap’s pressures were checked in both eyes and found to be 20 and 44 mm Hg (Normally the pressure ranges between 8 – 21). Gonioscopy (a test to study the angle where the iris meets the cornea) showed occludable angles in the right eye and closed angles in the left. Hence a diagnosis of Right Eye angle closure suspect and Light Eye Acute angle closure glaucoma was made.
Glaucoma is a condition where there is damage to the optic nerve usually due to raised eye pressure. There are two types of glaucoma depending on whether the angle is open or closed (called open angle glaucoma and angle closure glaucoma).
The Glaucoma Specialist Dr. Rajesh Mishra at Advanced Eye Hospital who treated Mrs Gholap, started the patient on medications (oral acetazolamide and iv mannitol). Eye Pressure was checked afterwards and found to be 16 and 24-mm Hg.
Mrs Gholap was then advised to undergo a surgery called Peripheral Iridotomy in both her eyes. After surgery, Mrs Gholap’s eye pressures came down to 14 and 16-mm Hg. The patient was started on anti-glaucoma medications and was advised to follow up after 1 week.
After a week Mrs Gholap was delighted to see that her visual acuity in the left eye had improved to 6/18. Slit Lamp Examination showed a clear cornea, and eye pressures of 14 and 16-mm Hg respectively. Dilated fundus examination revealed a cup: disc ratio of 0.5:1 and 0.9:1 in the right and left eyes. (The lower this ratio is the better). While her field of vision had unfortunately reduced to an advanced stage in the left eye, that in her right was thankfully normal.
She was advised to continue her glaucoma medicines and follow up regularly at 3 monthly intervals. Luckily for her she followed up and at her last follow-up at 2 years her eye pressures were normal and her filed of vison was maintained without any further worsening.
Let’s check-out some of the facts related to glaucoma.
Glaucoma in India: Facts and figures:-
•Glaucoma is the third leading cause of blindness in India.
•12 million people are affected accounting for 12.8% of the country’s blindness
•Population based studies report a prevalence between 2 to 13 %
•Glaucoma can affect any age group, including newborn, infants, children and elderly
•Blindness from glaucoma is irreversible. Early detection is the key to preserving vision related quality of
•To facilitate early detection and help preserve vision in glaucoma individuals at risk :-
-age over 40 years of age
-glaucoma in the family
-those with diabetes/ thyroid disease / hypertension
-have received steroid containing preparations: tablets/ drops/ ointments/ puffs/ injections
-see rainbow coloured rings around bright light
-have a rapid change of glasses
-take medication for sleep/ anxiety / depression / asthma/ parkinsonism
-have had an injury to the face /eye