DIAGNOSING GLAUCOMA: Tools and Opportunities
Glaucoma is a chronic, progressive eye disease affecting the optic nerve (connection of the eye to the brain). Left undetected and untreated, it plods a slow course towards permanent, irreversible blindness. According to a 2012 study on Global Estimates of Visual Impairment, it is the leading cause of permanent blindness both globally and locally. Of the estimated 60 million cases worldwide, 8 million are permanently blind.
Blindness in glaucoma can be avoided by early diagnosis and treatment. Patients with early glaucoma and minimal visual disturbance can be treated by lowering eye pressure. This halts progression to a more debilitating state, effectively avoiding blindness.
Early diagnosis however is easier said than done and presents many challenges. More than 50% of glaucoma patients are asymptomatic and therefore will not actively seek consult. At times, patients present to the clinic with one eye already significantly blind. Glaucoma diagnosis requires eye specialists trained at recognizing changes in the optic nerve and matching this with established risk factors such as age, high intraocular pressure, drainage angle abnormalities, steroid use, eye trauma and family history. Ancillary tests like Perimetry (testing of the central and peripheral field of vision) and Optical Coherence Tomography (advanced imaging of the optic nerve) are ordered to confirm or rule out possible glaucoma. These manpower and technical resources are only available in tertiary hospitals or highly specialized clinics. In addition to these challenges, glaucoma actually does not happen very often. Asian Regional estimates show a low prevalence of 3.2% in people over 40 year old. Mass screening for glaucoma therefore requires much effort but tends to have low yield. It is like looking for a needle in a haystack.
From the public health standpoint, how then do we approach an insidious disease of low prevalence but with dire consequences of permanent, irreversible blindness? The more prudent approach is “opportunistic screening”. This involves a targeted approach directed at people carrying a higher risk of developing glaucoma. There should be an enhanced awareness of glaucoma risk factors and a commitment to employing available glaucoma diagnostic tools at the proper opportunities. Involvement of the various stakeholders is crucial to this initiative.
Eye doctors should develop a high index of suspicion.
- Perform a thorough optic nerve exam on all patients
- Measure intraocular pressure of all patients regardless of complaint
- Encourage examination of blood relatives of known glaucoma patients
- Educate glaucoma patients and relatives
Other doctors and health professionals could refer high-risk patients accordingly.
- Encourage eye examination of geriatric and diabetic patients
- Suggest eye pressure measurement for patients taking steroids of any form
Eye patients should be more proactive in glaucoma screening.
- Actively request for glaucoma evaluation if 40 years old and above
- Take note of your eye pressure measurement
- Educate yourselves if diagnosed to have glaucoma
The general public could supportive glaucoma awareness campaigns.
- Participate in glaucoma awareness activities
- Spread the word on early diagnosis
St. Luke’s Medical Center-Global City celebrates World Glaucoma Week on March 13 - 14, 2018. This is an organized global campaign to heighten awareness of the disease in the hope of preventing glaucoma blindness. During this week, the St. Luke’s-Global City Glaucoma section will conduct glaucoma patient and lay forums and eye pressure screening activities. Utilizing the right tools and opportunities, we can truly avoid blindness in Glaucoma.
Dr. Jose Ma. Martinez received fellowship training in Glaucoma at the Royal Victorian Eye and Ear Hospital in Melbourne, Australia. He has been practicing and teaching Glaucoma for the past 19 years in both public and private settings. He is the current Glaucoma section chief of the St. Luke’s-Global City Eye Institute and the Department of Health Eye Center. He has served as Past President of the Philippine Glaucoma Society and is a current Board member of the Philippine Glaucoma Foundation.
