The initial treatment for most types of glaucoma is the lowering of eye pressure, which can be achieved using outpatient laser treatment or long-term eye drops. If this approach is inadequate, then a variety of surgical interventions are available to lower eye pressure - ranging from minimally invasive devices (Istent, Xen) performed in isolation or in conjunction with cataract surgery, filtration surgery (trabeculectomy) and the insertion of drainage devices (tubes, aqueous shunts). All surgery for glaucoma can be performed on a day-case basis or with overnight stay at Moorfields Eye Hospital.

Glaucoma is more common in individuals with a family history, extremes of spectacle correction and in people of African or Caribbean heritage. Accurate and timely diagnosis, treatment and monitoring are essential to ensure that glaucoma does not impact patients' quality of life, or their ability to work or drive.

Glaucoma is a leading cause of irreversible worldwide blindness characterized by damage to the optic nerve which connects the eye to the brain. The damage and loss of sight from glaucoma is related to high pressure within the eye, although sight loss from glaucoma can be seen in patients with normal eye pressures. Typically glaucoma affects the outer part of the vision (see simulated photo opposite) and progresses to eventually involve the central vision.

There are many causes for glaucoma which can be divided into Primary Open Angle Glaucoma, Primary Angle Closure Glaucoma and Secondary Glaucomas. The majority of glaucomas do not cause symptoms to patients until significant loss of vision has occurred and therefore early detection, diagnosis and treatment is essential to maintain good vision throughout life. A diagnosis of glaucoma is made by clinical examination of the eye including the optic disc, testing of the visual field and using state of the art imaging techniques to study the innermost layer of the retina (nerve fibre layer) which goes on to form the optic nerve, which is damaged in glaucoma. Appropriate treatment can prevent the natural course of glaucoma that is illustrated in the adjacent diagram.

© 2017 by Hari Jayaram

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