Philippine Glaucoma Society

Continuing the vision quest
By Earl D.C. Bracamonte

Glaucoma is a complicated disease in which damage to the optic nerve leads to progressive, irreversible vision loss. The disease permanently damages the optic nerve, which is what connects the eye to the brain, and causes a shrinking of the visual field. According to the World Health Organization (WHO), it is the second leading cause of blindness in the world. Globally, around 70-million people already have this condition due in part to the rapidly aging population, as revealed by a data provided by the Glaucoma Research Foundation of the United States. “While AMD is the death of the macula and central vision, glaucoma targets the main optic nerve and causes permanent vision loss. It first attacks peripheral vision, top and below, and then darkness. It is not age-related but age is a major risk factor. Some are born with it, these are the congenital cases. Having larger eyes is one of the symptoms and so are frequent tearing and sensitivity to light. We differentiate glaucoma with cataract in that the latter is a lens disease. Night blindness, on the other hand, plagues the retina,” informed Dr. Ma. Imelda Yap-Veloso, incumbent president of the Philippine Glaucoma Society (PGS). Dr. Veloso received glaucoma training from the Harvard Medical School – at the Massachusetts Eye & Ear Infirmary – in Boston, USA. She is affiliated with the Asian Eye Institute (Rockwell) and a member of the teaching faculty at the Sentro Ophthalmologico Jose Rizal of the Phil. General Hospital (UP-PGH). Glaucoma is a condition that affects the eye’s optic nerve, a bundle of tissues that carries information about what one sees from the eyes to the brain. This damage is usually – but not always – caused by the build-up of naturally-produced fluid within the eye. When fluid cannot escape, the resulting pressure causes the optic nerve to deteriorate, resulting in vision loss and irreversible blindness.It slowly impairs vision. Like the dreaded disease, cancer, it has no cure and commonly neither show signs in the early stages nor manifest painful symptoms. Moreover, a small number of patients with glaucoma also experience episodes of eye pain, blurred vision, redness, headache, vomiting, and seeing ‘rainbows around lights.’In fact, by the year 2020, it is estimated that 11.2-million more individuals will be blind in both eyes from this condition, as stated by Prof. Harry Quigley and Aimee Broman of the Wilmer Ophthalmological Institute in Baltimore, Maryland.In the Philippines, glaucoma has been ranked as the leading cause of blindness in both eyes. Yet, as a blindness that is a permanent paralysis, it is taken much too lightly. It is the country’s No. 1 cause of bilateral irreversible vision loss, as reported by the Philippine National Survey of blindness. Unfortunately, there are no currently reliable estimates as to how many more Filipinos have the disease. Glaucoma is not picky. It can afflict a person regardless of age, health, or race. It can occur at any age, but the most commonly affected are the older individuals. “The PGS does nationwide research to determine which provinces have more of the condition. Glaucoma has to be diagnosed in its earliest stage; before loss of peripheral vision occurs. At an earlier stage, the disease is easier to manage and control; that is, if preventive measures are given that early,” advised Dr. Yap-Veloso.There is no single diagnostic test for glaucoma. Early detection and treatment is important to control it. Once diagnosed, the patient must follow-up with their doctors periodically, without fail, for the rest of their lives.In most cases, glaucoma develops gradually and painlessly, and without symptoms as only half of those who are actually diagnosed with the disease have any symptoms at all. Symptoms related to loss of vision or reduced vision in a person with glaucoma indicates advanced disease stage.There are several types of glaucoma; each presenting a variety of symptoms. The most common types which are called primary open-angle and angle-closure glaucoma have completely different symptoms.Primary open-angle glaucoma is generally quiet in terms of symptoms. There is a gradual loss of peripheral vision, usually in both eyes. Noticeable tunnel vision only occurs in the advanced stages.In acute angle-closure glaucoma, one should watch out for the occurrence of severe eye pain, nausea and vomiting (accompanying the severe eye pain), sudden onset of blurred vision, halos around lights, as well as reddening of the eye.Majority of patients who are elderly individuals often attribute their loss of vision to just growing old, which is not always the case. While vision loss from glaucoma is silent, slow, progressive, and irreversible, one should realize that it is treatable and that blindness may be prevented. Glaucoma can be controlled especially when detected early. “It is imperative that patients know the risk factors like age, family history, those taking steroids, and even those self-medicating with eye drops. Neo-vascular glaucoma, for example, is a risk for those with diabetes. We are thankful of entities like Allergan who help us do free eye screening in hospitals as well as in helping disseminate literature in our info campaign,” intoned the assertive PGS prexy.Everyone is at risk: from babies to senior citizens; though the disease is far more common with the latter. It is therefore important to have regular eye examinations by a medical professional, especially if one is over the age of 40. The risk of developing glaucoma increases if one is found to have high eye pressure (as measured in a routine eye exam), a family history of glaucoma, is aged over 45, have previous eye injury, chronic steroid use, diabetes mellitus and is of Asian descent.During a glaucoma screening exam, the eye doctor will look inside the eye for signs of damage to the optic nerve. In addition, the doctor will gauge the fluid pressure inside the eyes with an instrument called a tonometer, which either rests against your eyes (numbed) surface or sends a puff of air onto the cornea. The adequacy of the eye’s fluid drainage channels is also assessed (gonioscopy). Other tests that may be included are those that measure one’s peripheral vision (perimetry) and visual acuity.To tackle this growing problem, the PGS held numerous glaucoma forums for lay people as well as glaucoma screening activities in selected hospitals and eye centers countrywide last month.In partnership with the medical community, Allergan brings scientific excellence and rigor to deliver leading products that address glaucoma concerns. Allergan goes above and beyond this to provide information and education to the highest level of integrity. This helps patients to fully understand the choices available to them and make well-informed treatment decisions with their doctors.Allergan is a global, technology-driven, multi-specialty health care company pursuing therapeutic advances to help patients live life to their fullest potential while the PGS is an internationally-recognized leader in providing excellent glaucoma care in the Philippines through education, exchange of ideas, research and publication.The PGS also strives to eradicate glaucoma by increasing awareness of the disease in the community, healthcare system, policy-making bodies, and among patients with the disease. The organization also aims to educate the community, provide improved service for indigent patients, and initiate research on the condition.“Some of the treatments include laser and surgery. In open-angle cases, the pressure builds up because the drainage canal is not functioning. In closed-angle cases, eye drops are administered to help in the outflow thereby easing pressure. Should scarring occur after surgery, a silicon tube implant is placed to afford continuous flow of fluids and do away with pressure build-up,” concluded Dr. Yap-Veloso.Glaucoma can be prevented by having regular eye check-ups. Immediately consult your doctor or ophthalmologist if you have blurry vision or if you experience eye pain.Despite the increasing worldwide prevalence of glaucoma, both the PGS and Allergan believe that increasing glaucoma awareness will lead to early diagnosis and treatment, and eventually to a better chance of preventing blindness from the disease. All of the aforementioned concerns are geared towards achieving the PGS’ vision that no Filipino shall ever go blind from glaucoma.


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