#By Dr R B Chaudhary

In India, where glaucoma affects an estimated 12-13 million people—nearly one-sixth of the global burden—eye specialists at Dr. Agarwal's Eye Hospital are sounding alarms over a preventable crisis: steroid-induced glaucoma (SIG). This secondary form of the disease, triggered by unsupervised corticosteroid use, is escalating into a silent epidemic, leading to irreversible vision loss.

Imagine losing your eyesight without any warning—no pain, no blur, just darkness creeping in. That's glaucoma for you. In simple terms, glaucoma is eye damage from too much pressure inside the eye, which slowly kills the optic nerve—the cable that sends pictures from your eye to your brain. It's like a thief that steals your sight bit by bit, often without you noticing until it's too late.

How does glaucoma work?

Your eye is like a balloon filled with fluid called aqueous humor. This fluid keeps the eye healthy and shaped right. Normally, it drains out through tiny drains in the eye's front room (called the trabecular meshwork). In glaucoma, these drains get clogged or blocked, so pressure builds up.

This squeezes the optic nerve at the back, damaging its nerve fibers. Over time, you lose side vision first, then central vision. Steroid-induced glaucoma (SIG) happens when steroids—medicines for swelling or allergies—mess up those drains even more. Steroids make the drains swell and tighten, trapping fluid and spiking pressure fast. Common culprits? Eye drops, pills, inhalers, or shots like dexamethasone, often grabbed without a doctor's okay.

Exploding Into A Hidden Crisis

In India, this is exploding into a hidden crisis. About 12-13 million Indians have glaucoma—that's one-sixth of all cases worldwide. Eye experts at Dr. Agarwal's Eye Hospital are blowing the whistle. Steroid misuse is the big trigger, especially over-the-counter drops for itchy eyes or allergies. Dr. Soundari S, who leads clinical services at their Chennai branch, sees more SIG cases every year. Without checks, these steroids silently wreck eyes. By 2040, global glaucoma could hit 111 million cases, with India hit hardest. January 2026's Glaucoma Awareness Month is our wake-up call.

India's Growing Concern

Glaucoma hits 3.23% of people over 40 here. That's primary open-angle (drains slowly clog) at 2% and angle-closure (sudden block) at 0.8%. By 2050, it could jump to 4.5%—a 29% rise. SIG makes up 1.4% overall but skyrockets in groups like kids with eye allergies (vernal keratoconjunctivitis or VKC): 4.7% get it, and 19% in rural areas using steroids unchecked. In Central India, 6% of VKC patients develop SIG from long-term strong drops. Even COPD patients on inhalers face 4% risk. Worst? Kids prescribed steroids for VKC—two-thirds end up blind in one or both eyes.

Why so common?

Indians love self-medicating. Surveys show 88% misuse steroids, thanks to easy pharmacy buys and non-eye doctors prescribing them. Cities see more allergy cases (23% vs. 8% rural), plus myopia and steroid use. At Dr. Agarwal's Chennai clinic, SIG cases rose over 2-3 years. Half of steroid users get high eye pressure first—a red flag. Many show up with zero symptoms but major optic nerve damage. Hospital stats: 5-8% SIG in general patients, 90% in suspects. Just one week of dexamethasone ups lifetime risk by 4%. Nationally, 85-90% of glaucoma goes undiagnosed, making SIG deadlier.

Fresh Science Unlocks Clues

New 2025 studies explain why steroids are sneaky. Cornell's eye-on-a-chip lab test showed steroids wake up bad receptors in drain cells, shrinking fluid exit paths like tightening a hose. Genetics play a role too—some people are steroid responders with gene tweaks that clog drains faster. Pollution worsens allergies, feeding more SIG. Donor eye research spots gooey buildup and stiff drains in at-risk folks.

Hopeful New Treatments

Good news: fixes are advancing. The 2025 LiGHT study proves laser zaps (SLT) beat drops as first treatment—they open drains better, slowing damage. Tiny surgeries (MIGS) fix eyes with fewer risks. Implants like iDose TR pump medicine for 3 years—no daily drops needed. Bimatoprost lasts a year. A new gadget, Eyetronic, zaps the optic nerve to boost cell energy and maybe regrow sight (first U.S. try in 2025). Gene fixes target dying cells, and netarsudil drops lower pressure plus protect nerves. AI scans spot trouble early in 2026. Even gels that cut pressure without drugs are coming.

Big Hurdles Ahead

Still, 90% cases slip by until damage is done—16% eyes blind at first visit. Rural India lacks checks, where 19% misuse steroids freely. Risks stack up: age 40+, diabetes, myopia, South Asian roots. Sick folks have 50% higher pressure. Many skip follow-ups or need steroids for other ills. Surgery hits 25% of tough cases, with 3% permanent harm from repeat exposure. Result? Slashed quality of life, blindness in 40% late eyes.

Simple Steps to Fight Back

We can stop this. Dr. Agarwal's runs awareness drives—join them! Key moves: Educate everyone: Steroids save lives but check eyes during use. Stop early if pressure rises. Mandate eye pressure tests for high-risk folks (family history, diabetes).Eye docs team with family doctors for allergy swaps. Free yearly screens over 40, using AI. Start with SLT. Rules: Ban over-the-counter steroids, test genes for risk, crack down on fake prescribers. Push research for SIG blockers. Dr. Agarwal's offers free glaucoma checks for diabetics till Feb 2026—grab it!

India's Steroid Slip-up

India's steroid slip-up doesn't have to blind millions. With Chennai insights, cutting-edge tools, and smart action, we can save sight. Don't wait—check your eyes today. India's steroid misuse crisis underscores a pathway to preventable blindness. By integrating Chennai findings, latest advances, and targeted interventions, vigilance and innovation can preserve sight. Action now is crucial to avert this silent surge.

(# Author is associated with the Hindusthan Samachar as representative of the Tamilnadu State)

---------------

Hindusthan Samachar / Dr. R. B. Chaudhary