Glaucoma is an ophthalmic disease which can affect and damage the optic nerve (connecting the eye to the brain). It can lead to permanent loss of vision if left undetected and untreated, and is the main cause of permanent blindness in the UK.
Glaucoma usually occurs because fluid in the eye is not draining properly which in turn increases pressure inside the eye, damaging the ganglion cells of the retina and ultimately the optic nerve.
Loss of vision starts at the periphery, restricting vision progressively with a ‘tunnel vision’ effect, gradually widening towards central vision. This gives clinicians an opportunity to treat and contain it (usually with eye drops and sometimes surgery) if diagnosed soon enough.
There are various kinds of glaucoma including:
- Open-angle: slow development, no pain and gradual loss of vision
- Closed-angle: slow or sudden presentation and severe pain
- Pigmentary: an inherited condition (more commonly found in near-sighted young men) causing iris pigment to shed into the aqueous humour and neighbouring structures, interfering with the trabecular network and consequently raising eye pressure
Glaucoma is a common condition. It can affect people of all ages including babies and young children but is most common amongst the elderly.
It can be induced by topical steroid use including medications and creams such as those used to treat eczema.
Earlier this month, the BBC reported an exciting new medical research development, suggesting that in future it might be possible to diagnose glaucoma much sooner than is presently the case.
Researchers at University College London have developed a new kind of eye exam that might spot glaucoma a decade before symptoms appear. The test uses a fluorescent dye (injected into the bloodstream) that sticks to the cells in the retina that are about to die due to increased pressure.
Currently, diagnosis of glaucoma is made by measuring eye pressure and cupping of the optic nerve – often when the disease has reached an advanced stage having already caused irreversible vision loss.
However in future, it is hoped this treatment will only require an optician to look at the back of the eye with diagnosis made if the retina is illuminated in white fluorescent dots, 5 or 10 years earlier then is presently the case.
More research and studies will be needed to develop this treatment, but the hope is that in future it might lead to an ophthalmic screening programme that will ultimately significantly reduce the number of future glaucoma suffers.
Delayed diagnosis of glaucoma
As an experienced practitioner in claims involving medical negligence, I have handled several cases involving the sub-standard management of glaucoma (by General Practitioners, Optometrists, and Ophthalmologists), resulting in avoidable loss of vision.
Tell-tale signs of sub-standard treatment can include the following:
- Failure to take proper history or account of the patient’s symptoms (halos, foggy vision, headache, and loss of peripheral vision are most obvious signs)
- Failure to properly measure intra-ocular pressures (this can often happen when an air-puff tonometer (which is less accurate and can provoke a blink response) is used instead of an applanation tonometer is used
- Failure to look at the back of the patient’s eye for optic nerve damage (disc cupping)
- Failure to elicit whether the patient is taking any steroid medication, preparations, or creams
- Failure to make an emergency referral to hospital in cases involving acute and/or closed angle glaucoma
If you have suffered a poor visual outcome as a consequence of suspected sub-standard management of glaucoma (or indeed general ophthalmic medical care) you may be entitled to financial compensation. A specialist in legal claims involving eye injuries will be able to advise further.