Glaucoma blindness in Africa

Mr. O.N, a 42-year-old trader, visited the Friday clinic for presbyopia symptoms. He was also found to have moderately advanced glaucoma. He had normal vision but his eye pressures were 36/39mmHg in right/left eye respectively. He was offered surgery but refused because his wedding was only 4 weeks away. He was commenced on medical treatment. Mr. O.N did not return for follow up until 7 years later, led by his younger brother. His wife had left him with their two children for economic reasons.  He broke down in tears. Mr. O. N’s brother was examined and he had early/moderate glaucoma. He was asked to invite his whole family for screening. This is a common manifestation of glaucoma in Africa.

Glaucoma is the leading cause of irreversible blindness worldwide and most prevalent in people of African descent. About 6 million have glaucoma and up to half a million of them are already blind in Africa. Glaucoma has an earlier onset in Africans and is more aggressive in its course. It therefore leads to blindness earlier than in Caucasian counterparts. In most of Africa, only about 1 in 20 of those with the disease are aware, with over 50% being unilaterally blind on presentation. Low awareness of the disease, late presentation/diagnosis and poor adherence to follow up visits are major challenges to glaucoma management.

Treatment is for life, which can be too expensive because of widespread out-of-pocket expenditure in the face of poorly effective national health insurance schemes. The potentially acceptable laser treatment is very limited in its availability. The more cost-effective, recommended incisional surgery, trabeculectomy, suffers poor acceptance due to cost and fear from uncertain outcomes, resulting partly from insufficient training. Meanwhile most need surgery because of the advanced stage at diagnosis.

To have earlier diagnosis and reduce burden of blindness from glaucoma, screenings among high-risk groups such as family members is recommended. A lot of awareness campaigns have started in the past few years in several African countries, with free glaucoma screenings for the public, especially during World Glaucoma Week. This should be encouraged to gain more momentum though the outdoor screenings are discouraged this year because of the COVID-19 pandemic. Establishment of family glaucoma screening clinics, effective integration of eye care into comprehensive/universal health care and strengthening/standardization of human resource skills/practices and national health insurance schemes will go a long way in reducing glaucoma blindness in this cost-constrained continent.

Image: Community Service during World Glaucoma Week 2020 by Adedoyin Adeleke