M Nazrul Islam is Professor of Ophthalmology at Bangladesh Eye Hospital. He is the President of Bangladesh Eye Care Society and Immediate Past President of the Bangladesh Glaucoma Society. At present, he is the Chairman of Jessore Community Eye Hospital in Bangladesh, Board Member of the Asia Pacific Glaucoma Society (APGS) and Board Member of Asian Angle Closure Glaucoma Club (AACGC). He is the Chief Editor of the Journal of Bangladesh Glaucoma Society and author of 60 scientific articles published in different journals.

A failed glaucoma filtration bleb is an expected outcome. The body wants to seal off the fistula. Early after surgery the body mounts an aggressive inflammatory reaction which can quickly result in scarring of the bleb. Fibroblast proliferation, synthesis of the extracellular matrix, subconjunctival fibrosis, fibrosis at level of sclera causes sealing of flap and finally external bleb failure. The signs of bleb failure are: local conjunctival hyperemia, vascularization, increased IOP, flat bleb, highly elevated cystic bleb/Tenon’s cyst and small avascular cystic blebs. IOP which does not decrease after massaging risk factors are: Young age, Black race, congenital and juvenile glaucoma, subconjunctival hemorrhage, ICE syndrome, secondary glaucoma following PKP, RD, excessive inflammation, long-term topical glaucoma therapy, traumatic glaucoma, NVG, etc. The options when bleb/trab fails are digital ocular massage, argon laser suture lysis, Release of releasable sutures, loosening of adjustable sutures, medical treatment with bleb needling, revision of trab, repeat trab, GDD, cyclophotocoagulation, etc. The procedures will be

discussed with videos.

Said JamalEddin is a Consultant Ophthalmologist currently working in Saudi Arabia, the doctor has finished his MD degree from Cairo Medical University and obtained the Syrian Board in Ophthalmology. His clinical experience goes back to nearly 30 years which started in Syria by introducing many technologies, some of them, as the first ophthalmologist who worked on PHACO, and fluorescein in angiography. He also worked as the Head of the Ophthalmology department in Homs County Hospital (Alwatany), and worked in many private and state owned hospitals. After that, he moved to Libya for two years where he started to develop a new surgical technique for the strabismus and the glaucoma fistula. He is an active member in the Syrian Ophthalmology Society, and published a research paper titled, “The first 70 cases of PHACO in Syria and its complications”, and attended many international conferences, some of them in Egypt, Morocco, India, Lebanon and Riyadh.

Aim: To explain a new surgical technique in squint surgery, and to discuss and compare with old conventional ones. Material & Methods: A retrospective study was done from 2011 until 2015, at Nour Aloyoun Private Hospital, Libya and in Saudi Arabia, at Baish General Hospital, Jazan. Both hospitals approved this study and oral permission was obtained from all the patients who took part in this study. The confidentiality of the patients was preserved for the study. Complete evaluation of the patient medical and psychological history was made, the necessary lab tests were demanded, and CT investigation was performed before and after the surgery to evaluate the adjustment of the muscles. We operated 74 primary strabismus patients (XT-ET and some secondary cases–re-operated) using this new technique. 40 cases were in Libya and the 34 from Saudi Arabia. All patients were evaluated clinically; imagery and follow-up were conducted for up to two years.

 

Results: Out of the 74 cases, 68 (92%) were successful with high ocular motility after three months. Overcorrection and under correction only appeared in 8% (6) of the cases. No major complications were recorded during and after the surgeries. The results are supported by documents and images.

 

Conclusion: This myectomy technique is a new revolution in our ophthalmic field because it didn’t interrupt the integrity of the normal ocular motility and it’s simpler, easier, with high successful rate (92%), require less time, without suturing much and more efficient with less complications.

Rajender Singh Chauhan completed his MS in Ophthalmology in 1990 from Medical College Rohtak. He joined PGI of Medical Sciences Rohtak in 1993 and continued as Consultant till date. He has undergone training in LVPEI Hyderabad, Dr. R P centre AIIMS New Delhi and Dudley Hospital irmingham UK. He had been actively involved in teaching in PGIMS Rohtak and Oman Medical College. He is Postgraduate teacher since 1998 and guided many MS student and DNB students. He has attended many international and national conferences and had chaired many sessions and conducted instruction courses in SICS. He has plenty of publications and presentations to his credit. He is presently working as Professor in Regional Institute of Ophthalmology in PGIMS Rohtak.

Sight threatening glaucoma needs meticulous management by medical or surgical modalities. Surgery remains the mainstay of treatment when medical treatment becomes inefficient. The surgery of choice remains the classical trabeculectomy. To have the best outcome of this surgical modality, we should learn the intricacy and modification according to desired outcome and risk factors. Written information should be provided to the patient. It has mainly two approaches-limbal based and fornix based. The basic principal of trabeculectomy is to handle the conjunctiva carefully and minimally. When aggressive filtration is needed, Mitomycin- C is used. Kelly’s punch has been found to be of utmost use. Modification in the form of adjustable /releasable sutures can also be used. Long-term follow up and management of failure are of paramount importance.

Navonil Sau has completed his MS Ophthalmology from Kasturba Medical College, Karnataka, India in 2011 and then completed 2-year long term fellowship in Anterior Segment and IOL Microsurgery from Aravind Eye Hospital, India. Presently, he is working as a Consultant at Vivekananda Mission Asram Netra Niramay Niketan, India. He has 2 national and 1 regional conference presentation.

Purpose: To look into the magnitude and pattern of visual profile of patients present with varieties of secondary glaucoma.

 

Methods: A retrospective hospital based analysis of medical records of patients attending Vivekananda Mission Asram Netra Niramay Niketan, Chaitanyapur, West Bengal, India, over a period of 18 months (Dec 2013 – May 2015) was done in order to know the magnitude and pattern of visual profile of different types of secondary glaucoma walk-in patients.

 

Results: Out of 224 secondary glaucoma cases, 158 were Open Angle (70.5%) and 66 were Close Angle (29.4%). Secondary glaucoma patients comprised of 0.17% of total out patient, and Secondary Open Angle (SOA) and Secondary Close Angle (SCA) comprised of 1.63% and 0.68% of total glaucoma patients attended the hospital respectively. Male female ratio is 2.8:1 and 2.4:1 in SOA and SCA respectively. We found Psedoexfoliation Glaucoma was the most common cause of SOA and Neovascular Glaucoma was more common SCA glaucoma in our study. Mean presenting visual acuity for SOA was 1.16 logmar and 2.24 logmar for SCA. Mean IOP was 35.9 mm of Hg and 40.7 mm of Hg for SOA and SCA respectively.

 

Conclusion: In spite of unimpressively lower number of Secondary Glaucoma patients, management strategy of those patients should be prompt and effective considering their presenting vision.

Leila Mohan is a leading veteran Ophthalmologist from Kerala specialized in Anterior Segment and Paediatric Ophthalmology. Her special areas of interest are Paediatric Ophthalmology and Oculoplasty. After accomplishing her Medical Graduation (MBBS) and Post Graduation (MS & DO), she worked under Ministry of Health in Saudi Arabia for 6 years. She also worked as Consultant in Baby Memorial Hospital, Calicut and Nirmala Hospital.

Lifestyle diseases which include hypertension, diabetes, arthritis, obesity, insomnia, etc., have been said to be treated or altered by yoga, which is an ancient form of Indian art of living. Today’s stress and lack of physical exercise contributes to many lifestyle diseases. Yoga is a physical, mental and spiritual practice where exercise, breathing and meditation is said to have an influence on reducing high blood-pressure, improving symptoms of heart failure, enhancing cardiac rehabilitation and lowering cardiovascular risk factors. With the awareness of lifestyle diseases and its modifications by exercise, yoga practice has become popular and there is a revival of this among middle aged people. I would like to discuss 4 cases of progressive glaucomatous field loss-two of them with advanced field loss, which had no other risk factors but ardent practice of yoga for more than 10 years as the only ‘risk factor’. One is a male yoga teacher by profession; who, at the early age of 34 years, started developing laucoma and the field changes were progressing at an enormously fast rate. He was being followed up with medication which had to be increased on each visit. The second, a spiritually oriented 45 year old male, who was diagnosed to have glaucoma with intraocular pressures of above 40 mm of Hg, had trabeculectomy and during the postoperative period, was found to be practicing yoga on a regular basis. The third one, a professor in arts, a gentleman who vigorously practiced yoga after retirement-at the age of 55- developed moderate to severe glaucomatous field defects. Intraocular pressure was in the thirties and with maximum medication progression necessitated trabeculectomy. The fourth case was that of a 73 year old doctor, an ardent practitioner of yoga and a spiritual teacher, who had advanced glaucomatous field defects in both eyes with an intraocular pressure in forties without medication who underwent trabeculectomy after a trial of 3 anti-glaucoma medications. Many patients ask us the benefits of exercise or food which may modify glaucoma. Often the answer is negative. But this experience shows that we need to probe into their yogic practices, especially postures in which head goes below the level of the heart as in ‘shirasasana’-standing on the head. All four patients did ‘shirasasana’ for more than10 minutes regularly. 

 

Conclusion: Posture with head below the level of heart for prolonged periods of time can produce deleterious optic neuropathy due to high intra ocular pressures. There are few papers in literature showing the influence of posture on intra-ocular pressure, which need to be studied in more detail.

Enghmingliani Ralte has completed her MBBS from Lady Hardinge Medical College, New Delhi and MD (Ophthalmology) from Rajendra Prasad Centre for Ophthalmic Sciences (All India Institute for Medical Sciences) New Delhi, India. She has worked in the Government of Mizoram for more than 23 years. At present, she is the Head of the Eye Department in Civil Hospital, Aizawl, Mizoram.

Mizoram is a small state in the North Eastern part of India. Hence, all Ophthalmologists have to practice as general ophthalmologist treating all diseases of the eye. In my practice of over 20 years, I have come across a number of patients having glaucoma associated with cataract. Many of the patients have lens induced glaucoma. In such cases, the best treatment is to do a combined surgery after controlling the IOP. In combined surgery, the trabeculectomy and phacoemulsification incision site may be done at different sites. Usually the trabeculectomy is done at 12 O’clock site and the phacoemulsification is done at the temporal site with the surgeon sifting position or first the trabeculectomy is done at one sitting and then phacoemulsification with IOL implantation is done at a second sitting. In some cases, first phacoemulsification with IOL implantation is done which alone may control the IOP in cases of intumescent cataract. In some cases, phacoemulsification with IOL with trabeculectomy is done at the same site i.e., at 12 O’clock position. This method is the best so far in my experience. First, after making a fornix based conjunctival flap, a partial thickness scleral flap is made. Then, the trabulectomy site is marked with a sharp knife and then phacoemulsification with IOL implantation is done under the scleral flap. This reduces the postoperative astigmatism. After this, the trabeculectomy is done and sutures are passed. When combined surgery is done, two surgeries are incorporated into one surgery. This saves the patient having to undergo two operations at two sittings which are cost effective, time saving and emotionally less traumatic. It also gives the best results.

Philip Kuruvilla completed his MBBS from Christian Medical College, Vellore and his Postgraduation in Ophthalmology from Christian Medical College, Ludhiana. His deep Christian faith and convictions moved him to serve in the North Indian villages of Punjab, Himachal Pradesh and Uttar Pradesh where he performed several thousands of Eye Surgeries in the span of 10 years and gained tremendous expertise in Cataract Surgery, Squint Surgery, Trabeculectomy (Surgery for Glaucoma), Ptosis, and Oculoplastic Surgeries like corrections of conditions like Ptosis (droopy eye), Entropion (inversion of eye lid), Ectropion (eversion of eye lid), Dermatochalasis (excess skin in the upper lid), etc.

This is a case presentation of a gentleman born in 1950 who came to me in Sep 2006 for refraction. On routine examination, he was found to be slightly hypermetropic (<1 D), with a BCVA of 6/6 N6, IOP of 30.4 mm BE, narrow angles BE and glaucomatous field defects (more in the LE) C/D 0.7 RE and 0.9 in LE. Nd Yag PI was done in BE. Despite treatment with three drops (latanoprost, dorzolamide and timalol), IOP remained around 20 mm Hg. So trabeculectomy was done in RE in July 2008. AC was formed on the first post-op day. But 1 week later, AC was minimally shallow, IOP was 9 mm Hg. Vision was 6/6 with glasses and retina was normal. Without any treatment AC got formed and IOP went up to 20. Releasable suture was removed for 3 months he was fine, then suddenly he presented with dim vision, flat AC and a tension of 26. Responded well with pad and bandage, atropine drops (every 10 mts), acetazolamide tabs and steroid drops. He had repetitions of similar episodes of flat AC and slightly high tension later in the same month (Oct 2008), again in Feb 2009 (episodes followed stoppage of atropine). So he was put on atropine drops at least once in 2 or 3 weeks in the mean time, he was developing a cataract and by March 2012 it was significant enough for it to be operated and cataract extraction with IOLI was done. Since then, he has not had a single episode of high tension in that eye till today even without cycloplegics. In the LE IOP remained in the high teens with 3 drops and he has been too scared to agree for any surgery for that eye. RE is a typical case of Primary Angle Closure Glaucoma (common in India) going on to malignant glaucoma (rare), probably initiated by over filtration after trabeculectomy. This case presentation will be followed by mentioning a few points about malignant glaucoma and treatment modalities.

Zakia Sultana Shahid Associate Professor of Anwer Modern Medical College And Hospital, Dhanmondi, Dhaka. She was Former Head of the department of ophthalmology of the same medical college. She is from Chittagong. Studied at Convent, ST. Scholasticas Girls High School and Chittagong Govt College. Graduated from Chittagong Medical college in 1988. She has done her training in ophthalmology in NIOH and obtained Diploma in ophthalmology from NIOH under Dhaka University in 1993. She obtained Master of Surgery in Ophthalmology from NIOH under BSMMU in 2003. Performed her Fellowship in Glaucoma from LV Prashad Eye Institute,Hyderabad ,India in 2005. Her area of interest Cataract ,Glaucoma & Uvea. Along with her many credentials DR. Zakia .S.Shahid has many publications in different journal of both Home

and Abroad. She attended many Conference both Home and Abroad and participated with scientific pappers. She is the Secretary General of Bangladesh Glaucoma Society. Assistant Editor of BGS Journal. Life member of Bangladesh Ophthalmological Society, Founder Life Member of Bangladesh Glaucoma Society, Life Member of Bangladesh Uvea Society, Bangladesh National Society of Blind, Chittagong Maa O Shishu Hospital, Kidney Foundation ctg, Diabetic Assiciation Ctg. She is the President of Soreptimisit International Club Dhanmondi who works for women and girls to improve their lives and status. She achieved ‘ MOTHER TERESSA’ award 2016 for her

contribution in medical science, in Ophthalmology and social work.

Glaucoma is being considered as a second leading cause of blindness in the world and is responsible 12.5% of total blindness. It is a neurodegenerative disease where ganglionic cell become degenerated progressively leading to blindness. Due to lack of proper treatment blindness which occurs is irreversible. Though increased intraocular pressure is the major risk factor to cause damage yet glutamate, nitric oxide, vascular supply can also be considered as other risk factors.

 

In POAG to maintain the baseline level of IOP to reduce the extent of damage we can do medical, laser or surgical treatment. to with to reduce the mechanical effect over the nerve To reduce IOP, vascular damage, and biochemical effect. Medical therapy is the initial treatment to start. There are different line of treatment. Even we can use single or multiple drug depending on IOP. PG analog, Alpha agonist , beta blocker are most widely used. Along with this newer drug are also being introduced eg Tufluprost .But whatever we use it should be effective, tolerable, and affordable. Future upcoming anti glaucoma drug will not only reduce IOP but also protect trabecular meshwork, improve blood flow to optic nerve head, and slower the progress of damage.

 

Key word: PG analog, Alpha agonist, IOP, Tufluprost

 

Disclosure: The authors have no conflicts of interest to declare.

Syed Imtiaz Ali Shah (a nationally and internationally well known scholar/researcher of Pakistan origin) qualified MBBS with Distinction in 1980 from Chandka Medical College/University of Sindh, Pakistan. He passed Fellowship Examination of College of Physicians and Surgeons of Pakistan and was elected as Fellow in Ophthalmology (FCPS) in 1987. He has 40 published research papers and numerous scientific presentations to his credit.

Purpose: To determine the frequency of occurrence of pigmentary Glaucoma in patients with Pigment Dispersion Syndrome (PDS).

 

Material & Methods: This prospective follow up study was conducted from August 2001 to March 2015 at Ophthalmology Department Chandka Medical College, Larkana, Pakistan. Patients presenting with Krukenberg’s spindle on the endothelial side of cornea and pigmentation of angle of anterior chamber seen on slit lamp examination and gonioscopy were considered as cases of PDS. Patients with presence of secondary pigment dispersion associated with causes like, pseudoexfoliation, iris cyst, nevus, malignant melanoma, intraocular inflammation, intraocular surgery, ocular trauma and irradiation were excluded from the study. Slit lamp examination, Applanation Tonometry, Gonioscopy, Fundoscopy, Automated Perimetry and Refraction was performed on every case. SPSS version 20 was used for data entry and analysis.

 

Results: 72 cases of Pigment Dispersion Syndrome according to the inclusion criteria were included in the study, amongst them 63 (87.50%) were males and 9 (12.50%) were females. Mean age ± standard deviation of patients was 35.00±6.54 years and age range was 24 to 46 years. 47 (65.28%) patients had an IOP in the range of 10-14 mmHg, 22 (30.56%) patients had an IOP in the range of 15-18 mmHg and 3 (4.17%) patients developed an IOP of greater than 19 mmHg. Fundoscopy showed myopic degeneration in 49 (68.06%) patients and optic disc cupping in 3 (4.17%) patients. 4 (5.56%) patients had refractive error between +1D to +3D, 9 (12.50%) patients had refractive error between -1D to -4D, 21 (29.17%) patients had refractive error between -5 D to -8 D and 38 (52.78%) patients had refractive error between -9 D to -12 D. Our study showed that 1.64% patients having PDS developed glaucoma at 5 years of follow up and 7.32% patients developed glaucoma at 14 years of follow up. 

 

Conclusion: On the basis of this study we conclude that early onset primary open angle glaucoma associated with Pigment Dispersion Syndrome or Juvenile glaucoma associated with PDS might have been mistaken as Pigmentary Glaucoma in Pakistani patients (black population) and a distinct entity in the form of Pigmentary Glaucoma may be non-existent in blacks.

M V Francis is a highly experienced Ophthalmologist from Kerala specializing in Neuro Ophthalmology, Headache and Ocular Allergy. He has 24 years of rich expertise in Clinical Research in Neuro-Ophthalmology and Headache. He has accomplished his Medical Graduation (MBBS) & Post Graduation (MS) and has been in practice since 1999. He is currently associated with Teresa Eye Migraine Centre in Aleppey, Kerala.

Objective: To document subacute angle closure glaucomas mimicking moon migraines.

 

Background: Intermittent angle closure episodes with headache, nausea, vomiting and blurring of vision can mimic migraine with or without auras. The traditional concept among many people in this part of the world is that any recurrent unilateral head pain with nausea and vomiting is migraine and if symptoms manifest after sunset, it is named Moon migraine and early morning onset as Sun migraine. It is also well known that early on in the course of painful eye disorders, including narrow angle glaucoma and uveitis, the eye may be “white” or “quiet” and the disease often misdiagnosed. Subacute angle closure glaucoma is intermittent and difficult to diagnose between attacks without gonioscopy. SACG may present with intermittent headache (with or without eye discomfort) or with amaurosis fugax.

 

Methods: 17 patients aged 42 to 74 with recurrent late evening headaches were prospectively evaluated over a period of 19 years. All were diagnosed in the past as late onset migraines or moon migraines. A thorough history of headaches applying ICHD 3 beta migraine with and without aura diagnostic criteria applied to diagnose migraine or probable migraine (duration less than 4 hours). Full ophthalmic work up including gonioscopy done in all. 

 

Results: Eleven fulfilled probable migraine without aura criteria; four with definite migraine without aura and 2 with probable aura migraines. Clinching diagnostic evidence from history was redness/halos/blurring (lasting more than one hour) at the time of headache attacks and absence of past or family history of migraines. Well known angle closure triggers other than dark surroundings were noted in 7 people. Nausea/vomiting were present in most of them but not considered diagnostic as they are common in both the disorders. Intraocular pressure, slit lamp biomicroscopy and gonioscopy findings were confirmative of subacute angle closure attacks in all. 

 

Conclusion: When elderly patients present with history of recurrent unilateral headaches in the late evenings/night time or with a past or self diagnosis of moon migraine and if the pain doesn’t conform to a well defined headache syndrome, a carefully taken ophthalmic history and meticulous eye examination including gonioscopy to be done to rule out intermittent angle closure glaucomas. Subacute angle closure glaucoma (SACG) is difficult to diagnose between attacks without gonioscopy. This study concludes that ophthalmologists must be aware that headaches can be a prominent feature of SACG and that gonioscopy, which is not part of a routine ophthalmology exam, is necessary.

Angshuman Das Graduated in Medicine in 1995 from Burdwan Medical College, India. He started his Ophthalmology Residency there in 1996. He got his Diploma in Ophthalmology in 1999. He completed his MS in Ophthalmology in 2005 from the Regional Institute of Ophthalmology, Kolkata. He started his teaching career in 2006, and is now working as Assistant Professor of Ophthalmology in Murshidabad Medical College, India since 2012. He has been an ICO Fellow at Ludwig Maximillian University at Munich, Germany. He passed FRCS Ophthalmology from Glasgow in 2013.

Since inception in 1996, prostaglandin analogues (PGAs) have gained more attentions in recent years as the first line of drug for medical management of glaucoma. They can reduce the intraocular pressure (IOP) more effectively than other topical anti glaucoma medications; have fewer systemic side effects & above all once a daily dosing advantage. Four PGAs are now commercially available in India namely Latanoprost, Bimatoprost, Travoprost & Tafluprost. Studies indicate that the IOP-lowering efficacies of the prostaglandin analogues are comparable, although each has a unique receptor-binding profile. The mechanism of action is same with each drug and the adverse reactions are similar. Here, we discuss the basic pharmacology, clinical uses, indications, contraindications and the advantages over other anti-glaucoma medications. We also discuss some uncommon but important side effects of these drugs, which may be clinically significant. We made a search on Medline and other databases about the recent developments on the PGAs since 2011 and report some interesting findings.

S J Datta Mazumder joined Department of H&FW, Government of Assam, as M&HO in 1998. In 2006, he completed his Diploma in Ophthalmology from SMC, Assam University and joined VMANNN, Chaitanyapur as Medical Officer. He completed Fellowship from Aravind Eye Hospital, Madurai in 2008. In 2010, he became Chief, VR services, VMANNN. In 2012, he took over as Chief Medical Officer of VMA, NNN. He is a Senior Faculty of VMA, IOT. He attended several national and international conferences as delegates, presenter and faculty. He is a Vidyasagar University accredited examiner and paper setter.

Purpose: To look at how the status of awareness, attitude, practice and economy of any given population suffer from diabetic retinopathy (DR) is far more important than only clinical diagnosis and evaluation.

 

Material & Methods: We selected and covered around 1 million populations (exact figure 1014976) surrounding our base hospital (average distance 26 km). Out of the total population around 0.25 million people (23.6%) projected to be below poverty line. We did a baseline KAP study for diagnosing basic educational status of the population regarding the disease. Considering the recommendations of the study we had designed our awareness activities around the area along with financial support for examination and treatment at base hospital from 2008 to 2011. We then observed the impact of service uptake at the base hospital during the project period and after.

 

Result: We recognized rise (mean 51.75%) of DR patients at base hospital for evaluation and treatment during 4-year project period as compared to 2007 and fall (mean 17.15%) of DR patient in 2012 to 2015 as compared to project period, still maintaining rise (mean 34.6%) as compared to 2007.

 

Conclusion: Despite multitude of treatment options, appropriate awareness and square funding is the mainstay of early detection and prevention of moderate to severe vision loss and related morbidity due to DR.

Anita Shah completed MBBS in 1986 and DOMS in 1989 from APS University, Rewa, MP and is working in GB Pant Hospital, A&N Islands from 1994. She is managing the clinical and administration works for prevention of blindness in islands. She is trained in Glaucoma from Dr. RP Centre, AIIMS, New Delhi. Apart from Glaucoma, she is trained in Phaco Surgery, Medical Retinal and Eye Banking in Keratoplasty. Her works in preventing blindness in tribal population of Car Nicobar is well appreciated and published in reputed journal and presented in conferences. She is also working to prevent irreversible blindness due to diabetic retinopathy.

Glaucoma is a major cause of blindness in India, which could be greatly reduced by early diagnosis, proper management and lifelong follow up. There as at least 12 million people in India affected with glaucoma and 1.5 million are blind from disease. A study conducted by National Programme for Control of Blindness, Directorate General of Health Services, Govt. of India, during the year 1999–2001, showed prevalence of glaucoma as 5.9% in blind people among 50+ age group. The Union Territory of Andaman and Nicobar Islands comprising 572 Islands, is situated in Bay of Bengal. Out of 572 Islands, only 38 islands are inhabited with the population of 3.79 lakhs comprising mainly people from different parts of India and tribal population. Few islands are tribal restricted islands. The capital city of Andaman and Nicobar Islands is Port Blair which is more than 1000 kms away from mainland India. In A&N islands, no blindness survey of population based study on glaucoma has done till date. According to population prevalence of glaucoma in 50+ group of general population should be approximately 10765, but islands differ is demographic pattern from the rest of the India. 240 glaucoma patients are registered and managed in eye OPD of one District Hospital with single ophthalmologist. Patients are diagnosed after proper investigations like vision recording by Snell’s charts, IOP by NCT and AT, CCT, Vongrafe’s Sign, Goinoscopy, Fundus examination for disevaluation and HFA (Carl Zeiss), OCT (Carl Zeiss) by single ophthalmologist. In the absence of ophthalmologist in different islands, early diagnosis and management of glaucoma is a real challenge. Intensive awareness campaign and training of PMOs helped in preventing blindness due to glaucoma in Islands.