Common Glaucoma Questions Answered: An Interview with Gokulan Ratnarajan (Consultant Ophthalmic Surgeon)
When people look online for any medical, surgical or illness-related information, it can often be quite daunting and sometimes even inaccurate. At The McIndoe Centre, one of our main priorities is to educate our patients on the procedures we perform. We believe that by doing this, our patients can become their own health advocates and develop a better understanding of our practices.
In this article, we’re going to be taking an in-depth look at glaucoma. We’ll be covering the different types of glaucoma, the causes, symptoms, treatments and finishing with a personal interview with our resident ophthalmic surgeon Gokulan Ratnarajan.
Understanding the Different Types of Glaucoma
While there are many different types of glaucoma, the symptoms remain very similar. It is also important that patients are able to identify the different types in order to act accordingly.
The name given to the most common type of glaucoma is Open Angle Glaucoma. This is arguably the most dangerous form of glaucoma because it usually goes unnoticed due to the slow-building symptoms. Open Angle Glaucoma is caused by your eye’s drainage channels clogging up over time.
Additionally, you may have the symptoms for years before you realise that your eyesight is deteriorating, which is why it’s important to have your eyes tested once a year to ensure your eyes are in good health.
Acute Angle Closure Glaucoma is the name given to the less common type of glaucoma. This is caused when the fluid in the eye suddenly becomes blocked, which sees the pressure inside the eye rise at a dangerously fast rate. This type of glaucoma requires immediate medical attention due to how quickly it can impact your vision.
While glaucoma is usually associated with age, children are also at risk. Childhood glaucoma – otherwise known as Congenital Glaucoma – is caused by an abnormality of the eye. This is another rare type of glaucoma and is usually diagnosed within the first year of their life. One cause of congenital glaucoma might be due to the eye’s drainage system failing to develop properly. In some cases, it can be inherited.
Secondary Glaucoma is the name given to any type of glaucoma where there’s an identifiable underlying problem. For example, inflammation of the eye may cause secondary glaucoma, whereas primary glaucoma isn’t caused by any previous eye conditions.
What Causes Glaucoma?
While the symptoms of glaucoma do have varying levels of similarity, the condition itself can occur for a number of reasons.
The most common cause is when pressure builds in the eye, meaning the fluid surrounding your eye has trouble draining properly. This means the pressure has nowhere to escape and this will eventually damage the optic nerve that connects the eye to the brain, which in turn, causes impaired vision and sometimes blindness.
The main problem surrounding glaucoma is that it still remains unclear what causes the build in pressure. However, there are certain factors that may increase the risk, such as:
Heritage – if someone in your family has suffered with glaucoma, then it’s more likely that you will develop the condition (however, this varies from family to family).
Prior medical conditions – if you have suffered from any sight-related issues in the past, this may increase your chance of developing glaucoma. Additionally, diabetes has also been linked as a contributing factor.
Age – with age comes a higher risk of developing glaucoma.
While it’s difficult to identify early symptoms of glaucoma, what we do advise is frequent eye tests to ensure your eyes are healthy. Frequent eye tests will ensure that you’re kept up to date with the condition of your eyes and if a problem is found, treatment can begin right away.
Treatment: What to do if you have Glaucoma
Diagnosing glaucoma early is very important, as it’s not currently possible to repair or reverse the vision you’ve already lost. However, treatment is still an option after your diagnosis and it can prevent you from suffering further vision impairment.
As mentioned previously, the way your treatment will be assessed depends on the type of glaucoma you have. The most common treatment options consist of eye drops, laser treatment and surgery. These treatments all help to:
Reduce the build-up of pressure in your eyes
Reduce fluid production in your eyes
And open blocked drainage tubes to further reduce fluid build-up in your eyes.
It’s strongly advised that if you have been diagnosed with glaucoma, regardless of the severity of the condition, you seek regular eye checks to ensure you’re doing everything you can to monitor and track the progress of your treatment.
Looking at Laser Treatment
Treatment for glaucoma, as discussed previously, depends on both the type of glaucoma, the aggressiveness of it and how its developed since diagnosis. Below are the most common treatment options you will be offered to help treat your condition:
Laser treatment (Selective Laser Trabeculoplasty)
Laser treatment has seen success with helping people restore their vision through laser eye surgery (known as refractive surgery or vision correction) and lens surgery. While both of types of surgery are used to help you rely less on your glasses and/or contact lenses, laser treatment for glaucoma adopts a different aim.
The main surgical option is laser trabeculoplasty, as briefly described before, and its function is to drain the tissue in the eye which helps the eye expel excess fluid and therefore release pressure. Prime candidates for SLT are those who have primary or secondary glaucoma and when other treatment options (such as eye drops) have failed. SLT has proven to help prevent future vision loss and patients welcome it due to it being almost painless.
The procedure itself takes on average 10 minutes and is completely painless. The eye is numbed with anaesthetic drops, meaning sedation and general anaesthetic is never needed. Once the procedure is finished, you will be able to resume normal activities straight away.
There are occasional side effects, but they are minimal and easily treatable. Patients may encounter slight inflammation (which is common) and easily treated with eye drops. The treatment itself has shown impressive effectiveness, lowering the pressure build-up by as much as 30%. Although, if the patient is already taking medication to fight the glaucoma, the effect of surgery may be lessened slightly. The treatment usually lasts around 1-5 years, sometimes even longer. If treatment fails to last up to a year, it’s likely it has failed.
If you feel as though your treatment is wearing off after a few years, simply revisit your surgeon and ask to have the procedure repeated. While repeated treatment may not have the same effectiveness as the first, patients do report positive results. However, continuously having the treatment will eventually lead to ineffectiveness. If you do find that SLT has run its course, then glaucoma medication can be used as a substitute.
Complications and Recovery
Complications are incredibly rare, and the recovery period is immediate.
With SLT, the recovery period takes on average 6-8 weeks. It’s strongly advised that you avoid manual labour and even tasks such as bending and heavy lifting. Swimming is also not advised, so be sure to ask your doctor and/or surgeon about when you’re able to go back in the water.
Are there any other treatments?
There are of course other non-surgical, non-invasive treatments to consider. Eye drops are almost always an option when treating glaucoma, as they’re known to help control eye pressure. Unfortunately, all eye drops will cause a very minor stinging sensation upon application, but this only lasts a few seconds.
If eye drops aren’t taking effect, pills are likely to be prescribed alongside your eye drops. Your doctor will decide which specific type of pill you will be given but they all serve the purpose of lessening the build-up of fluid in the eye.
Both these treatments are commonly prescribed before SLT is suggested. Be sure to speak with your eye specialist to ensure that you understand the treatment process. However, if you do have any questions, the team at The McIndoe Centre are here to help.
Testing for Glaucoma
Fortunately, glaucoma is a condition that can be spotted during a routine eye check-up. This is why it is so important to visit your optician regularly. We recommend visiting your optician at least once a year (or more depending on your current eye condition).
Routine checks are often quick and painless, usually involving simple vision tests and measurements of your eye pressure. If your optician finds that you may have developed glaucoma symptoms they will refer you to an eye specialist. The specialist will take you through the various treatment options available and ways you can prevent the condition from worsening.
When to Contact a Doctor
We advise that if you are experiencing any issues with your eyes, such as blurred or deteriorating vision, you should visit your optician or GP. However, having blurred vision is not a direct sign that you have glaucoma, it's simply a sign that you're due for a check-up just to ensure that there are no underlying problems. If you have experienced a sudden loss of vision without any obvious explanation, it’s strongly advised that you visit the nearest A&E department, or eye casualty unit.
Asking an Expert: An Interview with Gokulan Ratnarajan
As it's National Glaucoma Week, we invited Gokulan Ratnarajan - a specialist in glaucoma and anterior segment surgery - to address some of the common questions surrounding glaucoma. Mr Ratnarajan is known for his innovative approach to glaucoma care and his empathetic approach to all patients who walk through his doors. Below, Mr Ratnarajan addresses some of the common questions associated with glaucoma:
Q. What is glaucoma?
"Glaucoma is an eye disease where the optic nerve that runs from the back of the eye to the brain is damaged, and the main risk factor is high eye pressure."
Q. What are the common symptoms of glaucoma?
"Glaucoma does not usually have any symptoms until the disease is already quite advanced, and this is why it is often referred to as “the silent thief of sight”. Unfortunately, once damage from glaucoma has occurred it is irreversible. This is why it is important to get your eyes checked regularly."
Q. What is the most common age that people get affected by glaucoma?
"The risk of glaucoma increases with age, but anyone can be at risk of glaucoma, especially if other people in the family have glaucoma."
Q. Are there any ways to prevent glaucoma?
"The key is to get your eyes checked regularly and if you have glaucoma start treatment early as there is no way of reversing the damage once it has occurred."
Q. How common is glaucoma?
"In the UK there are thought to be half a million people with glaucoma but there are many people who have glaucoma that do not know they have it. Unfortunately, it is the most common cause of irreversible blindness world-wide."
Q. How do you treat glaucoma?
"Eye drops are usually the first line of treatment with laser or surgery reserved for more advanced diseases. However, in the last few years safer and less invasive glaucoma operations have been developed for which I am a world specialist."
Q. What are these new surgeries?
"These surgeries often involve placing tiny stents in the eye to help drainage and lower the pressure in the eye to prevent the glaucoma from getting worse. I perform these innovative surgeries at the McIndoe Centre. The added benefit is this surgery can easily be combined with cataract surgery and the wide range of premium lenses we have to offer."
Q. What can you expect from a glaucoma consultation at The McIndoe Centre?
"You will receive a full comprehensive eye examination, including of course, a check for glaucoma. If you have glaucoma, we will go through your options, explain the diagnosis and discuss which treatment option is best for you. We will be able to offer you the full range of treatments including drops, laser treatment and all the new safer and less invasive glaucoma surgeries that are not widely available in the UK at present."
Glaucoma is the second leading cause of blindness. Over 600,000 thousand people in the UK alone have glaucoma, with many more living with the condition who are yet to be diagnosed. They encourage all of their patients to have regular eye-checks at with their optician every one to two years, depending on your age.
If you have any further questions about glaucoma please do not hesitate to get in touch with their friendly team today.