Eternal vigilance is the price of freedom

WHEN Bimpe (not real name) presented in the eye clinic several years ago, complaining of frequent headaches, fatigue and general feeling of being unwell, she was very sure it had something to do with her eyes. She had taken antimalarial medications and had treatment for typhoid but no respite. I examined her from head to toe. I was alarmed by the outcome of my physical examination. Bimpe was pregnant!

When I told her, she was frenzy. I could see her struggling to restrain herself from telling me I was out of my mind. “I am 52 years old,” she said, “And I have four children. The last born is 10 years old and my last menstrual period was over five years ago.”

“Madam, calm down. We can easily confirm this scientifically,” I counselled. I scribbled a note to the laboratory for a pregnancy test. The result came within the hour. She was pregnant. About six months later she gave birth to a bouncing baby boy.

Bimpe’s symptoms led to a full physical examination which helped me to identify the signs typical of a normal pregnancy state. By urine and blood testing, it was possible to obtain additional objective evidence that Bimpe was pregnant.

What is a symptom? A symptom is a subjective observation or feeling by the patient of disease or something unusual happening to him or her. It can only be detected or sensed by the patient. It cannot be measured and feelings are neither right nor wrong! A patient has the right to feel the way he feels.

Sometimes a symptom may also be a sign – an objective evidence of disease or that something is different or wrong. For instance a patient may complain of a red eye or purulent discharge. The doctor may find both on examination thus making the complaints (symptoms) also the signs of disease found by the doctor on examination.

Glaucoma develops slowly over time. Unfortunately there are neither symptoms nor signs during the latency period and early stages. The latency period of a disease is the stage before symptoms and signs develop. The patient is completely at ease and unaware of any problem in his eyes.

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Damage (loss of vision) most occur before symptoms or signs are noticeable or quantifiable. Thus the glaucoma patient is at a considerable disadvantage. He has no hint that he is in danger of becoming blind until he is face to face with the danger of blindness.

Even more upsetting is that an initial visit to the specialist may coincide with the early stages of the disease when the patient has no symptoms and the doctor sees no signs of the disease.

If stupidly, the patient does not repeat his visit in subsequent years, he may be stunned several years later when he is told he has advance glaucoma. You can only protect yourself with regular eye examinations. Eternal vigilance is the price of freedom from glaucoma blindness.

If there are no specific symptoms or signs in the early stages is there anything that increases a person’s chances of developing the disease so we can at least be on our guard? These are called risk factors – things or associations that increase the chances of getting a disease.

Everyone is at risk for glaucoma but you are at higher risk than others if you are above the age of 40; if members of your immediate family have glaucoma; if you use steroids frequently; if you have high myopia and if you are hypertensive or diabetic.

From a simple blood test, a diagnosis of pregnancy was made in Bimpe. Is it possible to have tests or find signs of early glaucoma before there is any functional or structural damage in glaucoma?

Yes technology is coming to the rescue. Various gadgets are already out. The latest central visual (CVF) machines would tell us about early loss of function while Optical Coherence Tomography (OCT) would tell us the structure of the optic nerve.

Apart from the fact that these are expensive tools and not within the reach of those who actually need them, they do not have the finality of a pregnancy test. The search continues!

Professor Oyin Olurin, OFR, was the first to make some meaningful contributions to the field of glaucoma in Nigeria. She described the pattern of the disease in Nigeria several decades ago. Since then some of our younger colleagues have added some more, albeit, slowly because of lack of funds.

One of the objectives the Ophthalmological Society of Nigeria’s initiative, PASSION (Partnership for Sight Initiative of Nigeria) is to solicit support for glaucoma research because it is convinced that the missing links would be found in Africans.

Please, support this initiative today by becoming a Partner for Sight. Do something positive to bring glaucoma under check. The next eye that will be saved from blindness may be your own. Send a WhatsApp message to 0805 400 5447 for more information on how you can help.