March 8-14 of every year has been set aside as world glaucoma week.World glaucoma week is a joint global initiative of the World Glaucoma Association and World Glaucoma patients association. This week is set aside every year to sensitive and create awareness about the scourge called glaucoma which is now spreading like wide fire all over the world.
Being an eyecare practitioner,and a nairalander,I want all my fellow nairalanders to to be aware of the deadly and irreversible loss of vision called glaucoma.

UNDERSTANDING GLAUCOMA

Glaucoma is the second leading cause of blindness worldwide after Cataract.Glaucoma happens to be the most deadly among all the eye diseases due to some unique etiologies associated with it.
What really makes it deadly is that a patient can have this disease without even knowing that he/she has it, because it doesnt come with any signs or symptoms during its early stage,but this might later be present in advanced stage,after massive destruction of the nerve fibres which sends visual signals to the brain, thereby leading to constricted visual field and reduced vision.That's why its called SILENT THIEF OF SIGHT.

ETIOLOGY/CAUSES : Glaucoma is associated with Increase pressure of the eye called IOP(Intraocular pressure).This increase/raised IOP results from either oversecretion of aqeous humor and reduced outflow through the trabecular meshwork which escapes via the canal of schlem into the body.Also any obstruction in this drainage channel can also lead to increase intraocular pressure which is a triggering factor for Glaucoma.

There are two main common types of Glaucoma:

PRIMARY OPEN ANGLE GLAUCOMA(POAG): In this type of glaucoma,the drainage system for aqeous outflow seems to be ok,and there is no blockage,only that the rate of production of aqeous is so much that it tends 2 accumulate in d drainage system.This is the most common type of Glaucoma found in africa and in other part of d world except Asia.This type of Glaucoma is the most deadly because it doesnt come with any signs or symptoms.it is only in the latter stage that the patient may start noticing some symptoms or signs which include,not seeing object close 2 his /her sides,which is called tunnel vision.At this stage Glaucoma is already present and there is already destruction of nerve fibres which makes up the optic nerves,and the bad thing about this stage is that vision loss can never be restored be it pharmaceutically or surgically.

ANGLE CLOSURE GLAUCOMA(ACG):Angle closure glaucoma usually results from trauma and people with narrow anterior chamber angles,leading to reduced outflow of aqueous humour.It usually comes with pain in the affected eye/eyes,dilated pupil,and heavyness of d eye while moving d eye/ eyes.Redness of the eye which is known as conjuctival congestion is also a sign of ACG. This is mainly common among Asian population,due to their narrow anterior chamber angle.One common signs of both ACG and POAG is peripheral vision loss which results from destruction of the peripheral nerve fibres of the optic nerve which sends visual signals to the brain.
Other types include:
Normal tension Glaucoma
Secondary Glaucoma etc

PEOPLE AT RISKS OF HAVING GLAUCOMA :

AGE : people above 40 years are at the risk of having Glaucoma due to degenerative changes which leads to narrowing of the anterior chamber angle.

FAMILY HISTORY : Glaucoma is really a familial disease i.e it runs in the family.If you have ever heard of any of your family member gone blind without any known cause or as a result of glaucoma, you are really at risk of having glaucoma,it doesnt matter if the person was your great great grandfather.You are supose tovist an eye clinic @ least once or twice a year to carry out glaucoma screening test.
DRUG ABUSE : People who also abuse drugs by using steroid drugs without doctor's prescription are also at risk.

REFRACTIVE ERROR: Patients who have high refractive errors,especialy those having myopia and hyperopia of high powers are at risk of having glaucoma and must always make sure they undergo glaucoma screening always because high myopia affects cup to disk ratio which causes destruction of nerve fibres.

LIFESTYLE : Acohol drinkers and smokers are also at risk of having glaucoma,although some research have implicated nicotine in most tobacco to have a reducing effect on intraocular pressure. Research also showed that some foods can also be a triggering factor,most especialy foods containing glutamate.e.g our favorite noodles seasoning powder.

SYSTEMIC PROBLEMS : Patients having
diabetes,and also high blood pressure are also at risk of having Glaucoma and Cataract.

TRAUMA [/b]Trauma and injury to the eyes or its adnexia is also a major cause of glaucoma.

[b] TESTS CARRIED OUT TO CONFIRM GLAUCOMA :

A very important clue to diagnosing glaucoma starts with a proper and detailed case history from your patient and the patient's visual acuity test V.A, there are also some selected tests which helps to clear the doctor's doubt and help in confirming glaucoma. These tests are :

1) TONOMETRY : This has 2 do with measuring the IOP of the patient's eye with an instrument,which comes in various types, designs and usage.If the measured pressure is higher than 21mmHg,then Ocular hypertension is present but Glaucoma not yet confirmed.Normal pressure ought 2 be in d range of 11-21mmHg.If lower than 10mmHg,then Ocular hypotension is present

2) OPHTHALMOSCOPY : This is done using an instrument called Opthalmoscope.This instrument enables the Doctor to view the internal part of the patient's eye.It is really a very good and important diagnostic instrument because it shows you some disease which the patient may not know he has. A cupping of 50% and above with an Elschnig classification of V is indicative of Glaucoma.

3) VISUAL FIELD ANALYZER :this is an instrument used in assessing a patient's visual field I.e the extent to which a patient can see object around him.In glaucomatous eye,the patient fails 2 see objects brought from his sides.
Any patient that fails 2 or 3 of these tests,is confirmed 2 be suffering from Glaucoma.

4) GONIOSCOPY : This test is done to acertain the depth or shallowness of the anterior chamber.It is done with a goniolens usually mounted on a slitlamp biomicroscopy.Patients with or succeptible to having angle closure glaucoma,usually have a narrow anterior chamber.This test can also be use to differentiate between POAG and ACG.

TREATMENT
There is really no known cure to Glaucoma,but the only available step is geared towards lowering the IOP,as this is really the triggering factor.once Glaucoma destroys the eyes and the patient goes blind,there is nothing dat can be done to regain the patient's sight.Early detection is surely the only available and efficient way of preventing blindness from glaucoma.The treatment options available are:

1) USE OF DRUGS : some specific drugs are used in treating glaucoma.These drugs interfere with the production of aqeous from the cilary bodies.These drugs help to reduce the production of aqeous thereby leading to less aqeous in the eyeball preventing raised IOP.these drugs comes in different combinations.These drugs are to be used on a daily basis throughout the patient lifetime.Failure to do so will really lead to quick blindness as d drugs help to stop the destruction and preserve the remaining vision.

2) SURGERY :In cases where there is narrowing of the anterior chamber or blocked trabecular meshwork or canal of schlem,a special kind of surgery called trabeculectomy,can be done so as to open up these drainage system,thereby increasing aqeous outflow.
In extreme and severe cases,combination of drugs and surgery can be necessary

3)COUNSELLING : This is usually necessary when it has been confirmed a patient has glaucoma,advise and counselling is usually very necessary in order for the patient to always use his/her drug and stick to the drug regime on a daily basis.
For patients who are already blind as a result of Glaucoma,counselling is the only option in other to help the patient adjust to his /her new status so that him/her can fit into the society without any emotional trauma.

HINDERING FACTORS [b]

There are many factors associated with blindness from glaucoma.These factors ranges from;

1) [b] ILLITERACCY/IGNORANCE - just as the saying goes,when there is no knowledge my people perish. Most people living in rural areas are culprits.whenever they encounter any problem with their eye,they tend to use different medications most especially herbal drugs which specifications and formulations are not well spelt out.They always tend to seek medical attention when everything had gone bad.the funniest thing also is that most Educated fellows are also culprit.
A patient walked up to our clinic abt some months ago,he was highly educated.His family members brought to his notice of his mother having vison problems,he invited her to his base in lagos n without taking her to any nearby eye clinic,took her to traditional healers who realy helped by making his mum go blind.It was then he came to our clinic,and at that stage there was nothing that can be done again because she had totally gone blind in both eyes. Visual acuity in both eyes were NLP.I called him personally by making him know he caused his mother's blindness.The medications given to him by the herbalist really caused more damage to the eyes.It is better to always visit the closest eye clinic even if you notice any problem as minor as itchy eyes.This is why there are specialiazation in medical field.

2)LACK OF/LITTLE AWARENESS: This is also a major problem as most patients I do attend to on a daily basis,always say they have never heard of Glaucoma before,while some mistakes it for cataract.I think Govt and we in the Eyecare profession really have a lot to play in this aspect.that's why I took it as a duty upon myself to inform my fellow nairalanders,because I know a lot of people wil benefit from this information due to d large numbers of nairaland members, which is why this week was dedicated by the World Glaucoma Association to create awareness about Glaucoma.

3) RELIGIOUS BELIEFS : As martin luther king had earlier said,Religion is really the opium of the people. Most people due to religious belief,always try to shy away from medical treatment believing their pastors or imams have the solution to their problems. I encoutered such some years back,when a member of one of the popular pentecoastal church walked into my clinic with her mum.After carrying out the necessary tests on her mum,I discovered she had glaucoma,and broke the news to her daughter.To my greatest surprise this woman almost fought with me when I started telin her about the diagnosis and the implication of not taking emergency medical treatment. I never knew she had been told before at luth that her mum has glaucoma but she refused medical treatment saying there was nothing like glaucoma in her family.she said glaucoma was something caused by devil and she has been praying and giving her mum holy water and she believed the God of a particular pastor (name witheld) can never allowe that.I tried making her believe it is not the way she was thinking,that the good thing is,her mum can be prevented from going blind if she starts using her drugs as soon as possible. She walked out in annoyance.
I was surprised seeing her after 8months later in our clinic with her mum.She said she came to complain that after all prayers and other things done,her mum still complains of not seeing well.When a proper test was carried out on her mum,it was discovered that one of her eye was already gone(blind),while the other is almost gone also.I told her delay made that possible because if she had agreed 2 what I told her the other time,her mum vision would have been preserved.At the end, she and her mum were shedding tears like babies,I had 2 send her to the reception such would have been prevented if not for her religious belief.
The ideal truth is that prayer is good and helps,but God himself can't really come down to help.I believe there is no other way God can help if he has already shown u where your problem lies,why not take the necessary step to materialize your prayers being answered.just as d saying goes,heaven helps those who help themselves.
Most educated and none educated people re victims of this.

Our eyes is one of our most precious Gifts from God..because when God said let there be light and there was light,he gave us eyes to appreciate the beauty of the world...Preserve your Vision,
Visit an Eye clinic 2day, and know your Glaucoma status.

Drsteroid

Under the administration of GEG there's been a very low rate of glaucoma because of good governance. In summary come 2019 GEG Will wipe out glaucoma

Impressive. I was thinking of writing something about Glaucoma for the Glaucoma week b4 I saw this.

Glaucoma should be a public concern like HIV. Because you won't know until its too late if you don't get tested.

I have seen kids as young as 7yrs old with advanced glaucoma, who are likely to go blind even b4 their 10th birthday if not properly monitored.

Had a Pastor who was using "Faith" on his glaucoma for 5yrs but had to come to clinic after he lost one eye.

I bet that more that 80% of Nigerians who have Glaucoma r not even aware.

Follow the glaucoma week on twitter. #WGW2015 #WGW #Glaucoma

cc :
drsteriod
rexbuton
Optom
Lalasticlala

Btw...drSteriod, can u make dat write up shorter n less technical so as not to discourage people frm reading !

It's a good one op. Bt ehm, I find it rather difficult reading it. Pls kindly re-format and bold d sub-headings 4 eas readability.

Glaucoma needs our JTF. More reason periodical all-round check-up is advised.

Prevention is the best than cure. For prevention of cataract and glaucoma, I urge Nigerian to prevent them by taking supplements that is high in atioxidant properties like bilberry, marigold, beta carotene, vitamin A and C, zinc. Also add essential fatty acids like omega 3 and 6 to ur diet. Products that contain these nutrients are available @ www.swissgardedistributorph..com or whatsapp 08136478517 for further info.

jauntty:
Impressive. I was thinking of writing something about Glaucoma for the Glaucoma week b4 I saw this.

Glaucoma should be a public concern like HIV. Because you won't know until its too late if you don't get tested.

I have seen kids as young as 7yrs old with advanced glaucoma, who are likely to go blind even b4 their 10th birthday if not properly monitored.

Had a Pastor who was using "Faith" on his glaucoma for 5yrs but had to come to clinic after he lost one eye.

I bet that more that 80% of Nigerians who have Glaucoma r not even aware.

Follow the glaucoma week on twitter. #WGW2015 #WGW #Glaucoma

cc :
drsteriod
rexbuton
Optom
Lalasticlala

Btw...drSteriod, can u make dat write up shorter n less technical so as not to discourage people frm reading !

noted! Thanx doc..will do dat