Glaucoma is one of the leading causes of irreversible blindness worldwide — and in Bangladesh, it remains significantly underdiagnosed. The International Council of Ophthalmology (ICO) Glaucoma Guidelines provide a globally recognized framework for diagnosing, managing, and treating glaucoma at every stage. As an ophthalmologist with specialized training in glaucoma services, Dr. Ashraful Huq follows these evidence-based protocols to deliver the best possible outcomes for patients in Dhaka.
Dr. Ashraful Huq’s Clinical Perspective
This blog was reviewed by Eye Specialist Dr. Ashraful Huq.
“Glaucoma is often called the ‘silent thief of sight’ — and in my clinical experience in Bangladesh, that description is painfully accurate. Many patients arrive at my clinic having already lost significant peripheral vision, simply because there were no warning signs to prompt them to seek care earlier.
The ICO guidelines exist precisely to give ophthalmologists a structured, evidence-based framework — so that whether a patient presents early or late, we are following the best available protocol for their stage of disease.
What I want patients in Bangladesh to understand is this: glaucoma is not a death sentence for your vision. Detected early and managed consistently, the vast majority of my patients keep functional sight for the rest of their lives. The problem is not a lack of treatment — it is a lack of awareness that leads people to present too late.
My advice is simple: if you are over 40, have a family history of glaucoma, or have high myopia, do not wait for symptoms. Come for a comprehensive eye examination. The test is painless, takes less than an hour, and the information it gives you is irreplaceable.”
Dr. Ashraful Huq
Consultant Ophthalmologist & Refractive Surgeon
15+ Years of Experience | 5,000+ Successful Eye Procedures
Specialist in LASIK, SMILE, ICL, Cataract & Advanced Vision Correction
What Is Glaucoma?
Glaucoma is a group of eye diseases that damage the optic nerve — the nerve that carries visual information from the eye to the brain. This damage is usually caused by abnormally high intraocular pressure (IOP). Left untreated, glaucoma causes progressive, permanent vision loss, starting with peripheral (side) vision and eventually leading to total blindness.
The most common types include:
- Primary Open-Angle Glaucoma (POAG) — the most prevalent form; develops slowly and painlessly
- Angle-Closure Glaucoma — can develop suddenly (acute) or gradually; more common in Asian populations
- Normal-Tension Glaucoma — optic nerve damage occurs even with normal IOP
- Secondary Glaucoma — caused by another eye condition, injury, or medication
Important: Most people with early glaucoma have no symptoms. Regular eye check-ups are the only way to detect it before significant vision loss occurs.
What Are the ICO Glaucoma Guidelines?
The ICO (International Council of Ophthalmology) publishes globally recognized clinical guidelines to standardize glaucoma care across different resource settings. The guidelines are stratified into three levels:
| Resource Level | Setting | Focus |
|---|---|---|
| Basic | Primary care / limited equipment | Screening, referral, IOP control |
| Standard | General ophthalmology | Full diagnosis, medical & laser management |
| Advanced | Subspecialty / surgical centers | Complex cases, surgical intervention |
Bangladesh Eye Hospital, where Dr. Ashraful Huq practices, operates at the Standard to Advanced level — meaning patients have access to comprehensive glaucoma diagnostics and treatment options.
ICO Guidelines: Key Diagnostic Criteria
According to ICO recommendations, glaucoma diagnosis requires a multi-parameter assessment — not just measuring eye pressure alone.
1. Intraocular Pressure (IOP) Measurement
- Normal IOP: 10–21 mmHg
- Elevated IOP (>21 mmHg) is a major risk factor but not the sole diagnostic criterion
- Goldmann applanation tonometry is the gold standard
2. Optic Nerve Head (ONH) Evaluation
- Fundus examination to assess cup-to-disc ratio (CDR)
- CDR > 0.65 or asymmetry > 0.2 between eyes warrants further investigation
- Disc hemorrhages are a significant risk marker
3. Visual Field Testing (Perimetry)
- Automated perimetry (Humphrey or Octopus) to map peripheral and central vision loss
- Repeated testing is required to confirm progressive field defects
4. Gonioscopy
- Essential to classify glaucoma as open-angle or angle-closure
- Determines whether laser iridotomy is needed
5. Pachymetry (Corneal Thickness)
- Thin corneas can cause IOP to be underestimated
- Central corneal thickness (CCT) adjusts IOP interpretation
ICO Guidelines: Treatment Framework
Medical Treatment (First Line)
The ICO recommends starting with the least invasive, most effective option:
- Prostaglandin analogues (e.g., latanoprost, bimatoprost) — first-line for POAG; once-daily dosing
- Beta-blockers (e.g., timolol) — effective but caution in asthma and cardiac patients
- Alpha-2 agonists (e.g., brimonidine) — used as adjunctive therapy
- Carbonic anhydrase inhibitors (e.g., dorzolamide) — topical or oral
Target IOP is individualized based on the stage of glaucoma and patient profile.
Laser Treatment
- Selective Laser Trabeculoplasty (SLT) — first-line alternative to drops for POAG; repeatable
- Laser Peripheral Iridotomy (LPI) — definitive treatment for angle-closure and prevention in narrow angles
Surgical Treatment
When medications and laser fail to control IOP adequately:
- Trabeculectomy — gold standard filtering surgery; creates a new drainage pathway
- Tube-shunt implants — for refractory or complex cases
- Minimally Invasive Glaucoma Surgery (MIGS) — newer options with faster recovery
Glaucoma Risk Factors: Who Should Be Screened?
The ICO recommends glaucoma screening for individuals with any of the following:
- Age over 40 years
- Family history of glaucoma (first-degree relative)
- High myopia (nearsightedness) — patients considering LASIK surgery or ICL surgery should be evaluated for glaucoma before surgery
- Diabetes mellitus
- History of ocular trauma or steroid use
- Previous eye surgery
- Thin central cornea
Patients with keratoconus or corneal disease also require careful monitoring, as corneal abnormalities can mask true IOP readings and complicate glaucoma assessment.
Glaucoma and Refractive Surgery: What You Must Know
Patients planning vision correction surgery need pre-operative glaucoma screening. Here is why:
- LASIK and SMILE reduce corneal thickness, which alters IOP measurements after surgery — making glaucoma monitoring more complex. Read more: LASIK vs SMILE vs ICL — Which Is Right for You?
- ICL (Implantable Collamer Lens) does not alter corneal thickness, which is an advantage for patients with elevated IOP or glaucoma risk. See: ICL Surgery in Bangladesh
- Cataract surgery can lower IOP in some patients with co-existing angle-closure glaucoma. See: Cataract Surgery in Bangladesh
Dr. Ashraful Huq performs a thorough glaucoma risk assessment for all surgical candidates as part of the pre-operative workup.
ICO Guidelines on Follow-Up and Monitoring
Glaucoma management is lifelong. The ICO recommends:
| Stage | Follow-Up Frequency |
|---|---|
| Glaucoma suspect / OHT | Every 6–12 months |
| Early glaucoma, stable | Every 6 months |
| Moderate glaucoma | Every 3–6 months |
| Advanced or progressing | Every 1–3 months |
At each visit, IOP is measured, medication compliance is assessed, and visual fields are retested periodically (at least annually in stable patients).
Glaucoma Care in Bangladesh: What to Expect at Dr. Ashraful Huq’s Clinic
Dr. Ashraful Huq has specialist training in glaucoma services from Bangladesh Eye Hospital & Institute, Dhaka, and L V Prasad Eye Institute, Hyderabad — one of Asia’s premier eye institutions. His clinic offers:
- Comprehensive IOP measurement and optic nerve assessment
- Visual field testing and optic disc imaging
- Gonioscopy for angle assessment
- Medical management with all major glaucoma drop classes
- Laser peripheral iridotomy
- Referral for advanced surgical intervention where indicated
Frequently Asked Questions (FAQ)
Q: Can glaucoma be cured? No — glaucoma cannot be cured, but it can be controlled effectively. With proper treatment, most patients retain functional vision for life.
Q: Is glaucoma always painful? No. The most common form (primary open-angle glaucoma) is entirely painless. Acute angle-closure glaucoma can cause sudden severe eye pain, headache, and nausea — this is a medical emergency requiring immediate treatment.
Q: Can I have glaucoma even if my eye pressure is normal? Yes. Normal-tension glaucoma is a recognized condition where optic nerve damage occurs at IOP within the normal range. A full eye examination — not just pressure checking — is essential.
Q: Does glaucoma run in families? Yes. Having a first-degree relative with glaucoma increases your risk by 4–9 times. Screening of family members is strongly recommended.
Q: Can high myopia increase glaucoma risk? Yes. People with high myopia have a structurally larger and more vulnerable optic nerve, which increases susceptibility. If you are myopic and considering LASIK or ICL surgery, glaucoma screening is part of the pre-surgical evaluation.
Book a Glaucoma Consultation in Dhaka
If you have risk factors for glaucoma, a family history of the disease, or have not had a comprehensive eye examination recently, early assessment is strongly advised.
Dr. Ashraful Huq — Consultant Ophthalmologist & Anterior Segment Surgeon
Bangladesh Eye Hospital & Institute, Dhanmondi | Zigatola | Banani
📞 01705879995 | 01797105780
📱 WhatsApp: +8801841788371
This article is based on the International Council of Ophthalmology (ICO) Guidelines for Glaucoma and is intended for patient education. It does not substitute professional medical advice. Please consult Dr. Ashraful Huq or a qualified ophthalmologist for personal diagnosis and treatment.