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| Issues involved in treating glaucoma |
One of the important principles in the management of glaucoma, which must be clearly defined and understood deals with what is glaucoma ? In glaucoma damage to different eye tissues is common , however the primary concern is the damage to the optic nerve head. Put simply this damage to the optic nerve is at least partially related to the eye pressure.
Therapeutic goal's of treatment in glaucoma ?
The objective of treatment (irrespective of the disease) is to maintain or enhance a person's health. In the context of glaucoma this would involve maintaining or enhancing the health of the person, restoring or at least preventing visual loss and enhancing the person's emotional, spiritual , psychological and physical health without causing any damage by the therapeutic modalities used. That is to prevent further damage to the optic nerve. To date, the only proven method to prevent damage to the optic nerve head is by reducing the IOP.
1) Awareness of goal of therapy is improvement or maintenance of one's health.
2) All treatments have side effects, hence no treatment can be justified without assessing the risk to benefits of treatment .
3) Its important to assess the clinical course of the disease . In early stages, there is ample time to make a decision. For many years, it was assumed that treating people with a raised eye pressure was beneficial, because it was believed that those with raised eye pressure developed visual field loss and become blind. Most patient's with raised eye pressure were then treated . The amount of damage caused by treatment then, was probably more than that caused by the glaucoma itself. However, had they not been treated 90% of those individuals would never have developed damage to the optic nerve, while the treatment itself caused unnecessary problems. Only 5-10% of those with eye pressure more than 21 mmHg in the OHTS actually developed visual field loss, the possible benefit of treatment would need to be assessed more meaningfully .
4) Therapies for glaucoma involve long-term goals. These goals involve preserving vision. One needs to realize, from the beginning, that it is impossible to recover vision lost from glaucoma. However it is possible to preserve whatever vision is left and this vision can usually be maintained for life.
5) No two people respond to the same treatment in exactly the same way. Similarly people will also differ in their type and severity of glaucoma. Hence treatment needs to be tailored to the individual patient taking into account several factors.
6) Treating glaucoma is a two way process involving communication between the doctor and patient. One of the best ways of combating blindness from glaucoma is for those involved to work together as a team .It is important to know as much about glaucoma as possible, so that one can ask questions that are important to onself.
In fact, we welcome your asking these questions. The more one know's, greater the likelihood of being a better patient and hence comply with one's therapy. The more one complies with therapy, the better it is to preserve one's vision. |
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