Prevention of Blindness Week 2023: Mumbai experts explain why you should be concerned about glaucoma and the need for regular eye checkups

The gift of vision is one of the most important aspects of our everyday life that we often take for granted. Even though many of us have the luxury of being able to see clearly, we do not take care of our eyes enough, and that often leads to damaged eyes.

Every year, the Government of India observes Prevention of Blindness Week between April 1 to April 7 to raise awareness about the causes of blindness and how it can be prevented. While the causes are many, there are certainly different ways that it can be prevented or delayed. Now, there are many kinds of diseases and conditions that cause blindness with some of the most common being age-related and cataract, others include those caused due to injury, diabetic retinopathy, retinal detachment, dry eye syndrome and last but not the least glaucoma.

Among all of these, Mumbai experts say there are approximately 12 million people who suffer from glaucoma and is a significant public health concern that people should know about. Simply put, Glaucoma is a cluster of diseases affecting the eyes which cause damage to the optic nerve, the nerve that is responsible for vision.

With the aim to create awareness around the disease, Mid-day Online spoke to Dr Sujal Shah, director and consultant, department of Ophthalmology at Sir HN Reliance Foundation Hospital and Research Centre, and Dr Rajeev Boudhankar, medical director, Holy Family Hospital to understand more about the eye disease. They not only share the causes, prevention and treatment but also stress on why people need to get their eyes checked regularly because it is not always easy to detect the symptoms.

What is glaucoma and how is it caused?
Shah: The term ‘glaucoma' refers to a group of eye diseases, characterised by progressive and irreversible damage to the optic nerve (the nerve responsible for vision). One of the important factors is increase in pressure of the eye, but people with normal eye pressure can also develop glaucoma. Glaucoma is associated with a gradual loss of the visual field, which can lead to total, irreversible blindness if the disorder is not diagnosed and treated early.

Boudhankar: Glaucoma is a cluster of diseases affecting the eyes which cause damage to the optic nerve. This damage can lead to vision loss and, in severe cases, blindness. The most common type of glaucoma is called primary open-angle glaucoma, which occurs when the drainage canals in the eye become clogged, causing fluid to build up and increase pressure within the eye. This increased pressure damages the optic nerve over time which leads to loss of vision. Other types of glaucoma include angle-closure glaucoma, which occurs when the angle between the iris and cornea in the eye narrows, blocking the flow of fluid and causing pressure to build up, and secondary glaucoma, which is caused by another underlying condition or disease in the eye, such as injury, inflammation or tumor.

While the exact cause of glaucoma is not fully understood, risk factors for the condition in India include age, family history of glaucoma, and certain medical conditions like diabetes and high blood pressure.

What are the symptoms of glaucoma?
Shah: According to the World Health Organization (WHO), there are several types of glaucoma, however, the two most common are, primary open angle glaucoma (POAG), having a slow and insidious onset, and angle closure glaucoma (ACG), which is less common and tends to be more acute.

The major impediment in glaucoma detection is that a majority of patients experience no symptoms in the early stages of the disease, and hence it goes largely undetected.

A minority of patients do experience symptoms in the early stages of the disease which can include redness, eye pain, blurring of vision and sometimes even headaches, nausea and vomiting. Patients consistently experience vision loss in more advanced stages of the disease.

Boudhankar: In India, the symptoms of glaucoma may vary depending on the type and stage of the condition. However, many people with glaucoma do not experience any symptoms until the disease has advanced and caused significant vision loss. Some possible symptoms of glaucoma in India may include:

Loss of peripheral vision: This is often the first symptom of glaucoma, and it may not be noticed until the condition has progressed significantly.

Tunnel vision: This refers to a loss of peripheral vision that becomes more severe over time, resulting in a narrower field of vision that resembles looking through a tunnel.

Blurred vision: Glaucoma can cause blurred vision, which may be especially noticeable in low light conditions.

Halos around lights: Glaucoma can cause halos or rainbow-colored rings to appear around lights, especially at night.

Eye pain or redness: In some cases, glaucoma can cause eye pain, redness, or discomfort.

Headaches: Glaucoma can cause headaches, especially when combined with other symptoms such as blurred vision or eye pain.

It is important to note that these symptoms can also be caused by other eye conditions or health problems. Therefore, anyone experiencing these symptoms should seek immediate medical attention from an eye specialist for proper diagnosis and treatment.

Which age group is most affected by this eye condition?
Shah: Though glaucoma can present at any age (including in newborns), the most common variant (primary open angle glaucoma) is usually a disease which manifests in the 40s. Earlier presentations are seen in patients who have a positive family history of glaucoma.

Boudhankar: Glaucoma is a significant public health issue in India, and it is estimated that more than 12 million people in the country are affected by the condition. According to a study published in the Indian Journal of Ophthalmology in 2017, the prevalence of glaucoma in India increases with age, with a higher prevalence in older age groups. The study found that the prevalence of glaucoma was 1.62 per cent in people over 40 years of age, 2.54 per cent in people over 50 years of age, and 5.82 per cent in people over 70 years of age. Another study published in the Journal of Glaucoma in 2018 found that primary angle-closure glaucoma (PACG) is the most common type of glaucoma in India, accounting for 50-70 per cent of cases. It's important to note that these statistics are based on population studies and may not reflect the prevalence of glaucoma in individual cases.

Can glaucoma be treated?
Shah: Glaucoma is a condition that can be effectively controlled with medicines, lasers in the early stages and surgical interventions in the more advanced stages. At present, there is no permanent cure for glaucoma, and any patient on treatment will require regular and timely eye checkups.

Boudhankar: Yes, glaucoma can be treated in India. There are several treatment options available for glaucoma, including eye drops, medication, laser therapy, and surgery.

Eye drops are usually the first line of treatment for glaucoma, and they work by reducing the amount of fluid in the eye or increasing the outflow of fluid from the eye. There are several types of eye drops available, and your doctor will determine the best one for your specific type of glaucoma.

If eye drops are not effective or not well-tolerated, medication may be prescribed to lower eye pressure. Laser therapy, such as selective laser trabeculoplasty (SLT) or laser peripheral iridotomy (LPI), can also be used to treat glaucoma by improving the drainage of fluid from the eye.

In more advanced cases, surgery may be necessary to lower eye pressure and prevent further damage to the optic nerve. Glaucoma surgery in India is performed by highly skilled ophthalmologists and uses the latest techniques and technologies.

How many people are known to be affected by glaucoma every year?
Shah: Population-based studies provide us with important information regarding the prevalence (number of individuals with glaucoma at a given point in time).

In 2010, an estimate of glaucoma prevalence in India was 11.2 million in individuals aged 40 years and above. By 2020, India was projected to account for 20 per cent of glaucoma patients globally.

Boudhankar: India has a National Blindness Control Programme to reduce the prevalence of blindness. However, it is estimated that there are more than 12 million people with glaucoma in India, making it a significant public health issue in the country.

Unfortunately, many people with glaucoma are unaware that they have the condition, as it often develops slowly and may not cause noticeable symptoms in the early stages. As a result, it's important for everyone, particularly those over the age of 40, to have regular eye exams to monitor for signs of glaucoma and other eye conditions.

Can Covid affect those with glaucoma?
Shah: Though direct causation between Covid and glaucoma is yet to be established, Covid has been known to cause inflammation within the eye (uveitis) which can elevate eye pressures. More importantly, the majority of the hospitalised Covid-19 patients were given systemic steroids to reduce inflammation and lung fibrosis. Steroid use has been linked to various eye problems including glaucoma. The linked risk increases with increasing dose and duration. Genetic susceptibility plays a role too, as certain individuals are more prone to steroid-induced problems. Hence, the use of systemic steroids in Covid-19 may increase the incidence of glaucoma cases.

Boudhankar: There is limited information on the specific effects of Covid-19 on people with glaucoma, but having glaucoma does not appear to increase the risk of contracting Covid-19. However, like all individuals, people with glaucoma are still susceptible to contracting Covid-19 and should take appropriate precautions to protect themselves.

Some studies have suggested that Covid-19 may have an indirect impact on glaucoma management due to changes in healthcare delivery systems and reduced access to medical services during the pandemic. For example, routine eye exams may have been postponed or cancelled, which could result in delays in glaucoma diagnosis and treatment.

In addition, some medications used to treat glaucoma, such as chloroquine and hydroxychloroquine, have been investigated for their potential use in treating Covid-19. However, there is currently insufficient evidence to support the use of these medications for Covid-19 treatment, and individuals with glaucoma should not stop taking their glaucoma medications without consulting their healthcare provider.

Overall, people with glaucoma should continue to follow public health guidelines to prevent the spread of Covid-19, maintain regular communication with their healthcare providers, and adhere to their prescribed glaucoma treatment plan.

Can glaucoma be prevented?
Shah: Eye doctors don't yet know how to prevent glaucoma from developing. However, regular eye exams can prevent serious vision loss and blindness. Certain lifestyle changes have a protective value, such as:

- Having a diet rich in green leafy vegetables, colored fruits and berries

- Brisk walking and regular moderate exercise helps lower eye pressure

- Avoid eye injuries with the use of protective eyewear

Boudhankar: Glaucoma cannot be entirely prevented, but there are steps that can be taken to reduce the risk of developing the condition or detecting it early before it causes significant vision loss in the Indian context.

Here are some tips to reduce the risk of developing glaucoma in India:

Regular eye exams: Regular comprehensive eye exams are important to detect early signs of glaucoma. It is recommended that individuals over the age of 40 should have regular eye exams every 2-4 years, while those over the age of 60 should have annual exams.

Control diabetes and hypertension: Diabetes and hypertension are known risk factors for glaucoma. Controlling these conditions through proper medication, diet, and lifestyle changes can reduce the risk of developing glaucoma.

Avoid smoking: Smoking is associated with an increased risk of developing glaucoma. Quitting smoking or avoiding it altogether can help reduce the risk.

Protect your eyes from injuries: Trauma or injury to the eyes can lead to the development of glaucoma. It is important to protect your eyes by wearing protective eyewear while playing sports or doing activities that may cause eye injury.

Follow your doctor's instructions: If you have been diagnosed with glaucoma, it is important to follow your doctor's instructions regarding medications, eye drops, and lifestyle changes.

Can people eat different kinds of foods to prevent glaucoma?
Shah: While there are no conclusive studies to prove the association between specific foods and glaucoma, following a healthy diet is beneficial to your overall health. That being said, a diet rich in fruits, vegetables, whole grains and fish has been shown to reduce blood pressure, reducing the risk of glaucoma. Conversely, a poor diet rich in saturated and trans-fat increases the risk factors for glaucoma, such as diabetes and high cholesterol

Foods rich in antioxidants and phytochemicals (berries, nuts, green leafy vegetables) may help protect against glaucoma. Fruits and vegetables are good sources of Vitamins A, C and antioxidants like lutein and zeaxanthin, which reduce oxidative stress and may provide protection against glaucoma.

Boudhankar: While there is no specific food or diet that can prevent or cure glaucoma, a healthy and balanced diet can help reduce the risk of developing various eye conditions, including glaucoma.

Some studies have suggested that certain nutrients, such as vitamin C, vitamin E, and omega-3 fatty acids, may be beneficial for eye health and may help reduce the risk of developing glaucoma. Foods that are rich in these nutrients include fruits, vegetables, nuts, and fatty fish like salmon and tuna.

In addition, maintaining a healthy weight, reducing salt intake, and staying hydrated can also help reduce the risk of developing glaucoma and other eye conditions.

Also See: IN PHOTOS: Eyes giving you trouble? Follow these 5 tips to maintain good hygiene