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World Glaucoma week 2014 – Beat invisible glauchoma

Kilimanjaro Christian Medical Centre (KCMC), Eye department, P0393, Moshi/Tanzania.  Resource trip by Ruth Leimig (editor), CBM Germany. Story of Kiwelu Joyce, female, glaucoma. For further information see report: TZA-13-1147R.pdf

Kilimanjaro Christian Medical Centre (KCMC), Eye department, P0393, Moshi/Tanzania.
Resource trip by Ruth Leimig (editor), CBM Germany.
Story of Kiwelu Joyce, female, glaucoma.
For further information see report: TZA-13-1147R.pdf

World Glaucoma Week 2014 runs from 9-15 March, the week aims to raise awareness of glaucoma worlwide. Glaucoma is the second most common cause of blindness worldwide after cataracts, however unlike cataracts, glaucoma is irreversible. CBM ophtalmologist Dr Heiko Philippin provides us with a brief analysis of the condition and possible strategies to reduce its impacts.

World Glaucoma Week 2014 is a joint initiative of the World Glaucoma Association and theWorld Glaucoma Patients Association. It aims to raise awareness about glaucoma and encourage people to be tested for the disease and receive treatment accordingly. 

Many people remain unaware that they have the disease until it’s too late, by which stage their untreated glaucoma can lead to blindness. In order to raise awareness of glaucoma, Dr Heiko Philippin an ophthalmologist working for CBM International gives us a brief analysis of the condition and what can be done to control it.

Glaucoma is the second most common cause of blindness worldwide after cataracts. Blindness through cataracts can be reversed with a cataract operation: removing the opaque lens. Blindness caused by glaucoma on the other hand, is irreversible.

Once the optic nerve is damaged, its condition can’t be turned around. In addition to this, glaucoma is also a challenge because it remains silent in its early stages, usually there’s no pain and no loss of central vision. Glaucoma can therefore remain undetected for years whilst the disease progresses silently.

Glaucoma is a disease of the optic nerve, the nerve bundle which transmits everything we see from the eye to the brain. Most of the time, an increased pressure inside the eyeball causes a slow death of numerous single nerve fibers until all of them have died and the person affected is totally blind.

There are different reasons for an increased eye pressure. Usually the drainage of the eye fluid (the aqueous) is reduced. Glaucoma is rare in children. Most of the time, adults suffer from this silent disease, the incidence of which increases with age. If a person has glaucoma, other family members are at a higher risk of also having the disease.

The earliest sign can be an increased eye pressure. This can be measured by an ophthalmologist or in some countries also by optometrists and clinical officers amongst other eye care professionals. Nevertheless, eye pressure can be “normal” (traditionally below 21mmHg) and one can still get glaucoma (so called “normal tension glaucoma”). A lot of people also tolerate pressures above 21mmHg without being affected by glaucoma (“Ocular Hypertension”).

A more definite sign is changes of the optic nerve head which can be seen with special equipment at the posterior wall of the eye. They are usually also associated with visual field damage, small areas of decreased sensitivity of the peripheral vision. Often these signs are detected when people seek eye care professionals for other reasons.

Once glaucoma has been diagnosed, worsening can be stopped by a reduction of intraocular pressure. Eye pressure below 18mmHg is sufficient for most patients to avoid becoming blind from glaucoma. But once the diagnosis has been established, regular examinations should be undertaken to monitor the disease.

Eye pressure can be reduced with eye drops, laser procedures or surgery if necessary. The provision of sufficient treatment can be challenging in low-income settings, resulting in a high burden of blindness from glaucoma in these areas.

Due to the character of the early stages of glaucoma a lot of individuals are unaware of their disease. General screening of populations for glaucoma is usually not efficient. Detecting the disease in combination with other medical examinations is currently the most common approach to detect glaucoma early enough to prevent blindness.

After glaucoma has been detected, it is essential to explain to patients the nature of the disease especially the need for lifelong follow-up examinations and treatment. The question for the optimal treatment needs to be answered individually, patience and knowledge are necessary for clinicians and patients to find the best treatment solution. Particularly in low-income settings, there is also a paucity of evidence-based knowledge and more research is necessary to guide patients, eye care professionals and health-care providers.

 

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