Ignorance is not always bliss. Particularly in matters of health.
Do you know what is the most scary thing about glaucoma? That you may be having it but not knowing it! “By the time you realise something is wrong in your eye, the damage is done,” says Dr.R.Krishnadas, Consultant Ophthalmologist in Glaucoma at Aravind Eye Hospital.
It is currently the World Glaucoma Week (March 8 to 14) and the specialist in diagnosis and treatment of glaucoma sits busy than ever in his cubicle examining and explaining to his patients how they can prevent the progression of the disease and also persuading them to get their family members screened.
“The symptomless condition that damages the optic nerve and affects mainly the older people has a serious outcome,” says Dr.Krishnadas of glaucoma stated to be the second leading cause of blindness in India. It is estimated that some 12 to 13 million Indians suffer from glaucoma but not even 10 per cent of them know they do. In India, more than a million people are said to be blind from the condition.
But we hear no alarm bells ringing. Glaucoma is somewhat like an orphan disease. Given its asymptomatic status it remains heavily under-diagnosed. After diagnosis, it remains far from cure. The best a doctor can do is to preserve the vision the patient is left with, says Dr. Krishnadas, while the patient has to be equally careful and responsible about continuous care, treatment and follow-up in order to prevent the vision from deteriorating further.
Dr. Krishnadas is serious when he says he is searching for famous people with glaucoma. His uppermost concern is to create more access to people so that they are automatically screened for a silent disease like glaucoma. The problem, he asserts, is people always go for a check up only when they are unwell. There is a need to break the distance barrier and motivate people into check-ups even when they are not ill, he says, citing Amitabh Bachchan’s famous slogan, “Do boond Zindagi ke” as one of the possible reasons for the success of pulse polio campaign.
While a set up like his gives him the edge in opportunistic and targeted screening of patients, he rues the dull public response to camps. His staff wrote to 4,000 glaucoma patients who were registered last year to bring their family members above 35 years for free screening on March 8. But only 375 people turned up of whom 125 were already diagnosed glaucoma patients.
Since risk of glaucoma is 20 times higher in people with family history of the disease, chasing the family is one of the focussed approaches of eye specialists, says Dr.Krishnadas. He also adds that the screening of at-risk people, like those suffering from diabetes, hypertension, myopia, is cost-effective than mass screening camps because glaucoma is still not marketable despite the rising numbers.
For instance, cataract, he says, guarantees 99.9 per cent satisfaction and safety after surgery. Cataract is like a curtain blurring a patient’s vision and forcing people to go for surgery followed by the thrill of vision restoration. But in glaucoma there is no such tangible result. While early detection remains a challenge, there is no perceptible change in vision either after treatment. To make it worse, patient has to work on maintenance and failure to do so leads to irreversible blindness.
When majority don’t see or hear glaucoma and the specialists are more like the backstage boys to cataract experts, what inspired Dr.Krishnadas to continue to play his important role for over two-and-a-half decades? The soft-spoken doctor smiles: “When a personality like Dr.V (Dr.G. Venkataswamy, the founder of Aravind eye hospitals) tells you to do something, can you refuse?”
He still remembers the Labour Day of 1990 when he walked into AEH in Madurai as a Consultant after graduating from Kilpauk Medical College and completing his residency at Aravind Hospital, Tirunelveli. It was a hot summer Monday morning and the cataract OP was overflowing with patients. “I did not have a seat to myself,” recalls Dr.Krishnadas, “and the nurses were helping me to shift from one corner to another depending on availability of space.”
Seeing him being shunted around, Dr.V held his hand and took him to the relatively empty glaucoma department and asked him if he would like to get trained in glaucoma. “No one was privileged like me to straightaway do the additional two-year fellowship training in glaucoma after MS,” says Dr.Krishnadas.
It means not every ophthalmologist is a glaucoma specialist and not everyone who claims to be a glaucoma specialist is fellowship trained. This put Dr.Krishnadas at the top as he single-handedly manned the glaucoma department for a decade. “I used to get 50-odd patients a day then and now it is not less than 350 a day,” he notes. But now he runs a team of eight Consultants and nine Fellows and feels all the eye care professionals put together can have a greater reach in prevention and giving the patients best quality of life.
A devoted and giving ophthalmologist, Dr.Krishnadas is proud of his work at the AEH. “I value the much-needed service I am able to give to our patients and I respect the mentors I meet during my continuing trainings,” he says.
When he was in class VI, he was fascinated by a story on heart transplant done by Dr.Christiaan Barnard and dreamt of becoming a cardio-thoracic surgeon. When in class X he visited the Sankar Nethralaya with an uncle and returned impressed by the professionalism of the doctors there. “I decided to become an eye surgeon,” says Dr.Krishnadas known for his affable nature and patience in guiding his patients’ management of glaucoma.
There is still much more to do in terms of management, he admits, having performed close to 30,000 cataract and glaucoma surgeries so far. But now with additional responsibility as Director Human Resource Development of Aravind Eye Care System, he restricts to 70-odd surgeries a week.
He is hopeful that in the years to come there will be new surgical techniques and drugs, gadgets and tools that will see breakthroughs in glaucoma. “But till then this public health issue should not be ignored,” he asserts.
Facts about Glaucoma:
What is glaucoma: Glaucoma occurs when fluid doesn’t drain from the eyes properly and builds up the pressure within the eye, above 10-20mm/Hg. It causes damage to the optic nerve. The older you get, glaucoma becomes more common and if not treated in time it can lead to loss of vision
Screening: Basic screening involves measuring the pressure in both the eyes. If glaucoma is suspected, for further screening, eye drops are used to enlarge the pupils for a better inside view of the eye and the optic nerve to check for damage. Visual field tests are conducted for assessing side and peripheral vision lost.
Treatment: Glaucoma surgery focuses on making a new outlet for drainage or doing away with the tissue that causes obstruction to the outflow. It can be managed with drugs depending on the severity.
Prevention: People think glaucoma causes blindness but it actually starts with loss of peripheral vision, which is not easy to diagnose early. But early diagnosis is the key to prevention. Like people go for blood pressure and sugar levels check up, everybody above the age of 40 should be encouraged to go for regular eye check up. And if there is a family history of glaucoma, then it is mandatory for those above 35 years.
Glaucoma treatment means living with the disease and managing it with long term commitment on part of both the doctor and the patient. It involves periodic monitoring and necessary follow up care.
