Glaucoma Management

Glaucoma is a group of eye diseases that cause progressive damage to the optic nerve — the cable that carries images from the eye to the brain — often linked to raised pressure inside the eye (intraocular pressure, or IOP). It can progress silently in its early stages, and vision that has been lost cannot generally be restored. Early diagnosis, appropriate treatment and regular monitoring help preserve the remaining vision and slow further damage.

Anyone diagnosed with or suspected of having glaucoma, and people at higher risk: those over 40, with a family history of glaucoma, raised eye pressure, diabetes, high short-sight, long-term use of steroid medicines, or a previous eye injury. Regular eye check-ups are recommended for these groups even when vision seems normal.

Diagnosis and monitoring use several tests: non-contact tonometry, which measures eye pressure with a gentle puff of air; Goldmann applanation tonometry, the reference standard for measuring eye pressure; gonioscopy, which examines the eye's drainage angle; optic nerve head evaluation, which checks the optic disc and its cup-to-disc ratio for signs of damage; an OCT scan of the retinal nerve fibre layer and ganglion cell complex, to detect structural damage; automated visual field analysis, which maps your side vision and tracks any loss; pachymetry, which measures corneal thickness to help interpret eye-pressure readings; and an anterior segment assessment of the depth and shape of the front of the eye.

Treatment usually starts with eye drops, chosen individually to bring the pressure down to a target level that protects the optic nerve.

Laser treatment may be advised: selective laser trabeculoplasty (SLT) improves drainage in open-angle glaucoma, and YAG laser peripheral iridotomy makes a tiny opening in the iris for narrow or closed drainage angles.

Surgery may be needed when drops and laser are not enough: trabeculectomy creates a new drainage path for fluid; combined cataract and glaucoma surgery treats both conditions in one operation; and cyclocryotherapy, which uses controlled freezing to reduce fluid production, may be considered in selected difficult cases.

Glaucoma is a lifelong condition and needs regular review even when you have no symptoms or the pressure seems controlled. Follow-up visits monitor your eye pressure, check the optic nerve by examination and imaging, track any change in your visual field, review how you are managing with your treatment, and adjust it if needed.

Use your eye drops exactly as prescribed, every day, even when your eyes feel fine, and tell your doctor about any side effects instead of stopping the drops.