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Diagnosis, treatment; key to preventing vision loss

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World Glaucoma Day falls on March 12

Visual impairment and blindness are on a sharp rise globally. An estimated 40 million persons are blind; 250 million have low vision and 300 million persons are visually impaired. The need to arrest this disturbing trend has thus become one of the most important priorities among health authorities worldwide and in Sri Lanka which has around 150,000 blind persons and some 400,000 persons with low vision.

It is also the main focus of ‘Vision 2020: The Right to Sight’, a global effort to prevent blindness, created by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness. These health authorities have pointed out that visual impairment is a major global health issue unless immediate interventions are put in place to prevent the causes. They have also pointed out that the preventable and treatable causes of visual impairments are as high as 80 percent.

While cataract remains the commonest preventable cause for blindness, globally and in Sri Lanka, glaucoma is one of the leading causes of treatable blindness especially among Sri Lanka’s swelling ageing population. At present, around 15,000 persons have been identified so far with vision impairment resulting from glaucoma.

The Nation spoke to Dr Muditha Kulatunga, Consultant Eye Surgeon, National Hospital, to ask her for some insights into how this disease is caused, how it can be detected and most importantly how its progression can be stopped with the right treatments.

Q. Not many people are aware that glaucoma is a leading cause for blindness, your comments.
I agree many people don’t know much about glaucoma although it is one of the four major causes of blindness. It is the 3rd leading cause of blindness with 14% of blindness worldwide, due to glaucoma.

Q. Tell us what glaucoma is and its consequences.
It is an eye disease causing gradual peripheral vision degradation, and is caused by intraocular eye pressure (IOP), which results in the death of the eye nerve.

Q. Is glaucoma blindness reversible like cataract? Can one detect it early to prevent it?
Unfortunately, there are no symptoms or signs in early stages as it is also painless. So by the time it is detected it is often late. Glaucoma blindness is NOT reversible like cataract blindness. But early detection could save your vision.

Q. As someone closely involved with the Vision 2020 program to reduce blindness globally and in Sri Lanka by the year 2020, how are you raising awareness on this eye disease?
We are conducting awareness programs throughout the island, putting out posters, stickers and talking to patients at district and provincial hospitals, clinics and when our field workers do home visits. Since it is essentially a disease affecting older persons, we are targeting mostly persons above 60 years of age. We are also training all our young medical officers to examine and screen patients for glaucoma.

Q. What are the risk factors that lead to glaucoma?
Those with a family history of glaucoma. Age also counts. The older you grow the worse the condition. If you get glaucoma at 60 years, it is likely to get worse at 80 years. Very high myopia (nearsightedness) is another risk factor. An injury to the eye, which we call blunt trauma, could be another risk factor. Other high risk groups will include: your parents having glaucoma or a sibling having glaucoma.

Q. How big is this risk?
If your parents have glaucoma, then your risk of getting it is five times higher than someone who has no close relatives with glaucoma. If one of your brothers or sisters has glaucoma, the risk of you getting it is nine times higher than another person.

Q. Non communicable diseases are very common among elderly persons. Do they also contribute to getting glaucoma?
Diabetes is a contributory factor as it affects all the organs in the body including the eyes. Chances of getting diabetic retinopathy, macular degeneration are higher when you have diabetes, as it affects the eye nerves. This is why we now test patients who visit eye clinics to also be tested for diabetes.

Q. If untreated, what happens?
If untreated, there will be gradual progression of optic nerve damage. This will lead to gradual loss of vision and eventually total blindness which is irreversible.

Q. If treated, what happens?
With proper treatment near normal vision can be preserved.

Q. Are there different types of glaucoma?
There are three types of glaucoma basically. They are: Primary glaucoma, Secondary glaucoma, and congenital glaucoma.

Q. What are the treatments available?
There are two types of treatment: Medical treatment and surgical treatment.

Q. Can you elaborate?
First, there is Medical treatment. To use some medical terms, they include: Beta blockers (medications in the form of eye drops to control the pressure which are usually well tolerated), Miotics, Adrenergic agonists, Carbonic anhydrase inhibitors, Prostaglandun analogues. Whatever treatment your doctor prescribes, they have to be taken regularly and for a lifetime.

Q. You mentioned surgical treatment. What are they?
We use several types of surgical treatment. Their medical terms are: Yag laser peripheral iridotomy, Argon laser trabeculoplasty, Trabeculoctomy, Deep sclerectomy, Filtration procedures, Tube-shunt procedure.
We also do follow up treatment regularly such as: measuring the IOP, Visual field tests, Family screening tests, counseling and distributing low vision aids to those who cannot afford them, along with rehabilitation.

Q. What are the Don’ts in treating glaucoma?
If you have eye pressure, don’t ferment your eye to bring down a swelling or if it is red as it will cause the pressure to go up. Don’t put margossa oil or some other oil to ward off some eye infection. Don’t touch your eye unnecessarily, because you are applying pressure on that eye.

Q. Do you have a message to pass on to possible patients?
Check your eyes for glaucoma once in 2-3 years. When you visit your Optometrist for a new pair of specs, ask him to give you an Eye Pressure test for glaucoma. Each time you consult your Ophthalmologist, inquire about glaucoma susceptibility.If you are on treatment, take it regularly without forgetting to put your eye drops even once, according to your doctor’s prescription. Treatment will protect remaining vision and nerves although you won’t get vision improvement with treatment since the optic nerve has been damaged. Visit your eye doctor every three months to get your IOP tested. Finally, since blood relatives are at a much higher risk of developing glaucoma, remember to ensure that your blood relatives are tested for glaucoma (not just a pressure test, but a careful assessment of their optic nerves) and get themselves regularly re-tested by their eye care professionals.

Visual impairment and blindness are on a sharp rise globally. An estimated 40 million persons are blind; 250 million have low vision and 300 million persons are visually impaired. The need to arrest this disturbing trend has thus become one of the most important priorities among health authorities worldwide and in Sri Lanka which has around 150,000 blind persons and some 400,000 persons with low vision.

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