In a review of 1,000 newly diagnosed glaucoma patients seen between January 2008 and February 2012, twenty three patients were detected with secondary glaucoma caused by long-term use of steroid medications.
Glaucoma is a sight-threatening condition often diagnosed late as it produces minimal or no symptoms in its early stages. The World Glaucoma Association has declared March 11-17, 2012 as awareness week.
"Steroid drops are commonly used for treating eye inflammation and eye allergy. Although these medications may be necessary in the treatment of the disease, their indiscriminate and long-term use can result in steroid-induced glaucoma," eye surgeon and glaucoma specialist Roopali Nerlikar who conducted the study, said.
Steroid-induced glaucoma is the change in intraocular pressure with steroid administration. This high intraocular pressure can occur within a week or can be delayed for months or years. It eventually results in damage to optic (eye) nerve.
"Intraocular pressure is the fluid pressure inside the eye. This fluid, or aqueous humor, nourishes the cornea, iris, and lens, and it helps the eye maintain its globular shape," Nerlikar said.
The typical eye produces about 4 cc of fluid a day, which is circulated and then drains out of the eye. If the drainage system becomes clogged or if too much fluid is produced, pressure inside the eye can build up.
"Increased intraocular pressure can also result from the use of topical steroid eye drops such as those used in the treatment of an inflammation within the eye," Nerlikar said.
Many forms of steroids like eye drops, periocular injections, intraocular injections, systemic steroid and inhaled steroids can be associated with increase intraocular pressure. "But mostly it will occur with steroid eye drops," Nerlikar said.
Eye surgeon and glaucoma expert Shraddha Satav said, "A few non-specific eye conditions are commonly treated with steroid medications. These non-specific conditions are redness, itching, stinging and burning sensation in the eye."
Whenever a patient with such a condition approaches a medical store, the chemist dispenses or suggests a steroid eye drop known to give quick relief. The patient continues to use it whenever he or she suffers from similar conditions later without consulting a doctor.
But if the patient suffering from these conditions consults a doctor, he or she will, after thorough examination prescribe steroids only when there is significant inflammation. Milder symptoms like slight redness, dryness and mild inflammation of the eye can be treated easily with non-steroid eye drops. Besides, in certain viral infections steroids may aggravate the condition and may result in loss of vision, Satav said.
On treatment of glaucoma, eye surgeon and glaucoma specialist Medha Prabhudesai said, "Glaucoma is a progressive condition. If left untreated it can progress rapidly and may lead to blindness. The blindness caused by glaucoma is irreversible."
Prabhudesai said, "Whenever a patient is detected with glaucoma, the course of treatment is life-long. It is like diabetes. If a diabetic leaves treatment mid-way, the condition worsens. The same is true about glaucoma. Patients fail to understand this and leave treatment midway resulting in loss of vision in some cases."
Patients who do have regular examinations, ophthalmologists can detect glaucomatous optic nerve damage before there is noticeable visual loss by examining the back of the eye. Sometimes, damage to the nerve can be observed even before specialised tests detect a change of vision.
Over 40? Get a screening done
PUNE: India has 12 million people affected by glaucoma and the number is increasing. There are numerous misconcepts about the condition, like it occurs only in patients with neglected mature cataracts, it cannot occur after cataract surgery and it affects only old people.
"However, in our review of 1,000 newly diagnosed patients, 166 patients were less than 45 years of age and 58 of them had moderate to advanced damage in at least one eye at the diagnosis," Nerlikar said.
Commonly occurring glaucoma are of two types -- open angle and closed angle. In open angle glaucoma, resistance to the flow of eye fluid is increased while in closed angle glaucoma there is physical obstruction to the flow of eye fluid.
On an average patients with closed angle glaucoma were nearly a decade younger than the open angle patients and had greater damage at diagnosis. In contrast, among the open angle glaucoma patients, 28 patients had very early disease and had been diagnosed during a routine check-up indicating an improved diagnostic sensitivity amongst ophthalmologists.
"Glaucoma can occur as early as the second or fourth decade of life wherein visual disability can affect their ability to earn a living and drive safely with a greater risk of accidents," Nerlikar said.
