Glaucoma: A Silent Thief

World Glaucoma Week is designed to spread awareness and understanding about the importance of early detection of glaucoma, the world’s second leading cause of blindness. This year the annual observation took place between March 12 to 18, 2023. As expected, many hospitals celebrated this week by raising awareness about the condition on various media stations […]

World Glaucoma Week is designed to spread awareness and understanding about the importance of early detection of glaucoma, the world’s second leading cause of blindness. This year the annual observation took place between March 12 to 18, 2023. As expected, many hospitals celebrated this week by raising awareness about the condition on various media stations as well as offering free glaucoma screening to the public.

Over the years, I have heard about many people’s journey with glaucoma: the crushed dreams, failed treatments, and their resignation to living a life without sight, however, this week I heard a pitiful narrative from a friend who works as an ophthalmologist. It is a story of pain, suffering, grit and resolve for both the patient and the doctor.

The first time Mallam Musa* came to the hospital, he came with two live chickens. An amiable, elderly farmer in his sixties, you can imagine the picture he painted, presenting to the clinic with two large, loud squawking birds making a spectacle of themselves at a public health facility.

His reason for bringing the chickens was simple; he wanted to trade them for money. One chicken would be sold to provide money for treatment, while the other would provide transport fare back home.

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Musa lives in the outskirts of Abuja and comes to the hospital as frequently as his pocket permits, with his son. Having lost his sight since his thirties, he relies heavily on his son to guide him through his activities of daily living. Poverty, and a general lack of awareness caused him to present to the hospital very late, so that by the time he presented to the hospital a few years ago, he was already blind, and his sight could not be saved. His occupation as a farmer meant that he was regularly exposed to dust particles, grass, and insects which frequently caused him to have conjunctivitis (Inflammation of the conjunctiva, the popular ‘Apollo’) which meant he usually came with pain and redness in his eyes.

Kindness is a beautiful virtue; however, when experienced from someone with such a terrible disability, it can be quite humbling. Despite his poverty, ever since his first presentation, mallam Musa would always bring tubers of yam and other farm produce as gifts to the doctors and nurses who attended to him.

As the years passed, his son who often brought him to the hospital also started complaining of declining vision. When screened, it was discovered that he also had glaucoma.

Genetic studies have suggested that more than 50 per cent of glaucoma is familial. Glaucoma can be inherited as a Mendelian autosomal-dominant or autosomal-recessive trait, or as a complex multifactorial trait. Simply put, it can be passed from parents to their children. It has a very strong hereditary component, especially among siblings such that the rate of glaucoma can be 10 times higher among individuals with a sibling who has glaucoma.

Glaucoma is sometimes called the “silent thief of sight” because it slowly damages the eyes and can cause irreparable harm before there is any vision loss. It also starts silently, such that by the time you begin to have symptoms of pain or visual loss, the disease has already progressed beyond treatment. Glaucoma can cause blindness if it is left untreated. And unfortunately, approximately 10% of people with glaucoma who receive proper treatment will still experience loss of vision. Glaucoma is not curable, and vision lost cannot be regained.

Gradually and painstakingly, the doctors watched as both father and son became blinded by glaucoma. Another one of Mallam Musa’s sons, who was just a teenager himself, was suddenly burdened with the duty of caring for both his older brother and father. I do not need to tell you what that kind of responsibility can do to a child.

The main pathology in glaucoma is a rise in the Intra-Ocular Pressure (IOP) of the eye. It is this raised pressure that compresses and damages the optic nerve. Once the optic nerve is damaged, it fails to carry visual information to the brain, and this results in loss of vision.

Anyone can get glaucoma, but certain groups are at higher risk. These groups include Africans over age 40, all people over age 60, people with a family history of glaucoma, and people who have diabetes. Black people are 6 to 8 times more likely to get glaucoma than Caucasians.

The challenges of managing Glaucoma, especially in Nigeria, can be quite frustrating to both the doctor and the patients. The drugs used to control the IOP as well other conditions that arise from the glaucoma itself, are expensive. Additionally, for civil servants, most of the drugs are not on the NHIS scheme, meaning they have to pay out-of-pocket. No matter how rich you are, when you are buying medicines from your pocket every day for the rest of your life, your financial strength is bound to take a hit. And then there are the tests! Management of glaucoma involves, carrying out repeated tests like tonometry, gonioscopy, visual field test and the Optical Coherence Tomography (OCT) tests used to obtain a topographical map of the optic nerve, using non-invasive light waves to take cross-section pictures of the retina. These tests are mandatory because they are used to measure the progression of the disease. They are used to answer questions like: Is the treatment working? Is the blindness progressing? What more can we do to save the patients’ sight?

And yes, the tests are crazy expensive.

To the patient, however, it poses a dilemma. Should I use my limited resources for tests or for drugs? A very difficult decision to make, I tell you.

There is also room for surgery in certain types of glaucoma. In government hospitals, the cost ranges between N20,000 to N200,000 depending on the facility, state and complexity of the surgery. While surgery at private eye hospital in Nigeria can cost anywhere between N300,000 and one million, on average, it costs between 500,000 naira to 1.5 million in most major cities.

There is no cure (yet) for glaucoma, but if it’s caught early, you can preserve your vision and prevent vision loss. Simply put, blindness from glaucoma is preventable. However, visual loss from glaucoma when it has already occurred is irreversible.

You can therefore imagine how disheartening it is to watch people go blind from something that can be prevented if detected early.

At present, Mallam Musa has three children who have already gone blind, all before the age of forty. Some of them attended the FCT school for the blind in Jabi. My friend’s heart is saddened every time she sees the family troop to the hospital for follow up visits. His other children have and will continue to be screened so that they do not lose their sight to the thief that is glaucoma.

As a Muslim, whenever I meet people with visual loss, I am comforted with this hadith:

Anas ibn Malik reported: The Messenger of Allah, peace and blessings be upon him, said, “Allah has promised: If I afflict My servant in his two dear eyes and he remains patient, he will be compensated for them with Paradise”.

Source: Sahīh al-Bukhārī 5653.

 

So, my dear readers, please go and get screened for glaucoma. Nigeria is already hard enough with two eyes!