Glaucoma is a disease in which increased pressure inside the eye causes gradual damage to the optic nerve. The optic nerve is what carries visual information from the eye to the brain. Once it is damaged, the loss is irreversible. What makes glaucoma especially dangerous is its lack of early symptoms. In the initial stages, vision remains clear. Reading, driving, screen use, all feel normal. There is no pain or discomfort in most cases. By the time a person notices a problem, significant and permanent damage has already occurred.
The most common symptoms, such as reduced vision and narrowing of the visual field, appear only in advanced stages. Peripheral vision is usually affected first, which is why people don't notice the loss until it becomes severe.
Symptom-free does not mean disease-free
Absence of symptoms does not mean absence of disease. Glaucoma does not announce itself. It does not wait for you to feel ready.
Eye pressure checks alone are not enough. A complete glaucoma evaluation includes:
- Measurement of eye pressure
- Examination of the optic nerve
- Visual field testing to assess side vision
- OCT imaging to detect early nerve damage
- Central corneal thickness measurement, which affects pressure interpretation
Skipping these tests because vision feels "fine" is exactly how glaucoma steals sight.
Also Read: Uncontrolled Steroid Use Is Driving Up Glaucoma Cases In India, Say Doctors
A Case Study on Routine Check-Ups
Ram and Shyam, went for a routine eye check-up where one's results were normal but Shyam was found to have high eye pressure and was advised further tests for suspected glaucoma; he refused because he had no symptoms and his vision felt fine. Three years later, a follow-up revealed that nearly 50% of Shyam's optic nerve was already damaged due to uncontrolled pressure, and although eye drops and further evaluation were advised, he again declined because he still felt symptomless. Two years after that, Shyam returned in distress, having lost vision in his left eye, only to be told that the damage was permanent and irreversible. He had glaucoma all along, silently progressing without pain or early warning, exactly as this disease is known to do.
Who should be screened and when
Anyone can develop glaucoma, but the risk increases after the age of 40. Family history, diabetes, long-term steroid use, and high eye pressure further increase the risk.
That's why annual eye examinations after 40 are not optional. They are preventive medicine. Detecting glaucoma early allows doctors to slow or stop progression with eye drops, laser, or surgery. What cannot be done is reverse damage that has already occurred.
(By Dr Keerthan Rao, Consultant Ophthalmology, KMC Hospital, Mangalore)
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