“Glaucoma is a silent thief”, says Dr Cyprian Ntomoka, Head of CCBRT’s Eye Department. “We often receive patients at an advanced stage of the disease without them even knowing.”
At the start of World Glaucoma Week, 12-18 March, CCBRT’s eye experts are drawing attention to this serious condition, which can be treated and managed if caught early. The second leading cause of blindness in the world, glaucoma occurs when fluid in the eye cannot drain properly, increasing pressure inside the eye and puts pressure on the optic nerve. As the condition progresses, so can damage to the optic nerve, leading to impaired vision and even blindness.
The condition cannot be cured, nor visual damage restored, but through treatment the eye can be stabilised and further damage prevented. People aged 40 and above are at higher risk, as are those with glaucoma in the immediate family.
Dr Cyprian explains that in Tanzania many people rarely go for routine sight check-ups, so detecting the disease in the critical early stages is difficult. Glaucoma can also develop slowly, at first causing only peripheral vision loss, which can go unnoticed. By the time a patient notices a change in vision, the disease can be at a late stage. CCBRT patient numbers at different stages of the disease are high: “We receive 40-50 patients at our dedicated glaucoma clinic every Friday, but many others come throughout the week, too.”
The mainstay of treatment is medication to lower pressure inside the eye to within normal parameters: 10-21mm Hg. “The most important thing is to prevent optic nerve damage. If someone presents with severe damage, we are keen to get pressure back to the lowest possible reading within the normal range, and if there is moderate optic nerve damage, we can bring it down to the middle of that range”, says Dr Cyprian.
The most commonly available drug here in Tanzania, he explains, is Timolol. This single-strength medicine bring pressures down, but not by a large amount: so it is far more effective in early-stage cases with less damage to the optic nerve. Combined anti-glaucoma eye drops are also available, but at a prohibitively higher cost relative to the economic status of most of these Dr Cyprian’s patients.
Surgery is another intervention, but patients with severely damaged optic nerves are very difficult to operate. Dr Cyprian also points out a big challenge with this approach: “Some patients who undergo surgery assume afterwards that they are cured completely – so they disappear, and cease to come for follow-up. We’ll occasionally get these patients coming back blind. The reality is that glaucoma is a chronic disease requiring regular check-ups and management.”
Dr Cyprian emphatically appeals, “The biggest thing anyone can do to prevent glaucoma and eye damage is go for routine eye checks, especially if you are over 40 years old and a first-degree relative of someone with glaucoma”. He also encourages his fellow clinicians in the field of eye to develop a culture of glaucoma screening: “Don’t miss the signs. Do pressure and optic nerve checks on all your patients over 40, by default. You could save someone’s sight!”