Glaucoma surgery can’t result in blindness – Ophthalmologist

A Professor of Ophthalmology, Adeola Onakoya has dismissed the belief that glaucoma surgery can cause blindness, noting that people decline surgical intervention and management out of fear.

She said this in an interview with the News Agency of Nigeria on Wednesday in Lagos, stressing that compliance and acceptance of treatment are critical in reducing the progression and blindness from glaucoma.

Glaucoma is a disease that damages the eye’s optic nerve. It usually happens when fluid builds up in the front part of the eye and extra fluid increases the pressure in the eye, damaging the optic nerve.

According to Prof. Onakoya, elevated intraocular pressure is the only known modifiable risk factor in glaucoma management and IOP control is achieved through medical, surgical or laser therapy.

She said, “Over 70 per cent of patients are on medical treatment in Nigeria, however, less than 50 per cent of patients are adherent with treatment.

“Glaucoma is a lifelong disease where compliance with treatment for a lifetime is required to prevent blindness.”

The glaucoma specialist said that evidence-based studies have shown that a 1mm IOP rise can result in a cumulative 10 per cent reduction in the visual field.

She noted that surgical intervention assures the stability of the disease to an extent, however, in about 70 per cent of cases, additional medical therapy would be required to achieve the target IOP.

“Moreover, 70 to 80 per cent of patients in Africa and Nigeria present with advanced glaucoma, which requires aggressive therapy to lower the IOP,” she added.

Prof. Onakoya listed prohibitive costs, side effects, difficulties with drug storage, non-availability of drugs, counterfeit drugs, forgetfulness, complex regimen, and poor understanding of the disease as some factors responsible for poor compliance.

To resolve some of the listed impediments to treatment compliance, the professor appealed to pharmaceutical industries to give rebates on medication to improve adherence.

She noted that some pharmaceutical industries in Nigeria have been in the forefront of ensuring the availability and affordability of anti-glaucoma medications.

“Industries are also encouraged to provide fixed dose combination drugs, which have been proven to improve adherence, and newer drugs with better IOP reduction.

“Provision of high-grade generic medications at a lower cost can improve access to medication and improve compliance.

“Better still, the pharmaceutical industries may consider local manufacturing of anti-glaucoma medications to improve access and compliance,” she advised.

Prof. Onakoya urged the federal and state governments to provide rebates and subsidy on anti-glaucoma drugs and also the fees paid for surgery.

She as well appealed to the government to improve the acquisition of equipment, infrastructure and adequate staffing.

According to her, the majority of citizens pay out-of-pocket to access glaucoma care, while the National Health Insurance Act covers 90 per cent of the formal sector, which comprises of the elites, to the detriment of the deprived.

“Efforts should be made to make health insurance available in the rural areas for wider coverage,” she added.

Prof. Onakoya noted that this would ensure equality and equity-based glaucoma care in the country.

She said that adherence to treatment was crucial with regular follow-up to prevent blindness from glaucoma and advised patients to engage in lifestyle modifications with adequate exercise, and a healthy diet comprising lots of green vegetables, fruits and minerals.

The professor also advised patients to embrace stress reduction, weight control and optimal control of comorbid conditions to impact health outcomes.

“General wellness will improve the health of the optic nerves, thereby helping to improve the quality of life in glaucoma,” she added.

NAN