GLAUCOMA

This is an eye condition where the pressure of the eyeball is too high (akin to a ball that has been pumped too hard). This increased pressure can damage the optic nerve which leads
to gradual loss of vision. The peripheral vision is lost first but left untreated central vision becomes affected. The patient develops “tunnel vision”. In the majority of cases, there are
no symptoms which is why it is sometimes referred to as the “thief of the night”.

  1. Open Angle Glaucoma: most common variety
  2. Closed angle Glaucoma: less common but potentially blinding rapidly – treatment involves laser.

Family history
Age: The risk increases significantly after the age of 40
Race: The disease is worse in individuals of African heritage
Thin central corneas
Myopia: short sightedness

  1. Pachymetry: a handheld device is used to determine the central corneal thickness
  2. OCT: This device measures the optic nerve fibre layer thickness. The optic nerve layer becomes thinner as the disease progresses. This test is very sensitive and
    helpful in monitoring early signs of disease progression.
  3. Visual Fields: This assesses the area that each eye can see and is used to mop out field losses.

Goal: The goal of treatment is to lower the pressure to a level that ensures no further damage to the optic nerve. This can be achieved in different ways:

MEDICAL TREATMENT: This involves using drops. There are various classes of drops which are listed below with examples:

  • Prostaglandins: Example: Xalatan, Travatan, Lumigan. These are the first line treatment and work well. The main “side effects” are:
    – Redness: this usually settles
    – Eyelash growth
    – Darkening of eye colour in 15% of patients
  • Beta Blockers: Example: Timoptol, Betagan. These are also effective. They can exacerbate asthma or heart failure. Please discuss any change in your medical
    condition with your Local Medical Officer and Dr Ng.
  • Carbonic Anhydrase Inhibitors: Example: Trusopt, Azopt. These are good pressure lowering agents. Contraindicated in patients with Sulphur allergies.
  • Alpha Agonists: Example: Alphagan, Iopidine. Potential side effects are irritation.
  • Combination Agents: Prostaglandin + Betablocker. Example: Xalacom, Duotrav, Ganfort. Betablocker + Carbonic Anhydrase Inhibitor: Example: Cosopt, Azarga.

Your doctor will fashion a treatment plan to achieve adequate pressure control while minimising any side effects.

The drops bring pressure down but do not cure the patient of glaucoma. Continuous use is needed to maintain pressure lowering.

SLT LASER: – See SLT information sheet. Laser can be used as an alternative to drops or to augment drops.

SURGERY: This is performed when there is still inadequate pressure control despite maximal medical therapy and SLT laser treatment

Glaucoma requires regular monitoring by your doctor for the rest of your life. It is very important that you are compliant with the treatment and attend your appointments regularly.

Click here for Glaucoma Fact Sheet