ARAVIND EYE CARE SYSTEMAravind Eye Hospital

& Postgraduate Institute of Ophthalmology

ARAVIND EYE CARE SYSTEMAravind Eye Hospital

& Postgraduate Institute of Ophthalmology

DEPARTMENT OF COUNSELLINGDEPARTMENT OF COUNSELLING

GlaucomaGlaucoma

Glaucoma is a disease of the optic nerve, Glaucoma is a disease of the optic nerve, caused by an increase in the intra ocular caused by an increase in the intra ocular pressure (pressure inside the eye)pressure (pressure inside the eye)

This is characterised by a gradual This is characterised by a gradual progressive loss of neutrons causing a progressive loss of neutrons causing a progressive constriction of visual fieldsprogressive constriction of visual fields

Optic disc cuppingOptic disc cupping

What is Glaucoma?What is Glaucoma?

Patients with glaucoma may not have Patients with glaucoma may not have any symptomsany symptoms

Some patients may complain ofSome patients may complain of Frequent change of glassesFrequent change of glasses Loss of field of visionLoss of field of vision

SymptomsSymptoms

Patients with angle closure glaucoma Patients with angle closure glaucoma may complain of recurrent attacks ofmay complain of recurrent attacks of

RednessRedness PainPain Blurred visionBlurred vision Coloured visionColoured vision Headache, vomitingHeadache, vomiting

1.1. Primary Open Angle Glaucoma (POAG):Primary Open Angle Glaucoma (POAG):There is no functional block to the flow of fluid inside the There is no functional block to the flow of fluid inside the eye (aqueous humour)eye (aqueous humour)

2.2. Primary Angle Closure Glaucoma (PACG):Primary Angle Closure Glaucoma (PACG):There is a block in the flow of fluid (aqueous humour) in There is a block in the flow of fluid (aqueous humour) in the eye at the level of the pupilthe eye at the level of the pupil

3.3. Congenital Glaucoma: Congenital Glaucoma: Occurs from birth and is hereditary. Visual prognosis is Occurs from birth and is hereditary. Visual prognosis is guarded.guarded.These patients usually need multiple medications & These patients usually need multiple medications & surgerysurgery

Types of GlaucomaTypes of Glaucoma

Parents of children with congenital Parents of children with congenital glaucoma complain ofglaucoma complain of

Child avoiding lightChild avoiding light Increase in the size of the eyesIncrease in the size of the eyes Squinting of eyeSquinting of eye Increase tearing from the eyeIncrease tearing from the eye

44. Secondary Glaucoma:. Secondary Glaucoma: Can be due toCan be due to

TraumaTrauma Following surgeries of the anterior or Following surgeries of the anterior or

posterior segmentposterior segment Following chronic inflammationFollowing chronic inflammation Prolonged use of steroidsProlonged use of steroids Long standing diabetes, retinal vessel Long standing diabetes, retinal vessel

occlusionsocclusions

Phacomatic GlaucomaPhacomatic Glaucoma Phacolytic GlaucomaPhacolytic Glaucoma Pseudo extoliation GlaucomaPseudo extoliation Glaucoma Neo vascular GlaucomaNeo vascular Glaucoma Pigmentary GlaucomaPigmentary Glaucoma Aphakia GlaucomaAphakia Glaucoma Pseudo phakia GlaucomaPseudo phakia Glaucoma

Cont…..Cont…..

Types of GlaucomaTypes of Glaucoma

Steriod Induced GlaucomaSteriod Induced Glaucoma Traumatic GlaucomaTraumatic Glaucoma Low tension GlaucomaLow tension Glaucoma Normal Tension GlaucomaNormal Tension Glaucoma Ocular hypertensive GlaucomaOcular hypertensive Glaucoma Absolute GlaucomaAbsolute Glaucoma Jwenile GlaucomaJwenile Glaucoma

InvestigationsInvestigations

These are important for early These are important for early diagnosis of the disease and also in diagnosis of the disease and also in follow up to prevent out progression follow up to prevent out progression of the diseaseof the disease

Visual Field TestingVisual Field Testing This analyses the field of This analyses the field of

vision of the patientvision of the patient

Ideally should be repeated Ideally should be repeated every year or once in a every year or once in a ---- month to rule our ---- month to rule our progression of the diseaseprogression of the disease

The patient has to The patient has to understand and cooperate understand and cooperate with the test for it to be with the test for it to be usefuluseful

Central Corneal ThicknessCentral Corneal Thickness The intra ocular pressure measured by The intra ocular pressure measured by

applanation can vary with any change the applanation can vary with any change the thickness of the corneathickness of the cornea

So CCT is measured for all patients with So CCT is measured for all patients with glaucomaglaucoma

OCTOCT::

This is to diagnose early glaucoma a stage when it This is to diagnose early glaucoma a stage when it cannot be diagnosed, by routine field test and cannot be diagnosed, by routine field test and involves scanning of the nerve fibre layer around involves scanning of the nerve fibre layer around the optic discthe optic disc

SWAPSWAP::

This is a modified field, test which uses coloured This is a modified field, test which uses coloured stimulusstimulus

Also help in diagnosis early glaucomaAlso help in diagnosis early glaucoma

UBMUBM::

A technique to scan the anterior part of the eye to A technique to scan the anterior part of the eye to rule out structural abnormalitiesrule out structural abnormalities

Role of CounsellorRole of Counsellor

Counsellor should explain to the Counsellor should explain to the patient why specific investigations patient why specific investigations are essential and why they have to are essential and why they have to be repeated to rule out progression be repeated to rule out progression of the diseaseof the disease