Glaucoma takes your side vision first, and quietly

Why it is missed

Glaucoma damages the optic nerve from the outside of your field of vision inwards. The brain fills in the gap, so nothing looks wrong. By the time a person notices, a substantial part of the nerve is already gone, and nerve that has gone does not come back. Everything in glaucoma care is therefore about finding it early and holding the line.

How it is diagnosed here

One high pressure reading is not a diagnosis, and a normal reading is not an all clear. The picture is built from several tests, then repeated over time to see whether anything is changing.

• Goldmann applanation tonometry: the reference standard for eye pressure
• Optic nerve examination: looking directly at the nerve head for cupping
• OCT: measures the nerve fibre layer thickness in microns
• Computerised visual fields: maps the side vision you cannot self assess
• Gonioscopy: shows whether the drainage angle is open or closed, which changes the treatment entirely

Treatment

The aim is a target pressure low enough that your nerve stops losing ground. How that is reached depends on your type of glaucoma, your pressure, and how much damage there already is.

• Drops: first line for most people. Preservative free options are used where the surface of the eye will not tolerate preservatives
• SLT laser: selective laser trabeculoplasty, an outpatient laser that improves natural drainage
• YAG laser iridotomy: opens a drainage route in narrow and closed angle glaucoma
• Cyclophotocoagulation: reduces fluid production in selected advanced cases
• MIGS: minimally invasive glaucoma surgery
• Trabeculectomy: creates a new drainage channel when pressure has to come down a long way
• Drainage implants and tube shunts: for eyes that have failed other surgery

The emergency you should not sit on

Acute angle closure is a genuine emergency. Sudden severe eye pain, a red eye, blurred vision, rainbow rings around lights, and often nausea or vomiting. This can destroy vision in a day. Call the clinic immediately on +91 82963 57123 rather than waiting for an appointment slot, and if the clinic is closed go to a hospital eye casualty.

Once you have it, you have it

Glaucoma is managed, not cured. Drops work only while you take them, and the appointment that feels unnecessary because nothing has changed is exactly the appointment that proves nothing has changed. Patients who keep coming keep their vision.

Questions people ask about this