The World Health Organisation (WHO) has said glaucoma is the second leading cause of blindness in the world. Medical experts in the country have urged government to have the political will and invest in the health sector. Doing this, they say, will help in taking care of those suffering from glaucoma, writes MOSES EMORINKEN
Aside cataract, no other eye condition or disease renders a person permanently blind as glaucoma does. Unlike other eye defects and diseases, glaucoma does not explicitly show signs of vision deterioration except when it has reached stages of severe damage; after which the possibility of delaying blindness or averting it becomes nearly impossible.
Glaucoma is a disease that harms the optic nerve of the eye. It usually happens when fluid builds up in the front part of the eye as much pressure is increased in the eye as a result of the extra fluid, which eventually damages the optic nerve.
It is one eye condition that is mostly misunderstood, and very often, people do not realise the severity of it or their being susceptible to it. According to the World Health Organisation (WHO), glaucoma is the second leading cause of blindness in the world.
The disease is not a respecter of persons despite their social, financial, political, ethnic or religious status. It is blind to geographic and demographic locations. It affects both the rich and poor, wise and unwise, lowly and highly placed individuals; no one is immune to the stretch of its net.
Everyone is at risk for glaucoma. Older people are at a higher risk for glaucoma, even as babies can suffer from the ailment from the womb.
More frightening is the fact that damages caused by glaucoma can’t be reversed. Therefore, the individuals who suffer from it live the rest of their lives with the inconveniences that come with the resulting blindness. By implication, glaucoma presents perhaps an even greater public health challenge than cataracts, because the blindness it causes is irreversible.
Although glaucoma is a leading cause of blindness for people over 40 years, however, blindness caused by glaucoma can often be prevented with early detection and treatment.
“Globally, at least 2.2 billion people have a vision impairment or blindness, of which at least one billion have a vision impairment that could have been prevented.
“Population growth and aging, along with behavioural and lifestyle changes and urbanisation, will dramatically increase the number of people with eye conditions, vision impairment and blindness in the coming decades,” according to the WHO.
Globally, it is said that 285 million people are visually impaired, and 39 million of these are blind; 90 per cent of which live in low-income countries, and 55 per cent of those blinds are women. However, 80 per cent of blindness is due to avoidable causes.
According to the Nigerian National Blindness and Visually Impaired survey carried out by the Federal Ministry of Health in collaboration with key stakeholders which was conducted between 2005 and 2007, it is estimated that 1.13 million individuals aged 40 years are currently blind in Nigeria.
A further 2.7 million adults aged 40 years are estimated to have a moderate visual impairment and an additional 400,000 adults are severely visually impaired. Also, 4.25 million adults aged 40 years in Nigeria are visually impaired or blind.
The primary risk factors that are linked to the individual and the onset of glaucoma are age and genetic (family history) predisposition.
Our attitudes to health worsen it
Vision is, perhaps, the most dominant of our senses because of the important role it plays in all aspects of our lives. Truth is, without vision, we practically struggle to work, walk or participate in educational and social activities.
It is, however, worrisome that like the generality of our health, the well-being of our eyes is usually taken for granted.
According to the President of the Nigeria Optometric Association, Dr. Ozy Okonokhua, as a people, we don’t normally walk into the clinic and say we want to have our eyes checked. So, most glaucoma we detect in the clinic is advanced glaucoma.
“Because of the fact that glaucoma doesn’t give warning signs, it is actually only those who have been examined that are sure that they either have it or not; and if they do have it, can begin immediate treatment and management of the condition.
“I assure you that there are a lot of people walking around with glaucoma without being aware of it. So, the data we have today do not portray the real picture because, although there are cases that have been identified, there are, perhaps, more people who have glaucoma who have not been identified. One of the common risk factors is the presence of glaucoma in the family.”
Dr. Ada Ikeako, a private Medical Practitioner, said: “Up to 60 per cent of people who have glaucoma don’t even know that they have it. It speeds up accidentally, and this is because we are not going for eye checks often. Experts advocate that one goes for a check every one to two years, especially when one has the risk factors.
“If you have a first-degree relative, either your siblings or parents that have glaucoma, then, the probability that you’re going to have it is high.
“Glaucoma is more common in Blacks and Hispanics. It is a kind of glaucoma called closed-angle glaucoma. It is an irreversible progressive optic neuropathy. That indicates that it causes death in the optic nerves, which is the second cranial nerve that is responsible for vision. What happens is that the person gets a visual field loss and it eventually leads to blindness.
“Diabetes mellitus, which is considered a lifestyle disease is a risk factor that increases the chances of a person having glaucoma. Sedentary lifestyle, obesity, lack of exercise, a diet that is high in saturated fat, etc., are some of the lifestyle factors that predispose people to diabetes mellitus.
“Therefore, exercising, eating fruits and vegetables, staying away from saturated fats, etc., are some of the ways to reduce the risk factors to diabetes, as a result, it reduces the chances of coming down with glaucoma. The more you have diabetes, the more chances there are for one to have glaucoma because it is a risk factor.
“Visiting herbalists is not the answer. You need an ophthalmologist that has a slit lamp so he or she can check you when you go for your annual or biannual eye examination.”
Poor data gathering on glaucoma
Its time Nigeria carried out a new comprehensive national survey on blindness and visual impairment, because the last survey was done about thirteen years ago.
It is obvious that the numbers would have drastically changed and if we keep relying on moribund figures, we will not be able to make quality and informed decisions as far as eye health is concerned.
Dr. Okonokhua said: “As a country, we have very poor reporting nature of eye disease condition and do not prioritise statistics gathering. Currently, patients are walking into clinics reporting that they have glaucoma but they are not factored into the national database.
“However, between 2005 and 2007, a national blindness and visual impairment survey were done and it is only from there that we can actually use verifiable data. That data shows that glaucoma is the second leading cause of blindness in Nigeria.
“Also, of the number of persons that are blind, glaucoma causes about 16.7 per cent. This tells you that it is quite a very big burden in terms of visual impairment and blindness in Nigeria, more so, because the blindness is irreversible.
“It is sad that we are using data from a survey done between 2005 and 2007; over 13 years ago. I can tell you that the data now has gone beyond what it is because a lot of people who would have had access to care, for instance, in areas that are being ravaged by insurgency, can no longer access care.
So, that number would have increased tremendously because of our present security challenges. I’m sure if another survey is conducted, the figures for glaucoma and other eye conditions and diseases will be staggering.
“We now find children between 11 and 15 years coming down with glaucoma. Before now, the onset for glaucoma is between the ages of 40 and above.
Now, the age of onset is decreasing. So, you find glaucoma in persons of much lower ages, and these are persons who have the conventional type of glaucoma besides other infantile glaucoma or developmental glaucoma that we find in persons of infancy.”
Quality eye health services still elusive
Described as the ‘silent thief of sight,’ glaucoma is largely blind to personalities or patronage. However, those in rural areas, especially the most vulnerable – indigent women and children are the most affected because of their lack of access to quality eye care services.
The burden of eye conditions and vision impairment is not borne equally: it is often far greater in low and middle income countries, among older people and in women, and in rural and disadvantaged communities.
Dr. Okonokhua said: “Glaucoma doesn’t discriminate. However, it is easier for persons in urban centres to access care than for those in rural areas.
Also, because of the absence of eye care services in rural areas, they usually would first apply herbal medicines which are more harmful.
“By the time they have tried traditional eye medicines for a while and they don’t get any relief, they decide to visit the primary health care system. Most times, by this time, the glaucoma would have advanced to grave stages that are irreversible blindness.
“Even at the primary health care level, we don’t have enough trained and licensed eye care professionals. This is a failure of the government because optometrists are the primary eye care providers.
“We have been advocating for the engagement of optometrists at the primary eye care level, especially at the primary health care centres, and not the stop-gap method of getting one man to provide primary health care services. It will not work.
“We urgently need to get trained, licensed and competent primary eye care providers.”
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