Download Glaucoma Treatment

DEPARTMENT OF COUNSELLING
Glaucoma Treatment
ARAVIND EYE CARE SYSTEM
Aravind Eye Hospital
& Postgraduate Institute of Ophthalmology
Methods of Treatment
 Medication
 Laser
 Yag PI
 Diode CPC
 Surgery
Counsellor Role
The main concern in glaucoma counselling is ensuring
compliance to medications
 The counsellor should be able to communicate importance of
using medications to bring down the IOP and that
medications only preserve his vision from not deteriorating
further
 They are unlikely to improve it from the present stage
 She should try to ensure the support of the family in
prolonged treatment
Cont…
 It helps to allot specific times for the
medications to be instilled
 Most of the medications have no serious
side effects. However they may cause
worsening of asthma, allergy, redness of
eye etc
 The counsellor can also demonstrate the
correct method for instillation of
medications
YAG Peripheral Iridotomy
A small opening is made in the Iris to bypass the
block at the level of the pupil
 In patients who have already developed angle
closure glaucoma this relieves pain and brings
down IOP

In primary angle closure glaucoma suspects
this is done as a preventive measure to
prevent future rise in IOP and allow dilated
fundus examination
 The procedure does not need hospital
admission
 The patient has to use topical drops for
an hour
 The Laser procedure itself takes less than
10 minutes
 Patients can continue all normal activities
post laser
Counsellor Role
 To make patients in pain comfortable and
reduce the waiting period for treatment when
possible
 Explain the nature of disease and necessity of PI
in patients advised prophylactic laser PI
 Patient should be informed that a repeat sitting
may be necessary in some cases and it causes no
harm to the eye
Laser suturelysis
 At the time of glaucoma surgery 1 to 3
sutures are placed in the eye
 On follow up if necessary one or more of
these sutures are lysed using yag laser
 In the first 2 to 3 months period following
glaucoma surgery, patients might need
frequent followup to decide on suture lysis
Counsellor’s role
 To explain to the patient that though
cataract surgery may be sutureless,
glaucoma surgery involves 1-3 sutures
 Removal of this suture is done by a
laser beam and is painless
 This helps to further bring down
intraocular pressure
Laser Trabeculoplasty
Diode CPC : ALT (Argon Laser
Trabeculoplasty)
 A minor laser procedure done
Under local anaesthesia:
 It does not improve the vision of the eye
 It brings down IOP by partially the structures
that produce the fluid inside the eye
 It is done in eyes with poor visual prognosis
and when all other measures have failed
Counsellor Role
 To communicate to the patient that the
procedure will help to provide pain relief
 It cannot give back lost vision
Surgery
 Trabeculectomy
 Cataract surgery
 Combined surgeries
Trabeculectomy
 A minor surgery, done under local
anaesthesia to bring down the intra
ocular pressure and thereby protect the
optic nerve from further damage
Cataract
 The clouded lens in the eye is
removed and replaced with an IOL
 Can be done under local or topical
anaesthesia
Combined Surgeries
 If a patient who needs glaucoma
surgery also has operable cataract, the
surgeries can be combined through
cataract surgery may be sutureless
glaucoma surgery involves 3 sutures
and move frequent follow up
Counsellor Role
Trabeculectomy:
 She should communicate to the patient that
trabeculectomy does not improve the vision of the
patients but maintains as it is
 In very few patients there is even a chance for a mild
decrease in vision following the surgery there might
be a small scar in the white of the eye superior to the
cornea
Cataract:
 She should explain the wide variety of IOL’s and
surgicals options available for the patients
Surgery under guarded visual prognosis
Patients with advanced glaucoma and high
intraocular pressures may have poor visual
prognosis
 Due to the already damaged state of the optic
nerve
 Due to the higher rate of complications due to
raised IOP
Counsellor should be able to thoroughly
communicate this to the patient so that he has
realistic expectations regarding the surgery