A case for detecting glaucoma early in the community

Glaucoma continues to be a problem in Sub Saharan Africa. The absence of symptoms at the early stages means that many people in the community go about their daily business unaware that they have a problem until it is too late. That is when the vision in one eye gets significantly impaired. Even then some patients do not notice that because the vision in the other eye is compensating for the loss of vision in the other. So, it means that it is only when the second eye is also impaired that they notice it.

Urban Vs Rural Divide

It is easier for the urban literate than a rural non-literate person to notice loss of vision earlier because of the difference in the visual tasks they perform. The urban literate is usually able to notice problems when reading a newspaper for instance where they only see a section not the whole two-page spread.  Or they begin to notice problems when driving or are involved in some road traffic accidents when crossing a junction because they did not see the vehicle coming from the side. The urban literate therefore is more likely to present to hospital with some remaining vision.

For the rural non-literate, where exact visual tasks may not be needed because they neither read nor drive, loss of vison is noticed only when it is significant and affects their ability to recognise others or begin to have minor accidents like bumping and falling over because of their restricted visual field.

What this means is that emphasis should be laid on awareness creation more so in the rural areas. I remember a time when we had an outreach programme in a rural community. As part of the screening process, we asked the people to cover one eye and read our visual acuity chart. So, it was no surprise to us but a great surprise to many of the residents when they discovered for the first time that they could not see with one eye. So, a simple message to the people to occasionally check their vision against a distant object by covering one eye at a time can make a world of difference. It means that at least people who have lost vision in only one eye still have a chance to have the vision in the other eye preserved if they report to a hospital.

With the recent effort at integration of primary eye care into primary health care, many primary health care workers now have the training to recognise visual impairment and refer to the appropriate level on their referral network. Hopefully this will help significantly in reducing avoidable blindness from glaucoma.