Glaucoma - Standard Treatment Guidelines
Glaucoma is a group of eye diseases with multi-factorial etiology characterized by an acquired loss of retinal ganglion cells manifesting as progressive optic neuropathy with morphological abnormalities in the optic nerve head and retinal nerve fiber layer and visual field effects in which intraocular pressure (IOP) is a major risk factor. In short, it is a pressure sensitive optic neuropathy. It is estimated there are more than 60 million glaucoma cases worldwide of which 12 million are in India. With a rapidly growing ageing population in India, this figure will increase to 16 million by 2020 and population-based studies in India suggest that more than 90% of glaucoma cases in our country remain undiagnosed. Hence glaucoma is a significant public health problem of our country and requires a concerted effort on part of the health care community to counter irreversible blindness caused by the disease.
Ministry of Health and Family Welfare, Government of India has issued the Standard Treatment Guidelines for Glaucoma. Following are the major recommendations :
There are three major theories regarding the pathogenesis of glaucoma: -
- Mechanical (IOP related damage),
- Vascular (decrease in blood supply to optic nerve head) and
- Biochemical (decrease in neurotrophic factors / increased levels of neurotoxins)
Therefore the three possible therapeutic options would be to decrease IOP, increase perfusion to the optic nerve head and provide neuro-protection to retinal ganglion cells. As of today the only option available to us is to decrease IOP and treat systemic conditions which may compromise the vascular supply to the optic nerve head decreasing the perfusion pressure.
Compliance to therapy, affordability of treatment and family history should be ascertained and all siblings of a glaucoma patient encouraged to get their eye checked up.
The following table gives the guidelines of glaucoma management in general:
Goals for Glaucoma Management
|To achieve target IOP and reduce IOP fluctuations with minimal possible medications|
|To administer glaucoma medication which have the least side effects on the quality of life of the patient|
|To achieve this treatment at an affordable and sustainable cost for the patient|
|Monitor the structure and function of the optic nerve for further damage and adjust the target IOP to a lower level if deterioration occurs.|
|To treat non-IOP dependant systemic factors (systemic hypertension, low diastolic perfusion pressures [diastolic blood pressure minus IOP], diabetes, hyperlipidemia, vasospasm) which may contribute to the development and worsening of glaucomatous optic neuropathy.|
|To educate and involve the patient and his family in the management of the disease process|
Guidelines by The Ministry of Health and Family Welfare :
Dr. Venkatesh Prajna Chief- Dept of Medical Education, Aravind Eye Hospitals, Madurai