Glaucoma English Edition high res

Ranked once Again the 

BEST EYE HOSPITAL 

in Karnataka 

(Times Health survey 2016) 

CONTENTS 

Proudly Presents 

08 14 

VISION 

FIRST 

Women and Eye Health 

Glaucoma and Exercise 

A FULL-FLEDGED ONLINE EYE CARE MAGAZINE FOR THE 

FIRST TIME IN INDIA 

Vision First is a Narayana Nethralaya initiative to bring to you the latest in eye health and research, in an 

informative and informal way. Our aim is to spread awareness on how to maintain the health of your eyes and 

give you the knowledge to care for diseases which can affect your vision. This online magazine will cover various 

aspects of common eye conditions and keep you abreast of all the scientific and technological advancement 

in the field of ophthalmology. 

It also endeavors to be a platform to bring together a community of Narayana Nethralaya patients to share their 

ideas and experiences and contribute to the society to empower and encourage the visually impaired. 

Happy Reading 

DIALY NEWS 

www.narayananethralaya.org 

/NNethralaya 

@NNethralaya 

STRAIGHT TO YOUR DESK 

narayananethralaya.org/online-magazine 

STRAIGHT TO YOUR PHONE 

SCAN to see 

the latest hospital and 

healthcare news 

01 

Impact of Glaucoma on 

driving 

20 

Life with glaucoma 

made easier 

Who is at risk for 

retinal detachment? 

Glaucoma medications 

10 

18 

Published quarterly, The Narayana 

Nethralaya Vision first is an independent 

voice for the hospital, health and agedcare 

professional, containing regular 

features on major projects, health care 

disciplines, eHealth, news, conferences 

and events. 

07 29 

How will I know if I have diabetic 

retinopathy? 

Accomadation for outstation 

patients 

2 Narayana Nethralaya | Ranked Among The Top 10 Eye Hospitals in India Since A Decade www.narayananethralaya.org 

Narayana Nethralaya | Ranked Among The Top 10 Eye Hospitals in India Since A Decade www.narayananethralaya.org 3

#2565 

Impact of Glaucoma 

on Driving 

Dr Monika Soni 

Driving gives us independence and a sense of control over our lives. Being able to drive means one is not dependent 

on family members, friends or society. However, an unsafe driver poses a huge risk to himself and to others. A 

glaucoma patient with poor vision contributes to potential hazards on the road, and this becomes an important issue. 

FROM THE CHAIRMAN’S DESK 

Glaucoma is one of the leading causes of irreversible blindness in our country. As it has no symptoms in the early 

stages and can go unnoticed, people may realize that they are suffering from glaucoma only after the disease has 

reached an advanced stage. Though it’s not curable, if detected early, the progression of the glaucoma can be halted 

and total blindness can be prevented. 

Since patients who better understand their disease and its treatment have better success in managing their medical 

condition, we believe that patient education is an important part of long-term outcomes for glaucoma patients. This 

issue of Vision First provides a detailed explanation of glaucoma, its consequences, and the nature and importance of 

treatment, so that glaucoma patients and their family members have a better knowledge of the disease and how to 

manage it. 

At the start of the new academic year, we would like to reiterate the importance of good vision for the educational, 

physical and social development of children. Given a choice, many kids would prefer to spend all day indoors, glued to 

their digital screens. Fresh air, sunshine, and exercise benefit not only the body, but also the mind. Children who spend 

time playing outdoors can prevent myopia (short-sightedness) from developing and progressing, get better sleep, get 

relief from stress and anxiety, prevent childhood obesity, improve their imagination and develop good social skills. 

Encourage your children to eat healthy and spend more time outdoors this summer. 

Best Regards, 

Dr. K. Bhujang Shetty, 

Chairman and Managing Director, 

Narayana Nethralaya Hospital Bangalore 

What is the impact that 

glaucoma has on driving? 

To understand this we need to understand the effects that glaucoma has on a patient’s vision. 

Patients suffering from glaucoma can have loss of vision that ranges from mild to very severe. 

Loss of vision in glaucoma usually starts from the periphery or the sides. As the disease progresses the loss of vision 

progresses from the periphery towards the center. 

Peripheral loss of vision that patients with glaucoma suffer from makes it difficult for them to see objects that lie in their 

outer field of vision, such as pedestrians and vehicles coming in from the sides. 

For anyone who is driving, peripheral vision or its loss becomes a major concern since a person in the driver’s seat 

needs to be well aware of his environment. For this, good peripheral vision is a must, especially for the safe changing 

of lanes. Along with compromised vision, if a person has reduced cognitive ability and slower reflexes, driving becomes 

even more dangerous. A visual field test, which is a diagnostic test done routinely for glaucoma patients, can help 

assess the extent of a patient’s horizontal visual field loss. 

To be eligible for a driving license, most foreign countries have driving standards, which include certain criteria for vision 

that a person applying for a driver’s license should fulfill. The United Kingdom follows 2 standards (UK guidelines 2013) 

which include one for visual acuity and the other for field of vision. 

Unfortunately, in India, people applying for a driving license are not made to undergo a field of vision test and many a 

time, people with defective vision are not aware that they have compromised vision. This further increases the risk of 

accidents on the road. 

Drivers with perfect vision can also have accidents. If you find yourself in a situation where you have had an accident 

which you know is your fault or if you find yourself having near misses then you should re-evaluate your ability to drive. 



So, what should you do if you have glaucoma and are concerned that you might not be driving safely? Ask a family 

member to accompany you on a drive and evaluate the situation. Discuss any concerns that you may have with your 

doctor. 

Be open to suggestions that friends and family and your health care providers give you. It might mean a compromise on 

your freedom and independent commute, but safety should always come first. We must remember that we share the 

roads with others, so our own safety and the safety of others should be of prime concern to us always. 

Constriction of the field of vision in a glaucoma patient 

Blurred vision in a patient with glaucoma 

Glare that a patient with 

glaucoma might experience 



5. Lifestyle choices - Eye health is affected by poor lifestyle choices 

such as smoking, drinking alcohol, lack of proper nutrition and physical 

activity, which can lead to medical conditions such as diabetes, strokes 

and high blood pressure. Obesity due to lack of exercise and poor diets 

are on the rise among the adult female population. More women are also 

smoking and drinking as compared to earlier. 

6. Socio-economic factors - Vision loss can be prevented with early 

detection and treatment of eye problems. In many parts of the world, 

women are still unable to access quality eye health care due to various 

social or economic factors. Women have to juggle the demands of a 

job, children, households and aging parents, and tend to neglect their 

own health. 

Women 

and Eye Health 

When was the last time 

you had an eye exam? 

The risks to eye health in women can be prevented with regular eye 

exams, avoiding smoking, wearing sunglasses when outdoors, and by 

following a healthy diet and exercise regimen. Your sight is precious and 

the power to prevent vision loss is in your hands. 

April is women’s eye health and safety 

month. Research shows that more 

women than men suffer from visual 

impairments. Therefore, it’s very important 

for women to take better care of their eyes. 

Here are some reasons 

why women could be more prone 

to eye problems than men: 

1. Longer lifespan - Statistics show that women usually have a longer lifespan than men. Many eye diseases such as 

cataract, glaucoma, AMD and diabetic retinopathy are related to advancing age. 

2. Hormonal fluctuations - Women experience serious ups and downs in hormone levels during puberty, menstruation, 

pregnancy and menopause. Hormonal changes have been linked to dry eye and other vision problems such as blurred 

vision, trouble focusing, and watery eyes. 

3. Autoimmune diseases - Women are more susceptible to develop autoimmune diseases such as Sjögren’s Syndrome, 

Lupus, Multiple Sclerosis, Rheumatoid arthritis, Hyperthyroidism and Scleroderma. Vision can be greatly impacted by 

these conditions. 

4. Medications - Compared to men, women generally take more prescription and non-prescription drugs such as birth 

control pills and medication for hormone replacement. Many of these drugs can have serious side effects which can 

affect vision. 



Who is at risk for 

retinal detachment? 

The Four Stages Of 

Diabetic Retinopathy 

Though it is more common in people 

over age 40 and affects men more 

than women, retinal detachment can 

occur at any age to anyone. 

Risk factors for retinal detachment 

include severe myopia, retinal tears, 

a serious eye or head injury, family 

history, previous retinal detachment 

in the other eye, complications from 

an ocular surgery (especially cataract 

surgery), as well as eye conditions such 

as uveitis, retinoschisis, degenerative 

myopia, or lattice degeneration 

(peripheral retinal thinning). 

How is 

AMD detected? 

When AMD is in its early stages, it can be detected 

during a comprehensive eye examination, generally 

before any of the symptoms are noticed by the patient. 

Changes in vision such as distortion or blurring should 

be reported to an eye doctor who can detect AMD with a 

dilated eye exam. The earlier the disease is detected, the 

more responsive it is to treatment. 

If AMD is suspected, it can be diagnosed with the 

following tests: 

Visual acuity test - A standardized eye chart (Snellen 

chart) is used to determine how well you see at distances. 

Dilated eye exam - Eye drops are used to widen or dilate 

the pupils to provide a better view of the back of your eye. 

The ophthalmologist will then use a special magnifying 

lens to check for any abnormalities in your retina and 

macula. 

Amsler grid - is a special grid that’s made up of horizontal 

and vertical lines and a dot in the centre. Changes in your 

central vision may cause the lines in the grid to disappear, 

appear wavy, look faded or distorted, which is a sign of 

AMD. This test will give your ophthalmologist a better idea 

of how damaged your macula is. Since damage to the 

macula affects central vision, usually the lines towards 

the centre of the grid appear broken or distorted. 

Retinal Imaging - In order to determine the damage caused 

by macular degeneration, detailed images of your retina 

are used as part of the examination, using the following 

methods: 

Fluorescein angiogram - In this test, a fluorescent dye is 

injected into a vein in your arm. As the dye passes through 

the blood vessels in your eye, detailed images are taken 

with a special camera. These images can point out leaking 

blood vessels or abnormal new blood vessels that may be 

growing under the retina. This procedure can identify the 

type of AMD you have. 

Optical coherence tomography (OCT) - Similar to an 

ultrasound test, which uses sound waves to capture 

images of living tissues, OCT uses light waves to take 

high-resolution images of the retina and macula. This 

enables the ophthalmologist to establish whether any 

fluid has leaked through into the retina, or whether the 

macula is abnormal or thickened. 

Fundus Photography - the inside of your eye is 

photographed with a special camera (a fundus camera), 

through which 3D images of your macula are captured. 

The ophthalmologist, with the help of these images can 

establish whether any damage has occurred to your 

retina. 

Mild nonproliferative retinopathy- 

At the early stage of this disease 

microaneurysms( small areas of 

balloon-like swelling in the retina’s 

tiny blood vessels) occur 

Moderate Nonproliferative Retinopathy- 

During this stage, some blood vessels that 

nourish the retina are blocked. 

1 2 

How can I 

While some factors like age, family history 

and genetics is not in your control, 

you can reduce your risk of AMD or slow its 

progression by taking preventative measures 

such as avoiding smoking, exercising 

regularly to maintain a healthy weight, 

keeping your blood pressure and cholesterol 

levels in check, and eating a diet rich in green, 

leafy vegetables, whole grains, yellow and 

orange fruit, and fish. 

prevent AMD? 

4 

Proliferative Retinopathy- 

At this advanced stage, new blood 

vessels grow, but they are abnormal 

and have thin, fragile walls. If they leak 

blood, it could lead to vision loss. 

3 

Severe Nonproliferative Retinopathy - 

In the third stage, more blood vessels are 

blocked, depriving several areas of the retina 

with blood supply. These areas of the retina 

send signals to the body to grow new blood 

vessels for nourishment. 





Glaucoma and 

Exercise Dr Monika Soni 

Today yoga has a global presence and a lot of people worldwide 

are doing yoga as part of their fitness regimen. Some asanas 

in yoga are not advisable for glaucoma patients and it is 

important for those suffering from glaucoma to be aware 

of these asanas. Sheershasana is a yoga position in which 

the patient stands upside down or on his head. This asana is 

known to cause a temporary increase in the eye pressure and 

should be avoided in patients who have glaucoma. 

Some types of glaucoma such as the closed angle type are 

not responsive to the effects of exercise and others such as 

pigmentary glaucoma may develop a temporary increase in 

IOP after vigorous exercise. Hence patients with glaucoma 

should always check with their doctor about which exercises 

are suitable for them. 

Glaucoma patients should follow a few instructions while 

exercising which can reduce the rise of eye pressure during 

exercise : One is to exhale during periods of maximum exertion 

such as when lifting weights and to inhale when lowering the 

weight. This will help avoid the Valsalva effect (which is when 

a person exhales forcefully with a closed mouth or held nose 

and the exit of air is blocked). 

The Valsalva effect can increase eye pressure dramatically, 

sometimes up to 300% of the normal pressure. 

While doing yoga, avoid all inverted positions including 

headstands and inversions since all inverted positions raise 

IOP substantially. 

Glaucoma is a condition which affects the optic nerve in the eye and this is usually due to an increase in the eye 

pressure. Some patients can be affected by glaucoma and develop weakness of the optic nerve even though their 

eye pressure is normal. This generally occurs due to poor blood flow to the eye. Blood flow to the eye can decrease 

due to low blood pressure and poor circulation. 

While intraocular pressure (IOP) in glaucoma patients can be lowered with medication, laser treatment or surgery, 

there is some evidence that a regular moderate intensity exercise can help in decreasing the eye pressure. Most 

exercise or activity can improve blood circulation to the optic nerve and protect it from damage to some extent. 

So which exercises are good for glaucoma patients and which are bad? 

The long term effect of exercise on glaucoma 

progression is not clearly known, but anything 

that improves overall health and helps in 

maintaining the integrity of the optic nerve is 

a positive benefit. 

Aerobic exercises, running, swimming and 

jogging are cardiovascular exercises which 

help increase blood flow to the heart and also 

to the optic nerve and are good for the eye. 

However, if you are a glaucoma patient and 

have recently undergone an eye surgery, you 

should avoid swimming for a few weeks after 

the surgery or until your doctor gives you the 

go ahead. 

Certain exercises like squat thrusts and lifting 

very heavy weights can cause the eye pressure to rise for a short 

while during the exercise. It is not just the lifting of weights but 

also holding one’s breath as one exercises that can be bad. 

Patients with glaucoma can continue to exercise and even lift 

weights which are not too heavy but should avoid holding their 

breath while doing it. 

Exercise, 

Running and Yoga 

Sheershasana or 

Lifting heavy weights 

can increase the eye 

pressure briefly 



Diet 

Various studies have been undertaken to study the role of diet in glaucoma. A diet rich in green leafy vegetables is 

supposed to lower the eye pressure. Dietary nitrates in green leafy vegetables lowers risk of developing open angle 

glaucoma. 

Lifestyle 

changes that help 

lower IOP- Dr Bhavin Tilva 

In today’s world, people are quite aware about how lifestyle choices affect our overall health, and the same goes for 

glaucoma. Until now it was believed that lifestyle changes don’t play a role in glaucoma, but recent studies have shown 

the role of lifestyle factors which influence eye pressure - the major modifiable risk factor for glaucoma. 

DHA (docosahexanoeic acid) is an omega- 3 fatty acid and is helpful in preserving a healthy retina and lowering the IOP. 

Rich sources of DHA such as salmon, shellfish and tuna should be consumed twice or thrice a week. If natural addition 

to the diet is not possible, DHA supplements in the form of fish oil supplements can be taken. 

A diet rich in lutein and zeaxanthin helps in lowering intraocular pressure. It avoids oxidative damage to the optic nerve. 

Spinach, broccoli and sprouts are rich sources of lutein and zeaxanthin. 

Antioxidants provide nutrients and strengthen the muscles and nerves in the eye. Rich sources of antioxidants are 

blueberries, grapeseed extract, goji berries, pecan nuts and cranberries. 

Foods which are rich in trans-fats, the kind found in deep fried food, prevent the optimal functioning of omega 3- fatty 

acids and increases eye pressure. Such food should be avoided. 

Musical instruments 

such as the trumpet and the saxophone are known to cause an increase in the eye pressure. Glaucoma patients are 

advised to avoid playing such high resistance wind instruments which can increase the intraocular pressure. 

Lifestyle choices can, to some extent, influence eye pressure and affect the risk of developing glaucoma, but there aren’t 

enough proven studies about the same in glaucoma patients. However, a shift towards a healthier lifestyle makes for 

an overall positive change. 

Sources rich in antioxidants 

However, it is not mandatory that factors which increase intraocular pressure (IOP) may cause glaucoma, and those that 

lower IOP may prevent the development of glaucoma. There are various factors which contribute to the development of 

glaucoma and modifications in one’s lifestyle are just supplementary to these. 

This means that certain lifestyle factors that increase the intraocular pressure need not actually increase the risk of 

glaucoma and similarly certain factors which could reduce the intraocular pressure need not actually decrease one’s 

risk of glaucoma. 

Exercise 

Activities which raise your pulse by 20 to 25, like walking 

briskly, can help reduce IOP. The more number of steps 

a person walks throughout the day, less likelihood of an 

increase in IOP. Aerobics is known to cause a temporary 

decrease in the intraocular pressure but it has not 

been tested in glaucoma patients. Swimming reduces 

vulnerability of the optic nerve to an increase in the 

intraocular pressure. 

Lifting of heavy weights is known to cause a temporary 

increase in the intraocular pressure. Hence, patients who 

already suffer from glaucoma are advised to avoid lifting 

very heavy weights. 

Habit forming substances 

such as caffeine, alcohol, tobacco and marijuana are 

known to have a negative effect on eye pressure. 

Caffeine, which is consumed widely, is known to cause a 

temporary increase in the eye pressure. 

Consumption of caffeine in small quantities is alright, 

but an excessive intake of caffeine is has been proven to 

increase the risk of glaucoma. 

Alcohol is known to decrease the eye pressure for a short 

duration but a daily consumption of alcohol is supposed 

to increase the risk of glaucoma. 

Yoga, which is a very popular form of exercise includes 

various ‘asanas’ or positions. Some of these asanas, 

particularly those with the head – down position 

(sheershasana) have been proven to cause an increase in 

the eye pressure. Therefore, patients with glaucoma are 

advised to avoid such positions. 

Smoking cigarettes is known to increase the risk of 

glaucoma. 

Though marijuana is known to lower eye pressure, it is not 

recommended for treatment due to its side effects. 



Q: My doctor has prescribed more than one eye drop for glaucoma. Can I put them into the eye one 

after the other? 

A: No, usually you should keep a gap of 5-10 minutes between two eye drops as it helps in better absorption of the drop 

and helps in better eye pressure control. 

Q: Is it safe to put in an extra drop just to make sure? 

A: Yes, if you are not certain that the first drop went in, it is safe to put in another drop. In general, it is best to avoid 

putting in more than one drop. 

Glaucoma 

medications 

Know your medications and manage 

your glaucoma better 

Glaucoma is a disease in which the pressure inside 

the eye increases, and causes damage to the 

nerve of the eye, leading to irreversible loss of vision. 

Usually, it has no symptoms in the early stages and 

can go unnoticed, only to be diagnosed later with 

severe vision loss. It is not surprising that glaucoma 

has been called ‘The silent thief of sight’! 

How glaucoma affects vision 

There is a small space within the eye called the 

anterior chamber. Clear liquid (called the aqueous 

humor) flows in and out of the anterior chamber. It 

is the aqueous humor that plays an integral part in 

maintaining the pressure in the eyes. In some people, 

due to various reasons, the pressure inside the eye 

rises. This increased eye pressure, if left untreated 

can damage the eye nerve and can cause permanent 

vision loss. The disease usually affects both eyes, 

though one may be more severely affected than the 

other. Unfortunately, the damage to the eye nerve 

due to glaucoma is irreversible and the loss of vision 

cannot be reversed. But, this condition can be halted 

and the remaining vision can be retained if glaucoma 

gets diagnosed on time and appropriate treatment is 

started. 

A better understanding of your treatment and 

medications can make it easier to live with glaucoma 

Dr Shivani Dixit 

and easier for your doctor to control your disease. Here are 

answers to frequently asked questions by glaucoma patients 

regarding medications that are to be used: 

Q: How do my glaucoma eye drops work and help save 

my vision? 

A: The goal of glaucoma treatment is to lower the pressure in 

your eye. It often starts with prescription of eye drops. These 

can help decrease your eye pressure by improving how fluid 

drains out of your eye or by decreasing the amount of fluid your 

eye produces. 

Q:What are the different types of medications available 

and do they have any side effects? 

A: There are different types of medications available for 

glaucoma. They do have a few side effects so; feel free to ask 

your doctor when he is starting you on treatment. 

Q: What precautions should I take while putting my 

eye drops? 

A: Wash your hands before instilling your drops. While opening 

the cap of your eye drop, be careful not to touch the nozzle of 

the bottle. Gently pull your lower eyelid and put one drop into the 

eye. Gently close your eye for a few seconds. Do not squeeze 

the eye forcefully after putting the drop, as it may cause the 

medication to come out of your eye and get wasted. 

Q: I miss instilling my eye drops often. Will it 

affect my vision? 

A: Missing your eye drops often leads to inadequate 

control of eye pressure. In order for them to help your 

eyes, you will need to use your drops every day. Make it a 

part of your daily routine, like brushing your teeth. Follow 

your doctor’s instructions properly. 

Q: How important is it to put the drops at exactly 

the time stated? 

A: It is important to get into a routine and to instil the eye 

drops at around the same time each day, but the exact 

time is less important. 

There are several ways to help yourself remember when 

to put your drops in: 

• A chart with tick boxes, 

• A box with compartments for the drop bottles, 

• A special timer can be set to ring several times 

each day as required 

Q: Where should I keep the drops and for how 

long? 

A: Read the storage instructions mentioned on the cover 

of your eye drops. Keep your drops in a cool place or in the 

door of the refrigerator. Do not place them in the freezer 

section. Check the expiry date on unopened bottles before 

using them. 

Q: What happens if I forget to take my drops when 

I go out? 

A: Do not worry unduly if you forget on the odd occasion, 

but try to get into the habit of taking your drops with you 

wherever you go. If you have forgotten a drop, just put it 

as soon as possible after the time it was due. 

Q: Can I take other medicines at the same time as 

my glaucoma treatment? 

A: Patients with angle closure or narrow angle types of 

glaucoma should seek advice before taking some types of 

tranquillizer or certain asthma and indigestion medicines. 

However, glaucoma eye drops are usually safe if you 

have had laser treatment (laser iridotomy) or glaucoma 

surgery. 

Steroid (cortisone-type) drops and tablets should be used 

with caution because they can increase the pressure in 

the eye. 

Always mention that you are on glaucoma medication 

when you visit a doctor for any other treatment. 

Q: Why do I have to see the eye specialist or 

attend the glaucoma clinic regularly? 

A: Even if your glaucoma is stable, it is important to 

attend the glaucoma clinic regularly. The purpose of your 

visits is to monitor your glaucoma (through optic nerve 

appearance, visual field and eye pressure tests) and to 

ensure that the treatment is working. 

Q: Do I need to put the drops in before I come to 

the clinic? 

A: Yes, always continue as usual unless requested 

otherwise. It helps the doctor to judge the effect of the 

treatment. 

Timely instillation of glaucoma medications is 

of utmost importance 

The medical treatment of glaucoma is usually 

in the form of eye drops 



Life with glaucoma 

made easier 

Here are some TIPS 

to make the life of a 

glaucoma patient easier 

Glaucoma is one of the leading causes of irreversible 

blindness in our country. It has been aptly called the 

“silent thief of sight”. As it is a symptomless disease, 

people usually do not realize that they are suffering from 

glaucoma unless they visit the ophthalmologist or have 

reached an advanced stage of disease. 

Glaucoma affects the quality of life of millions of people. 

In the early stage of glaucoma, patients experience 

compromised vision which affects their quality of life. This 

worsens as the disease progresses. Ocular discomfort, 

psychological factors, economic factors and social 

constraints contribute to the burden of the disease. 

Glaucoma is not curable but if detected early, the 

progression of the disease can be halted and total 

blindness can be prevented. 

Here is an example to explain the difficulties a patient 

diagnosed with glaucoma faces: 

Dr Shruthi S 

A 46 year old auto driver visited an ophthalmologist with 

complaints of difficulty in near vision. He was examined 

in detail and was diagnosed to have an advanced stage of 

glaucoma where he had significant loss of the peripheral 

field of vision. 

He was started on multiple eye drops in both eyes. He was 

advised to use these medications and was also advised 

not to drive as his vision was severely compromised. 

On asking him for a detailed family history, he said his 

father had an eye disease for which he had consulted a 

doctor and was asked to get some investigations done. 

Unfortunately, before he could take him to the hospital, his 

father fell sick and passed away. It is possible that he had 

an unnoticed family history of glaucoma. 

Before the disease is detected: 

Prevention is better than cure 

Ophthalmic consultation is a must for everyone over the age of 40, in an eye hospital rather than getting tested for 

near vision at an optical shop. 

 

Get glaucoma screening done if you have family history of glaucoma, diabetes, hypertension, heart disease, asthma, 

arthritis, migraine, thyroid disease, using minus or plus powered glasses, any history of trauma to eye. If detected in the 

early stage, the disease can be arrested and existing vision can be retained. 

 

Babies born with whitish coloured eyes or bigger than normal eyes, or babies with severe watering and difficulty in 

opening their eyes at birth, should be screened for congenital glaucoma. 

After the disease is detected: 

Prevention is better than cure 

If you have undergone any surgery or laser treatment for glaucoma, it is important to understand that these procedures 

are performed to reduce the intra-ocular pressure and are an attempt to restore the remaining vision. 

Regular usage of medications – 

- keeping alarms on your mobile phones will remind you to put your medications on time 

- making a simple drug chart in a pocket diary as shown in the figure below so that it can be noted and showed to your 

doctor as well. 

The problems that the 

auto driver is facing are: 

Financial constraints for consultation fees and investigations, to buy medications, and for transportation - to make 

regular visits to his eye doctor. 

He has been an auto driver for 20 long years. It is challenging for him to change his profession as it is no longer safe 

for him to drive his auto. 

Adherence to medications becomes difficult as he tends to forget to use the medications on time. Missing his 

medication is harmful for him since it can worsen his glaucoma and make him more visually handicapped. 

Psychologically, he is stressed as he is the bread winner in the family and has to support his entire family. 

This is just one example! There are many similar stories that have affected the lives of many people. So, what can a 

glaucoma patient do to make his life easier? 

Date Morning 8 am Afternoon 1pm Night 8pm 

RE LE RE LE RE LE 



Follow the instructions of your doctor and attend follow up examinations as advised 

Follow the technique properly while instilling the medication into the eye so that the desired effect of medication is 

attained. 

If you have any difficulty in instilling the medication or if you have any discomfort with the medication, let your doctor 

know about it rather than stopping medication on your own. 

Never stop the medications on your own - people usually think that there is no change in vision and stop the 

medication themselves. This can compromise your vision further. 



Normal tension glaucoma /Low tension glaucoma: 

Glaucoma 

risk factors 

Dr.Sruthi.P 

Glaucoma is a disease that damages the eye’s optic nerve. In glaucoma the fluid pressure inside the eye increases, 

and this leads to progressive damage of the optic nerve, resulting in a gradual loss of vision. The front half of the 

eye is filled with a fluid known as the “aqueous humor”. 

This fluid is continuously produced and constantly flows out of the eye, maintaining a steady pressure inside the eye. 

If there is either reduced drainage or excessive production of this fluid, the pressure in the eye will increase, leading to 

glaucoma. Not everyone with high eye pressure will develop glaucoma, and some people with normal eye pressures 

may also develop glaucoma. There are several other factors which determine this. 

Primary open angle glaucoma 

Primary open angle glaucoma is the most common type of glaucoma. In this type of glaucoma, the part of the eye 

through which the fluid of the eye flows out is open, permitting the outflow of fluid, but the patient still has high pressure. 

This type of glaucoma develops slowly without any symptoms. Initially it affects the peripheral or side vision and very 

gradually progresses to the centre. This is the reason why many people are not aware that they have the condition 

until they have significant vision loss affecting central vision. Glaucoma has been labelled as the “sneak thief of sight” 

because many people remain undiagnosed until irreversible loss of vision occurs. If left untreated it can even cause 

blindness. 

In this type of glaucoma the optic nerve can get affected even though the pressure in the eye is normal. Although its 

cause is not entirely known or understood, normal tension glaucoma is believed to occur either because of an extremely 

fragile optic nerve that can get damaged even though the pressure in the eye is normal, or because of reduced blood 

flow to the optic nerve. Because of its silent nature, people usually do not have any visual complaints until a very 

advanced stage of the disease. 

Risk factors for normal tension glaucoma are: 

• Family history of normal tension glaucoma 

• Race - Japanese ancestry 

• Thinner corneas 

• Heart disease 

• Migraine and peripheral vascular disease 

Secondary glaucoma: 

There are certain other types of glaucoma where there is an identifiable cause for increased eye pressure resulting in 

optic nerve damage and vision loss. These are called secondary glaucoma. It may be caused by prolonged, indiscriminate 

use of steroids, severe diabetic retinopathy, injuries to the eye, inflammation of the eye (uveitis) or advanced cases of 

cataract. 

If you believe you have any of these risk factors get an eye examination done. Always remember to inform your eye 

doctor about the risk factors that you have. This will help your doctor decide how often you need to get your eyes 

examined. Glaucoma is a disease that can be easily controlled if it is diagnosed early. So encourage your friends and 

family to get regular eye examinations done. 

Risk factors for primary open angle glaucoma are: 

• Age more than 40 years 

• Race –African Americans 

• Family history of glaucoma 

• Systemic diseases such as diabetes mellitus, hypertension, heart disease 

• Injuries to the eye 

• High myopia 

Angle closure glaucoma or closed angle glaucoma: 

It is a less common type of glaucoma which occurs due to narrow drainage channels in the eye. Gradual closing of the 

angle is called chronic angle closure and if the drainage angle closes suddenly, it causes an acute angle closure attack. 

Acute angle closure glaucoma usually presents as an emergency. A patient who is in an acute angle closure attack will 

have symptoms of eye pain, nausea, vomiting, redness and blurred vision due to a rapid increase in the eye pressure. In 

such cases the patient needs immediate treatment by an eye specialist. 

Risk factors for angle closure glaucoma: 

• Age more than 40 years 

• Race - East Asians 

• Family history of glaucoma 

• Women 

• High hypermetropia or those with a high plus power 



World 

Glaucoma Week 

Who is at high risk for glaucoma? 

If you are more than 60 years old, have blood relatives with glaucoma, are on treatment with steroids (in the form of 

tablets, skin ointments, inhalers, eye drops), have diabetes or high blood pressure, are near sighted or have a history 

of trauma, your risk of developing glaucoma increases. 

What are 

floaters? 

Dr Rwithuja Thomas 

Part of the natural aging process, floaters are black or white spots in our vision. They can appear as specks, 

strings, or cobwebs that drift about when you move your eyes and appear to shift away when you try to look 

at them directly. 

With age, the jelly-like substance (vitreous) inside your eyes begins to dissolve and becomes more liquid. 

Microscopic fibers within the vitreous tend to aggregate and cast tiny shadows on the retina as light passes 

through the eye. These shadows are called floaters. 

Floaters can be distracting at first, but usually settle down at the bottom of the eye (below the line of sight), 

becoming less bothersome over time. 

What is Tonometry? Why is Gonioscopy important? 

Tonometry is a diagnostic test that 

measures the fluid pressure, known as 

intraocular pressure (IOP), inside your 

eye. 

The tonometry test is important as it 

can help your doctor evaluate whether 

or not you may be at risk of glaucoma. 

Glaucoma is a serious eye disease that is 

characterised by increased fluid pressure 

within the eye which can damage your 

optic nerve. 

Glaucoma Treatment by Laser 

Gonioscopy is a painless eye examination 

of the front portion of your eye (anterior 

chamber), to examine whether the 

area where fluid drains out of your eye 

(drainage angle) is open or closed. 

This test is important as it helps 

your doctor to diagnose and monitor 

various eye conditions associated with 

glaucoma. 

Glaucoma is a treatable disease that needs early detection as the 

damage is irreversible. Treatment can include eye drops, laser or 

surgery. Laser treatments such as Laser Peripheral Iridotomy and 

Selective Laser Trabeculoplasty are used to lower the intraocular 

pressure and increase the outflow of fluid from the eye. 

What is a Visual Field test? 

The Visual Field test is a method 

of measuring your peripheral or 

side vision (which is affected first 

by glaucoma), through which 

your doctor can diagnose and 

monitor glaucoma. The data from 

the test is used to determine the 

severity of your glaucoma, level of 

vision loss, damage to the visual 

pathways of the brain, and other 

optic nerve diseases. 

Symptoms of eye floaters 

may include: 

• Small dark spots in the vision 

• Spots that move when you move your eyes 

• Spots that are more noticeable when you look at a white 

or light-colored background, such as a blue sky, a white wall 

or a computer screen with a background 

Causes of eye floaters include: 

• Age-related eye changes 

• Retinal detachment or tears 

• Inflammation in the back of the eye - due to the release 

of inflammatory material into the vitreous that are seen 

as floaters 

• Bleeding in the eye - Blood can be seen as floaters. 

Bleeding in the vitreous can be due to diabetes, hypertension 

and blocked vessels or injury 

• Eye surgeries and eye medications - Medications that 

are injected into the vitreous can cause floaters to develop 

till they are absorbed into the eye. Surgery of the 

retina involves adding silicone into the vitreous that can 

also be seen as floaters. 

Factors that can increase your 

risk of floaters include: 

• Age over 50 

• Nearsightedness 

• Eye trauma 

• Complications from cataract surgery 

• Diabetic retinopathy 

A sudden increase in the number of floaters or 

flashes of light can be symptoms of detachment of 

the retina, which is the nerve layer of the eye. 

Contact your ophthalmologist 

immediately if: 

• You see several floaters at once 

• See new floaters suddenly 

• Flashes of light along with the floaters 

• Darkness on any side of your visual field 

The above symptoms are painless but require urgent 

attention. 



Glaucoma Statistics 

Glaucoma is one of the leading causes of 

irreversible blindness, where damage to the 

optic nerve leads to loss of visual function. 

Dr Guddeti Praveena 

Why is it important to know the statistics, 

percentages, proportions or the number of people 

affected with glaucoma? 

The prevalence is the proportion of a population with the disease 

at a given point of time. Hence, the answer to this question is 

that the awareness about its prevalence alerts individuals to 

the disease. This is necessary as early diagnosis, and therefore 

early intervention, is crucial in delaying the progression of the 

disease process. 

What is Diabetic 

Retinopathy? 

Diabetic retinopathy is a serious complication of diabetes where tiny blood vessels inside the retina 

are damaged, causing them to bleed or leak fluid, leading to vision complications or even vision loss. 

How many people are affected by glaucoma? 

A recent systematic review estimated that the number of 

people aged between 40 - 80 years with glaucoma worldwide 

is 64.3 million, and that it will increase to 76 million in 2020 and 

111.8 million in 2040. The number of people blind and visually 

impaired due to glaucoma worldwide will be 2.1 million and 4.2 

million respectively. 

How many people are affected by glaucoma in India? 

In India, the estimated number of cases of glaucoma is 12 

million. This is around one fifth of global burden of glaucoma. 

What are the different types of glaucoma and what is 

the prevalence of different types of glaucoma? 

There are different types of glaucomas like primary open angle 

glaucoma, angle closure glaucoma, congenital glaucoma and 

secondary glaucoma. 

> Prevalence of primary open angle glaucoma ranges from 

0.41 to 2.99%. 

> Prevalence of angle closure glaucoma is between 0.88 to 

7.24 %. 

> Prevalence of congenital glaucoma in South India is one in 

every 3300 children. 

> One of the risk factors for glaucoma known as the 

pseudoexfoliation is an abnormal material formed in the eye 

which can cause high pressures in the eye. The prevalence of 

pseudoexfoliation glaucoma is reported to be between 1.87 

and 13.5%. 

> Studies have reported the prevalence of secondary 

glaucomas to be 0.08 to 0.3%. 

The highest rate of blindness in India is at least partially explained by the large proportion of the undiagnosed disease 

in the population based studies.So, get yourself screened for glaucoma and save your vision! 



Challenging the 

challenges 

Narayana Nethralaya in collaboration with National Federation of the Blind and Sthree Vani - A WhatsApp group 

for visually impaired women, celebrated Women’s Day in a program exclusively for women with impairment. 

Ms. Rajani Gopal Krishna, the first visually impaired Chartered Accountant in India, was the chief guest who shared 

her journey and its challenges. 

Health is wealth –a workshop on Gynecology was conducted by Dr. Shilpa Venkatesh, a renowned Obstetrician 

and Gynecologist. The 1st Anniversary of Sthree Vani was celebrated and their services to the visually impairment 

community was narrated. Prizes were distributed by Mrs. Naina Shetty and Ms. Priya Seshadri to the winners of 

two fun filled competitions. 

Accommodation for 

outstation patients 

At Narayana Nethralaya, the comfort of our patients is very important to us. We understand that outstation patients 

who consult with us often have issues with proper accommodation while undergoing treatment. 

We are happy to announce that accommodation within the hospital premises is now available for outstation 

patients and their attender in a safe, clean and friendly environment. Services offered include AC rooms for Rs 2500 

and non-AC rooms for Rs 2000, with an attached bathroom. 

For room enquires, 

please contact Mr. Naveen at 08066121311. 

Working hours 8 AM - 6 PM. 



Ranked once Again the 

BEST EYE HOSPITAL 

in Karnataka 

(Times Health survey 2016) 

Thanks for Reading 

vision 

A Narayana Nethralaya Initiative 

FIRST 

We invite your feedback & suggestions. 

Would you like to contribute Articles or Testimonials? 

write us to wecare@narayananethralaya.com 

Editorial board : Mrs Shilpa Rudra, Mr Praveen.I.M, Mrs Chitra Seshadri 

Creatives & Photographs : Mr Najeeb Rahman, Mr Kallappa

Glaucoma English Edition high res

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