Glaucoma: A silent thief of sight | By Dr Jahanzeb Durrani


Glaucoma: A silent thief of sight

GLAUCOMA is a condition of raised fluid pressure in the eye which needs urgent attention and treatment by a specialist.

A regular eye examination by your doctor, who can catch the visual problems before it’s too late.

Glaucoma occurs commonly amongst older people above the age of 40 years and likely to be more common in women. The underlying cause of glaucoma is very complex and remains unclear.

Several theories exist for its exact cause but the focus of treatment remains increased fluid pressure in the eye which is mostly higher than 21 mm of mercury.

Patient usually complains of pain, irritating halos around the lights, redness, sometime nausea and vomiting in acute cases with gradual weakness of eye sight.

However, most of the cases are asymptomatic. Since it is a condition of both eyes which can only be diagnosed by an eye specialist as it affects mobility and daily working of a person.

In certain cases, there is positive family history of Glaucoma being 2-4 times as a known risky factor.

Smoking increases the risk of glaucoma and cardiovascular disorders. But it does not affect the of cardiovascular involvement.

However, the issue gets more complex due to high percentage of non-complained patients.

Therefore, the effects of under-diagnosis are obvious but there are implications of over-treatment as well which are far more deleterious.

Hence the under-diagnosis of glaucoma is a pressing issue facing the world today

According to an earlier study, 67 million people suffer glaucoma in the world, which is the second-leading cause of blindness (8%) after cataracts (51%).

It is the leading cause of blindness in African Americans and is commonly known as the “silent thief of sight” The loss of vision usually occurs gradually over a period of time in 90% of un-treated or poorly compliant glaucomatous cases.

But 2010, there were 44.7 million people suffered in the world with glaucoma and 2.8 million people in the United States alone.

By 2020, the prevalence is estimated to increase by 58.6 million worldwide.According to researchers, the best time to look after your vision is 20-30 years of age.

Adults under age of 40 should get a comprehensive eye exam every 3-5 years. The visual problems are preventable with simple treatment and good habits.

Scientists observe that half of the glaucoma patients remain undiagnosed and most of the “glaucoma patients” using medication do not need the medications. They are either being over-treated or remain under-diagnosed.

It is a common thinking that lack of vitamin causes glaucoma, butthere is no evidence to support this paradigm.

However, caffeine (commonly used for pain) increases the intraocular pressure only in those who already suffer from glaucoma, but it does not appear to affect normal individuals.

Many people of Asian descent especially black population are more prone to developing glaucoma, but it has been reported in white populations of Canada as well.

Though most of the cases do not involve the genetic mutations (rarely one third of normal-pressure glaucoma).

However, raised fluid pressure has been observed in various other conditions like prolonged use of steroids, diabetes, vascular conditions like Hypertension and injuries.

Currently, varied classes of medications are used to treat glaucoma in addition to laser and surgery which are possible to slow down or to stop the progression of the disease through lowering of the eye pressure.

Such treatment are very effective in people who do not respond sufficiently to medication. The first researched drug Pilocarpine was used in 1870 to reduce eye pressure and to avoid damage to retina (internal sensitive layer of vision to perceive finer objects) and the optic nerve.

In this context, the Ahmed glaucoma valve implant devised by a Pakistani eye specialist is a very safe device, has been successfully used all over the world in cases, which are not responding to any therapy or in failed surgery.

However, Glaucoma is a unique pressing problem in the medical history and doctors are more concerned with under-diagnosis and over-treatment of Glaucoma patients.

However latest micro-vascular shunt surgery is progressively on the horizon and we hope that sooner or later this technology of stem cell will overcome the problem of under-diagnosis or over-treatment.

Current research also consists of a pair of goggles connected to a pressure-modulating pump, when activated establishes a targeted negative pressure surrounding of the eye, resulting in instantaneous lowering of IOP.

This treatment promises to improve upon traditional surgical approach and provide the first non-invasive lowering pressure therapies to help most difficult cases.

—The writer is a practicing Eye Specialist in Maroof Int’l Hospital, F-10, Islamabad.


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