12 April 2011

BEWARE the sneak thief of sight! This is glaucoma which is now occurring in teenagers and increasingly among those in their early 20s and 30s.

Previously the disease was only prevalent among those above 45 but today’s lifestyle has put a severe strain on the people’s eyesight and the government is very concerned as 1.8 per cent of the country’s total population of 27 million are suffering from the disease, Deputy Health Minister Datuk Rosnah Rashid Shirlin said at last year’s World Glaucoma Day.

She pointed out that in 2008, a total of 1,269 Malaysians sought treatment for glaucoma in government hospitals while 7,238 went to private doctors.

She also noted that awareness of the disease was lowest among Malaysians compared with people in other Southeast Asian countries, adding that 70 per cent of them did not even know what glaucoma was.

Last year, nine government hospitals were equipped to treat glaucoma and in 2008, 68 million people worldwide were diagnosed with the disease and the World Health Organisation estimated that the number would rise to 88 million by 2020.

Tun Hussein Onn National Eye Hospital (Thoneh) consultant ophthalmologist Dr Linda Teoh Oon Cheng said this year, the World Glaucoma Association had decided to celebrate World Glaucoma Week from March 6 to 12, inclusive of the designated World Glaucoma Day on March 12.

“The theme selected is “Don’t Lose Sight of Your Family” — which carries a double message to remind patients that they can become blind and also to remind members of their families to go for eye checks.

“While glaucoma is irreversible, in most cases of early detection and treatment, it can slow or even halt its progression,” she said.

Glaucoma is a group of diseases that can damage the eye’s optic nerve, a bundle of over one million nerve fibres that connect the retina, the light sensitive layer of tissue at the back of the eye, to the brain and result in blindness.

It is caused by increased intraocular pressure (IOP) resulting either from a malformation or malfunction of the eye’s drainage structure.

She warns that the disease is an insidious disease and thus called the Sneak Thief of Sight as it progresses without obvious symptoms.

The common types of glaucoma are open angle glaucoma (chronic), closed angle glaucoma (acute), low-tension or normal tension glaucoma, congenital glaucoma, secondary glaucoma, or some other eye condition.

She said Asians were most prone to acute or closed angle glaucoma. The factors are age, diabetes, blunt trauma to the eye such as being hit by a shuttlecock, and genes.

While the disease may be insidious, congenital glaucoma as seen in infants, does present some signs.

“Babies with very big eyes and hazy corneas and those who refuse to open their eyes and tear a lot are indications. Another factor that leads to glaucoma in babies are mothers who contracted Rubella during their pregnancy,” Dr Teoh said.

Another consultant ophthalmologist, Professor Dr Muhaya Mohamad of Prince Court Medical Centre, said it was very unfortunate that even educated people in their middle age went for treatment late.

“Many people who experience reading difficulty first go to the optician and keep changing their prescription glasses. They think everything can be corrected with glasses.

“The optic nerve is a permanent tissue and cannot regenerate once it is gone,” she said.

“Those in the high-risk group such as those above 40, with a family history of glaucoma, have high cholesterol, are hypertensive and shortsighted should for go for annual screening to preserve their sight.

“Another group are those who have undergone eye or lasik surgery a long time back. They should monitor their eyes too.

“They must go for a comprehensive check up for glaucoma that includes checking the central corneal thickness (CCT), the IOP and the visual field,” she emphasised.

Just testing the IOP and obtaining a normal range of 10-20 mmHg was not indicative of no risk of glaucoma as those who had done lasik surgery would have thinner corneas that exerted lesser IOP, she said.

The measurement of the CCT was important as those who had undergone lasik treatment needed to have a CCT reading exceeding 460 microns, Dr Muhaya said.

With 20 years experience as a ophthalmologist, her advice is to seek professional help early and even for those under 30, go for annual glaucoma screening.

“There are a lot of myths that old age means poor vision when it should be the other way round. We need better eyesight as we age as any fall can lead to fractures that take a longer time to heal.

“With today’s technology unlike 20 years ago, early diagnosis of the disease offers many options of easy treatment that require no surgery. Patients just need to comply with the scheduled application of their eye drops and go for regular check-ups.”

Besides the comprehensive checkups with sophisticated equipment, at the medical centre which are digitised with pictures for objective analysis, and all it takes is 20 minutes of painless examination.

The measurements and visuals can also detect whether age-related macular degeneration and retinopathy are present.

“We should not be reactive to the problem as early detection could save your eyesight. Regular eye checks can also detect problems with kidneys and save patients from debilitating dialysis.

“While diabetes is a factor and not a cause of glaucoma, it is the number one cause of blindness,” she said.

Unlike cataract which is curable by surgery, glaucoma affects the optic nerves and thus not curable. Hence the importance of early detection and its management to prevent blindness.

Dr Muhaya is also very concerned with the practice of Malays who believe in using traditional eye sprays and eye massage touted to work for improving shortsighted and long-sighted problems.

“I call upon the Health Ministry to stop all these non-medical preparations and claims to treat glaucoma by those who have websites to promote their wares. This is wrong and misleading,” she stressed.

This article was published in www.nst.com.my on 6 March 2011.