Eye Care
Glaucoma
Diagnosis and management of optic nerve conditions to prevent progressive, irreversible vision loss.
Glaucoma is the second leading cause of irreversible blindness worldwide, and its silent progression makes it particularly dangerous — most patients have no symptoms until significant, permanent vision loss has already occurred. In India, an estimated 12 million people are affected, with millions more undiagnosed. Dr. Mala R. Zala specialises in the early detection and long-term management of all forms of glaucoma, preventing the insidious theft of sight that this disease causes.
Types of Glaucoma
Glaucoma encompasses a group of optic neuropathies, most associated with elevated intraocular pressure (IOP):
- Primary Open Angle Glaucoma (POAG) — the most common form; gradual IOP rise with no angle obstruction; no pain
- Primary Angle Closure Glaucoma (PACG) — more common in Indians and Asians; narrow drainage angle; can present acutely with severe pain and blurred vision
- Normal Tension Glaucoma (NTG) — optic nerve damage despite IOP within the normal range
- Secondary Glaucoma — from uveitis, trauma, steroids, pseudo-exfoliation, pigment dispersion
- Congenital / Developmental Glaucoma — presents in infants or children
- Ocular Hypertension — elevated IOP without optic nerve damage; requires monitoring
Diagnostic Assessment
Dr. Mala's glaucoma workup is thorough and serial — a single snapshot is never sufficient:
- Goldman applanation tonometry for accurate IOP measurement
- Gonioscopy — visualisation of the drainage angle (open vs closed)
- Dilated fundus examination with stereoscopic disc assessment
- Optical Coherence Tomography (OCT) of the retinal nerve fibre layer (RNFL) and ganglion cell complex
- Humphrey Visual Field testing (perimetry) for functional status
- Central corneal thickness (CCT) — thinner corneas underestimate true IOP
- Disc photography for serial comparison over time
Treatment & Long-Term Management
Glaucoma has no cure, but progression can be halted with appropriate treatment:
- Topical IOP-lowering drops — prostaglandin analogues, beta-blockers, carbonic anhydrase inhibitors, alpha-agonists
- Fixed-combination drops — improve adherence and reduce exposure to preservatives
- Laser Trabeculoplasty (SLT) — effective, repeatable alternative to drops for open angle glaucoma
- Laser Peripheral Iridotomy (LPI) — curative for narrow angle and angle-closure glaucoma
- Surgical referral (trabeculectomy, MIGS, tube shunt) for medically uncontrolled glaucoma
- Structured IOP and disc monitoring schedule — every 3–6 months for treated patients
Risk Factors — Know Yours
You are at higher risk of glaucoma if you have: a family history of the disease, are over 60 years old, have elevated IOP on previous eye checks, are of Indian or Asian ethnicity (higher angle-closure risk), use long-term steroid eye drops, or have had a previous eye injury. Dr. Mala recommends a baseline glaucoma evaluation for all patients over 40, and more frequent screening for high-risk individuals.
Dr. Mala R. Zala
MBBS, MS · Ophthalmologist