Living with Glaucoma

Dr Aarchal Kotecha
reviews the next in the series of self-help books aimed at educating patients about common eye diseases

Glaucoma is one of the leading causes of blindness in the developed world. In the UK, one in 50 people over the age of 40 have this condition, with the frequency increasing with increasing age.

The term glaucoma, however, is an umbrella term used to cover a complex groups of diseases. Consultant ophthalmologist Mark Watts attempts to demystify the condition in his book ‘Living with Glaucoma’, part of a series of self-help books by the Sheldon Press. This comprehensive book is aimed at patients and family members who wish to gain a deeper understanding of the condition.

The book begins by considering the definition of glaucoma and the mechanism of the disease, and provides a simplified description of the ocular structures that are affected. There are also sections clarifying the differences between the different glaucomas (primary open angle/closed angle/normal tension/juvenile) and ocular hypertension, with a discussion of the differences in treatment of each.

There is a chapter devoted to diagnosis which reviews the triad of tests currently employed to detect glaucoma – namely the measurement of intraocular pressure, testing visual function and monitoring changes at the optic nerve head. The author provides a detailed description of the different tests used by both optometrists and ophthalmologists and what the patient should expect to experience with each of the different tests, as well as giving the rationale behind the different procedures involved.

The reader is also presented with a series of case scenarios illustrating common situations that they might find themselves in, such as returning to the optometrist at a different time of day for repeated intraocular pressure measurements, and the reasons for these. These scenarios are very useful, as they also present situations where there are differences of opinion between eye care specialists, illustrating the difficulties in diagnosing this progressive condition and the differences in ‘thresholds for concern’ between specialists.

The rest of the book covers the medical, laser and surgical treatment of glaucoma. The chapter on medical treatment discusses the different categories of anti-glaucoma medications, describing the mode of action and potential side effects of the most commonly used drugs.

Again, case scenarios are presented to illustrate the symptoms of side effects and the actions taken to remedy these. The author also briefly covers the topic of neuroprotection and discusses the potential of memantine, a drug better known for the treatment of Alzheimer’s disease than in the treatment of glaucoma.

This section is mainly for the reader who wishes to have more information, and can be easily omitted if found too technical. There is also a section on how to instil eye drops, and the importance of compliance with treatment for successful management of the condition. The chapter on surgical management covers the trabeculectomy procedure in great detail and discusses the use of anti-metabolites in improving the long-term outcomes of drainage surgery.

The risks and complications of the operation are also discussed. Most useful, however, is the case scenario illustrating the experience of an asymptomatic patient listed for glaucoma surgery. It is quite common for patients to expect an improvement in their vision after ocular surgery, and the case scenario and discussion afterwards explains how surgery is used to arrest progression of visual field loss, rather than reverse any changes that have occurred.