ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute of Ophthalmology ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute of Ophthalmology DEPARTMENT OF COUNSELLING Glaucoma

 Glaucoma is a disease of the optic nerve, caused by an increase in the intra ocular pressure (pressure inside the eye)  This is characterised by a gradual progressive loss of neutrons causing a progressive constriction of visual fields  Optic disc cupping What is Glaucoma?

 Patients with glaucoma may not have any symptoms Some patients may complain of  Frequent change of glasses  Loss of field of vision Symptoms

Patients with angle closure glaucoma may complain of recurrent attacks of  Redness  Pain  Blurred vision  Coloured vision  Headache, vomiting

1.Primary Open Angle Glaucoma (POAG): There is no functional block to the flow of fluid inside the eye (aqueous humour) 2.Primary Angle Closure Glaucoma (PACG): There is a block in the flow of fluid (aqueous humour) in the eye at the level of the pupil 3.Congenital Glaucoma: Occurs from birth and is hereditary. Visual prognosis is guarded. These patients usually need multiple medications & surgery Types of Glaucoma

Parents of children with congenital glaucoma complain of  Child avoiding light  Increase in the size of the eyes  Squinting of eye  Increase tearing from the eye

4. Secondary Glaucoma: Can be due to Can be due to  Trauma  Following surgeries of the anterior or posterior segment  Following chronic inflammation  Prolonged use of steroids  Long standing diabetes, retinal vessel occlusions

 Phacomatic Glaucoma  Phacolytic Glaucoma  Pseudo extoliation Glaucoma  Neo vascular Glaucoma  Pigmentary Glaucoma  Aphakia Glaucoma  Pseudo phakia Glaucoma Cont….. Types of Glaucoma

 Steriod Induced Glaucoma  Traumatic Glaucoma  Low tension Glaucoma  Normal Tension Glaucoma  Ocular hypertensive Glaucoma  Absolute Glaucoma  Jwenile Glaucoma

Investigations These are important for early diagnosis of the disease and also in follow up to prevent out progression of the disease

Visual Field Testing  This analyses the field of vision of the patient  Ideally should be repeated every year or once in a month to rule our progression of the disease  The patient has to understand and cooperate with the test for it to be useful

Central Corneal Thickness  The intra ocular pressure measured by applanation can vary with any change the thickness of the cornea  So CCT is measured for all patients with glaucoma

OCT: This is to diagnose early glaucoma a stage when it cannot be diagnosed, by routine field test and involves scanning of the nerve fibre layer around the optic disc SWAP: This is a modified field, test which uses coloured stimulus Also help in diagnosis early glaucoma UBM: A technique to scan the anterior part of the eye to rule out structural abnormalities

Role of Counsellor Counsellor should explain to the patient why specific investigations are essential and why they have to be repeated to rule out progression of the disease