Microsoft Word - Editorial 23,2,07.doc


57 

Editorial 
 

Glaucoma Revisited 
 
Glaucoma being the commonest cause of irreversible 
blindness all over the world is rather complex disorder 
requiring timely detection and optimal management to 
preserve the remaining vision. Whatever vision has 
been lost is permanent and irreversible, hence the need 
for earliest detection and appropriate management. 

In our part of the world the incidence of angle 
closure and open angle glaucoma seems nearly equal. 

While the chronic simple glaucoma (POAG) is 
branded as slow, insidious, asymptomatic disease and 
angle closure glaucoma as acute symptomatic disorder, 
we have to bear in mind a few important facts. 
1. Not all angle closure glaucomas present as acute 

symptomatic disorder. 
2. Angle closure glaucoma can cause visual loss in 

very short period and delay in its management is 
disastrous. 

3. Angle closure glaucoma is a different type of 
disorder requiring immediate specific management 
with inexpensive miotics like pilocarpine, followed 
by non-invasive laser iridotomy or simple surgical 
intervention like peripheral iridectomy, achieving 
permanent cure in most of the cases. 

On the contrary chronic simple glaucoma requires 
very expensive, life long medications with systemic side 
effects or complex surgical interventions with less than 
desired outcomes with chances of early and late 
complications. 

While very expensive time consuming at times 
unreliable and inconclusive diagnostic tests are required 
for chronic simple glaucoma, the most important and 

inexpensive test to diagnose angle closure glaucoma is 
gonioscopy  which unfortunately is usually ignored. 

Perimetry also despite being time consuming and 
expensive is an important and necessary investigation in 
glaucoma though its role in diagnosis of early glaucoma 
is unreliable. It is very useful in differentiating typical 
and diagnostic glaucoma visual field defects from visual 
field defects of other disorders like hemianopias and 
pituitary tumors etc. 

Perimetry is again of limited help in follow up of 
established glaucoma cases unless it is precisely 
correlated with disc changes. 

The most important investigation in glaucoma is 
the appearance of optic disc, provided the size of the 
disc and position of cup is taken into consideration. The 
cup disc ratio is still an important criterion in diagnosis 
and follow up of glaucoma if the size of the cup, with its 
location, shape, eccentricity and distance between the 
edge of the cup and neural rim is properly recorded. 

Recently more stress is laid on the relationship of 
disc size with neural rim size, recording the rim size at 
its narrowest part and if absent document its position 
and extent in follow ups to evaluate the disc damage 
likelihood index. 

 
 

M Lateef Chaudhry 
Editor in Chief 

Pakistan Journal of Ophthalmology 

------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 
Glaucoma guidelines: 

See page no: 68 
See page no: 72 
See page no: 76 
See page no: 79 
See page no: 83 
See page no: 91 
See page no: 99 
See page no: 102