Directors Desk

Saptarshi Mukherjee, M.Optom, F. Optom

Director of Advanced Studies – India

Vision Science Academy


Vision Science Academy Exclusive


A qualified optometrist must possess the required skill set to distinguish a multitude of ophthalmological conditions during their early clinical phases. Modern optometrists, being equipped with the most advanced diagnostic procedures are well capable of detecting and monitoring the prognosis of several complex eye diseases. This especially holds true for the clinical diagnosis and management of glaucoma, which is one of the most notorious causes of adulthood blindness.

What is Glaucoma?

Glaucoma is described as a progressive loss of the ganglion cells of retina and damage of optic nerve, which is usually secondary to raised intraocular pressure (IOP) and is also associated with a gradual deterioration of visual field. The overall prevalence of open angle glaucoma (OAG) in the United Kingdom is approximately 2% among individuals aged above 40 years while glaucoma is responsible for up to 6% of cases of blindness globally. (1)

In the South Asian region, up to 18% of blindness cases arise as a direct end-result of glaucoma (Figure 1). In India, the International Agency for the Prevention of Blindness (IAPB) records reveal that there are 13 ophthalmologists and 39 optometrists per million population (IAPB). (2) Glaucoma being a major cause of irreversible blindness, affects up to 12 million people in India whereas nearly 1.2 million people have become blind from the disease. Moreover, greater than 90% of glaucoma cases still remain undiagnosed in the community (NHP). (3) This shows how broadly the burden of disease outweighs the medical resources of the South Asian country.

Figure 1: Glaucoma and its Contribution towards the Crude Prevalence of Blindness worldwide.


Diagnosis and Management: Role of an Optometrist

Diagnosis of glaucoma is largely centered at the early detection of retinal changes. This can be achieved with certain diagnostic scan like ocular coherent tomography (OCT) Visual field test, monitoring IOP which informs an eye specialist regarding the suspicion of glaucoma. (4) Broadly speaking, an optometrist is an indispensable member of the glaucoma management team. He must be fully capable of performing the following tasks:

  1. Timely recognition of the important risk factors of glaucoma among the elderly
  2. Diagnosis and classification of the overall extent of ocular glaucoma
  3. Counselling the patient in terms of management options, their clinical monitoring, and expected prognosis of the disease

Optometry and Community Screening for Glaucoma

A vital preventative measure against glaucoma involves community-based screening programs which can allow eye specialists to limit the gradual loss of vision in the affected eye. This can only be achieved with the assistance of a trained team of optometrists. In the UK, optometrists are functioning satisfactorily by detecting various ophthalmologic conditions beforehand, and then referring their patients to eye specialists as and when required. It is noteworthy that it is far easier to access qualified optometrists than ophthalmologists which drastically improves the patient outcome while also saving valuable health resources. (1)

With an adequate glaucoma-based training, studies have indicated that an optometrist can achieve a competent diagnostic accuracy.(1) Following are a few important clinical aspects which maybe noted during the glaucoma examination:(5)

  1. IOP raised above 21 mmHg
  2. Reduced depth of the anterior chamber of eye
  3. Atrophic changes targeting the optic disc


With a rising prevalence of glaucoma, it has now become imperative to train more optometrists in the field of glaucoma care to promote their clinical know-how of the disease management. Indeed, both optometrists and ophthalmologists must learn to boost their interdisciplinary interaction as they continue using their proficiency and skills to the greatest possible level.



  1. Azuara-Blanco, A., Burr, J., Thomas, R., Maclennan, G., & McPherson, S. (2007). The accuracy of accredited glaucoma optometrists in the diagnosis and treatment recommendation for glaucoma. Br J Ophthalmol, 91(12), 1639-1643. doi:10.1136/bjo.2007.119628
  2. IAPB. Retrieved from (Last accessed: 22 May 2021; 17:25 IST)
  3. NHP. World Glaucoma Week. Retrieved from (Last accessed: 22 May 2021; 17:45 IST)
  4. Bourne, R. R., Taylor, H. R., Flaxman, S. R., Keeffe, J., Leasher, J., Naidoo, K., . . . Jonas, J. B. (2016). Number of People Blind or Visually Impaired by Glaucoma Worldwide and in World Regions 1990 – 2010: A Meta-Analysis. PLoS One, 11(10), e0162229. doi:10.1371/journal.pone.0162229
  5. Kersey, T., Clement, C. I., Bloom, P., & Cordeiro, M. F. (2013). New trends in glaucoma risk, diagnosis & management. Indian J Med Res, 137(4), 659-668.