By Sarah Chua Li Xuan, Pre-University Student
Glaucoma is the second most common cause of blindness worldwide. It can cause irreversible blindness and affects 68 million people globally. Early detection and treatment of glaucoma is vital to prevent permanent loss of sight. Dr Lavanya Raghavan, Consultant Ophthalmologist in the Department of Glaucoma and Cataract Services in Narayana Nethralaya Eye Hospital, Bangalore, India, gave a Special Guest Lecture titled “Imaging in Glaucoma” to practising optometrists and opticians at the TK Low Academic Specialist Centre in Farrer Park Hospital, Singapore, on 15 January 2020.
Having conducted several clinical trials as well as community-based screening for angle-closure glaucoma in both India and Singapore, Dr Lavanya is well aware of the challenges glaucoma poses to the ageing population and the prevalence of undetected glaucoma. She started off her talk by introducing what glaucoma is and sharing recent studies which show high proportions of Singaporeans having undetected glaucoma. Glaucoma usually develops slowly and subtly, but not uncommonly, it can develop rapidly which demands immediate medical attention. This form of glaucoma is known as angle-closure glaucoma which was Dr Lavanya’s focus in the talk as it requires greater urgency.
Dr Lavanya emphasized on good history taking, including family history of glaucoma as genetics play a role in the development of the condition. She also spoke of the importance of asking the patient if they have a history of myopia, or whether they are on steroid medications such as inhalers. She then shared about the warning symptoms of angle-closure glaucoma and demonstrated certain clinical signs of different types of glaucoma with commonly available instruments that primary eye care practitioners would have access to. Being able to detect the condition in its early stages allows the primary eye care practitioners to refer the patients to eye specialists for timely treatment.
Thereafter, she shared her expertise on the use of different imaging techniques available for both anterior and posterior segments of the eye and discussed their advantages and limitations. On top of diagnosing the condition, this would allow one to assess the severity and progression of the glaucoma. From her years of experience, she discussed the optimum use of the anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) in detecting angle-closure glaucoma. In addition, she reminded the audience that non-invasive equipment like OCT, OCT-angiography (OCT-A), optic disc photography and visual field analysis are invaluable in assessing both structural and functional damage to the optic nerve in glaucoma. Dr Lavanya recognised the potential in OCT-A, but added that it is a developing technology that has yet to be part of the glaucoma workup in clinics. However, one must note that there is no single method to diagnose glaucoma as it is a complicated condition.
In conclusion, Dr Lavanya raised awareness on the importance of early detection and treatment of glaucoma given that it is a leading cause of blindness especially in the elderly. She also shared her knowledge on how to use different equipment with primary eye care practitioners so they can play a part in the diagnosis of glaucoma and refer patients to ophthalmologists to prevent the suffering and problems that come with a permanent loss of sight.