Georgetown: The World Glaucoma Association and World Glaucoma Patient Association has designated March 9th to 15th 2014 World Glaucoma Week. The theme for this year’s campaign is 'B-I-G – Beat Invisible Glaucoma' campaign. This campaign was chosen because of the fact that many people suffer with glaucoma and they still do not know it! It’s called “invisible” glaucoma because the disease acts silently by causing damage to the optic nerve (the eye nerve which allows us to see the world) without the patient having any notable symptoms. Hence, bit by bit over the years this damage continues, unknown to the patient, until the entire nerve is destroyed. This nerve damage (called glaucomatous optic neuropathy) is permanent and cannot be reversed. Hence, at that time when the patient begins to start experiencing visual symptoms, they would already have had significant nerve damage. Thus, there is need for early screening of the disease. Once glaucoma is diagnosed in the early stage, treatment can commence, and thereby prevent persons from becoming blind unnecessarily. Glaucoma can be controlled with treatment so that patients can enjoy comfortable vision throughout their life.
This is the reason why public awareness and education are of utmost importance. Every year in the month of March, an entire week is designated to raise awareness about this blinding disease.
60.5 million persons had glaucoma globally in 2010 and given the aging of the worlds’ population, this number may increase to almost 80 million by 2020. In the English-speaking Caribbean, the 1990’s Barbados Eye Studies found prevalence rates of Open Angle Glaucoma (OAG) by self-reported race to be 7.0% in the black population aged 50 yrs and over. Over 50% of the Barbados Eye Study population were unaware they had the disease. Hence, there is need for constant public education to increase awareness of the disease.
In Guyanese patients, Open Angle Glaucoma is the most common form of this disease. Patients of Afro-Guyanese origin are more prone to develop open angle glaucoma and are more likely to have family members suffering from glaucoma. It has also been found that glaucoma in Afro-Guyanese patients is usually very severe and more difficult to treat.
At the Georgetown Public Hospital Corporation, the Department of Ophthalmology offers services for diagnosing and treating Glaucoma. These services are now boosted with the presence of a Guyanese Consultant Ophthalmologist who is also a Glaucoma Specialist. The hospital offers daily eye clinics on weekdays where patients can be given eye examinations for the detection of Glaucoma. Patients need to be referred to the hospital before they can obtain an appointment for any service. These referrals can be obtained from their general physicians.
Diagnosis of glaucoma is multi-faceted and involves quite a few examination techniques to determine all risk factors. Some of these investigational techniques available at the hospital are:
1. Tonometry – Measurement of the eye pressure (Intra-ocular Pressure). The hospital offers both applanationtonometry (Goldmann and Perkin’s) along with pneumotonometry.
2. Gonioscopy – Measurement of the width of the angles in the eye. This test determines whether a patient is suffereing from either open-angle glaucoma or closed-angle glaucoma.
3. Dilated Stereoscopic Optic Nerve Evaluation – This is an important clinical evaluation of the eye nerve that helps to determine structural/physical changes in the optic nerve.
4. Perimetry – Measurement of the Visual Field. Humphrey’s Visual Field Testing is an important test for both diagnosing and for following up of patients to determine if their disease is being managed optimally.
5. Pachymetry – Measurement of the thickness of the cornea. This is an important measurement that helps to determine accuracy of eye pressure measurements and also helps ophthalmologists to calculate various risks which patients may have.
Primary Open Angle Glaucoma is generally a disease of aging. Hence, it's more frequent in patients 60 years and above. Though, if a person has other risk factors that can affect their drainage system such as genetic factors, structural factors and systemic factors it can occur in younger age groups. In patients of African heritage it can occur as early as age 40. It can also occur in a subset of patients who are less than 20 years and in this case they are referred to as Juvenile Open Angle Glaucoma. Even though symptoms are not common in the early stages, some patients who are very sensitive to visual changes may notice spots in their vision. In the advanced stages of glaucoma patients lose their peripheral vision – their vision appears as if they are looking through a dark tunnel with only a small central hole of vision.
Patients who suffer from closed-angle glaucoma and other secondary glaucoma may or may not have eye pains and other symptoms, but in general open angle glaucoma does not routinely cause eye pains.
There are many ways to treat open angle glaucoma. Treatment of glaucoma includes anti-glaucoma eye drops, laser treatment and glaucoma surgery. The usual pattern is to start patients on anti-glaucoma eye drops and some patients can be prescribed as much as 4 different eye drops. If eye drops fail to control glaucoma, patients can then be given the option of having laser treatment or glaucoma surgery.
Management of glaucoma at GPHC includes constant follow-up visits to the eye clinic to have the eye pressures being checked and for the ophthalmologist to evaluate whether the eye drops are controlling the glaucoma. The visual field examination results of patients are evaluated on a regular basis to ensure that the patients’ optic nerve is being protected from further damage.
Patients need to understand the importance of using their medications on time and in the correct manner. At GPHC, the most common surgery that is offered for glaucoma is called Trabeculectomy. Unfortunately, once a patient has lost all function of their optic nerve there isn't any option available currently to regenerate the nerve. Damage to the optic nerve is permanent – thus loss of vision is permanent.
This year, in observance of World Glaucoma Week, the Ministry of Health in collaboration with the Georgetown Public Hospital has created an information pamphlet on glaucoma (attached) that will be distributed at regional hospitals and health centres. The pamphlet, created by Glaucoma Specialist Dr Shailendra Sugrim, has simple language for easy comprehension by the general public. It carries basic information about glaucoma and how to get your eyes screened. During World Glaucoma Week, articles on Glaucoma will also be published in the media, along with radio and TV interviews.
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