Glaucoma cannot be cured but it can be treated. However, awareness is key as a delay in detecting the problem can lead to a worse situation for patients. Top eye experts Padma Shri Dr J.S. Titiyal, Professor, Head of Cornea Services and Chairman, National Eye Bank, AIIMS, Padma Shri Dr Harsh Kumar, Director, Glaucoma Services, Centre for Sight, and Dr Viney Gupta, Professor of Ophthalmology at the R.P Centre, AIIMS, explain what is glaucoma and why people need to undergo regular check-ups, especially if they have a family history of the disease.
Dr Viney Gupta
Dr J.S. Titiyal
Dr Harsh Kumar
Q: What exactly is glaucoma?
Dr Kumar: Glaucoma is a dangerous disease that is known as the silent thief of sight. It is a group of diseases which raises the pressure of the eye and leads to damage in the nerve that collects all the vision signals and sends it to the brain. In India, and even in the USA, it happens that by the time people realize they have glaucoma, 50% of them have lost 90% of their eyesight. So, it is an extremely dangerous disease.
Q: What are the symptoms of glaucoma?
Dr Kumar: Glaucoma cannot be easily detected because there are hardly any symptoms. There are two types of glaucoma: angle closure and open angle. In angle closure glaucoma, the patient actually gets an attack and develops redness, pain and watery eyes. When he rushes to the doctor, the problem is detected. But unfortunately the angle closures usually present themselves silently. The pressure starts increasing and we do not realise it. What you should be careful about is that if you are not able to see something at night, which you could before, or your distant vision is getting blurred, you are developing headaches, seeing coloured halos around bulbs in the evening, or your number is changing every six months or so, you may have early glaucoma.
Q: Does it occur only in people above 60 years of age?
Dr Kumar: Dr Viney is a specialist in children’s glaucoma and operates on children below two years of age also. But usually it occurs in people above 40 years of age unless there is a secondary cause like use of steroids, surgery or other reasons. 1 in every 8 persons are either suffering from or may develop glaucoma, which is why we suggest annual check-ups.
Q: Is glaucoma in children also a congenital disorder?
Dr Gupta: There are many children in our country who develop glaucoma at birth or within a year. It is called infantile glaucoma. It can be detected in children early as they have large eyes. If a doctor detects it, he may refer to a specialist earlier. Although rare, 1 in every 3000-4000 children born in India will have glaucoma so it is necessary to diagnose it early. Adolescents can also develop glaucoma, which is called juvenile glaucoma. Both of these are primary glaucoma and have hereditary components. It is ideal to treat it early.
Q: Can it be cured if detected at a young age?
Dr Gupta: Glaucoma does not have a permanent cure generally. Treatment continues life-long. The patient needs to be monitored throughout their life.
Q: How can stem cells treatment help in curing glaucoma?
Dr Titiyal: As far as glaucoma is concerned, no research is going to help in curing it because the damage is to the nervous tissue and the regeneration of this tissue is one of the toughest things possible. But studies in genetics might have a better option for treating it, especially the congenital variety.
Q: Have gene therapies for glaucoma been conducted in other countries?
Dr Gupta: They have done so in animal models, where they induced the glaucoma-causing gene in the animal and corrected it through gene therapy. But human trials are going to take a very long time.
Q: Are we doing such trials in AIIMS also?
Dr Gupta: Currently, we have not started any such therapies. We need to try it first on animal models and after we are confident enough, we will start human trials. For gene therapy you need to identify the genes responsible for the disease. In glaucoma, only 30% of the cases have known genes. So, unless we do not identify the gene, we cannot correct the disease.
Q: What causes glaucoma?
Dr Kumar: First of all, it is very important for people to know that there is no possible cure through stem cells, so if anyone promises a cure through it, don’t believe them. Secondly, there is an area in the eye through which water percolates through the eye. Due to certain genetic modifications, these holes keep closing by the age of 40 and the water starts collecting in the eye which causes pressure on the optic nerve. This can also be caused due to surgery, trauma or steroids. Whenever children have allergies and are taken to a doctor, the doctor gives them steroids, but if parents continue the use of the same steroids it can have severe repercussions. So we request people to halt the use of steroids without consulting a doctor.
Q: Some people use gulab jal whenever their eyes feel itchy. What would you say about that?
Dr Kumar: When I was at AIIMS, we did research on the use of drops like gulab jal, Itone and Drishti and the studies concluded that these are totally useless.
Dr Titiyal: These drops are quite popular among the public because it is propagated that they are capable of treating every possible disease in the human eye which is not exactly true. We have not tested these medications at all. As far as glaucoma is concerned, these drops are not going to be useful. If the gulab jal is freshly prepared, it may give temporary relief, but when stored for long, it may cause infection. We would definitely test the use of these drops, especially Drishti, in the future.
Q: Many parents admit giving their children these drops from a very young age. Have you seen any cases related to this in your OPD?
Dr Gupta: Yes. If you are using them once or twice, it is okay, but it may cause problems when used for a long time. There used to be a tetracycline ointment that was available in the form of capsules. A lot of such drugs are easily available in the market and are easy for parents to buy. But using these drugs for a child may cause glaucoma, which can then become difficult to cure. We have seen many cases where children have gone blind due to the carelessness of parents and pharmacists. One should consult an ophthalmologist before putting these drops in their child’s eyes.
Q: What is the latest technology available for the treatment of this problem?
Dr Kumar: There are several surgeries available for glaucoma but they are available for very advanced situations. A lot of new medications are coming up and that is why the number of surgeries has actually gone down drastically all over the world. Newer drugs are available now. There was a time when only two drugs like pilocarpine and beta blockers were available in the country.
Q: What would you say about the new mobile app that claims to diagnose glaucoma?
Dr Gupta: In these apps, you enter your data and they work as a risk calculator. But this information must be entered by the doctor because it includes parameters like pressure of your eye, corneal thickness, degree of myopia you have, etc. Only then can the risk be detected for the patient. People who have a family history have to be very careful because the risk is almost 10 times higher. It is ideal to screen and inform members of the family and refer them to an ophthalmologist.
Q: Around 1.2 crore people in India have glaucoma and around 5 lakh of them are from Telangana. What can be the reason behind this concentration?
Dr Titiyal: It depends upon the place of study. Currently we cannot calculate the prevalence of the disease in the country because it is very difficult to conduct surveys on glaucoma. Telangana must have done this study and come out with this report. If you look at blindness, glaucoma-related blindness may not be prominent, but if you look at eye diseases, it would be very common. In other countries, there are a lot of myths related to glaucoma and cataract. So there is a definite need for a good survey in the country so that we come to know about the prevalence of the disease. Rehabilitation and treatment will have to be implemented accordingly. Glaucoma blindness, unlike other blindness, cannot be reversed. I am sure we will be able to conduct a survey in the whole country—if not all districts, important ones can be taken up. According to a study by MPCB, glaucoma is already the third leading cause of blindness in India.
Q: How have glaucoma patients suffered during Covid-19?
Dr Kumar: A lot of people could not visit us and some of them could not get their medications due to which the pressures were not checked. I have seen that most of them had good vision but went on to develop poor vision. Most of them were elderly people. But the first thing often is to save their lives rather than sight. We would request everyone to stock medicines for an adequate time so that in case of a lockdown for 2-3 months, they can be well prepared. Glaucoma patients should never stop their medications. People who have a family history may also develop glaucoma, while others at risk are those who are diabetic, hypertensive, suffering from thyroid or myopic.