Page 91 - NAME OF CONDITION: REFRACTIVE ERRORS

IV. PREVENTION AND COUNSELING

The majority of patients are asymptomatic. Vision lost in glaucoma cannot be restored.
The purpose of therapy is to preserve existing vision. Diagnosis of angle closure needs a
detailed slit lamp examination, intraocular pressure assessment, indentation
gonioscopy, optic nerve head assessment and investigations as required. Since cataract
and glaucoma can coexist and the patient may attribute their vision loss to the former, it

is essential to have a comprehensive eye examination above the age of 40 years at least
annually or biannually. Being a progressive blinding disorder, if glaucoma is detected in a
patient, the patient is counseled and explained the need for regular eye examinations
throughout life. The need to screen close family members of the patient with angle
closure disease is stressed as glaucomas at times may be heritable and may show
familial predisposition.

V. OPTIMAL DIAGNOSTIC CRITERIA, INVESTIGATIONS,
TREATMENT & REFERRAL CRITERIA

*Situation 1: At Secondary Hospital/ Non-Metro situation: Optimal
Standards of Treatment in Situations where technology and
resources are limited

a) Clinical Diagnosis:

History:

Most primary angle closure glaucoma in Indian eyes is asymptomatic. A patient may
present with intermittent attacks of redness or pain with halos and blurred vision in eyes
or may present with acute onset of such symptoms. Previous or concomitant use of
steroids in any form should be noted. Drugs likely to precipitate angle closure such as
such as adrenergic and anticholinergic agents, tri and tetracyclic antidepressants, MAO
inhibitors and sulfa based such as topiramate to be recorded along with any history of
angle closure in family.

IOP:

Intraocular pressure is preferably assessed with Goldmann’s applanation tonometer.

Gonioscopy:

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