Glaucoma surgery does not result in blindness – Ophthalmologist explains

A Professor of Ophthalmology, Adeola Onakoya, says glaucoma surgery does not result in blindness but fear makes many patients decline surgical intervention in management.

Onakoya said this in an interview on Wednesday in Lagos.

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

Onakoya noted that compliance and acceptance of treatment were critical in reducing progression and blindness from glaucoma.

According to her, elevated intraocular pressure (IOP) is the only known modifiable risk factor in glaucoma management, noting that IOP control is achieved through medical, surgical or laser therapy.

“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,” she said.

The glaucoma specialist said that evidence-based studies have shown that 1mm IOP rise results 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 require aggressive therapy to lower the IOP,” she said.

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, Onakoya appealed to pharmaceutical industries to give rebates on medication to improve adherence.

She noted that some pharmaceutical industries in Nigeria have been at the forefront to ensure 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 antiglaucoma medications to improve access and compliance,” she said.

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

She also 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 comprising 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 said.

Onakoya said this would ensure equality and equity-based glaucoma care in the country.

The professor said that adherence to treatment was crucial with regular follow-up to prevent blindness from glaucoma.

She advised patients to engage in lifestyle modifications with adequate exercise, 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 said.