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Glaucoma, an eye disease that progressively damages the optic nerve, is one of the leading causes of vision loss. The disease causes gradual and silent damage without any apparent symptoms in the initial stages. This is why most people who have glaucoma are not even aware they are living with the condition. However, it is a dangerous disease that can result in vision loss is left treated. It is estimated that in India at least 12 million people are affected by glaucoma with around 1.2 million people already blind from the disease. Unfortunately, glaucoma induced vision loss is irreversible. The disease itself cannot be cured. However, its progression can be contained, and the damage prevented if it is diagnosed and treated in time. Complete eye examinations when conducted regularly can help people identify glaucoma in early development stages.
Over the years, the available treatment options for glaucoma have widened and include the use of eye drops, oral medicines, laser treatment as well as surgery. All treatment modalities have a common goal that of reducing the eye pressure on the optic nerve by allowing drainage of the accumulated eye fluid. Increased ocular pressure is one of the most significant conditions associated with glaucoma. This high pressure can be particularly bad for a damaged optic nerve and relieving it can help prevent further damage and resultant vision loss. This is why people diagnosed with glaucoma have to undergo regular eye examinations to check their eye pressure and ensure regular treatment.
Both eye drops and laser treatment are first line treatments for glaucoma and both can be considered by patients while starting treatment. Surgical intervention is mostly made when the eye drops and lasers do not yield the required benefits. But given a wider basket of available treatments, patients often wonder which treatment line is the right one for me. While the decision must be made by the patient after thorough consultation with the doctor, you must understand the pros and cons of multiple treatments effectively before deciding which one to undergo. Here, we elaborate on the available treatment options so that you have a better idea and are better equipped to deal with the problem.
Eye drops are the most commonly prescribed treatment for glaucoma. Some classes of eye drops help the access fluid drain out of your eye while others reduce the amount of fluid generated in the eye. Both types of drugs achieve the same objective of reducing the pressure on your optic nerve.
Eye drops or for that matter any other treatment modality will not cure glaucoma, but it will certainly contain its progression and prevent further damage. It is important to remember that these prescription eye drops have to be taken regularly every day without skipping to ensure they are doing their work effectively. Often, many people tend to forget or skip their dosages often. In other cases, they deliberately stop using the drugs because they take the condition lightly. This behaviour can be dangerous and may cost you your vision.
Side-effects: While most people tolerate eye drops well, a few may experience some side effects such as itching, burning or redness in the eye along with headaches or even blurry vision. In some patients, eye drops may not have the desired reduction in eye pressure. In such cases, the doctor may either add oral drugs to your prescription or may offer other treatment options.
Laser treatment or trabeculoplasty is another first line treatment that patients can opt for right when their treatment begins or even at a later stage. However, in many cases, patients opt for it when prescription eye drops are not working to sufficiently reduce the eye pressure or in cases when they are causing some significant side effects.
The procedure uses laser energy to induce a chemical change in the eye tissue that results in better drainage of the eye fluid and reduction in optic pressure. While it will take up to 3 months for the results to show, the effect is likely to last for several years. In fact, laser treatment is found to lower the intra ocular pressure by about 30% when it is used as an initial treatment. But for patients who are already on other medications, the effect may not be as profound. At the same time, when the positive effect wears off after few years, you may need a repeat treatment. However, repeat treatments have a lower chance of working as effectively as the first time, eventually requiring you to return to medication.
Side-effects: In a small number of cases, laser treatment may not be successful and these patients are then managed with other medications or treatment lines. Laser treatment may also be accompanied by some form of swelling, soreness or pain but it heals quickly and enables the patient to get back to normal life. Speak to your ophthalmologist at length to take a final call on whether you want to take up laser as an initial therapy or not.
Surgical intervention is considered the final line of treatment when eye drops, medication or laser treatment has failed to have the required effect. Different types of surgeries are offered today to help glaucoma patients deal with the rising ocular pressure. A quick procedure, trabeculectomy involves the creation of a tiny opening on the upper eye enabling the excess fluid to drain out. A glaucoma implant surgery, on the other hand, involves insertion of a very small tube into the eye to quicken the drainage process.
Minimally invasive glaucoma surgeries are the latest advancement which are much safer. In most cases, minimally invasive glaucoma surgery is combined with cataract surgery to achieve significant reduction in eye pressure.
However, whatever the treatment line you chose to take, undergoing regular eye check-ups is something you will have to adhere to all your life to ensure the treatment is having its desired effects or the effects are not wearing off.
(This article is authored by Nikkhil K Masurkar, Executive Director, ENTOD Pharmaceuticals)
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