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Dr Arvind Morya
Glaucoma is a group of progressive eye diseases and a leading cause of irreversible blindness worldwide. In India, glaucoma is a prevalent eye condition that poses a significant public health challenge. The chronic eye condition affects approximately 1.2 million individuals and is responsible for 5.5% of all cases of blindness. This places it among the primary causes of permanent vision loss in the country. The high burden of glaucoma in India can be attributed to factors such as the large population, genetic predisposition, increasing life expectancy, and a lack of awareness and access to proper eye care services in certain regions.
Glaucoma causes damage to the optic nerve and loss of side vision. It’s often linked to high pressure in the eyes. But apart from high pressure, other things also play a role in how glaucoma starts and gets worse.
Age: Glaucoma can happen at any age, from a newborn to a teenager to an adult to a geriatric person. Age is a significant risk factor for glaucoma, particularly for primary open-angle glaucoma (POAG) which is also known as a ‘Silent Thief of Vision’. The incidence of glaucoma rises with advancing age, with individuals over 60 years old at a higher risk. As the population continues to age, the prevalence of glaucoma is expected to increase, emphasising the importance of early detection and management.
Family history and genetics: Glaucoma frequently demonstrates a hereditary aspect, indicating a genetic inclination towards the condition. In a specific instance, a patient suffering from glaucoma while delving into their family’s medical history, discovered that one of their parents had been diagnosed with glaucoma in their later years. If someone in your close family (like a parent, brother, sister, or child) has glaucoma, your chances of getting it yourself go up. Diverse gene mutations and variations have been linked to distinct types of glaucoma, providing an understanding of the fundamental biological processes involved.
Elevated Intraocular Pressure (IOP): In an eye checkup, the intraocular pressure inside the eye is measured. Even if it’s in the normal range, consistent check-ups are suggested as higher intraocular pressure could eventually result in glaucoma. Elevated IOP is the most well-established risk factor for glaucoma. The aqueous humour, fluid within the eye, normally circulates and maintains healthy eye pressure. When this balance is disrupted, increased IOP can damage the optic nerve over time. However, it is important to note that not all individuals with elevated IOP develop glaucoma, and some may develop glaucoma even with normal IOP levels and it is known as Normotensive Glaucoma. In short axial-length, high hypermetropic and deep-seated eyeballs, Angle Closure Glaucoma can occur along with sudden painful loss of vision. Angle Closure Glaucoma happens when aqueous humour fails to move out of the eye as there is a blockage due to angle closure.
Ethnicity: Certain ethnic groups have a higher prevalence of glaucoma compared to others. For instance, individuals of African, Hispanic, or Asian descent have an increased risk of developing certain types of glaucoma, such as primary open-angle glaucoma or normal-tension glaucoma. The reasons for these ethnic disparities are not fully understood but may involve genetic, anatomical, and environmental factors.
Other medical conditions: Certain health conditions have been connected to a higher chance of getting glaucoma. Things like diabetes, high blood pressure, heart problems, Type-A personality and migraines might make someone more at risk. People with these conditions should make sure to have regular eye check-ups to catch glaucoma early if it shows up.
Medications and eye injuries: Certain medications, such as long-term use of steroids, can raise the risk of glaucoma. Additionally, eye injuries, particularly those involving blunt trauma, may lead to the onset of angle recession glaucoma. Individuals with a history of eye trauma or long-term corticosteroid use should be vigilant. Age, family history, elevated IOP, race and ethnicity, other medical conditions, and eye anatomy all contribute to an individual’s risk of developing glaucoma. By understanding these risk factors, we can improve the chances of early diagnosis and the implementation of appropriate treatment strategies to preserve vision and enhance the quality of life for those affected by glaucoma. Everyone above the age of 40 must undergo a regular eye checkup once a year.
Medical and surgical management: At present, intraocular pressure is the only treatable factor in glaucoma. First, medications are instilled to control the intraocular pressure and if it is still not controlled then various surgical procedures are available to make artificial pathways for the enhanced flow of aqueous humour from the eye.
(The author is head and additional professor at AIIMS, Bibinagar, Hyderabad.)