India shoulders the largest burden of global blindness and while cataract and refraction errors, the key causes of blindness, are better studied, glaucoma — the third largest cause — is known among specialists as the “silent thief of human sight”. Glaucoma is an eye disease characterised by damage to the optic nerve (that carries information from our eyes to the brain) due to raised pressure inside the eyes, ultimately leading to irreversible blindness. Medical statistics reveal that every eighth individual or nearly 40 million of the estimated 309 million population aged 40 or older in India either has glaucoma or is at risk of developing the disease.
Unlike other eye ailments, the initial damage done by glaucoma is neither sudden nor robust enough for a patient to go see an ophthalmologist. By the time glaucoma is detected, the patient has already suffered damage to the vision and visual field beyond repair.
Check-ups a must The real challenges are a lack of accurate diagnosis and abysmal follow-up. Regional studies conducted in India suggest that 90 per cent of the cases are undiagnosed, whereas this percentage is 40-60 per cent for other developed nations. Numerous KAP (knowledge, attitude and practice) surveys on the adherence of anti-glaucoma medications and lifestyle modifications in glaucoma patients also make for a dismal picture. Early detection, regular follow-up and increased awareness about some basic lifestyle modifications could be the key to solving this menace. Mostly the open angle form of glaucoma is asymptomatic but some patients with angle closure form of glaucoma may experience frequent headaches, see coloured halos around a light source and experience pain or pressure around the eyes, occasionally accompanied by nausea and vomiting.
Since most cases are asymptomatic, it is recommended that individuals aged over 40 take a comprehensive eye check-up at least once a year. Additionally, individuals must know their family’s eye health history as glaucoma has a hereditary component.
Slowing progression The second part of the problem is of treatment. There is no cure for glaucoma but treatment helps to slow disease progression. Most doctors focus only on reducing the eye pressure. And that’s where they falter, because glaucoma can be diagnosed with normal or even lower-than-normal eye pressure. It is an established fact that glaucoma is a multifactorial disease.
There are many scientific studies encompassing a list of lifestyle modifications that could help alter the disease progression. For example, studies have shown additional lowering of eye pressure with aerobic exercises. Yoga is also beneficial but strenuous head-down positions should be avoided. Caffeine, smoking, consumption of a high-fat diet, patients taking bedtime antihypertensive medication are some other factors which cause notable disease progression. Diseases like diabetes, hypertension and thyroid diseases also contribute to the acceleration of glaucoma.
How can we tame the glaucoma “tsunami”? The facts and figures highlight the need for macro-level changes to be incorporated within Indian medical system to increase awareness about this disease even at grass-roots level. The National Programme for Control Blindness has taken up this issue during the 12th Five Year Plan (2012-17). It’s time we joined hands to increasing awareness about the disease.
Dr. Parul Ichhpujani is Associate Professor, Department of Ophthalmology, and Chirayu Mohindroo, an MBBS student, at the Government Medical College and Hospital, Chandigarh.
