Glaucoma: The Imperative for Frequent Eye Checks

As the world commemorates Glaucoma Week beginning today, opthalmologists have advised on the need for frequent eye checks as the disease, which causes irreversible blindness, can be treated when detected at the early stages. Kuni Tyessi writes

Glaucoma is a leading cause of blindness in adults globally and one estimate claims nearly 68 million persons, out of which seven million become bilaterally blind. Unfortunately, nearly 50 per cent of people with glaucoma may go undetected until they have lost substantial vision. With the increasing risk of glaucoma with age, it is important that the elderly population should see the need to cultivate the habit of routine eye checks.

Quite a number of new glaucoma cases are expected to proportionally increase. The importance of obtaining a full medical eye evaluation, including a glaucoma check, is advised for anyone over the age of 40. Many cases of glaucoma may take years to show signs of visual loss. The goal in Ophthalmology is to detect glaucoma at the earliest stage so that appropriate medical and surgical therapy may prevent visual loss.

Research shows that in Nigeria alone, no fewer than 1.2 million people above 40 years are living with glaucoma, the chairman, Ophthalmology Society of Nigeria, Lagos State chapter, Dr. Abiola Oyeleye, has said.

The expert spoke on the sidelines of an event which made the 2016 World Glaucoma Week (WGW), slated for March 6 to March 12, with the theme: ‘Beat Invincible Glaucoma’.

He said the figures were valid statistics from the Nigerian National Blindness and Visual Impairment Survey of 2005 to 2007.

According to him, up to 90 per cent of those affected with glaucoma are unaware that they have the defect and one in five people, that is, 20 per cent of those with glaucoma, are blind.

“These statistics are staggering. However, early detection by screening and appropriate treatment can prevent blindness,” he said.

Oyeleye said that late diagnosis, poor medication compliance, high cost of treatment, and poor access to eye care were some of the challenges facing the management of glaucoma in the country.

“In Nigeria, most cases of glaucoma are diagnosed when glaucoma is in its advanced stage, or when vision has been completely lost in one eye.

“Glaucoma can be present for several years without being diagnosed, and as we have not developed a culture of having routine eye tests, the early stages go undiscovered.

“Only a few states in Nigeria have regular government programmes for eye care and free screening. Programmes like these encourage people to have eye examinations, to reduce poor access to eye care,” he said.

He further said that in Nigeria, individuals with glaucoma usually paid out of their pockets when it comes to treatment and this could be very challenging, looking at the economic situation of the country.

According to him, the treatment of glaucoma is expensive as some individuals may require medication worth up to N15, 000 or N20, 000 monthly, based on today’s costs.

“In more developed health systems, health insurance, either government or private, will pay for the medication.
“Over the last 10 years, the health insurance system is developing in Nigeria, but too slowly.

“Most people covered by health insurance are in the middle income class, except for a few schemes targeted at the lower income groups.

“Healthcare financing is a major issue in Nigeria, which must be addressed,” he said. Oyeleye said that glaucoma, when not well managed, could alter the strata of an individual’s life.

“Glaucoma is the leading cause of irreversible blindness worldwide.
“Before glaucoma gets to that stage, vision diminishes progressively and the individual may not be able to maintain the same job to earn a living. “The individual may also be vulnerable to all sorts of accidents, which may cause loss of life.

“There can be poor health indices like depression and the need to rely on others for day-to-day things.
“In Nigeria, you will see a lot of blind people being led around by children; what is the future for that child, who loses the opportunity to get educated?” Oyeleye asked. Still in the commemoration of the Glaucoma week, a consultant Ophthalmologist, Garki Hospital, Abuja, Dr. Sewuese Bitto, said that results from the screening which was done for over 30 persons, revealed that most of them were suffering from glaucoma, and other eye diseases diagnosed during the screening were allergic conjunctivitis, blunt ocular trauma to the eye and refractive errors.

Bitto underscored the importance of screening in the diagnosis and treatment of the disease, saying “we are able to pick cases from doing so and try to manage the condition.”

She described glaucoma as a degenerative disorder of the optic nerve, which affects the axons of the optic nerve, causing them to die due to pressure and cannot regenerate as there is no treatment for the nerve and the disease has no cure and can only be managed to reduce the progression of the disease.

While one form of glaucoma- primary glaucoma- is associated with old age and genetics, secondary glaucoma is caused by factors such as uncontrolled diabetes, an injury or use of steroidal drugs and ointments applied topically on the skin that are often prescribed in dermatology treatment.

“At least one in four cases of secondary glaucoma is because of usage of eye drops that have antibiotic-steroid combinations,” said Dr. Rajul Parikh, ophthalmologist and member, advisory board of the World Glaucoma Association, adding that people should stop using these OTC drugs. Not just eye drops, even steroidal skin creams can be potentially harmful. Parikh explains that it’s not just about the cream coming in contact with the eye; it gets absorbed in the body and finds its way to the eye through the blood vessels.