ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute of Ophthalmology ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute of Ophthalmology DEPARTMENT OF COUNSELLING Glaucoma Treatment

 Medication  Laser  Yag PI  Diode CPC  Surgery Methods of Treatment

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… Counsellor Role

 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

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 YAG Peripheral Iridotomy

 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

 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 Laser suturelysis

 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 Counsellor’s role

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

 A minor surgery, done under local anaesthesia to bring down the intra ocular pressure and thereby protect the optic nerve from further damage Trabeculectomy

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