Glaucoma is a sneak thief of sight. In this report by Sade Oguntola, experts say timely intervention and treatment is crucial to prevent the condition causing permanent vision loss or even total blindness within a few years.
TWO years ago, Mrs Taiwo Azeez, a civil servant, discovered that at bedtime, she experienced flashes of light that made sleeping through the night difficult. Without dark glasses, walking to the office or reading was also impossible.
At the University College Hospital (UCH), Mrs Azeez’s eye problem was diagnosed as glaucoma and drugs and glasses were recommended. For the past two years, she has been going to see her eye doctor every week for eye checkups and treatment.
“It started suddenly; when walking, somebody needed to hold my hand walking to the office. To be able to sleep, I had to sleep with my eyes covered with a dark fabric. This year, my doctors have asked me to stop wearing the glasses. I can now read well and the light flashes have subsided.” Mrs Azeez stated.
Mrs Azeez recounted her experience and what she is doing to ensure she retains her sight when the Nigerian Optometric Association (NOA) Oyo State chapter had a walk to create awareness on glaucoma at the Oyo State government secretariat.
Chairman, Nigerian Optometric Association, Oyo State chapter, Dr Ifeanyi-chukwu Uwadia said the walk was to create awareness on glaucoma, an eye disease that can cause irreversible blindness.
It was also to create awareness about a week-long free glaucoma screening in all optometrist centres across the state.
Dr Uwadia stated, “We will check their eye health and eye pressure so that they can know their status regarding glaucoma. They will also get to be aware of their risk of blindness from the eye problem.”
Glaucoma is a group of eye conditions that can cause blindness. With all types of glaucoma, the nerve connecting the eye to the brain is damaged, usually due to high eye pressure, leading to gradual sight loss.
Unfortunately, Professor Ronke Baiyeroju, a consultant opthalmologist at the UCH, Ibadan, said glaucoma is a blinding disease that unfortunately generally does not have symptoms.
She added, “The commonest glaucoma in Nigeria is open-angle glaucoma. It has no symptoms but it is progressive. But there are some glaucomas that have symptoms.
“But most of the time, it is when the patient is almost blind or blind that they know that they have glaucoma, which is why we screen for glaucoma.”
Open-angle glaucoma often has no symptoms other than slow vision loss. But angle-closure glaucoma, although rare, is a medical emergency and its symptoms include eye pain with nausea and sudden visual disturbance.
Professor Baiyeroju added: “That is why we ask everyone to have their eyes checked at least once a year. But if you have been found not to have glaucoma, we could ask you to come back in two years.
“But if there is a strong family history of glaucoma, every year such an individual must come in to have their eyes checked because generally they would not know that they have glaucoma.”
She stated that screening for glaucoma can also be done by an optometrist; and if the pressure in the eye is high, the individual is supposed to be referred to an ophthalmologist, a medical doctor or ophthalmic surgeon for treatment.
Dr Tarela Sarimiye, a consultant opthalmologist, stated that glaucoma is a group of eye diseases, whose endpoint is the destruction of the optic nerve, and as such each type of glaucoma have their own peculiar risk factors.
He stated that in Nigeria, over 80 per cent are from primary open-angle glaucoma whose risk factors include age, being black, a family history of glaucoma and a raised intraocular pressure.
Dr Sarimiye declared: “Blacks have a four to seven times higher risk of having glaucoma than the whites. Having a blood relation with glaucoma increases a person’s risk of glaucoma by almost 10 times.
“If we all live long enough, we will all have glaucoma, but it can occur at any age. Raised intraocular blood pressure increases the risk of having glaucoma. Reducing the intraocular pressure by 1mmHg can reduce the risk of glaucoma damage by as much as 10 per cent.”
Dr Sarimiye, however, declared that people that are short-sighted are slightly more at risk of developing primary open-angle glaucoma than others; similar to patients with diabetes and thin corneas.
But being longsighted, he said, increases the chances of developing another type of glaucoma, the primary angle-closure glaucoma.
Similarly, he said hypertension is a risk factor for another type of glaucoma, normal-tension glaucoma.
Moreover, he said things like air pollution, prolonged use of contact lenses and brain pressure are not well-established reasons why individuals develop glaucoma.
According to Dr Sarimiye, “There is no relationship between prolonged use of contact lenses and development of glaucoma, though such a person may be at risk of other eye complications like infections but not glaucoma. But infection from wearing contact lenses wrongly may predispose to secondary glaucoma.
However, he declared there are some instances pressure in the brain may contribute to development of glaucoma.
According to him, “A raised brain pressure may cause compression of the optic nerve and cause what is called optic neuropathy that is not glaucoma.
“The optical nerve is a connection between the eye and the brain. If the pressure on the exit of the optic nerve in the brain is lower than that in the eye, it can result to glaucoma.”
Although glaucoma can cause irreversible blindness, he lamented that about 80 per cent of individuals with glaucoma have not still been identified in Nigeria.
“A lot of people are walking around with very good vision but have glaucoma. Glaucoma will have been in the eye gradually damaging the nerve for about 10 years before they start having symptoms and then they come to the hospital,” he said.
He said regular eye screening for glaucoma by everyone would ensure that individuals with glaucoma are detected early. The earlier the diagnosis, the easier it is to treat.
“But when people come with advanced glaucoma when the damage is so adverse and irreversible and maybe one of the eyes is already blind, all that is left will be to try to manage to keep the vision left in the other eye. That is actually very tasking and worrisome,” he declared.
Dr Sarimiye stressed that individuals with glaucoma should not hide it from their family members because they stand a higher risk of developing it.
According to him, registered relatives of glaucoma patients at the UCH, Ibadan are given free glaucoma screening alternate Wednesdays.
He declared that glaucoma is a disease unlike malaria, and as such, they will have to be on treatment for life and require adhering to treatment and clinic appointments.
“Any vision loss from glaucoma is permanent; we cannot revert it. The only modality of treatment is to try to keep the remaining vision the person has as much as possible.
“Some patients that have been on the same medications for maybe two years just assume that ‘it is the same medications doctors are giving me.’ They stay at home and keep replenishing it at the pharmacy.
“When they now decide to come maybe five or six years later, they then realise that one eye is almost completely blind or blind. The reason is the medications may not be continually effective. Since there are no signs and symptoms in the early stage when the pressure goes up they will not know even though they are still on the medication.”
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