Times of India
08 March 2011
By Umesh Isalkar
Pune, India

Glaucoma Awareness Week
Despite consulting an eye specialist, 50–year–old Subash Sanap lost his eyesight. His doctor failed to pick up the ‘sight–stealing’ disease at an early stage, resulting in irreversible loss of vision for Sanap. March 6–12 is observed as Glaucoma awareness week across the world.

A study conducted by the H V Desai Hospital, from 2006 to 2008, among 100 patients of glaucoma found that 20 per cent of them had consulted doctor during the development of the disease, but they suffered because they were not treated in time. The study also underlines the low level of awareness about the disease not only among patients but also among doctors.

"Awareness level about glaucoma needs to be scaled up even among doctors and opthalmologists. About 20 patients with advanced glaucoma said their doctors failed to pickup symptoms and the risk–factors. Importantly, half of these doctors hail from cities like Pune and Solapur," said ophthalmologist Parikshit Gogate, principal investigator of the study.

The study by the Hadapsar–based hospital has earned a place in the prestigious Indian Journal of Ophthalmology, an official journal of All Indian Opthalmology Society, in February 2011.

New statistics gathered by the World Health Organisation (WHO) show that glaucoma is now the second leading cause of blindness globally, after cataracts. Glaucoma, however, perhaps presents greater health challenge than cataract because the blindness it causes is irreversible.

Glaucoma has been nicknamed the ‘sneak thief of sight’ because the loss of vision normally occurs gradually over a long period of time and is often only recognised when the disease is quite advanced. Once lost, this damaged visual field can never be recovered.

Vidya Chelerkar, a glaucoma consultant at the H V Desai eye hospital and one among the researchers in the study, said, "There may not be enough symptoms suggestive of glaucoma at an early stage. But there are certain risk–factors that can help doctors detect the disease in the early stage of development. Importantly, family history of glaucoma, high minus or plus number (myopia or hypermetropia), use of steroid drugs for any condition, diabetes and hypertension are the major risk factor for development of glaucoma."

Chelerkar said, "Generally, if the above mentioned risk factors are present, and if the patient is above 40 years of age, then it is advisable to call him for an eye check–up every six months or a year, to rule out development of the disease."

Besides, measurement of intraocular pressure (IOP) i.e. pressure of fluid within the eye and evaluation of the optic nerve which is the main nerve of the eye, are important for detection and diagnosis of glaucoma. Visual field testing (perimetry) is another equally important factor for detection of glaucoma. Failures to carry out these specific tests may lead to missing out the disease at an early stage, Chelerkar added.

"A comprehensive eye examination should be done for every patient attending an eye clinic and this should be stressed in ophthalmologists' and optometrists' training programmes," she said.

Glaucoma tends to run in families. A study in Boston (US) showed that people who had a first–degree relative with glaucoma were more aware of the disease. In Moorefield's eye hospital study, it was observed that stronger the patient's family history, the lower the odds of late attendance.

"But in our study, even patients with a positive family history were likely to present late as awareness of glaucoma was very poor. Perhaps the ophthalmologists who treated the affected family member did not take time to counsel the patient that the disease runs in families and all siblings and children should undergo a regular comprehensive eye examination," said ophthalmologist Roma Deshpande, who is a part of the research team.

Who is at Risk

• People with a family history
• People with high intraocular pressure
• Anyone above 40 years
• Diabetics and those with hypertension
• Prolonged users of steroids
• People with eye injuries

Symptoms

• Rarely any in the early stages. Regular eye check–up is important
• Sometimes patchy loss of peripheral vision or reduced clarity of colours
• Symptoms of angle closure glaucoma may include pain in or around the eye ball, headache, nausea, vomiting and visual disturbances

Diagnosis

• Routine visits to an eye care professional
• Ophthalmologists and optometrists will diagnose glaucoma on the basis of intraocular pressure (IOP), visual–field tests and optic nerve head appearance