Delayed Glaucoma diagnosis
Patient Wilson's personal account
It all began when my mother was diagnosed with glaucoma in 2002. A health check in Mumbai determined high intra ocular pressure in her eyes and the damage to her vision. Medication began with eye drops. The doctor also warned me of glaucoma’s hereditary nature, the high likelihood that I may have it. Since he underlined the need to get my intra ocular pressure checked every year, I checked it then and left without worry.
Two years later, in 2004, nervousness caused blurred, hazy vision. Light from fluorescent lamps turned into coloured halos or the whole rainbow range of colours.
Structural Engineer, Wilson J.
All these visual distortions manifested if I felt nervous or cold. During my secondary years of education, protracted hours of reading and writing, academic study caused acute migraines. In retrospect, I think that was probably because I had high IOP (Intra-ocular pressure) then. Yet, ‘doctors’ were never consulted or considered even as a remote option at the time.
While working abroad, eyesight difficulties made medical consultation essential for me by 2005. After learning my intra ocular pressure measured 20 mm Hg, that doctor confirmed it was high but surmised it as caused by migraines. A field vision test normally done for patients at risk of getting glaucoma was in consequence not done. I was still unaware of the extent of damage in my eyes.
First clear explanation
My vision problems increased. So I consulted Dr. Radha Ramanan, Little Flower Hospital And Research Centre, Angamaly in 2010 during my vacation in Kerala. My IOP or intra ocular pressure had risen further to 35 mm Hg. The extremely concerned glaucoma specialist conveyed without reservation that my diagnosis was considerably delayed, emphasising the adverse and irrevocable resultant damage. Applying 4 to 5 different drops - some to reduce the production of aqeuous humor (fluid in the eye), and some to open up the drainage channels - was his prescription. He brought my IOP down to 25 mm Hg but was dissatisfied since his target was to get it down to 12 mm Hg.
I returned to work after the vacation, continuing the same medication under ophthalmologist Dr.Kubra Banu in Al Noor Hospital, Abu Dhabi. My IOP declined to 17 mm Hg, but not to 12 mm Hg. My vision problems diminished, but did not vanish. Wide variations happened for unknown reasons. They recurred, I realised, when my IOP rose to higher levels. Increasing the drops did not help. I felt helpless.
I had adenoviral conjunctivitis in 2013. Even after the five-day anti-biotic treatment for it was over, my eyes remained red. Glaucoma specialist Dr. Anita Shakunthala from New Medical Centre found it was an adverse reaction to one of the curative drops I used. Sure enough, after discontinuing that particular medication, the redness vanished.
90% of all glaucoma cases are primary open-angle. She also explained I had the same. I continued using the rest of the prescribed drops, but IOP kept climbing, at times swinging above 20 mm Hg.
Stories abound that alternative medicines like Ayurveda may help. I tried an in-house treatment in Kerala for 25 days. It did nothing for me.
Indication for surgery
A little later, Dr. Anitha ruled out drops as a treatment method because my left eye became resistant to it. Next option? Surgery.
I searched for more options and learnt of Dr.Scott Smith at Sheikh Khalifa Medical City (SKMC) with promising references. He began medication with drops too but arrived at the same conclusion as Dr.Anitha about my left eye’s resistance to it.
To accomplish the necessary IOP reduction, Dr.Smith conducted a normal conventional Trabeculectomy on the left eye in April 2014. Two brain MRIs at Ahalia Clinic and at SKMC checked the health and sensitivity of my optic nerves. There was no problem there. The pressure reduced to 18mm Hg a week after surgery. By removing a stitch at the incision, Dr.Smith reduced the pressure to 6 mm Hg. It did not rise above 8 mm Hg for several months. He did the same surgery for the right eye in August, reducing IOP to 10 mm Hg a week after surgery. Precaution to keep IOP above 4 mm Hg was taken because if it drops below 4 mm Hg, vision becomes hazy again.
Wilson vacations with his family in Sri Lanka
Life with glaucoma
I live with loss of vision in my left eye. It cannot be recovered. It definitely affects my confidence. Well aware of my limitations, I am very careful. I avoid long, tiring journeys.
The constant objective is to prevent further loss of vision. I do Yoga regularly but there too, caution must be exercised. Inverted positions where my head is lowered below my heart are detrimental. Strenuous physical activity, or … jumping from a height … is out.
I asked my different doctors the same question. Does a change in my lifestyle make a difference to my intra ocular pressure? Their answer: no, since it is genetically received. My sister has it in a milder form. My kids can get glaucoma. From their 20s onwards, constant annual eyesight check is a must.
Reducing glaucoma occurrence
My own life experience has homed in the extreme importance of raising awareness about glaucoma. A lay person cannot identify it or isolate it on their own. Symptoms are often absent. You can lose vision before it is diagnosed, the way it happened to me. Only a doctor can determine glaucoma through a series of specific investigations. The journey is traumatic.
I was shocked when I was told about my vision loss in 2010 the first time. The doctor asked me point-blank “in spite of knowing that your mother had glaucoma, what were you doing for so many years?” If you have glaucoma, maintain discipline in your treatment schedule. It is medication for a lifetime. Save your medical records.
Because glaucoma is hereditary, doctors are generally very supportive. I am relieved that I do not have blurred or hazy vision any more, no coloured halos or rainbow range of vision. I check my IOP every 3 months now or if I feel that my IOP has risen. No spikes have been recorded for a while.
I have believed all along that I will not lose my vision completely. May it stay that way.
Wilson at Bandhipur Wildlife Sanctuary and Tiger Reserve, Karnataka, India