These are among a few questions a recent client and his relatives asked me when I told that the young man has been diagnosed with glaucoma. It"s not frequently that you diagnose a young man with glaucoma, but the incidence is increasing with each passing year and the age of onset is coming down. So what is the cause of glaucoma? I wish to answer those questions asked by this young man and his relatives.
Glaucoma is defined as an optic neuropathy with typical changes at the optic disc. Increased intra-ocular pressure is a major but not the only cause of glaucoma and this is the only cause that can be treated. Age related changes, oxidant damage, blood flow to the optic neurons, coexisting systemic diseases, all have been implicated as contributing to glaucoma. But intra-ocular pressure remains as the only factor that can be modified. All research and surgeries have been directed to modify the intra-ocular pressure.
Over the years many drugs have been developed by pharmaceutical companies with the aim of controlling intra-ocular pressure. Starting from timolol to latanoprost and travaprost various drugs are available for management of intra-ocular pressure. Various surgeries are also developed to control intra-ocular pressure. We have trabeculectomy with and without the use of anti-metabolites, drainage and shunt devices and in the last stages we have cryo and laser cyclo ablation.
How successful have we been in restoring normal vision to a person with glaucoma? Have we at least improved his or her quality of life? In this race to prescribe drugs and do surgeries have we lost the big picture that we are treating a person?
All the drugs that are available today in the market have been tried in western countries first on animal models and then on a limited number of people before being put up for sale. We have seen that these drugs lose their potency with continued use over the years. Even surgeries become ineffective after a few years.
All the theories and postulations of the origin of glaucoma need rethinking. There are many other factors other than intra-ocular factors that contribute to optic neuropathy. In the current scenario systemic diseases such as diabetes, hypertension, hyperlipidaemia, cardiovascular diseases and other lifestyle diseases can be thought to be factors for the development of glaucoma. Addictions such as nicotine and alcohol also contribute to optic neuropathy.
Yes, modern diagnostic modalities have helped us in diagnosing in the disease. It is necessary to proper review and to assess the progression of the disease. It has helped to assess the efficacy of the drugs and surgical modalities. Now we need to apply this thinking to improve the quality of vision and reverse or the least prevent the progression of glaucomatous damage by looking at a lot more factors that can be modified other than intra-ocular pressure.
For this goal to be achieved there needs to be a good assessment of the patient by the treating physician. He or she should do a complete examination of the patient.Not only his eye, a complete and wholesome treatment of the patient is needed. One should be able to use basic science knowledge to evaluate the patient and arrive at a diagnosis of why glaucoma has happened. The diagnosis should be confirmed with the use of appropriate investigations. While addressing the management lifestyle diseases also should be taken into account and modification of lifestyle which includes healthy diet, wholesome diet and proper relaxation should be emphasized. Medication should be such that it suits the patient and does not worsen his quality of life. A good rapport needs to be maintained with the client so that e can approach the physician with comfort. Above all emphasis should be to heal and not treat the client.
What you can do:
Contact Dr. Ashley Mulamoottil, who is the Medical Director & Chief Surgeon in Mulamoottil Eye Hospital & Research Center, Kozhencherry, Kerala. You can also interact with him from his Facebook page.