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| Issues involved in treatment |
Medicine is an art and not a science. Although the diagnosis of glaucoma is based upon years of scientific investigation and research, the diagnosis of glaucoma involves a great amount of diagnostic skill. It is at times difficult to diagnose a disease that has no symptoms until it produces blindness. And because symptoms in the early stages of glaucoma are uncommon it is uncommon for people to present themselves for a thorough eye examination until too late .
While looking for manifestations of the disease in the early stages several confounding variables exist. Predominant among these is that normal in medicine is never an absolute value but is represented by a range. Can this apparently suspicious looking factor actually be a part of the wide variation of normal ?
Glaucoma is truly present only if is damage is noted in the optic nerve and or nerve fibre layer (structural damage). The level of eye pressure usually does not make that much difference as does the appearance and function of the optic nerve. However, the risk of glaucoma can greatly increase if the eye pressure gets high. In these situations, treatment to lower the eye pressure may need to be taken, despite the fact that there might still not be any damage present, In other words treatment may need to be started when the risk of developing glaucoma and loosing vision is higher than the risk of the treatment itself .
Excerpts from the lecture series " Basic Course in Glaucoma : Intraocular pressure" by Dr. Devindra Sood at Dr.Shroff's Charity Eye Hospital, New Delhi , December 2008 |
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