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Category: Glaucoma

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Lifestyle Tips to Slow Glaucoma Progression: Backed by the Best Glaucoma Treatment in Mumbai

Glaucoma is one of the leading causes of irreversible vision loss worldwide, and the condition is commonly linked to increased intraocular pressure, which can damage the optic nerve over time. Without timely and proper treatment, glaucoma can result in severe vision impairment. Fortunately, lifestyle changes can play a significant role in managing glaucoma and slowing its progression, enabling individuals to preserve their eyesight and quality of life.

In this article, we will discuss lifestyle changes that can help slow glaucoma progression, the importance of regular monitoring, and how Ojas Eye Hospital provides the best glaucoma treatment in Mumbai.

What Is Glaucoma, and What Are Its Effects on Vision?

Glaucoma refers to a group of eye diseases characterized by damage to the optic nerve, which is essential for clear vision. Most cases of glaucoma are associated with elevated eye pressure, known as intraocular pressure (IOP). If left untreated, high IOP can lead to progressive damage, ultimately causing permanent blindness. Early detection and regular eye exams are key to managing glaucoma effectively.

To minimize the risk of vision loss, it’s important to follow a combination of medical treatments and lifestyle changes that can help control IOP and protect the optic nerve from further damage.

The following habits and lifestyle choices play an important role in slowing the progression of glaucoma:

The Importance of a Healthy Diet in Glaucoma Management and Eye Pressure Control

What we eat can significantly affect our eye health, including managing glaucoma. A nutrient-rich diet can help protect the optic nerve and reduce eye pressure.

Below are some dietary tips to support glaucoma management:

  • Incorporate foods high in antioxidants, such as leafy greens, berries, and nuts, to protect the optic nerve from oxidative stress and damage.
  • Fatty fish like salmon, mackerel, and sardines are rich in omega-3 fatty acids, which can improve eye health and reduce inflammation.
  • Excessive caffeine intake can raise IOP, so it’s advisable to limit consumption to maintain eye pressure at a healthy level.
  • Staying hydrated is important, but it’s better to drink small amounts of water throughout the day instead of large quantities at once, which can temporarily elevate eye pressure.

The Role of Regular Exercise in Glaucoma Management

Exercise is another essential component of glaucoma management. Regular physical activity can help lower IOP and enhance blood circulation to the optic nerve, contributing to better eye health.

Below are a few exercise guidelines for those with glaucoma:

  • Walking, swimming, and yoga can help lower IOP. These activities promote circulation and improve overall eye function.
  • Exercises involving heavy lifting or positions where the head is lower than the body (like certain yoga poses) can increase IOP, so they should be avoided.

Stress Management and Its Benefits in Glaucoma Management

Stress is a well-known factor that can increase IOP and potentially worsen glaucoma symptoms. Incorporating regular relaxation techniques can be essential in controlling glaucoma progression and maintaining good eye health.

Manage stress through the below relaxation techniques, such as:

  • Meditation
  • Deep breathing exercises
  • Mindfulness and yoga

Healthy Sleep Habits to Support Glaucoma Management

Adequate sleep is essential for overall health, and it also plays an important role in managing glaucoma. Poor sleep quality or sleep disorders can increase IOP, thus worsening glaucoma symptoms.

Below are a few tips for better sleep hygiene:

  • Maintain a consistent sleep schedule
  • Establishing a calm, cozy, and comfortable environment for better sleep
  • Limit screen time, especially before bedtime

The Impact of Smoking and Alcohol on Glaucoma

Lifestyle choices such as smoking and excessive alcohol consumption can negatively impact eye health, including worsening glaucoma symptoms. Smoking reduces blood flow to the optic nerve, while alcohol can increase IOP. Quitting smoking and reducing alcohol intake can play an important role in slowing glaucoma progression and maintaining better eye health.

Regular Monitoring of Eye Pressure

Consistent monitoring of eye pressure is essential for managing glaucoma. Routine visits to an eye specialist in Mumbai ensure early diagnosis of any changes in IOP. These check-ups allow for timely treatment plans, preventing further damage to the optic nerve.

Ojas Eye Hospital: A Trusted Name for Glaucoma Treatment in Mumbai

If you’re concerned about glaucoma and want the best possible care at the top eye hospital in Mumbai, visit Ojas Eye Hospital. Renowned for offering the best glaucoma treatment in Mumbai, we specialize in advanced diagnostic procedures and cutting-edge treatments tailored to your unique needs.

Booking an appointment at Ojas Eye Hospital ensures access to state-of-the-art facilities and a personalized treatment plan aimed at preserving your vision and enhancing your quality of life. Trust us for expert care in glaucoma management and comprehensive vision care. Book your appointment today with the best eye specialist in Mumbai!

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How Can Stress Management Improve Glaucoma Treatment in Mumbai?

Recent researches have revealed a significant link between psychological stress and raised intraocular pressure (IOP) in individuals with primary open-angle glaucoma (POAG). This research highlights the importance of stress management for glaucoma patients and provides valuable details about how stress could potentially lead to irreversible vision loss if not managed properly.

What is Glaucoma?

Glaucoma is a progressive eye disease characterized by optic nerve damage that can result in vision impairment or even blindness. Elevated intraocular pressure (IOP) is a major risk factor for worsening glaucoma, significantly affecting a patient’s quality of life. The most common form of glaucoma is the open-angle glaucoma (POAG), which is often managed by controlling IOP, that is the fluid pressure inside the eye.

How Is Stress and Intraocular Pressure (IOP) Linked?

Traditionally, glaucoma treatments focus on lowering intraocular pressure (IOP) through medications, laser therapy, or surgery. However, stress has been observed to temporarily raise IOP, even in individuals without glaucoma. This has made doctors to investigate whether stress has a deeper impact on glaucoma patients.

Could Stress Worsen Glaucoma?

Yes, repeated stress exposure is believed to impair IOP control in glaucoma patients, potentially increasing the risk of disease progression. Therefore, managing both physical and emotional health is essential as part of a complete glaucoma treatment plan.

How to Manage Stress for Better IOP Control?

Incorporating stress relaxation methods into daily routines may help glaucoma patients manage IOP more effectively. Consider the following methods:

  • Mindfulness meditation: Helps calm the mind and reduce stress hormones.
  • Deep breathing exercises: Promotes relaxation and lowers blood pressure.
  • Physical activities or tai chi: Combines physical movement with mental well-being.
  • Cognitive-behavioral therapy (CBT): Provides coping strategies for managing stress and anxiety.

Why Timely Treatment of Glaucoma Matters?

Glaucoma is often called the “silent thief of sight” because it progresses without noticeable symptoms until significant vision loss occurs. Regular screenings and timely intervention are essential for preserving vision and quality of life.

Act Today, Visit Ojas for the Top-Quality Glaucoma Treatment in Mumbai

Ojas Eye Hospital is known for providing the best glaucoma treatment in Mumbai, combining the most advanced procedures with expert care. The hospital has some of the best eye specialist in Mumbai and the best eye surgeon in Mumbai, with extensive experience in diagnosing and treating complex eye conditions.

Having state-of-the-art equipment for vision correction and glaucoma surgeries makes Ojas -Eye Hospital a leading destination for top-quality glaucoma treatment in Mumbai.

Your vision is valuable, and protecting it requires expert care and timely attention. Whether you’re seeking the best glaucoma treatment in Mumbai or advanced surgical solutions, Ojas – Eye Hospital is your trusted choice. Book your appointment today at the best eye hospital in Mumbai and take a step toward a brighter, healthier future for your eyes.

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Best Glaucoma Treatment in Mumbai: Can You Prevent Blindness from Glaucoma?

Glaucoma usually does not result in blindness when treated properly. However, without treatment, it will gradually lead to blindness. Glaucoma-related vision loss usually occurs gradually and is one of the leading causes of irreversible blindness worldwide. With timely treatment and effective management, the progression of vision loss can often be slowed or even completely stopped.

Will Glaucoma Lead to Blindness?

This question is one of the most common concerns raised by those diagnosed with glaucoma,and below are a few factors that can help determine the possibility of vision loss.

  • Stage of glaucoma: The more advanced the damage, the greater the chances of experiencing vision impairment.
  • Symptoms: Unfortunately, most patients do not experience symptoms in the early and moderate stages of glaucoma. By the time vision changes occur, the disease is often quite advanced.
  • Monitoring and treatment: Consistent monitoring and treatment can help control intraocular pressure and slow the progression of the disease.

Early detection and regular monitoring by a qualified eye specialist are essential to managing glaucoma effectively. The best eye specialist in Mumbai can assess the stage of glaucoma— whether mild, moderate, or advanced and create a personalized treatment plan based on your individual needs.

What Are the Risk Factors for Glaucoma?

Some individuals are more susceptible to developing glaucoma due to various risk factors, including:

  • People over 40 years of age are at higher risk.
  • A family history of glaucoma increases your possibility of developing the condition.
  • Elevated intraocular pressure (IOP) is a primary risk factor for glaucoma.
  • Other health conditions like diabetes, high blood pressure, and extreme nearsightedness can contribute to glaucoma risk.

Regular eye exams with the best eye specialist in Mumbai are essential for those with these risk factors, as early diagnosis leads to an effective treatment with a better result.

What Are the Treatment Options for Glaucoma?

Glaucoma treatment primarily focuses on controlling eye pressure to prevent further damage to your optic nerve. Depending on the severity and type of glaucoma, treatment options may include:

  • Prescription eye drops
  • Oral medications
  • Laser therapy
  • Surgery

For those seeking the best glaucoma treatment in Mumbai, specialists at top eye hospitals offer a range of cutting-edge solutions.

How Can You Manage Glaucoma for Long-Term Vision Health?

It is important for individuals diagnosed with glaucoma to follow their eye specialist suggestions closely. That may include:

  • Regular eye check-ups
  • Medication adherence
  • Lifestyle adjustments

Why Choose Ojas For the Best Glaucoma Treatment in Mumbai?

Ojas – Eye Hospital, known for offering the best eye treatment in Mumbai, including the most advanced glaucoma care.

From early detection to advanced treatment options, Ojas offers the best glaucoma treatment in Mumbai. Don’t wait until it’s too late; schedule a consultation with the best eye hospital in Mumbai and take proactive steps to protect your vision today.

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January 2023, Glaucoma Awareness Month: What’s New And What Do I Need To Know About Glaucoma?

January is Glaucoma Awareness Month, making it the perfect time to talk about how to spread the word about this condition that can cause blindness. Early detection of glaucoma is necessary for receiving proper treatment.

Alarming key facts about glaucoma:

  • 50% of glaucoma sufferers are unaware of their condition.
  • 80 million people globally have glaucoma.

What is glaucoma?

Glaucoma is a group of eye conditions that damage your optic nerve and is usually caused when fluid builds up in the front part of your eye. This increased fluid exerts pressure on the optic nerveswhich can permanently affect eyesight if not diagnosed in time and treated. It is also noticed that some people have normal eye pressure but still get glaucoma. Untreated or poorly managed glaucoma can cause blindness and irreversible vision loss, which makes it the second most common cause of blindness worldwide.

What mostly causes glaucoma?

Aqueous humor is the fluid inside your eye, normally flows out of the eye through a channel. The liquid might build up if this channel gets blocked or if the eye is producing too much fluid, leading to a rise in pressure inside the eye and thus damaging the optic nerve.

What are the types of glaucoma?

There are various types of glaucoma, such as:

Open-angle glaucoma:

This is the most common type that happens when resistance builds up in the eye’s drainage canals. Because most people don’t have symptoms, the condition may go unnoticed for years.

Closed-angle glaucoma:

This is a rare type of glaucomathat often manifests suddenly. It happens when the angle between your iris and cornea is too small. It might happen if the pupil changes and dilates too quickly. This restricts the flow of aqueous fluid out of your eye and blocks your drainage canals, increasing eye pressure. Eye pain and headaches are two symptoms that can be very severe and need immediate medical attention.

Normal-tension glaucoma:

Even in the few cases where eye pressure is normal or not too high, optic nerve damage occurs.

Congenital glaucoma:

Some babies are born with improperly formed drainage canals from the womb. Your baby’s glaucoma symptoms may be visible to your doctor from birth, or symptoms may become noticeable in childhood.

What symptoms exist for glaucoma?

Some forms of glaucoma don’t have any early warning symptoms, and vision problems might occur gradually, making it easy to miss the symptoms. Regular eye examinations are crucial for catching this disease in its earliest stages. Since glaucoma damage is irreversible, early detection and treatment are essential to prevent blindness.

You might experience:

  • Pressure or pain in the eyes
  • Headaches
  • Red eyes
  • Sensitivity to light
  • Vomiting and nausea
  • Lights with rainbow-colored halo effects
  • Vision problems include tunnel vision, low vision, blurriness, or blind spots

If you encounter these symptoms, you should get immediate medical attention.

Who is more at risk of getting glaucoma?

Several significant risk factors have been found, which include:

  • Age greater than 60 years
  • A first-degree relative with glaucoma
  • A history of eye trauma or multiple surgeries
  • Chronic eye conditions like diabetic eye disease
  • Extreme nearsightedness or farsightedness
  • Use of steroid medications

How is glaucoma diagnosed?

It’s possible that you have glaucoma and may not even be aware of it. For the purpose of detecting glaucoma or other eye issues, routine eye exams are important. The eye exams can assess your optic health and vision loss.

An eye specialist may do one or more of these tests to check for glaucoma:

  • Visual acuity test
  • Visual field test
  • Dilated eye exam
  • Pachymetry
  • Slit-lamp exam
  • Ocular pressure test
  • Gonioscopy Optical coherence tomography (OCT)

How is glaucoma managed or treated?

Glaucoma, if left untreated, can lead to the faster development of permanent blindness or permanent vision loss. Treatments can slow down additional eyesight loss, but they cannot restore the lost vision. If you experience eye pain, severe headaches, or vision issues, it’s crucial to see an eye specialist as soon as possible.

Medications to treat glaucoma:

Glaucoma can be treated with a variety of prescription eye drops.

Laser therapy to treat glaucoma:

Your eye specialist uses a laser to enhance fluid outflow from your eye, and they might advise using lasers as a first-line treatment in place of or in addition to eye drops.

Surgery to treat glaucoma:

Surgery is another method to lower ocular pressure. As compared to drops or lasers, it is more invasive but also more quickly leads to improved ocular pressure control.

Is glaucoma curable?

No, glaucoma cannot be cured, but you can control the disease’s progression and its symptoms.

The best ophthalmologist in Mumbai can help you plan your glaucoma treatment

While there is no known cure for glaucoma, there are therapies that can manage eye pressure and prevent eyesight loss. Eye exams might save your vision by detecting the condition early, and you can prevent glaucoma from getting worse and leading to irreversible vision loss or blindness by carefully selecting your course of therapy. If you have glaucoma or are at high risk of developing it, it’s important to schedule an appointment at Ojas-Eye Hospital in Mumbai right away.

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Important Facts About Glaucoma That You Should Know

Overview

Glaucoma is a serious medical condition related to the eyes. If left untreated, it may silently cause permanent loss of vision. It damages the optic nerve (nerve of your eyes).

The risk factors for glaucoma include:-

  • Age: Risk increases with age
  • Family History of glaucoma: It runs in families, which means that you are more likely to get it if you have a family history of glaucoma.
  • Increased eye pressure ( intraocular pressure )
  • Increased risk in patients with High myopia, Diabetes, hypertension
  • Due to increased pressure in the eye, the nerve of the eye ( optic nerve ) that sends the image to the brain is damaged, and as a result, peripheral vision and later central vision is severely affected. Most people suffering from glaucoma would not notice any kind of symptoms and it damages vision silently.

What Are The Causes Of Glaucoma?

Due to multiple reasons, the fluid pressure of the eye maybe increased leading to damage to nerve cells (neurons) resulting in loss of vision.

Seven Facts About Glaucoma

  • You may not have any kind of pain or other signs and symptoms in the early stages of glaucoma. Only advanced type of closed angle glaucoma may present with pain, redness, watering.
  • Glaucoma if untreated results in advanced vision loss. This vision loss may be permanent and cannot be reversed. The increased pressure has already damaged the nerves of the eyes that cannot be reversed.
  • According to the Glaucoma Research Foundation, an estimated 3 million people in America suffer from glaucoma. It has also revealed that about 12 per cent of all blindness is caused by glaucoma. However, glaucoma is a common eye condition but we still need to increase its awareness amongst general public.
  • Certain factors increase the risk of getting affected by glaucoma. Therefore, it is very important to understand the risk factors for glaucoma. In addition, by knowing the risk factors, people may get aware of how frequently and important it is to consult an eye doctor for an eye examination.
  • Early diagnosis and appropriate treatment is beneficial. Glaucoma can be recognized in its early stages by going for a regular eye exam. The doctor can detect glaucoma by performing some specialised eye tests.
  • Glaucoma can be treated , but damage once done cannot be reversed.

Types of surgeries are used such as:-

  • YAG PI Laser: This is used if you suffer from narrow-angle (closed angle type) glaucoma. The person suffering from narrow-angle glaucoma is at a higher risk of getting affected by vision loss. In this surgery, a small hole in the corner of the eye is made. It enhances the outflow of fluid through the eye, equalizing the pressure between the compartments of the eye.
  • SLT Laser: This is a pain-free option. In this process, the doctor will increase the width of the fluid channels to increase the outflow of the fluids accumulated inside the eyes.

Anyone can be affected by glaucoma. Glaucoma can affect anyone, but certain risk factors can increase the chances of getting affected by it. Some of these risk factors are:-

  • People have a family history of glaucoma.
  • People aged over 60.
  • Mexican Americans are at a high risk of getting affected by glaucoma.
  • If you have a thin cornea at its centre, you are also at high risk.
  • Diabetes, hypertension
  • High Myopia

Conclusion

There are several treatment options available for medical and surgical management of glaucoma. These treatments can help reduce the pressure inside the eyes and help relieve its symptoms.

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Contact Lens Sensor In Monitoring 24-Hour IOP

Common Eye Myths And Myth Busters

Glaucoma is a condition in which increased intraocular pressure leads to alteration in the visual function. The symptoms of glaucoma are believed to be caused due to pressure on the posterior part of the eye, especially the lamina cribrosa, which is a part of the back of the eye where the sclera gives way to the retinal ganglion cell axon to leave the eye.

It is essential for the people undergoing treatment for glaucoma to get their IOP (INTRA OCULAR PRESSURE) checked at frequent intervals to evaluate the efficacy of the treatment. Almost all the patients undergo a daytime intraocular pressure measurement at the doctors office due to its convenience. However, the efficacy of the daytime measurement of IOP is under serious debate as people who have well-managed daytime intraocular pressure also complain about the development of the symptoms of progression of glaucoma including visual field defects. Intraocular pressure does not remain the same throughout the day and measuring the extent of fluctuation during 24 hours is the mainstay in deciding the treatment strategy for controlling this risk factor.

Various studies have indicated that patients with low IOP have their disease progressing leading to reduced eyesight. This is supposed to be due to variation in IOP which makes optic nerve vulnerable to increased mechanical stress and strain. The stress on the optic nerve is measured far better through 24- hour variability rather than measuring the IOP only during office hours.

Common methods used for measuring IOP include handheld applanation tonometry, Goldman applanation tonometry (GAT), and pneumotonometry. These methods are largely used in day time settings and are not implemented in 24-hour IOP measurement because they are time-consuming and inconvenient to the patient. Various ambulatory methods for measuring 24-hour IOP have been developed. These methods include permanent IOP monitoring, self-tonometry, and temporary IOP monitoring.

The researchers found that IOP is a principal and only modifiable risk factor for the progression of glaucoma. However, the lack of effective methods for IOP data collection reduces the efficacy of strategies for managing IOP. Various decisions related to the management and surgery for glaucoma are based on ambiguous and unauthenticated IOP data leading to poor outcomes. The IOP characteristics such as mean, peak and fluctuations in IOP should be accurately measured to improve therapeutic efficacy.

A study was done to determine the use of a contact lens sensor device in measuring the 24-hour IOP in the patients who had undergone various interventions in the management of glaucoma. The contact lens sensor device works on the mechanism that fluctuations in intraocular pressure change the curvature of cornea which is measured by this device. This device provides a 24-hour data related to changes in IOP. The study also determines which intervention is the most effective in providing minimum IOP fluctuations.

The study includes 30 centers from sixteen countries and a total of 182 patients were involved. The number of eyes undergone interventions was 182. IOP in 60 eyes was managed through topical medications, incisional surgery was done in 53 eyes, and 69 eyes were with laser trabeculoplasty. The ocular dimensional profile was measured before and after the interventions through CLS (CONTACT LENS SENSOR )

Patients with ocular hypertension, open-angle glaucoma and who are glaucoma suspects were included in the study with a provison that they must have reliable and sufficient CLS readings. Patients who do not have complete and sufficient readings were excluded from the study. Various statistical tools were used during the study such as linear regression and Benjamini-Hochberg approach. Spearman rank correlation coefficient was used to analyze the relationship between changes in CLS parameters and GAT ( GOLDMAN APPLANATION TONOMETER) IOP.

The study concludes that all three interventions, viz, the medications, laser trabeculoplasty and, incisional surgery were effective in managing the IOP. In the patients with incisional surgery, the IOP before and after the intervention was 21.4 mm Hg and 14.7 mm Hg respectively, indicating a mean reduction of 6.8 mm Hg. In the laser trabeculoplasty patients, there was a mean reduction of 2.7 mm Hg with before and after the intervention, IOP measured 17.2 mm Hg and 14.6 mm Hg respectively. The topical medications lower the IOP by 0.97 mm Hg with measured IOP before intervention 18.1 mm Hg and after intervention 17.1 mm Hg.

Incisional surgery was found to be significantly effective on 20 CLS parameters as compared to the other two methods while on one parameter, laser trabeculoplasty was more effective than topical medications. Incisional surgery was found to be predictive for most of the changes in CLS parameters. The researchers indicated that contact lens sensor is an effective method to monitor the 24-hour IOP fluctuations as compared to GAT which is mostly used for day time IOP measurement. The researchers also found that sensitivity was more in nocturnal CLS parameters as compared to diurnal parameters. The authors concluded that this device is effective in measuring the efficacy of the treatment.

A multicenter, retrospective cohort study was conducted on 445 patients at 50 centers in 13 countries. The study also advocates the used of CLS in measuring the IOP. The study indicates that the 24-hour CLS measurements may be associated with previous rates of progression of glaucoma. It is a more convenient and effective method than Goldman which requires multiple time measurements during office hours. The CLS, according to the study, is a useful tool in analyzing the future progression of glaucoma.

In a prospective, cross-sectional study done on forty treated patients, it was found that CLS parameters were related to the field of progression in treated eyes. The device is effective, especially in high-risk eyes, in monitoring IOP while receiving treatment.

Reference:

Chun Hing Ho and Jasper K. W. Wong, Role of 24-Hour Intraocular Pressure Monitoring in Glaucoma Management, Journal of Ophthalmology, Volume 2019

Anastasios G. Konstas, Malik Y. Kahook et al, Diurnal, and 24-h Intraocular Pressures in Glaucoma: Monitoring Strategies and Impact on Prognosis and Treatment, November 2018, Volume 35, Issue 11, pp 1775–1804

Cutolo CA, De Moraes CG, The Effect of Therapeutic IOP-lowering Interventions on the 24-hour Ocular Dimensional Profile Recorded with a Sensing Contact Lens, J Glaucoma. 2019 Mar;28(3):252-257

De Moraes CG, Mansouri K et al, Association Between 24-Hour Intraocular Pressure Monitored with Contact Lens Sensor and Visual Field Progression in Older Adults with Glaucoma, JAMA Ophthalmol. 2018 Jul 1;136(7):779-785

De Moraes CG, Jasien JV, Visual Field Change and 24-Hour IOP-Related Profile with a Contact Lens Sensor in Treated Glaucoma Patients. Ophthalmology. 2016 Apr;123(4):744-53

Dunbar GE, et al. The Sensimed Triggerfish contact lens sensor: efficacy, safety, and patient perspectives. Clin Ophthalmol. 2017; 11: 875–882.

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Is Trabeculectomy Still The Best In Glaucoma Surgery?

Digital Eye Strain

Trabeculectomy is the surgical procedure to treat the increased Intra-ocular pressure, the condition medically known as glaucoma. The surgery involves removing a small piece of trabecular meshwork by making a tiny hole in the eye. The surgery is regarded as the Gold Standard in the management of intra-ocular pressure when other measures to bring down the pressure, such as medications or laser surgery, does not offer satisfactory results. Various studies have demonstrated the efficacy of trabeculectomy in lowering the IOP and there is adequate data to demonstrate that this surgery results in high proportion of drop free patients.

The procedure of trabeculectomy is not the recent one although the method and instruments with which the surgery is done is progressively advanced. However, the efficacy of this procedure is derived from old studies as well. An old study concluded that there was a significant fall in the intra-ocular pressure due to trabeculectomy with simultaneous rise in aqueous outflow. In a study done on Chinese patients suffering from Pigmentary glaucoma, the researchers concluded that there was a satisfactory reduction in IOP with follow-up of 8 years after trabeculectomy surgery along with maintained visual function.

In a study done on Japanese patients, it was found that by achieving a single digit IOP through trabeculectomy, there was a delay in progression of visual function defect in those who have progressive normal tension glaucoma.

No surgery is devoid of disadvantages and this is the reason that the research in the direction of innovation and advancement is virtually a never-ending process. Although trabeculectomy is highly effective in lowering the intraocular pressure which is not controlled by medications and laser therapy and ticks all the boxed in context to efficacy. However, it has certain disadvantages. The primary disadvantage of trabeculectomy is its complications. The complications are sometimes serious and put a question mark on the safety of this technology.

A retrospective study mentions trabeculectomy as a surgical procedure with numerous complications. The study went on stating that sometimes the post-operative management of these complications are more difficult that performing the surgery. This study discusses in detail about the intraoperative and postoperative complications of trabeculectomy. Major intraoperative complications, according to the study were, Anterior Chamber Hemorrhage, Conjunctival hole, Hypotonia, Complications of the sclera flap, and Losing the anterior chamber of the eye. The study also mentions that patients with neovascular glaucoma, diabetes and vitrectomy before the trabeculectomy have lesser chances of success with trabeculectomy. Postoperative complications include hyphema, decompression retinopathy, and choroidal detachment.

The data indicates that because of the multifactorial reasons the number of trabeculectomy has been decreased with complications associated with this procedure being one of the primary reasons. Other important reasons for this decline are effective management of IOP thorough advanced medications and availability of non-invasive management techniques and minimally invasive techniques including glaucoma drainage devices.

Another study, apart from depicting the complications, also sums up the impact based on gender and ethnicity. The study concluded that the complications such as shallow or flat anterior chamber, encapsulated bleb, ptosis, serous choroidal detachment, and anterior chamber bleeding or hyphema occurred in more than 10% of the subjects. Also, the incidence of new anterior or posterior synechiae, serous choroidal detachment, and wound leak was relatively more in older patients. The blacks have more likely to have post-operative ptosis while they have low incidence of anterior chamber bleeding.

However, with the advancement of technology and new methods evolving in trabeculectomy procedure, the complications are minimized and are handled effectively in case they appear. The result of another study shows that easy-to-perform, safe and low-cost compressive sutures may be useful in prevention and management of complications due to glaucoma surgery. Apart from the procedural advancement, postoperative care also plays an important role in the management of complication developed due to trabeculectomy. A study done on 428 eyes of 395 patients throws light on this important proposition. The study stresses on the importance of strict postoperative care to minimize complications after trabeculectomy. Most patients require postoperative care after trabeculectomy surgery.

Minimally Invasive glaucoma surgery (MIGS)

The trabecular surgery is done through Minimal Invasive Glaucoma Surgery to reduce the complications. The surgery is performed with the use of tiny incision and tiny instruments and the procedure involves clearing up the ocular drainage system by cutting up the trabecular meshwork with causing any damage to the surrounding tissues. During the MIGS, the trabecular meshwork may either be bypassed or destroyed. The major advantage of MIGS is that it does not cause the complications related to bleb and hypotony. One of the major limitations of Minimally Invasive Glaucoma Surgery is that it has a limited IOP reduction and is less effective than trabeculectomy.

Cost is another important factor to be kept in mind while performing the glaucoma surgery. The surgeon must keep a balance between preserving the visual function and cost attracted by a surgical process. The impact that the cost imparts to the patients are non-inferior to side effects of surgery. The factors affecting the cost of surgery includes surgery time, the device used in surgery, surgeons experience, follow-up frequency and post-operative care. Further, the cost perspective should not be counted solely on direct cost rather other factors which are worth considering in the overall cost makeup include recovery period, restriction on the lifestyle and risk of permanent or temporary vision loss.

Reference:

Watson PG, Barnett F., Effectiveness of trabeculectomy in glaucoma., Am J Ophthalmol. 1975 May;79(5):831-45

Qing GP, Wang NL et al, Long-term Efficacy of Trabeculectomy on Chinese Patients with Pigmentary Glaucoma: A Prospective Case Series Observational Study., Chin Med J (Engl). 2016 Jun 5;129(11):1268-72.

Tomoko Naito, Miyuki Fujiwara, et al, Effect of trabeculectomy on visual field progression in Japanese progressive normal-tension glaucoma with intraocular pressure < 15 mmHg, PLoS ONE 12(8)

Barac Ramona, Pop Monica et al, Intraoperative and postoperative complications in trabeculectomy, Clinical study, Rom J Ophthalmol. 2015 Oct-Dec; 59(4): 243–247.

Jessica A. Olayanju, BS, Mohamed B. Hassan, BA, David O. Hodge, MS et al, Trabeculectomy-related complications in Olmsted County, Minnesota, 1985 through 2010., JAMA Ophthalmol. 2015 May;133(5):574-80.

Henry D. Jampel, David C. Musch et al, Perioperative Complications of Trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS), Am J Ophthalmol. 2005 Jul;140(1):16-22.

Fernanda Spinassé Agostini, Fábio Petersen Saraiva et al, Use of compressive suture in the prevention and management of perioperative complications of glaucoma surgery, Rev. bras.oftalmol. vol.77 no.4 Rio de Janeiro July/Aug. 2018

Kirwan JF, Lockwood AJ, Shah P et al, Trabeculectomy in the 21st century: a multicenter analysis, Ophthalmology. 2013 Dec;120(12):2532-2539.

Lívia M. Brandão and Matthias C. Grieshaber, Update on Minimally Invasive Glaucoma Surgery (MIGS) and New Implants, J Ophthalmol. 2013

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Is Immune System A Cause For Glaucoma?

Cataract surgery in mumbai

Before initiating the discussion about the relationship between the autoimmune disease and glaucoma, let’s have a quick review of the impact of the immune system on eyes. The body has various sites that are immune privileged. These sites are places in the body where the graft tissues can be placed without any concern of tissue rejection which when placed in non-privileged sites could have led to an inflammatory immune reaction. These sites have the ability to tolerate antigens without any immune response. Eyes along with anagen hair follicles, testicles, placenta and fetus, and central nervous system are considered as privilege organs for a long period. Various mechanisms are present in the eyes that prevent the action of the immune system in the eyes. First, the barrier system in eyes is so strong that it does not allow the entry of immune cells inside the eyes thereby preventing the immune response. Second, various immune cells, intrinsic to the ocular region are present, which detects the foreign antigen. These cells are responsible for suppressing the immune response of the systemic immune system. This suppression of the systemic immune system is known as the Anterior Chamber Associated Immune Deviation (ACAID).

Various studies have indicated the impact of the immune system on ocular health and the latest study has again concluded that autoimmune disease may have an impact on the development of glaucoma. However, the previous studies were having a little impact on the treatment of glaucoma and the treatment was mainly concentrated on reducing the intra-ocular pressure for the management of glaucoma.  The reason being not much of the information was available in context to the mechanism of autoimmune disease that may lead to glaucoma and lack of effective therapy for managing glaucoma due to autoimmune disease. It is also been indicated that in almost 25% of the people, increased intraocular pressure is not the cause for progressive glaucomatous neuropathy and the number of people in this class in Asia is even higher and is up to 90%. In such patients, direct stress on optic nerve and retina contributes to the symptoms of glaucoma. Various mechanisms are postulated for the development of glaucoma in these patients such as genetic mutation, underlying disease conditions such as ischemia, altered morphology of optic nerve and presence of aberrant immunity.

The study conducted at MIT and Massachusetts Eye and Ear has shown that autoimmunity may be one of the reasons behind the development of glaucoma. Scientists found that this mechanism may be true in patients whose glaucoma worsens even after maintaining the IOP at safer levels through medications. While finding the exact reason for this unusual condition, the reason that strikes the mind of scientists was the immune system. They were surprised to find that T cells were present in the retina of these mice because, in general conditions, these immune cells are blocked by the blood-retinal barrier to entry in the retina. The reason for this may be a change in permeability of the system due to increased ocular pressure due to which T cells find their way in the retina and continue to damage retina even when the IOP is normal.

It was also interesting to find that the mice with high intraocular pressure, which were devoid of T cells had no progression of disease after maintaining IPO at a safe level. The study also proposes the mechanism through which T cells damages the retina. The study reveals that the T cells target the heat shock protein that helps the retina to fight against stress. Normally, the immune system does not attack the protein of the host but due to earlier encounters by the bacterial heat shock protein, and due to a high level of similarity with the heat shock protein of mice, T cell attack the retinal T cell protein. This hypothesis was also tested by inducing glaucoma in mice who never encountered bacterial exposure. These mice were resistant to developing glaucoma.

The next question that needs to be answered was how far this study on mice applies to humans. The researchers of this study found that human with glaucoma has five times more T cells that target heat shock proteins. The researchers also pointed out that there is no specific bacterium that causes glaucoma and the mechanism is due to a combination of bacteria. This study will help in identifying potential tool for managing glaucoma by managing the autoimmune response. The researchers also believe that this mechanism may also apply to various neurological conditions related to autoimmune disease that may lead to advanced management of these conditions.

Reference:

Nature Communications, 2018; 9 (1) DOI: 10.1038/s41467-018-05681-9

Exp Eye Res. 2011 Aug;93(2):187-90.

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Glaucoma

Digital Eye Strain

A new innovation in Glaucoma treatment. The Beacon Aqueous Microshunt (MicroOptix) –  the brain child of David Brown, MD, 20 years in development-is 3.1 mm in length with an external flange width of 7 mm. It is implanted into a paracentesis-like incision, allowing aqueous to flow through a central channel.

 Mitigation against retrograde flow of pathogens would be a concern for such an idea. However, Dr. Riedel said that this is prevented 1 ) by shear stress and 2) by the polyethylene glycol material that composes the central layer of the three-layer device. Polyethylene glycol is considered the gold standard of anti-bio fouling materials. It is super hydrophilic, and it prevents adherence of protein and bacteria to the channel wall, Dr. Riedel explained.

In a porcine animal model followed to 6 months, Dr. Riedel noted no infections and significant, persistent IOP lowering. An aggressive bacterial challenge with the device on eight animals did not result in eye infection, Dr. Riedel said.

Preliminary data from an early bird study in the U.S. and E.U. has shown a mean IOP ( eye pressure ) of 13 mm Hg at 6 months, compared to a baseline mean of 27 mm Hg that was medicated with no washout of patients. Eighty-seven percent of patients showed a 20% reduction in pressure compared to baseline and all patients except one were off all medications postop. Most patients, Dr. Riedel said, were vet or extremely comfortable at 6 months.

In terms of safety, there were no infections or uveitis, no dislocations or device migration, and no sight-threatening complications. There were there device blockages, two of which resolved completely with no or minimal in tervention. The third was remove for persistent blockage.

Dr. Riedel said investigators will soon conduct a prospective, multicenter study to evaluate safety and efficacy in refractory glaucoma.

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