The challenge of glaucoma care

World Glaucoma Week is a global initiative of the World Glaucoma association (WGA) in order to raise awareness on glaucoma, the silent thief of vision and the second leading cause of blindness globally. The theme for 2021 is “The world is bright, save your sight.” This phrase signifies the hope and optimism that can come with early detection and timely management of glaucoma.

Glaucoma is a multifactorial, progressive eye condition with an end point leading to irreversible damage to the optic nerve. Without general awareness, regular eye examinations and careful adherence to the management plan, vision can deteriorate progressively. In most cases, glaucoma is asymptomatic until the late stages of the disease and diagnosis is frequently delayed, resulting in significant, irreparable damage to vision. It is critical to have an annual comprehensive eye examination, particularly if the person is above the age of forty, has history of using steroids medications or has sustained any eye injury. Diabetes mellitus and hypertension are also notable risk factors for development of glaucoma. Since some forms of glaucoma are inherited, it is also important to talk with the family members to see if there is any history of the disease in the family.

Reduction of ocular pressure is the only method proven to effectively treat or at least halt the glaucomatous damage. Numerous drugs are commercially available, however their efficacy is often accompanied by local side effects. The financial constraints play an equally important role in procuring preservative free formulations specially in the developing countries.

Surgery for glaucoma is reserved for cases recalcitrant to combination of drugs. Although it is usually very effective, but patients run the risk of potentially severe side effects, including the complete loss of residual vision sometimes in advanced cases.

There is an urgent need for advocacy and policy to improve early detection of glaucoma. Active involvement of all the health care cadres including optometrists, general practitioners, and general ophthalmologists is needed. A well-trained optometrist can pick up symptoms of frequent changes in near glasses and unexplained headaches by a complete and concise history taking. Adding tonometry, evaluation of disc and angle as a routine protocol of vision assessment and refraction helps in detecting many such underlying cases. Thus, primary comprehensive eye and vision examinations may be the most cost-effective way to detect glaucoma in a high-risk population. Timely referral to specialist ophthalmologist is the key to prevent vision loss.

The whole world is going through unprecedented times with the pandemic, which has created huge disruptions and caused many people to consider delaying their in-person clinical appointments.  It is imperative to keep scheduled clinic visits to ensure that the eye pressures are controlled, visual fields are stable and to adjust the treatment plan accordingly.

Until December 2019, there was no concern about pooling hundreds of patients into an outreach camp. This year, this scenario is almost impossible to imagine. Our NGO Manthan Eye Healthcare Foundation is trying to evaluate methods to recruit, train, manage, track, and validate the ways of eye health care service delivery methods while maintaining social distancing and ensuring all safety standards. With new social distancing requirements, we have an uphill battle to carry out and scale up our community and extension activities. Awareness campaigns play a key role in encouraging regular eye checks and implementing screening programmes for high-risk populations. A valuable starting point for patients to understand glaucoma is our free information leaflet has been published by the team in three prominent vernaculars namely Hindi, Urdu and English. The foundation’s website and social media handles also offers a plenty of resources to keep people aware and updated about this disease.

With the advent of vaccinations drive around the globe there is a new hope of a brighter world. Let us save sight!