Dr Syed Shoeb Ahmad is a leading glaucoma specialist and practising ophthalmologist based in India. A well-published expert in the field, he is also the creator of ‘Glaucoma Specialist Blog: The Glog‘, an online resource designed to support ophthalmologists at all levels. In this Q&A, he shares his insights on the challenges of early diagnosis, advances in treatment, and the often-overlooked connection between glaucoma and systemic disease.
1. What are the main challenges in diagnosing glaucoma early, particularly in patients who may present with other systemic diseases?
One of the main reasons glaucoma is often diagnosed late is the absence of early symptoms such as blurred vision or pain. In patients with systemic diseases, especially life-threatening conditions like metastatic cancers, physicians’ attention is typically focused on the primary illness. If there are no specific complaints suggestive of glaucoma, diagnosis is frequently delayed. While systemic cancers have identifiable markers for metastasis, there are no widely used general tests for glaucoma. A complete ophthalmological evaluation remains the only reliable method for early detection.
2. What do you consider the most promising recent or upcoming developments in the treatment of glaucoma?
Although glaucoma has been recognised since the early 19th century, current management strategies are still largely focused on controlling intraocular pressure (IOP). However, studies show that the lifetime risk of blindness in glaucoma patients can range from 20–40 per cent, even when “target IOP” is achieved. This highlights the urgent need for treatments aimed at neuroprotection and neuroregeneration. The development of Rho kinase (ROCK) inhibitors represents a promising step in that direction.
3. Your recent article published in touchREVIEWS in Ophthalmology highlights the rare but important association between breast carcinoma and glaucoma. Why is it important for ophthalmologists to be aware of this link?
Patients and their families often do not disclose a history of cancer, particularly in sensitive cases like breast cancer, assuming it is unrelated to eye issues such as blurred vision, pain or redness. However, ophthalmologists should be aware that certain types of glaucoma, such as inflammatory and neovascular glaucoma, may be secondary to an underlying malignancy. In some cases, a patient may not even have a known history of cancer, and investigations into secondary glaucoma may reveal the diagnosis.
4. Can you briefly explain the implications of glaucoma treatment in patients with ocular metastases from breast cancer, and why management may differ in this group?
The uveal tissue of the eye has the highest metastatic efficiency index of any human tissue due to its vascular and microenvironmental characteristics. Consequently, breast cancer frequently metastasises to the eye, potentially leading to secondary glaucoma. Managing glaucoma in these patients poses unique challenges: the disease is often refractory to standard treatment, systemic cancer therapies may elevate IOP, and some anti-glaucoma drugs can worsen inflammation or are contraindicated (for example, prostaglandin analogues and pilocarpine). Surgical interventions such as drainage procedures may also fail due to tumour blockage. In addition to glaucoma treatment, addressing the intraocular metastasis itself is critical. Compliance with glaucoma medications is often poor, as patients tend to prioritise systemic cancer treatment.
5. Your blog, GLOG, has been an excellent resource for a number of years. What inspired you to start it, and how has the experience been so far?
I started the “Glaucoma Specialist Blog: The Glog” after realising there were very few online resources for healthcare professionals focused specifically on glaucoma. Most search results online are targeted at patients or the general public. The Glog was created to serve ophthalmologists at all levels, from residents to consultants, looking for targeted, reliable information. Over the past nine years, the blog has had nearly 200,000 visitors. We have been fortunate to feature contributions from leading glaucoma experts as well as students, offering a valuable learning experience for everyone involved. It has been a truly rewarding endeavour.
Read Dr Ahmad’s recent article Association of Breast Carcinoma with Glaucoma: A Review here.
Take a look at Glaucoma Specialist Blog: The Glog here.
Disclosures: Dr Syed Shoeb Ahmad has nothing to disclose in relation to this article. No fee or funding were associated with this article
Citation: Syed Shoeb Ahmad. Seeing the bigger picture in glaucoma care. touchOPHTHALMOLOGY.com. 30 June 2025.
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