Glaucoma: a hidden disease in Sierra Leone

“What you have, Sir, is glaucoma, a disease which causes high pressure in your eyes and damages the nerve connecting your eyes and brain. I’m afraid the damage to your eyes is too far advanced for us to be able to do anything and this disease is irreversible.”

As I uttered these dreadful words to this 42-year-old man, the breadwinner in his family, I saw the hopeful looks on his and his wife’s faces slowly change into one of anguish, confusion and hopelessness all at the same time.

No matter how many times I say these words to a patient (as much as 4 or 5 times in a bad week), it never gets easier

Those words always invoke a sense of guilt in me, making me wonder what we could have done to prevent this from happening to yet another person. At the same time, they fill me with strength and resolve to keep fighting, to keep doing everything possible to eliminate avoidable blindness from glaucoma in Sierra Leone. Because I know that, caught early enough, glaucoma can be managed so that the person’s sight won’t decline.

In Sierra Leone, glaucoma is the second leading cause of blindness and the number one cause of irreversible blindness. Here, the disease is aggressive, and we often see young patients already totally blind from it. Even worse, sometimes you see different generations of the same family blind from this disease.

For many years, glaucoma was a hidden disease in Sierra Leone, with many people not having access to proper information, diagnosis and treatment for this condition. In 2010, research done in people aged 50+ years showed that only 2% of people had any knowledge about glaucoma.

Today, we are working hard to change this story. Through a lot of advocacy, sensitization and screening campaigns, glaucoma is fast becoming visible and is now recognized as a condition that can be managed.

Furthermore, over the past decade, the number of trained eye health workers and facilities equipped to diagnose glaucoma has slowly increased from being virtually non-existent before. Specialized glaucoma surgery (trabeculectomy, trabeculotomy, glaucoma drainage devices) is now routinely done in Connaught Hospital, the only public tertiary eye unit in the country.

Despite these advances, we still have a long way to go. The majority of eye units across the country still lack basic equipment, medications and trained eye health staff needed for proper diagnosis and treatment of glaucoma respectively.

Many patients are still being diagnosed too late or receive inadequate care. Also, a recent study just completed in Connaught Hospital found worrying rates of patients’ compliance to glaucoma medications due to factors like cost of drugs, limited and inconsistent availability of drugs and poor knowledge about the disease.

The Sierra Leone eye health system needs a lot of investment to tackle this alarming sight-threatening disease, investment in the right balance of human resource, infrastructure, equipment and policies. This requires commitment from the government, local and international partners, the health workers, communities and the patients themselves to work together to prevent avoidable blindness from glaucoma.