World Glaucoma Day
6th March 2016
The theme for the Glaucoma Week this year is “BIG – Beat Invisible Glaucoma”. The focus is on early detection and prevention of glaucoma through family screening.
Glaucoma is seen as the leading cause of irreversible blindness in India. It is a disorder associated with increase in the eye pressure, and is characterized by damage to the optic nerve leading to irreversible blindness. Currently, in India, every 8th individual or nearly 40 million aged 40 years or older either has glaucoma or is at risk of developing the disease. 11.2 million Indians suffer from the disease with 1.1 million blind, including children. Glaucoma more commonly affects people beyond the age of 40 years. High myopes, diabetics and those with a positive family history have higher risk of developing glaucoma. Screening family members of patients with glaucoma is mandatory, as this disease can affect siblings and children of patients with glaucoma in up to 10-20% of cases. Also, educating the general public on the harmful effects of prolonged steroid use can prevent serious and blinding steroid induced glaucoma that mostly affects children.
61 million persons worldwide have glaucoma and that is expected to rise to almost 80 million by the year 2020. Blindness from glaucoma is 80% preventable, yet almost 7 million people are blind from glaucoma in the world, and 2/3 of the world’s blind and visually impaired are women. Coinciding with International Womens’ Day on March 8, Dr Sirisha Senthil, Head of Glaucoma service at LVPEI, shared her words on Glaucoma with HarNeedi.com, “One in every 10 family members of glaucoma patients is affected with the disease, silently. This disease has no symptoms and significant vision is lost when detected. It is critical to create public awareness, to inspire those at high risk for development of glaucoma to go in for a comprehensive eye check including glaucoma evaluation to prevent needless blindness from Glaucoma.”
Ninety percent of Glaucoma in the country is undetected, mostly due to lack of awareness. Most patients are unaware that
a) They could be suffering from glaucoma, because the disease causes very late onset of symptoms, which could be as late as when they begin experiencing loss of vision;
b) Presenting themselves to eye care providers at a very late stage makes restoration of visual function quite impossible;
c) Early diagnosis can reduce progression of the disease and prevent blindness; and
d) All it takes to prevent such a situation is regular eye check-up or screening.
What is STEROID INDUCED GLAUCOMA ?
Glaucoma is the third leading cause of blindness in India and 12 million people are affected accounting for 12.8% of blindness. High rates of blindness in India are due to undiagnosed glaucoma.
Steroids are the important treatment for a variety of illnesses that involve inflammation in the body. Examples include allergic conditions in the lung (asthma), inflammation in the joints (e.g. rheumatoid arthritis), skin (e.g. eczema), eye (uveitis) and eye allergy.
Although these medications may be necessary in the treatment of the disease, their indiscriminate and long-term use can result in steroid-induced glaucoma and cataracts. Steroids are safe and effective as long as the doctor understands the risks and can effectively treat side effects.
Steroid-induced glaucoma occurs due to rise in the intraocular pressure with steroid administration. This high intraocular pressure can occur within a week or can be delayed for months or years after steroid application. About 5 % of the general population is considered to be “steroid responder”, i.e., may develop steroid induced glaucoma when steroids are administered. It eventually results in damage to optic (eye) nerve. Glaucoma is a progressive condition, if left untreated it can progress rapidly and may lead to blindness. The blindness caused by glaucoma is irreversible.
This problem is rampant with unscrupulous, unregistered and quite often ignorant practitioners prescribing steroids for nonspecific redness. Owing to the quick relief of red and itchy eyes, these drugs can be readily procured over the counter on a regular basis leading to self and unmonitored treatment.
One such victim of indiscriminate steroid usage is 26 year old Sumathi, mother of two young children, who continued to use steroids which were prescribed for itchy eyes. However, she was totally unaware of the silent disease progressing in her eyes, “The Glaucoma”. She presented to us with very high intraocular pressure with advanced stage of glaucoma and cataracts. This meant that she was blind in one eye and only 10% vision remaining in her other eye. The sad part is, this could have been prevented totally, had Sumathi known that the price she was paying for her red itchy eye relief, was her vision. There are many such undiagnosed victims of steroids especially young children who are treated for eye allergies.
The most effective management is discontinuation of the drug and administering antiglaucoma medications till the intra ocular pressure is reduced. When medical therapy is ineffective, it is advisable to go in for surgery.
Certain homeopathic and ayurvedic preparations also contain steroids. Therefore it is very important to be cautious in their usage and periodic eye checkup is warranted for all the patients using oral steroids for joint pains, other systemic allergies like immuno- suppressives, inhalers for asthma and skin ointments for skin allergy and other problems like acne. Although some forms of steroids in indicated conditions are life saving, they can and should be used only under the supervision of the treating doctor who understands the benefits and risks of using these medications in the long run. Self-medication and injudicious use of steroids should be avoided.
Family history role in effecting glaucoma.
When it comes to glaucoma, family ties may not be a boon. Open-angle glaucoma, which accounts for 90% of glaucoma cases is hereditary.However, blood relatives of people with glaucoma often don’t realize that they are also at risk.
All primary care doctors should ask their patients about family history of glaucoma especially if it has an early onset of important risk factor for the disease. Patients with glaucoma should be told to alert their first- degree relatives towards the need for glaucoma screening.