Glaucoma - Eye Surgery

Glaucoma is a group of eye diseases that damage the optic nerve, which is essential for vision. This damage is often caused by abnormally high pressure in the eye. Over time, this can lead to vision loss and, eventually, blindness if left untreated. Glaucoma is often referred to as the "silent thief of sight" because it typically has no early warning signs and progresses gradually.

Glaucoma is a major eye condition that affects many people worldwide, including in Nigeria. It is particularly concerning because it can lead to irreversible blindness if not detected and treated early.

Source: Fort Worth Eye Associates

What Are the Causes of Glaucoma?

The primary cause of glaucoma is increased pressure inside the eye, known as intraocular pressure (IOP). This pressure builds up when the fluid inside the eye, called aqueous humour, doesn’t drain properly. Normally, this fluid flows out of the eye through a drainage system called the trabecular meshwork. However, when this drainage system is blocked or doesn't work effectively, the fluid builds up, causing an increase in eye pressure. Over time, this elevated pressure can damage the optic nerve, leading to vision loss.

In addition to high eye pressure, there are several other risk factors and causes of glaucoma:

1. Age

People over the age of 40 are at a higher risk of developing glaucoma, especially those with a family history of the disease. As people age, the drainage system in the eye can become less effective, leading to increased pressure.

2. Family History

Glaucoma tends to run in families, meaning that if someone in your family had or has glaucoma, your chances of developing the disease increase. In such cases, it's important to get regular eye check-ups to detect the disease early.

3. Medical Conditions

Certain medical conditions can increase the risk of developing glaucoma, including:

• Diabetes
• High Blood Pressure (Hypertension)
• Severe Eye Injuries.
• Previous Eye Surgery

4. Ethnicity

People of African descent, including Nigerians, have a higher risk of developing open-angle glaucoma, the most common type of glaucoma. This higher risk is believed to be related to genetics and differences in the structure of the eye. Glaucoma also tends to develop earlier and progress more rapidly in people of African heritage, making early detection and treatment critical.

Reported rates of glaucoma by ethnicity (%±SE).

Source: UK Biobank

5. Use of Steroid Medications

Prolonged use of steroid medications, whether in the form of eye drops, oral medications, or injections, can raise intraocular pressure, especially in people who are sensitive to steroids. These medications are commonly used to treat conditions like allergies, asthma, and inflammation, but their side effects on eye pressure can lead to glaucoma over time.

6. Poor Blood Circulation

Conditions that affect blood flow, such as vascular diseases or migraine headaches, can also contribute to the development of glaucoma. Poor circulation may weaken the optic nerve, making it more vulnerable to damage from increased eye pressure.

7. Thin Corneas

People with thin corneas are at higher risk for developing glaucoma. The cornea is the transparent front layer of the eye, and its thickness can affect how pressure is distributed within the eye. A thinner cornea might indicate weaker eye structures, making the optic nerve more vulnerable to damage.

8. Anatomical Factors

Some people are born with eye structures that naturally increase their risk for glaucoma. For example, people with narrow drainage angles in their eyes (called angle-closure glaucoma) are more prone to sudden increases in eye pressure, which can lead to an acute attack of glaucoma.

Understanding these causes and risk factors can help in the early detection and prevention of glaucoma. Regular eye check-ups, especially for individuals at high risk, are key to managing and treating glaucoma before it leads to permanent vision loss.

Diagnosis of Glaucoma

Since glaucoma doesn’t usually show early symptoms, regular eye check-ups are crucial, especially for people at risk. An eye doctor (ophthalmologist or optometrist) will carry out tests to diagnose glaucoma. These tests include:

• Tonometry: Measures the pressure inside the eye.
• Ophthalmoscopy: Examines the optic nerve for signs of damage.
• Perimetry (Visual Field Test): Checks for missing areas of vision.
• Gonioscopy: Examines the drainage angle in the eye to see if it’s open or blocked.
• Pachymetry: Measures the thickness of the cornea.

What Are the Symptoms of Glaucoma?

In the early stages, glaucoma typically has no noticeable symptoms. This is why many people may not know they have it until significant vision loss has occurred. However, as the disease progresses, symptoms may include:

• Loss of Peripheral Vision: You may notice that you can't see things to the side.
• Tunnel Vision: As glaucoma worsens, your field of vision narrows.
• Severe Eye Pain: This can occur in cases of acute glaucoma.
• Redness in the Eye: Often associated with eye pressure buildup.
• Blurred Vision: Vision may become hazy, especially as the disease advances.
• Seeing Halos Around Lights: A sign of increased eye pressure.

Glaucoma Treatment in Nigeria

The primary goal of glaucoma treatment is to lower intraocular pressure (IOP) to prevent further damage to the optic nerve. Although the damage caused by glaucoma is irreversible, the progression of the disease can be slowed or halted with proper treatment. Early detection and timely intervention are crucial to preserving vision. Below are the most common treatments available in Nigeria:

1. Medications

Medications are usually the first line of treatment for glaucoma, and they are widely available in most eye clinics across Nigeria. These medications, often in the form of eye drops or sometimes oral pills, work by either:

• Reducing the production of fluid in the eye (aqueous humour).
• Improving the drainage of fluid from the eye.

Common types of eye drops include:

• Prostaglandin Analogs.
• Beta Blockers.
• Alpha Agonists.
• Carbonic Anhydrase Inhibitors.

Oral Medications may also be prescribed for short-term use, especially in cases of acute glaucoma attacks, to lower eye pressure rapidly. Patients typically need to use these medications daily, sometimes for the rest of their lives.
2. Laser Treatment

Laser therapy is another effective treatment for glaucoma, and it is used to improve fluid drainage from the eye or to reduce fluid production. While laser treatment may not be available at every clinic, it is offered at specialized hospitals in major cities across Nigeria, including Lagos, Abuja, and Port Harcourt where there are well-equipped eye care centres and experienced ophthalmologists. Contact Surjen Healthcare to weigh your options  WhatsApp | Phone Call | Email. Laser therapy is a non-invasive procedure, meaning there is no need for cuts or stitches, and it is typically done as an outpatient procedure.

There are different types of laser treatments used for glaucoma:

• Selective Laser Trabeculoplasty (SLT): This treatment targets the drainage system in the eye (trabecular meshwork) to increase fluid outflow, reducing eye pressure. It is commonly used for open-angle glaucoma.
• Laser Peripheral Iridotomy (LPI): This is used for angle-closure glaucoma. A small hole is created in the iris (the coloured part of the eye) to allow fluid to flow more freely between the front and back chambers of the eye.
• Cyclophotocoagulation: This laser treatment targets the part of the eye that produces fluid to reduce the production of aqueous humour.

Laser treatment is usually quick (often taking just a few minutes), and patients can go home the same day. However, it may take several weeks to see the full results, and in some cases, additional treatments or medications are needed to control the eye pressure fully.

3. Surgery

In more severe or advanced cases of glaucoma, or when medications and laser therapy do not adequately control the intraocular pressure, surgery may be required. Glaucoma surgery aims to create a new drainage pathway for the fluid in the eye or to enhance the eye’s natural drainage system.

Types of glaucoma surgery performed in Nigeria include:

• Trabeculectomy: This is the most common glaucoma surgery, where a small part of the drainage system is removed to create an opening for fluid to leave the eye. This reduces the pressure inside the eye. It is a more invasive procedure but is highly effective in controlling eye pressure.
• Glaucoma Drainage Devices (Shunt Surgery): In this procedure, a tiny tube or shunt is implanted in the eye to help drain excess fluid. This is usually reserved for more complicated or severe cases.
• Minimally Invasive Glaucoma Surgery (MIGS): A newer form of glaucoma surgery that uses smaller incisions and has fewer complications. It may not be as widely available in Nigeria but can be found in some advanced centers. Contact Surjen Healthcare for enquiries.  WhatsApp | Phone Call | Email.

How to Prevent Glaucoma

While you can’t completely prevent glaucoma, there are steps you can take to reduce your risk:

• Regular Eye Check-ups: If you are over 40 or have a family history of glaucoma, get your eyes checked at least once every two years.
• Manage Medical Conditions: Keep conditions like diabetes and high blood pressure under control.
• Use Eye Protection: Protect your eyes from injuries during sports or hazardous work.
• Follow Doctor’s Advice: If you’ve been diagnosed with high eye pressure, follow the treatment plan your doctor gives you.

Alternative Treatments for Glaucoma

Although alternative treatments cannot replace medical care, they may be used to complement standard treatments. Some options include:

• Herbal Remedies: Some traditional herbs, like ginkgo biloba and green tea, are believed to help reduce eye pressure, but there is no strong scientific evidence.
• Lifestyle Changes: A healthy diet rich in fruits, vegetables, and omega-3 fatty acids, along with regular exercise, can support eye health.
• Acupuncture: Some people use acupuncture, but its effectiveness for glaucoma is not well established.

It’s important to remember that alternative treatments should only be used alongside medical care, not as a replacement.

What Happens When Glaucoma Is Not Treated on Time?

If glaucoma is left untreated, it will eventually lead to blindness. The damage to the optic nerve is irreversible, so once vision is lost, it cannot be restored. Early detection and treatment are key to preserving vision. The later glaucoma is diagnosed, the harder it is to stop vision loss.

Glaucoma Surgery Cost in Nigeria

The cost of glaucoma surgery in Nigeria varies depending on the type of surgery and the hospital. In public hospitals, the cost may range from ₦100,000 to ₦300,000. In private hospitals, especially in cities like Lagos or Abuja, the cost may be higher, ranging from ₦300,000 to ₦700,000 or more. Additional costs may include pre-surgery tests and post-surgery medications. Contact us for the best rate.

Glaucoma is a serious eye condition that requires early detection and treatment to prevent blindness. Regular eye check-ups are especially important for people in Nigeria who are at higher risk. With proper medical care, including medications, laser therapy, or surgery, glaucoma can be managed effectively to protect vision. Contact us at Surjen Healthcare for the best treatment with the best ophthalmologist and optometrist in Nigeria. We partner with the best doctors and best hospitals to provide the best medical care in Nigeria.

Frequently Asked Questions on Glaucoma

Can glaucoma be cured?
No, glaucoma cannot be cured. However, it can be managed to slow down or halt its progression. Early detection through regular screening and following the prescribed treatment regimen (medications, laser therapy, or surgery) can help preserve vision.

What is the prevalence of glaucoma in Nigeria?
Glaucoma is highly prevalent in Nigeria, with studies showing that about 5% of people over 40 years old are affected. It is estimated that more than 700,000 Nigerians live with glaucoma, making it a leading cause of blindness in the country. Approximately 20% of the world’s glaucoma blindness cases are in Nigeria. However, due to late diagnoses, many are unaware they have the condition.

Source: Glaucoma Society of Nigeria, Nigerian Journal of Ophthalmology

Who is at higher risk of developing glaucoma in Nigeria?
Certain groups in Nigeria are at higher risk, including:

• People over 40 years old.
• Individuals with a family history of glaucoma.
• Those with conditions like diabetes or hypertension.
• African heritage (glaucoma is more prevalent among people of African descent).

What is the likelihood of blindness from glaucoma in Nigeria?
Unfortunately, due to the silent nature of glaucoma and the lack of awareness, a significant percentage of people in Nigeria seek treatment too late. 50% to 90% of glaucoma patients in Nigeria may already have severe visual impairment or blindness at the time of diagnosis. The World Health Organization (WHO) estimates that glaucoma is responsible for 16% of blindness cases in Nigeria.

Source: WHO Nigeria, Nigerian Journal of Ophthalmology

How can I prevent glaucoma?
While glaucoma cannot be entirely prevented, regular eye exams, especially for those over 40 or with risk factors, can help with early detection. Managing conditions like hypertension and diabetes can also reduce your risk. Wearing protective eyewear in risky environments (e.g., farming or industrial work) can prevent traumatic eye injuries that could lead to glaucoma.

Where can I get tested for glaucoma in Nigeria?
Most tertiary hospitals, eye clinics, and some general hospitals offer glaucoma screening services. Contact Surjen Healthcare to make an appointment.

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Disclaimer: The information provided herein is for patient general knowledge only and should not be used during any medical emergency, diagnosis or treatment of any medical condition. Duplication for personal and commercial use must be authorized in writing by Surjen.com.