Losing your sight
Glaucoma is the leading cause of irreversible blindness.
Glaucoma is the leading cause of irreversible blindness.
IT was pitch black in the eatery when our motley media crew, in groups of eight, staggered in with hands on each other’s shoulders.
Our instructions were to follow our visually-impaired guide-cum-waiter, who’d lead us to our table. The only sounds audible were the clinking of glasses and cutlery.
After taking a few cautious steps, one claustrophobic member asked to be escorted out as she was overcome with anxiety. I felt the hand on my shoulder grip harder.
Not a light, not a sight – only nervous chatter as we sightlessly weaved our way to our seats at Dining In The Dark, a restaurant in total darkness.
We were about to have a sensory experience and enjoy a gastronomic journey, where food taste and flavours are not influenced by sight.
The food arrived in a few small plates placed on a bigger platter, with directions to pick up the plate and start eating, beginning clockwise, from the bottom left. It took some getting used to as the food kept slipping off the cutlery before reaching our mouths.
We tried to guess what we were eating, which was to be revealed upon the meal’s conclusion.
When dessert arrived in five little plates, I used my spoon to pick something that resembled a ball, but oops, it rolled off!
I imagined the terrible stains on my white blouse.
I tried using a folk to stab another dessert and it rolled off, too! Gosh, I was really leaving a mess on the floor. Two down, three to go.
This is what the blind have to deal with everyday.
The silent thief
Most of us take our sight for granted, and may not be aware that we may be losing our vision slowly, but surely.
The most common cause of blindness worldwide is cataracts, but a leading cause of irreversible blindness is glaucoma, with less than 50% of sufferers aware of their condition before blindness occurs.
Glaucoma is an eye disease where the optic nerve, which connects your eye to your brain, becomes progressively damaged.
It usually occurs when the fluid in the eye cannot drain properly, which increases the pressure inside the eye (intraocular pressure or IOL) and puts pressure on the optic nerve.
“If not treated, the disease would gradually worsen the peripheral visual field, leading to visual impairment and blindness. The optic nerve damage is permanent and irreversible,” says consultant ophthalmologist Assoc Prof Dr Jemaima Che Hamzah, who was speaking at the launch of a combination eye-drop therapy here recently.
In Malaysia, glaucoma is the third leading cause of blindness after cataracts and diabetic retinopathy.
Its symptoms are subtle or even nonexistent, thus many people are unaware they have the disease until they go for an eye check.
Left untreated, bit by bit, glaucoma robs their vision, and pretty soon, their world is plunged into darkness.
Assoc Prof Dr Jemaima says, “Patients always present to us at the later stages.
“Glaucoma develops slowly and most patients do not feel their vision is affected for several years.
“This is because the loss of vision is at the periphery, while central vision remains stable until the disease is severe or the better eye is affected. By the time the patient is aware, it is already too late.
“Sometimes, glaucoma can simulate the symptoms of a brain tumour, such as halos around light, sudden loss of vision, headache, severe eye pain, nausea and vomiting, so we send patients to the neurologist to rule this condition out.”
The exact cause of glaucoma is unknown, but increased IOP is a recognised risk factor.
Other causes include age over 45 years, genetic history of glaucoma, diabetes, history of elevated IOP, decrease in corneal thickness and rigidity, high myopia, steroid use and previous eye trauma.
There are several types of glaucoma, but simply put, there is no cure, whether > TURN TO PAGE 4
patients are seeking allopathic or homeopathic options. You cannot get your sight back; you can only slow down the disease progression.
“As glaucoma becomes increasingly common with age, individuals over the age of 40, especially those ‘at risk’ from risk factors are urged to schedule regular eye exams with their ophthalmologists. Or else, it can impact your quality of life with increased incidence of falls and motor accidents,” says Assoc Prof Dr Jemaima.
The only treatment is to lower the IOL and prevent functional visual loss during the remainder of the patient’s life. This can be done via eye drops, laser treatment or surgery.
Treatment challenges
However, doctors face plenty of challenges in treating these patients, because once diagnosed, Assoc Prof Dr Jemaima says almost 80% of patients deviate from treatment, especially the elderly.
She adds, “There is a high dropout rate due to many reasons – inability to instil eye drops, forgetting to use the drops, poor knowledge of glaucoma, worsening visual field loss and lack of access to medication.”
Consultant ophthalmologist and glaucoma specialist Datuk Dr Linda Teoh agrees that adherence to therapy remains a key challenge as patients have “many drops to put in”.
Back then, patients would cart around a big bag with multiple drugs wherever they went. But latest fixed combination drugs cut down on the number of times the drops are administered and lessen the side effects.
“Unfortunately, you cannot put all the medications in at one go; you have to wait about five minutes between drops to give time for a drug not to be washed out. If you’re a working adult, this takes time and is inconvenient, so this might affect adherence,” says Dr Teoh.
The question everyone wants to know is how long before a glaucoma patient goes blind?
“It depends on many factors and how motivated the patient is to comply with treatment,” she says.
According to the United States-based Glaucoma Research Foundation, approximately 10% of people with glaucoma who receive proper treatment still experience loss of vision.
A 2014 study published by the American Academy Of Ophthalmology estimated that globally, 60 million individuals aged 40-80 had glaucoma in 2013; by 2020, this figure is anticipated to increase to 76 million, and by 2040, the numbers are expected to spike to a further 111 million.
“This is going to pose a big burden as medications are very expensive. Vision lost to glaucoma cannot be restored, so it’s best detected early. Please get your eyes tested routinely,” advises Dr Teoh.
Early detection saves the eye
If she hadn’t gone for an annual eye check-up a four years ago, Sharon Ooi Beng Poh could have easily lost her vision.
She was told her IOP was high and was referred to another specialist, who prescribed a battery of tests. Ooi had no other symptoms.
“I had a sneaky feeling that something was not right, but the doctor didn’t instil fear in me. Instead, she said our eye muscles will degenerate with age and asked if I would be afraid if she told me something. I said no, especially if there is a preventive measure. Then she diagnosed me as having glaucoma.
“A former colleague had glaucoma and I recall her telling me she only had to put eye drops and all was well. The seriousness of the condition didn’t really hit me until I listened to a talk,” shares Ooi, who had a Lasik procedure done to correct her high myopia some years back.
Ooi was put on treatment immediately and with the availability of newer drugs, she now uses her eye drops twice a day – at 7am and 7pm.
Life goes on as normal otherwise.