Glaucoma is often called the “silent thief of sight”, a progressive eye disease that damages the optic nerve and can lead to irreversible vision loss. What makes it particularly dangerous is its stealth:
in the early stages, glaucoma usually develops without noticeable symptoms. Many people remain unaware of the condition until significant and permanent damage has already occurred. Emerging research suggests that certain physiological traits may predispose some eyes to an especially subtle, symptom-free progression, making early detection even more challenging.
Dr Sudipto Pakrasi, Chairman, Ophthalmology, Medanta, Gurugram, shares key insights into this silent condition.
The Slow Erosion of the Optic Nerve
At the heart of glaucoma lies the gradual deterioration of the optic nerve, the vital channel that transmits visual information from the eye to the brain. Elevated intraocular pressure (IOP) is a well-known risk factor, but optic nerve damage can also occur in individuals with normal IOP levels. This complexity underscores why glaucoma cannot be diagnosed by pressure checks alone; comprehensive evaluation is essential.
Hidden Variations in Eye Physiology
In many cases, vision loss begins in the peripheral field, an area we rarely notice in daily life. The brain’s remarkable ability to compensate for these subtle deficits often masks the problem. Some individuals, however, appear to have ocular physiology that inherently suppresses symptoms. Their optic nerves may tolerate stress for longer periods, allowing damage to accumulate silently before any perceptible impairment emerges.
Why Symptoms Stay Invisible
Several factors influence whether glaucoma remains unnoticed:
Optic nerve resilience: Some optic nerves can withstand elevated IOP or other stressors longer before showing signs of damage.
Pattern of nerve fibre loss: Damage in certain regions causes subtle visual field defects that are easily overlooked.
Cognitive adaptation: The brain unconsciously “fills in” missing visual information, masking deficits.
Rate of progression: Slowly advancing glaucoma can remain hidden for years, delaying awareness.
The Critical Role of Regular Eye Examinations
Because glaucoma often progresses without warning, routine eye examinations are the most effective safeguard. Individuals at higher risk including those with a family history of glaucoma, older adults, people of African or Asian descent, and those with conditions such as diabetes or hypertension should undergo comprehensive testing.
Key diagnostic tools include:
Tonometry: Measurement of intraocular pressure
Visual field testing: Assessment of peripheral vision
Optic nerve imaging: Using ophthalmoscopy or optical coherence tomography (OCT)
Early Detection: The Only Defence
While glaucoma-related damage cannot be reversed, early detection can preserve vision. Treatments such as medicated eye drops, laser therapy, or surgical interventions can lower intraocular pressure and slow or even halt disease progression.
Raising Awareness to Protect Sight
Public awareness is critical. By understanding that glaucoma often develops silently and by encouraging regular eye examinations, we can significantly reduce the devastating impact of late-stage diagnosis. Vigilance today is essential to safeguarding vision for tomorrow.
