Rate of Undiagnosed Glaucoma Cases in India is 90% | BCR NEWS

Rate of Undiagnosed Glaucoma Cases in India is 90% | BCR NEWS

BCR NEWS (Mumbai): Glaucoma is a common eye condition in which the fluid pressure inside the eye rises to a level higher than healthy for that eye. If untreated, it may slowly damage the optic nerve, causing the loss of vision, or even blindness, without showing any symptoms or warning signs. Hence, it is termed as ‘the silent thief of sight’.

Vision Sankara, Malad West, stands tall as the leader in the fight towards curing preventable blindness with the launch of the Sign4Sight – Year of Million Miracles campaign, which aims at raising awareness about eye donation and motivating people to donate, with an ambitious goal of one million pledges.

According to World Health Organisation (WHO), corneal disease is the chief cause for vision loss and blindness. The National Programme for Control of Blindness estimates that India accounts for 20% of the global blind population. With about 120,000 blind people in the country, the yearly addition of 25,000-30,000 cases further tips the scales into a dark pit.

Dr Ashish Bacchav, Vision Sankara, says, “In most cases, loss of sight can be corrected by eye donation through a surgical procedure of corneal transplantation. A person can gain vision only when a donor donates a healthy cornea. The corneal transplantation has a success rate of about 95%. Every pledge will give back the boon of eyesight to two individuals. You can become a sight ambassador by registering at www.sankaraeye.com/Sign4sight, and a donor card will be sent to you immediately.”

How common is glaucoma in India?

Dr Bacchav states, “In India, 30 million individuals are blind owing to cataract. Nearly 90% of them could have their vision restored. In contrast, about 12 million Indians aged 40 years or over are afflicted with glaucoma, and would become permanently blind without appropriate therapy. Another 28.1 million people have primary angle-closure glaucoma or are ocular hypertensives and primary angle closure suspects. Every eighth Indian (i.e. nearly 40 million of the estimated 309 million population aged 40 years or over) either has glaucoma or is at a risk of developing it.”

“The problem we face is daunting. The rate of undiagnosed glaucoma cases is 90%, as opposed to 40% in the developed world. Most of these patients are either visually disabled or permanently blind from the disease. Glaucoma awareness in both rural and urban communities is poor. Less than half the patients diagnosed with glaucoma via the Aravind Comprehensive Eye Survey had undergone a previous eye examination. A significant number of patients diagnosed with primary open-angle closure glaucoma prior to examination in the Chennai Glaucoma Study actually had primary angle-closure glaucoma. Knowledge and perceptional barriers have resulted in a low follow-up rate in the clinic setting,” he adds.

How is glaucoma detected?

Dr Sushil Deshpande, Vision Sankara, says, “Cataract is easily amenable to detection by mass screening, while glaucoma is not. Currently, we perform opportunistic screening in the form of comprehensive eye examinations, which includes tonometry, gonioscopy, optic nerve head examination, and, if necessary, visual field examination. We request that all patients coming to the clinic, as well as those with a positive family history and other risk factors for glaucoma, undergo a detailed eye examination. A comprehensive eye examination plays a crucial role in opportunistic glaucoma screening.”

How to manage glaucoma in the developing world?

Dr Bacchav says, “Medical management is the mainstay of treatment in early stages of glaucoma.”

“Many low-cost generic drugs have flooded the market, and their quality control is debatable. Generic drugs are not as potent as the original formulations, but they are the only hope for many poor patients. A chunk of the semi-urban and rural population does not have access to generic medications. Compliance and long-term adherence to medical therapy is a serious concern, and there is also the issue of a proper technique for the administration of drugs. The counsellors also play a vital role in family screening for glaucoma, which helps with early-stage detection of the disease,” he adds.

Co-existing cataract and glaucoma

Dr Deshpande says, “The prevalence of cataract and glaucoma increases with age. There are many patients with advanced cataract and glaucoma. In fact, they are detected to have glaucoma only due to vision problems caused by growing cataract! In such a scenario, trabeculectomy, combined with cataract surgery provides a safe and cost-effective technique with the least complications. One needs to be careful while selecting lenses for the cataract surgery in glaucoma patients so as to avoid deterioration of vision quality.”

Glaucoma surgery

There are many different ways to treat glaucoma. In addition to conventional and laser surgery, there is a variety of drugs to lower intraocular pressure (IOP). If these methods alone fail, doctors may suggest implants or shunts.

Even though trabeculectomy is still the gold standard in India, we need to perform early surgery in patients with advanced glaucomatous damage, because of the poor compliance to treatment, side-effects of anti-glaucoma medications and difficulty with long-term follow-up. Managing intractable glaucoma continues to be a challenge, as most glaucoma shunts are expensive. Tube shunts help glaucoma surgeons deal with failed trabeculectomies and difficult cases with relative ease.

The idea behind implants is to enhance standard glaucoma surgery by positioning a device that will help keep the surgically-created drainage opening from healing and closing down. Many current implants include a tube through which the aqueous fluid passes. Ahmed Glaucoma valve is the commonly used implant as it has a safety valve, which provides significant safety to the surgery.

Conventional surgery

In conventional surgery, a tiny drainage hole is made in the sclera (the white part of the eye). This procedure is known as trabeculectomy or sclerostomy. This opening allows fluid to drain out of the eye under the delicate membrane covering the eyeball known as the conjunctiva. Locally applied medications or injections may be used to help keep the hole open.

When are implants/shunts used?

Dr Bacchav says, “It is estimated that several thousand implants are used in the USA each year. Most of these are performed on what eye surgeons think of as complicated glaucomas. Glaucoma implants may be considered in forms of glaucoma following injuries to the eye.”

“They are also used in cases of congenital glaucoma when other surgeries have not worked, and in cases of neovascular glaucoma (a type of glaucoma often associated with diabetes, characterised by blood vessels that grow across the iris and drainage area, closing off fluid outflow). Implants may also be used when other glaucoma treatments have not been successful,” he adds.

How often should glaucoma visit an eye doctor?

Dr Deshpande says, “As a person who has recently been diagnosed with glaucoma, you may need to have your eye pressure checked every week or month until it is under control. Even when your eye pressure is at a safe level, you may need to see your doctor several times a year for checkups depending on the severity of glaucoma.”

“These checkups will include IOP monitoring as well as the visual field test and other tests to ensure the glaucoma is not worsening. Change of treatment modalities are planned on the results of these tests used to monitor the progression of glaucoma,” he added.

“It is important that your doctor listens and responds to your concerns and questions, is willing to explain your treatment options, and is available for calls and checkups,” Dr Deshpande said.

“A good working relationship with your eye doctor is the key to effective glaucoma care,” he added.

Will a diagnosis of glaucoma limit your life?

Dr Deshpande says, “We are limited only by what we think we can or cannot do. You can continue with what you were doing before glaucoma was diagnosed. You can make new plans and start new ventures. And you can trust the eye care provider to keep looking for better treatment methods for glaucoma. Take good care of yourself and your eyes, and get on with enjoying your life. Certain scenarios with advanced glaucoma might require you to be avoid driving and use more light indoors and in dark areas as contrast and sensitivity is poor in advanced glaucoma.”

What can I do to help others?

As a glaucoma patient, you have the opportunity to teach your friends and relatives about this disease. Many people are unaware of the importance of eye checkups and do not know that individuals with glaucoma may have no symptoms. You can help protect their eye health by encouraging them to have their eye pressure and optic nerves checked regularly.

Family screening is an important tool in for glaucoma detection. Once someone has glaucoma, the chances of developing glaucoma in siblings is 49%, in offspring (son and daughter) is 30% and in parents is 25%. Hence, help your family first and then the community around you.

Conclusion

Glaucoma has a high prevalence in India. Poor patient awareness, coupled with factors such as compliance issues and cost of medications, make glaucoma an extremely dangerous condition with high potential for causing irreversible blindness in millions of patients. Strategies to overcome these barriers that would involve ophthalmologists, epidemiologists, and policymakers need to be intelligently and quickly devised.

About Sankara Eye Foundation:

Sankara Eye Foundation is a Non Profit NGO and part of the Sri Kanchi Kamakoti Medical Trust founded in 1977 at Coimbatore with a vision to provide quality eye care. With the goal of replicating oneSankara Eye Hospital in every State in India, the group is working towards freedom from preventable and curable blindness – Vision 20/20 by the year 2020 – wherein no one would be needlessly blind

Sankara has a chain of 13 eye hospitals comprising a team of 200 doctors, 600 paramedical professionals, 275 support staff and total bed strength of 1800. It has treated and performed more than 1.2 million FreeEye Care surgeries and every day about 500 eye care surgeries are performed in Sankara Hospitals.