Good vision is a key factor for living a healthy happy life. The earlier we start looking after the health of our eyes, the better is the chance of maintaining good vision throughout our lives. Vision problems can occur at any age, which is why regular eye examinations by an ophthalmologist are important. Glaucoma is a group of eye conditions that damage the optic nerve, which is vital for good vision. Worldwide. glaucoma is one of the leading causes of irreversible blindness. Medicircle is conducting an awareness series on glaucoma with the eminent ophthalmologist to boost awareness and educate people about eye health. 

Dr. Urmi Shah is a cataract surgeon and medical retina specialist. She consults at two clinics in Mumbai - Eye Solutions, Kemps Corner and Alldoctors Clinic, Walkeshwar. She is a highly skilled clinician and surgeon providing  patients with spot-on diagnosis and excellent surgical results. She treats various retinal diseases like diabetic retinopathy, retinal vein occlusions, and age-related macular degeneration. Other than medical management of various retinal disorders, she has great expertise in managing general ophthalmology problems like glaucoma, eyelid problems, eye infections, dry eyes, etc. 

Overview of what glaucoma is

Dr. Urmi explains, “Glaucoma is something where our eye pressure starts to increase and that starts to affect the nerve of the eye which is known as the optic nerve. This leads to a progressive loss in the visual field. By visual field, we mean that when I'm looking at something, I can still see everything else around me, even if I'm focusing on a particular object. That is known as my entire field of vision. What happens in glaucoma is that with time, as the pressure stays high, this field of vision starts constricting, so the patients start losing their peripheral vision.”

Many patients are not aware of eye pressure

Dr. Urmi emphasizes, “A lot of my patients I know are not even aware that there is something known as eye pressure, When I tell my patients that I need to check their eye pressure, they tell me that “oh but my blood pressure is normal.” And I have to tell them that eye pressure is different from their blood pressure. So, the awareness starts at that level to understand that we have something known as eye pressure and what happens when that eye pressure starts rising.” 

Family history creates a risk factor for open-angle glaucoma

Dr. Urmi points out, “Glaucoma is typical of two types. One is known as Primary open-angle glaucoma, where essentially the structure of the eye is normal. The second is something known as angle-closure glaucoma, where the angles of the eyes are narrower. There is a block to the flow of the fluid inside the eye. Because of that block, the eye pressure can certainly rise which is known as angle-closure glaucoma. So, the risk factors for both of these conditions are a little different. For primary open-angle glaucoma, one of the main risk factors is a positive family history. Today, about 50% of patients who have this type of glaucoma will have a positive family history. The first-degree relatives will have a 10 times higher chance of developing glaucoma themselves. By first-degree relatives, we mean their parents, siblings, or their children - blood relations. So, any first-degree relative of a person with glaucoma needs to get their eyes regularly screened once a year after the age of 40,” says Dr. Urmi.

Some professions create a risk of high eye pressure

Dr. Urmi mentions, “There is also a certain type of professionals who might be at an increased risk of developing a higher eye pressure. For example, some musicians who play these high resistance wind instruments like trumpets, or people like scuba divers, or weightlifters. In them, there might be episodes where the eye pressures are increasing because of the nature of their work. So, they need to get their eyes screened regularly.”  

Steroid usage leads to high eye pressure

Dr. Urmi points out, “An important factor that can lead to higher eye pressures is steroid usage. Steroid drops are very frequently used for different eye conditions. For people who are on steroid drops, it's very important to monitor their eye pressures regularly. Because that can also cause the pressures to go up or even people who are taking steroid tablets or steroid creams, all of them need to monitor the high pressures.”

Narrow-angle glaucoma is common in people with smaller eyes

Dr. Urmi informs, “People with smaller eyes can develop narrow-angle glaucoma because it leads to crowding of structures at the angle and a block to the outflow. It is a little bit more common in females, and it increases with increasing age.”

The risk of glaucoma increases with age

Dr. Urmi emphasizes, “It is very rare for somebody below the age of 40 to have glaucoma. What I do in my practice is that any patient who walks in even for just a number check-up, but is above 40 years of age, I routinely check their eye pressures. In open-ended glaucoma, our normal pressure ranges from 10 to 21 for all adults. If the pressures are staying at a level of 24, 25, or even 30, a lot of times the patient will have no symptoms because of the change rate but would get evident only when it is checked at the clinic. It is there that we can pick up that the eye pressures are higher than normal and then we need to look into the whole glaucoma workup.”

If the higher eye pressure is picked up early, they can be controlled

Dr. Urmi explains, “Glaucoma is typically the name given when the eye pressure has started to affect the nerves and the patient has started to lose vision. So yes, if the higher eye pressures are picked up early, and they are controlled, we can stop the patient from reaching the stage where it has started to damage the optic nerve. We cannot control a patient developing high eye pressure, but we can put a stop to that if it has not affected the optic nerve. Also, in patients who have an angle closure, a laser procedure can be done for them which helps to open up the passage of the fluid which is getting blocked in narrow-angle glaucoma so that the pressure build-up does not occur.”

We can help to control the way glaucoma is progressing

Dr. Urmi mentions, “Glaucoma is very often similar to somebody having blood pressure or diabetes. There is nothing that you can give somebody that is going to cure their blood pressure. But they have to be on medication which is going to keep it under control. This is the case also for glaucoma. For somebody who has open-angle glaucoma, they have to be on lifetime drops. They have to be extremely regular with these drops. If they are regular with the drops, they come in for regular monitoring, the eye pressures need to be checked every three months. The visual fields need to be checked once in six or eight months. So, if these things are done regularly, then we can help to control the way the disease is progressing,”says Dr. Urmi.

Eye check-up once a year is important

Dr. Urmi points out, “There are a lot of patients who do not realize the importance of the condition. They do not realize that this is something that can lead to the loss of their vision. They do not realize that they need to put their drops, and then they end up with that end-stage disease, where they have lost most of the vision. Since they don’t have any symptoms, they don't realize exactly what the issue is. What happens with angle-closure glaucoma is that the eye pressure suddenly rises, the eye pressure might suddenly go up to 50 or 55. The patient will suddenly have severe eye pain, headache, vomiting, blurry vision, so they will immediately seek help for that. But for somebody with open-ended glaucoma, the pressures would be rising very slowly and gradually. Even at pressures of 26 or 30, it is causing damage to the eye, which many have not realized. This is why it's very important for everybody over the age of 40 to regularly get your eye check-up done once a year. Do not just go to an optician and get your number check, go to an eye doctor, who will also check your eye pressure and will also check your retina to see if any changes are occurring,” says Dr. Urmi.

Regular medications are the need

Dr. Urmi advises, “If somebody is diagnosed with glaucoma, they should realize the severity of the condition. Be regular with the medications. I have some patients who come regularly for their check-ups. And since the last so many years, there has not been even the slightest problem because it is being regularly monitored and medicated. On the other end of the spectrum, some people are not realizing the importance, or they become lax about putting the drops and in them, the vision loss keeps progressing. So that is what we want to prevent.”

Factors causing blindness is more patient-related, rather than disease-related

Dr. Urmi says, “I would say the factors causing blindness are a little more patient-related than actual disease-related. If the patients are not taking the medications regularly, not putting the drops regularly, if they are not monitoring properly, or sometimes you could be putting your drops but those levels of drops are not enough to stop the progression. And you will know only if you get your visual fields done every six months. And if we feel that yes, with these two drops, the disease's still progressing then you add another medication, if it is still progressing, okay, you might have to go on for other remedies. So, these are all the decisions that need to be taken. But today, if you're just putting the drops and not going into monitoring, not checking what's happening to your visual fields, not getting your pressures checked, then definitely you are on the way to losing your vision,” explains Dr. Urmi.

Symptoms need to be identified

Dr. Urmi mentions, “In angle-closure glaucoma, if the pressure suddenly rises, there is a severe headache, sometimes even nausea, vomiting, etc. And typically for that, they might go and see their general practitioner first. Right now, general practitioners do not realize that it is an eye condition, they might not ask them to get their eyes checked. I recently had a patient where the general practitioner realized that the eyes have a problem. And he sent the patient across for the pressure check-up. The patient’s condition got very well managed, and we managed to preserve his vision excellently. He is seeing amazingly well because things were picked up and diagnosed on time.”

Neglect can cost happiness

Dr. Urmi says, “I would just want to share one patient experience that I had. She was an 80–85-year-old lady. She had come because she said I am just not able to see well. I saw she had advanced glaucoma in both eyes. The sad part was that she had been diagnosed with glaucoma by a very leading glaucoma specialist about six, seven years ago. At that point, her visual fields were normal or showing very early changes, and she had been asked to put the drops. But that was not done, it was not monitored. And over six to seven years, she had lost her vision. She told me my only wish is that I want to see the face of my grandson who is getting married in a few months. That moment was heart-breaking because there was nothing that anybody could do to give her back that vision and the fact that it could have been prevented. This is where the whole importance of glaucoma awareness comes in where you can pick up a patient on time and stop them from reaching that end-stage. Because once you reach that stage, the vision loss is irreversible,” says Dr. Urmi.

Doctors have a responsibility too

Dr. Urmi mentions, “It’s a doctor’s responsibility to explain to patients what exactly glaucoma is. As an ophthalmologist, we must explain to them the whole condition and repercussions. That is the doctor’s responsibility, but it's the patients and relatives’ responsibility to ensure that advice is followed so that they do not have to face end-stage blindness.”

(Edited by Amrita Priya)