Angela Success
Glaucoma, otherwise known as the “sneak thief of sight,” is one of the leading causes of blindness in the world. Most of the time it destroys the optical nerves irreversibly without showing any noticeable symptom, which makes it mandatory for us to screen our eyes regularly.
There is actually no cure for glaucoma yet, but if it is detected early further vision loss can be reduced.
In this interview, Dr. Favour Chukwuka, a consultant ophthalmologist with the University of Port Harcourt Teaching Hospital, spoke on how to detect and prevent blindness caused by glaucoma.
What is glaucoma?
Glaucoma covers a group of eye diseases that are characterised by the cupping of the optic nerve head and visual field changes with intraocular pressure as a variable risk factor. It is characterised clinically by changes that are seen in the eyes on examination and on other changes that can be detected through specialised testing. Glaucoma does not cause any obvious eye symptom, like pain or blurring of vision until the late stages so it is not wise to wait till you have blurring vision or any symptom before you start testing for it.
Glaucoma is common in black people all over the world and is more aggressive in black people. It is more common after the age of 40. It is advisable that anybody who is over the age of 35 should be screened. If somebody has a family history of blindness even if the person is a distant relative, the entire family should be screened for glaucoma. Some people may say their fathers or mothers do not have it. This is beyond that, once someone in the family has had it, the entire family should be screened immediately and regularly.
How often should the screening be done?
We advise that people should go for eye screening every two or three years. What happens is that most people from the age of about 40 require reading glasses and this is the period the testing should be done. These glasses usually last for two or three years before you need another one. The people who do not read at all and do not have any reason to go for eye examination are more likely to become victims of glaucoma, as they don’t come to the hospital unless they feel something. They are the ones that ought to know that they should present themselves for screening every two to three years.
What are the tests that can detect glaucoma?
The routine screening we do in the clinic is the examination of the eye to check the optic disc at the back of the eyes, where the nerve ends inside the eyeball. In glaucoma, this test reveals characteristic changes around the optic nerve and we usually assess the degree of cupping around nerve ends. Looking at that optic nerve head in the clinic or anywhere else with a specialised instrument called an ophthalmoscope, we can tell if there are angle glaucomatous changes in an eye or not.
Based on this simple screening we can decide if there is no risk and ask the person to go. It cannot be detected by measuring the pressure of the eye alone because there are variations in the types of glaucoma. There are ones caused by low tension in the eye in this case the pressure may be within the normal range but blindness still sets in gradually. Other tests that can be done are visual field screening when you now suspect that what you are seeing could be glaucomatous. We send people for further screening.
What actually causes glaucoma?
The thing is that glaucoma is believed to arise due to increase in resistant to the out flow of fluid from the anterior chamber of the eye but nobody has been able to actually determine exactly what causes glaucoma. What happens is that the aqueous fluid in the eye is formed every day. Like all body fluids, they are not tears. Tears keep the eye moist that is why we can blink without pain. Without them the eyes will become dry even blinking will become painful. The aqueous fluid helps maintain the eye health. Inside the eye, the anterior space is relatively small and any increase in volume of the liquid in it; increases pressure in the eye and this affects the health of the entire eyeball.
Can diet increase our chances of coming down with glaucoma?
Glaucoma has not been linked scientifically to any food or diet. I have not seen any literature on that issue. The link between diet and health is for all organs of the body. What happens is that the optic nerve like any part of the body has to be nourished. The vascular supply of blood to the nerve has to be intact and the essential nutrients to that part of the body should be supplied to it. As part of the treatment for glaucoma we advise people to take a regular dose of vitamins to make sure they have the essential ones that have been proven to be beneficial for eye health. Lutein and Zeaxanthin are the vitamins we use in ophthalmology.
What other things can we do to reduce blindness caused by glaucoma in this country?
There are a lot of things that the government can do; funding is one of them. Doctors are ready to work but we don’t have enough things to work with. The teaching hospitals and the general ones do not have functional equipment. If they have equipment young doctors that are posted out there will be able to screen the people that come to the centres. Patients are sent from teaching hospitals to private hospitals for visual screening tests because of lack of equipment. The average Nigerian who earns the minimum wage cannot pay for these tests.
We also need government to encourage professionals to go for training in biomedical engineering. They can sponsor people to go abroad for courses in that area. Trained biomedical engineers will be able to repair and maintain our biomedical equipment. We need spare parts for these equipment; the Federal Government should replace ones that have broken down. Electricity is something we have been battling with in our health facilities. We need constant stable electricity as this will help reduce damages caused by power fluctuations. Despite stabilisers used our equipment still break down.
Advocacy is another area that can help create more awareness to fight this disease. This is World Glaucoma week and the government should promote it. We go out to talk but how many people can we talk to. The Federal Government should add its voice to this campaign in the area of providing publicity through national campaigns, in addition to adding programmes that will encourage eye screening in primary health programmes.
How much can personal efforts or institutional outreaches accomplish?
Drivers who go for driving licenses and renewals should be mandated to screen their eyes. This will help detect glaucoma early as well as save other road users from accidents that might have been caused by this gradual thief of sight. In Nigeria, glaucoma is the commonest cause of irreversible blindness. Cataract blindness can be reversed through surgery but with glaucoma the damage is permanent. Screening should be free for everybody especially for the people in our villages who do not have access to radio and television. Primary eye care can be a part of primary health care. We should reach out to our people against this disease, like the way we go out for other vaccinations. We have optometrist and people who can attend to the people and refer complex cases to higher health facilities. Blindness due to glaucoma can be reduced.
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