50 years ago, the diagnosis of glaucoma was often associated with the dread of impending loss of vision. Fortunately, due to the development of sophisticated diagnostic techniques and improved treatment modalities, today, glaucoma is very well treatable in most cases.

The eye is like a hollow ball and is maintained at a certain pressure by the continuous formation and drainage of a fluid known as aqueous humor. If an imbalance occurs between the amount that is being formed and the amount that is being drained away, the pressure of the eye will rise. This rise of eye pressure leads to damage of the neurons in the optic nerve, attached at the back of the eye. As the nerve fibres start to die, there are patchy areas of vision loss, which may well go unnoticed. But as the disease progresses, more and more nerve fibres die leading to substantial loss of peripheral vision. The central vision may remain normal until a very late stage. Because the loss of vision in glaucoma occurs due to death of nerve fibres, the visual loss is irreversible and permanent. We can only strive to prevent or at least minimize any further loss once glaucoma has been diagnosed. We cannot give back vision that is already lost. This is why early diagnosis  and treatment of glaucoma is so important.

Early routine check ups for glaucoma is important because glaucoma is often symptomless until a very late stage. All patients must have a routine check for glaucoma at 40years of age or earlier if there is a family history of glaucoma.

The main test for the detection of glaucoma is raised intra ocular pressure and assessment of the optic nerve cup:disc ratio. The ophthalmologist can also visualize the drainage angle of the eye by performing gonioscopic examination.

Luckily, if there is a suspicion of glaucoma, there are a number of sophisticated tests to confirm the diagnosis at a very early stage.

It is possible to test to see whether there are any early patchy areas of visual loss in the peripheral field of vision by Automated Perimetry.

Optical Coherence Tomography is an advanced tool that can analyse the nerve fibre layer of the eye to look for areas of thinning and nerve fibre loss in early glaucoma.

Once a diagnosis is made, medical treatment is usually initiated. There are now a number of medications available that help bring down the eye pressure to acceptable levels.

In those cases where medication does not suffice, a number of safe surgical options are available which are usually effective in controlling the intra ocular pressure.

There are also some glaucomas that present acutely with pain, fall of vision and redness. Lasers are often effective in such cases.

Glaucoma may be caused by some systemic medications, so if the eye pressure is found to be high, it is important to tell the ophthalmologist of all systemic medication the patient is on.

Some babies may be born with glaucoma. They may have unusually large eye and the parents may notice watering of the eyes. These children need specialized treatment.