Local Doctor Urges Early Vigilance for Glaucoma

What distinguishes glaucoma above many illnesses is that there are no symptoms and that’s where many persons are caught off guard. Losing one’s vision without knowing can be a frightening experience

Glaucoma is a condition that causes damage to the eye‘s optic nerve and can get worse over time.

It’s often linked to a buildup of pressure inside the eyeGlaucoma tends to be inherited and may not show up until later in life.

The increased pressure, called intraocular pressure, can damage the optic nerve, which transmits images to your brain.

If the damage continues, glaucoma can lead to permanent vision loss.

Without treatment, glaucoma can cause total permanent blindness over a period of time within ten to twenty years.

The Public Relations Department in the Ministry of Health and the Environment spoke with local ophthalmologist Dr. Alvin Edwards, taking an in-depth look at Glaucoma in light of the observance of Glaucoma week which is being observed in Antigua and Barbuda

Dr. Edwards, who has been treating patients with Glaucoma for over three decades, said that he has seen phenomenal changes in the management and treatment of the disease over the years.

“There is only one medication that we still use consistently now and that is Timolol eye drops; everything else has changed and some of the other medications are used only in special circumstances because of complications and side effects. We’ve gone through quite a lot of changes. We have so many glaucoma cases that I’ve had to focus a lot on its diagnosis and management,” Dr. Edwards stated.

With the diagnosis and treatment of the disease under continuous research, Dr. Edwards told us that the progressive loss of vision with Glaucoma seems to be related to the level of intraocular pressure.

There was a reason why he used the word ‘seems.’

While you are losing vision from Glaucoma in the early stages, at least 90 percent may be lost before you are aware that something is happening.

“I say ‘seems to be related’ because of two things we have to consider.

One (1), what is an elevated intraocular pressure? If we establish a figure as the standard for an elevated intraocular pressure, we still do see the loss of vision below that pressure.”

He continued, “Elevated intraocular is really a pressure above which you will lose vision as a result of that pressure. For some persons, that threshold is lower than others. That is why it is very difficult to use just this particular pressure and say above that is glaucoma and below that, it’s not; we can’t do that. We have to analyze whether or not the type of loss of nerve fibres that we get in glaucoma is occurring; that’s what’s important.” Dr. Edwards stated.

What distinguishes glaucoma above many illnesses is that there are no symptoms and that’s where many persons are caught off guard. Losing one’s vision without knowing can be a frightening experience.

Dr. Edwards said, “While you are losing vision from Glaucoma in the early stages, at least 90 percent may be lost before you are aware that something is happening. And the other thing is that you could have lost one eye completely and won’t even know you’ve lost that eye unless you cover the other. And most people might not have the need to cover the other eye. Sometimes, that is how people discover that there is a problem with their vision.”

He stressed that it’s critical that one of the things that must be done is to discover if a person has glaucoma even before symptoms appear. It can make a difference in the effectiveness of the treatment.

“It’s important to discover it early because you can stop the progress of the disease,  but also at an early stage treatment is more effective and you can prevent further loss.  Now we have different tools that we use to determine how much loss we have and one of the most common things we use is what we call a Visual Field. That determines how much vision one has lost; then again, this varies according to individuals because there was a study at one point which showed that you can lose as much as 40 percent of your nerve fibers without having a change in the visual field so that even if the field is normal and the pressure is normal, you may still have glaucoma. We, therefore, have to find other tools to help us.”

The main treatment for Glaucoma has been the eye drops, but Dr. Edwards noted that it may not always work.

“Eye drops are always important in Glaucoma. The first stage in the treatment of the most common type of glaucoma, which is Open Angle Glaucoma, is eye drops. Sometimes, the eye drops alone don’t work and other times, certain persons, depending on their state of mind may not take them and also, if you have a person who is 20 years old and has his whole life ahead of him, you can be assured that at some point in time, he is going to want to drop out from taking all these drops everyday so you have to take all those things into consideration.”

He said that with continued research on treatment of the disease, safe and low-risk intervention is now the order of the day.

There are many other treatment options and these include the Eye Stent and the newly introduced Zen implant.

The most common type of Glaucoma here in Antigua and Barbuda is Open Angle. There is also Pediatric Glaucoma where persons are born with the disease and Secondary Glaucoma which can develop after a trauma or surgery.

Neovascular Glaucoma according to Dr. Edwards is an interesting one since this usually occurs as a result of complications of diabetes and hypertension.

Dr Edwards said he has seen more Neovascular Glaucoma over the past year than he saw 10 years ago.

‘I think what is happening is that because of more cases of diabetes, we are getting a lot more Neovascular changes and also hypertension; hypertension can cause a vein occlusion and that vein occlusion can also lead to Neovascular changes. Prior to a few years,  it was actually the hardest form of glaucoma to treat and many persons lost their vision as a result of that but as I’ve said before, we have been able to get past that and we can treat it in such a way that doesn’t happen.”

Dr Edwards also shared that there is a type of glaucoma that affects women between the ages of 20 to 50 and who are usually of a stocky built.

It’s called Glaucomatocyclitic Crisis (GCC), a type of Glaucoma that’s temporary and is accompanied by inflammation and some pain.  It usually affects one eye but goes away, once the person can get past the phase of inflammation.

Medical Benefits to me is so important to the management of Glaucoma and eye disease in general.

We asked Dr. Edwards about the prevalence of Glaucoma in Antigua.

He replied that the Medical Benefits Scheme (MBS) can aid in a more accurate account of this, as practically everyone who has glaucoma at some point in time interacts with MBS as the statutory body is very important in the treatment of the disease.

But he said that in his view, the prevalence of glaucoma is fairly higher than he thought it was about five years – about 8-10 percent increase, depending on the age group.

“I don’t think there is anything one can really do to avoid getting glaucoma if it runs in the family. It is not necessary related to diabetes and hypertension. Even though you don’t have these complications, you can still get it. As with diabetes and high blood pressure, the incidence increases with age, but they are not a causative factor”, Dr. Edwards declared.

Although Glaucoma can lead to blindness, Dr Edwards noted that Antigua and Barbuda is not doing too badly where this is concerned. He attributed the success rate to MBS.

“If you work in other Caribbean islands that don’t have a medical benefits scheme, you kind of wonder how people survive,” Dr. Edwards commented. “I’m telling you, Medical Benefits to me is so important to the management of Glaucoma and eye disease in general, I can tell you that because I interact on a daily basis with patients and also with MBS; they are so important and I don’t want to underemphasize that,” Dr Edwards remarked.

He continued “Our incidence of blindness in my view  would have been higher had it not been for MBS; they are able to provide the medication for treatment and support throughout surgery and other factors  and other things that they have to do and so I think Antigua and Barbuda is fairly fortunate  and if you look at most other Caribbean islands, they don’t have anything like Medical Benefits to help with glaucoma, diabetes and hypertension and these can drain your resources to the extent that you may not want to get medication because of lack of resources when you are older and you may not be working. So Medical Benefits has been really helpful and effective in keeping down the incidence of blindness,” the Ophthalmologist declared.

Dr. Edwards also commended the Glaucoma Awareness Group and other organizations that have also been doing an excellent job in helping to keep down the incidence of glaucoma by various lectures and presentations.

The advice Dr. Edwards has for patients is not to put off eye checks with their eye care professional.

“It’s important to have your eyes checked by a professional. Once you’ve done that, then that professional should be able to tell you when you should have another one due to the fact that some persons have to be checked faster than others depending on the risk factors for glaucoma and an important one of them is a family history of glaucoma,” Dr Edwards said.

He discourages self-diagnosis but noted observations of slight pain and ocular discomfort at about 3 or 4 in the morning and feeling like something is in your eye are all red flags to do an eye check.

Dr Edwards said when it’s discovered that a child has glaucoma or cataract, it must also be dealt with at an early stage.

“What’s important with cataract in a child is that if the cataract blocks the vision, the light needs to be going to the brain for the brain to learn to use the eye and if there is something blocking light going to the brain, the brain will never learn to use that eye so that even if they get older and you remove that cataract, they still won’t be able to see because they didn’t learn how to use the eye. So it’s important that if a child is born with a cataract, it’s best to deal with it before the age of three so they learn to use the eye. Now if a child is born with glaucoma, it also has to be quickly dealt with or they’ll lose their vision before they get to an older age,” Dr. Edwards stated.

A series of activities are being held to mark World Glaucoma Week which culminates on Saturday with the annual March for Sight through the streets of St John’s.

It’s being celebrated under the theme,’ Beat Invisible Glaucoma (BIG).’

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