The silver lining

One in 20 Indians over the age of 40 either has glaucoma or is in danger of developing glaucoma in the future. Left undetected or poorly treated, it can result in irreversible loss of vision in patients.

The diagnosis is based on clinical examination - looking at the optic nerve, measuring the intraocular pressure and perimetry, all of which are easy to do and routinely available.

A better understanding of risk factors and causes of glaucoma-related visual loss over the past two decades has led to more appropriate treatment algorithms and a resultant ability to slow down further loss or preserve remaining vision, preventing blindness due to glaucoma.

Today, there is improved knowledge about the level of fluid pressure in the eye best suited for a particular degree of glaucomatous optic nerve damage. Achieving such a lowering of pressure has been shown to preserve vision over the long term in a very large percentage of glaucoma patients, in many large and small studies.

There are many effective medications available to lower the eye pressure, and Indian pharmaceutical companies have made these available at much lower costs than obtainable elsewhere in the world. In many cases, one to three eye drops, in one or two bottles are sufficient to lower the pressure to the right level. These need to be used extremely regularly, so that fluctuations of the pressure are prevented.

In case eye drops cannot control the eye pressure to the required level, a glaucoma surgery can be done. During such a surgery, a new channel is created to permit fluid within the eye to flow out where it can be easily absorbed. Improvements in the gold standard, trabeculectomy, now permit a much safer way of lowering pressure appropriately, without significant complications.

India has many special socio-economic problems and patients find it difficult to pay for life-long tests, medicines, surgery etc and travel to tertiary centres for review. Early surgery may help reduce this burden by decreasing the need for medications and frequent reviews.

To provide free glaucoma care to patients, the government provides a reimbursement of Rs 1,500 for diagnosis and medical treatment of both eyes or laser/surgical treatment of every patient treated by NGOs and private hospitals.

The Ministry of Health has also set up a national task force for glaucoma management to address the need for early detection of glaucoma before significant loss of vision. Under this scheme, district ophthalmologists, who are the first point of contact for most of the patients are given training in the diagnosis and appropriate management of various types of glaucoma commonly seen in India.

— Prof Ramanjit Sihota is Head, Glaucoma Research Facility and Services, AIIMS, New Delhi