The World Glaucoma Week is observed from March 12 to 18 yearly. This year’s theme is Beat Invisible Glaucoma (BIG). OYEYEMI GBENGA-MUSTAPHA writes that with proper diagnosis, treatment and compliance, one can win the war against the silent thief of sight.
when Alhaja Falilat Otule was 48, she took one of her children for physiotherapy at the Lagos University Teaching Hospital (LUTH), Idi Araba. But she did not expect what followed.
While the child was being attended to, she saw the Guinness Eye Centre, the ophthalmology arm of the hospital, in the Physiology Block. She decided to check her eyes at the unit, a decision she is thankful for, 19 years later.
At 67, Alhaja Otule is happy that she can see her grandchildren, “especially when they play around me, singing, dancing or helping out with their school exercises, despite having glaucoma. I am a good nanny, loss of eyes would have deprived me of that.”
She recalled that when she got to the Eye Centre, an ophthalmologist screened her eyes. “I was asked if I had ever been told that I had glaucoma. I said no. The doctor got my eyes dilated to see the back of them. After this, the doctor screened them. I was told that I had glaucoma.”
Expectedly, she was agitated and asked to be enlightened on the disease. She said: “The doctor educated me on glaucoma. I was told that I was going to have surgery. I was surprised and I told her I didn’t want to lose my sight. She said I wouldn’t, if I complied with her instructions. Later, we prepared for the surgery , it was done same day on both eyes. People were blamed me for this, but I told them that I accepted to do that based on the doctor’s explanations, on the urgent need to do the operation.”
Alhaja Otule said she researched on the disease and knew that conformity with treatment was the only way out because, “glaucoma is a group of diseases that gradually damage the optic nerve in the eye and may result in vision loss and blindness. It is often called the silent thief of sight because of its slow onset and progression, causing permanent vision loss with very few or no early warning signs, especially for people who are 40 years and above’’.
When she travelled overseas, the first thing she did was to look for an eye clinic. ‘’I was there for 15 years. I ensured that I attended the clinic regularly for checks.When I returned, the first thing I did was to come back to the Guinness Eye Centre to continue with my treatment. Over time, my drugs were changed. Despite their exorbitant costs, especially during this foreign exchange (forex) crisis, I ensured that I bought them. Even if I had to go hungry, I prefered that to losing my eyes. “
She and others with the condition, who are receiving treatment at LUTH, have formed a support group – Glaucoma Patient Care Initiative of Nigeria- to ensure, “availability, affordability, and compliance with drugs, and create awareness. We hold meetings every two months. Each time we do that, there are doctors to discuss with us’’.
She said: “To win the war against glaucoma, I will say people have to use medication as at when due and to see doctors regularly for screening. I am the secretary of the LUTH’s Glaucoma Patient Care Initiative of Nigeria.’’
If Alhaja Otule was proactive, not so 31-year-old Mrs Funmilola Damola, who is partially blind.
Mrs Damola said her eye problems started in 2006. “It was unfortunate that I did not know I had glaucoma. The first general hospital I went to told me I had eye problems. Two years later, I went to another hospital, a federal- owned. I was told I had glaucoma. They prescribed drugs for me, warning that I should be using them monthly,”she said.
Initially, Mrs Damola tried to cope. “But because I was seeing, though not clearly, I skipped the drugs once in a while because I could not buy them once they finished. I was teaching then.But it got to a time my appointment was terminated because I wasn’t able to mark my pupils’sheets and I couldn’t afford to buy the eye drops.”
She tried her best to get another job.But within six months her sight deteriorated. She was forced to stay at home.
Her saving grace was the Glaucoma Patient Care Initiative of Nigeria. Two years ago, during the group’s Glaucoma Week enlightenment campaign, the body’s officials went to a radio station in Lagos to create awareness on the disease. Damola listened.
Its secretary and the vice-chairman explained the disesase. At the end, the presenter asked the executives to leave their numbers and the address of their centre.They did. Mrs Damola later called them. She got a response. That was how her journey to victory started.
The LUTH’s Glaucoma Patient Care Initiative enrolled her as a member and she became a patient of the Guinness Eye Centre.
However, Mrs Damola’s case was helpless, the doctor said, as she had lost the vision in one eye. The second was also going bad but that it could be managed. “I have been managing the second eye through medical intervention. I had laser treatment. I have been using my medication everyday, according to doctor’s instructions. I can still see but faintly,” she explained.
Mrs Damola took to learning a trade. Last year, the Glaucoma Patient Care Initiative sponsored her at the Centre for the Blind at Isheri Olofin, owned by the Lagos State Government to learn bead making. I was also trained to operate a laptop using the software ‘mobile speech’. I graduated from the school last December,” she said.
Glaucoma Society of Nigeria (GSN) Chairman, Prof Adeola Onakoya, explained why Mrs Damola’s case was pathetic. “Medically, she is blind in both eyes. The little vision she had left we had tried very much to conserve it. As she said, she had laser treatment and she is on what I would call maximum tolerable therapy. She is young and she has two children. There are so many people like that on the streets, hence this awareness yearly. Because of our culture, people tend to associate the disease with some diabolical means, instead of going to the hospital to get the medical explanation,” Onakoya said.
She said there were about 1.8 million adults in the country who have glaucoma, and of these, 360,000, who are above 40 are blind.
She said: “One in 40 adults older than 40 years has glaucoma with loss of vision. Fifty percent of glaucoma cases are undiagnosed. As many as 60 per cent of the cases run in family. And we have recorded cases where even children less than 10 have aggressive glaucoma. It is highly recommended that people should get their eyes screened by professionals.”
Onakoya, the Head of Ophthalmology Department of the Guinness Eye Centre, said the reason for the high figure and the irreversible loss of eye is because glaucoma is asymptomatic.
“We need to educate people to let them know about the disease – that it is not a disease one can consciously know that one has, except the doctor examined your eyes. About 90 per cent of the time you may not know that you have glaucoma but at the time you know that you have glaucoma or that you see the ‘symptoms’, which is unclear vision, then it is late. That is why in developing countries, about 90 percent of the people develop loss vision before seeing the doctor.But in developed countries, only about 50 percent are aware at a point blindness can be prevented. So, because of this, we need to create a lot of awareness. That is the essence of this Glaucoma Week.”
Onakoya, a Consultant Ophthalmologist, warned that once a person is diagnosed of glaucoma and placed on treatment, he should not stop taking the drugs.
“We have seen cases where treatment was interrupted because patients cannot afford it. By the time they return for treatment, so much damage had been done, including appreciable loss of vision. Although glaucoma cannot be cured, treatment can often effectively stop the progression of the disease. Lowering eye pressure is the only effective way to halt progression of glaucoma and preserve vision. All glaucoma treatments are aimed at lowering eye pressure by either reducing the amount of eye fluid produced, and/or improving drainage of fluid out of the eye,” she explained.
According to the Head, Corporate Services Division, LUTH, Kenneth Otuneme, the hospital has been providing free glaucoma screening to the public. “This programme is part of the hospital’s corporate social responsibility and is geared towards helping to raise awareness for glaucoma, which is the second leading cause of blindness worldwide. There was also a public lecture at the Sickle Cell Centre, Opposite LUTH,” Otuneme said.
On how drugs could be made more affordable for patients, Pfizer’s Corporate Affairs Manager, Mrs Margret Olele, said the drugs giant partners patients and institutions.
Mrs Olele said: “For instance, we have journeyed with this Glaucoma Association from the inception and one of the things we worked out with them is actually creating awareness to ensure that different levels of stakeholders know about what is going on. We deliver these products to hospitals, so patients can easily get them at discounted costs.’’
She said Pfizer was committed to glaucoma care by creating awareness on preventive measures, treatment and others.
She said: “Just as Prof Onakoya mentioned that 1.8 million people are suffering from glaucoma, when you look at that, it seems one percent of the total population. When you imagine the implications, because we have a dependency structure in our society. For instance, Alhaja Otule will have probably 20 or more people she is supporting. You can, then, imagine the implications of one person going blind in Nigeria. The ripple effects of that on the society are tremendous. We need to talk about this. We are looking at the implications of glaucoma on the society and to let policymakers and stakeholders understand that this is really critical. I would encourage other stakeholders to work together with the association to increase awareness. We can talk about reaching out to policymakers and key stakeholders.”
Mrs Olele added: “Secondly, the issue of medicines is a critical issue and the discussions have been ongoing. We are committed to increasing access to good quality medicines. I hope to see more satellites’association in various teaching hospitals. This is where patients get empowered, knowledge and are able to spread the knowledge to their families and various stakeholders. So, that will improve our understanding of this disease. We should encourage research into the disease, so that we are better able to manage it. I laud what the Glaucoma Association is doing in creating awareness and supporting people who have glaucoma to manage it themselves. I pledge Pfizer’s commitment to the association to improve the lives of those living with glaucoma and, by extension, their dependants.”
