Beat invisible glaucoma

The awareness campaign is aimed at eliminating glaucoma mediated blindness, by encouraging regular eye check-up, which should include a check-up of the optic nerves which if damaged by a group of diseases called glaucoma, can result in vision loss and blindness.

However, with early detection and treatment, the eyes can often be protected against serious vision loss.

The optic nerve The optic nerve is a bundle of more than one million nerve fibres. It connects the retina to the brain.

The retina is the light-sensitive tissue at the back of the eye.

A healthy optic nerve is necessary for good vision.

The WGM Theme for 2017 is BIG – Beat Invisible Glaucoma.

Though glaucoma can lead to permanent blindness, there are many people who are still unaware of the risks involved in this condition. About 90 percent of glaucoma cases remain undiagnosed in the population as there are no symptoms and detection of the condition occurs after a physical examination.

Some basic facts about glaucoma include: 60 million cases of glaucoma are estimated to occur worldwide The number of glaucoma cases is expected to increase to 80 million by the year 2020 Above the age of 40, the prevalence of glaucoma is 2.6 per cent After cataract and refractive errors, glaucoma is the second major cause of blindness Glaucoma is the most common cause of irreversible blindness In India, the number of glaucoma incidence is 12 million The prevalence of glaucoma in the rural population is 1.7 per cent while the prevalence in urban cities is 3.5 per cent Eye doctors around the world are marking Glaucoma Week in different ways. The eye doctors of Ireland are highlighting that early detection is key to slowing progression of glaucoma and that regular eye tests are the only way to detect “symptomless” glaucoma early. At a late stage glaucoma is irreversible and results in sight loss and blindness as there is no cure for glaucoma. Vision lost from the disease cannot be restored.

Here at home, ophthalmologist Dr Desiree Murray of The Volunteers for World Sight Day, shares some findings from her research done in 2015, as part fulfilment of the MSc in Public Health for Eye Care at the University of London, London School of Hygiene and Tropical Medicine and as University of the West Indies lecturer in ophthalmology.

These are some local data: An estimated 40,000 people over 40 years living in TT have glaucoma, 10,000 between 30 to 40 years may also be affected.

People aged 30-60 years with glaucoma may be under-diagnosed.

There is a disproportionally high rate of glaucoma blindness in TT due to late diagnosis and suboptimal management.

Late diagnosis age: Older age at first visit is associated with blindness. A study conducted at the Eric Williams Medical Science Complex revealed that for every unit increase in age at presentation, the odds of being blind increased by 10 percent; 13 percent of patients referred to the eye clinic (25 of 193) were blind at first visit.

Message: Younger people and first degree relatives of people with glaucoma need to be encouraged to have regular eye examinations to check for glaucoma.

Gender: Compared to men, women were at slightly greater odds of being blind at first visit; 28 percent of glaucoma patients did not attend for their scheduled revisit appointment.

Women were slightly more likely than men to attend.

Message: This study suggests that gender is a social determinant of glaucoma-associated blindness. Women were more likely than men to be blind at initial presentation to the eye clinic, but were less likely to miss scheduled appointments.

A larger study to further explore this gender bias is warranted and gender differences should be considered in planning a national education campaign. Fifty-eight percent of respondents either strongly agreed, or agreed, that “I forgot” was a reason for not keeping appointments.

When patients do not attend for scheduled appointments it creates a backlog and increases waiting time to see a medical professional.

The introduction of a glaucoma liaison nurse to educate and counsel patients at clinic visits may assist in understanding reasons for non-attendance and may improve attendance and eye care following diagnosis.

Patient challenges A survey revealed some people are faced with an unreliable supply of medication.

Results from a patient questionnaire revealed the following: 73 percent of patients responded that the drops were sometimes, rarely or never available in the hospital pharmacy; 72 percent said they sometimes, often or always purchased eye drops; 40 percent responded that they sometimes, often or always run out of eye drops; Message: Efforts should be made to reduce cost sharing and out-of-pocket spending by patients for glaucoma eye drops.

Computerised systems to improve stock management should be considered. National targets for service activity should be set.

Existing health promotion and patient education programmes should be enhanced.

An appropriate national plan to reduce blindness from glaucoma, by reorganising glaucoma services should be formulated and implemented.

Treatment Immediate treatment for early-stage, open-angle glaucoma can delay progression of the disease. That’s why early diagnosis is very important.

Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.

Medicines, in the form of eye drops or pills, are the most common early treatment for glaucoma. Taken regularly, these eye drops lower eye pressure.

Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.

For more info: the National Institute of Health, https:// nei.nih.gov/health/glaucoma/ glaucoma_facts