Glaucoma Management, A Chronic Condition - Story Time

So, if you have read any of my writeups before you would probably know that i am all about the ocular health, if this is your first time visiting my blog though, then i quick intro should be ok? Anyway I am Ben-Nathaniel, I am a licensed Optometrist here in Ghana currently working with Westphalian Medical Center in Oyoko, Ashanti Region of Ghana.

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And ever since i could recall, i have always been about the eye health here on the blockchain, and today i would be sharing and interesting story, although quite sad but full of lessons for the lot of us to learn from so that we may not fall victim to some of these mistakes that people make as patients, or perhaps we could serve as guides for our wards, siblings, neighbors etc. I do hope you enjoy the read.

Glaucoma is a condition quite prevalent in West Africa and Africa as a whole and is also quite common among Afro-Americans. For the Eastern part of the world they tend to have issue with a particular occurence of Glaucoma known as close angle glaucoma which is quite deadly and mostly considered an emergency situation when it happens but that's not our focus for today.

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Glaucoma has been a major concern for all eyecare advocates and eyecare workers especially in my part of the world because this condition not only results in blindness but is extremely silent until the worst has already happened. For this, it is internationally nicknamed the "the silent thief of sight", which means, no symptoms, no pain or discomfort whatsoever just quietly going blind.

Because of this, as part of the routine eye examination, we are always on the look out for signs which could give any indication of Glaucoma so that we can save sights. Some are lucky to get diagnosed early and treatment to be started early whereas others are not so lucky, but then i noticed some few occurence with some patients of mine which was quite the sad situation, partially their fault and well the other half could be attributed to misunderstanding, unfortunately it was too late by the time i saw them but i wish to share story for our learning as i mentioned earlier.

My first patient with regards to this story was a 25 year old young man who got diagnosed with glaucoma about 3 years back before his attending the eye clinic to see me and his history was that he went for eyecare about 3 years ago and was given topical medication because the Doctor said his ocular pressure is elevated however after he used the drops he never went back for review again and 3 years down the line he has noticed that now he cannot see.

The vision in one eye was HM which means he can only see your hand if you bring it infront of that eye and wave and the other was CF3m which means that he could see your hands and tell the number of fingers you have raised from 3meters and thus as far as his vision could go.

Looking into the eye i realized that the disc/optic nerve head was almost completely atrophied and even without doing visual field tests i could tell that his peripheral vision was gone. I noticed that his pressures within the eye was over the 40s which was very bad and i could tell that this has probably been the case for the past year or two hence the rapid deterioration of his vision.

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It was at this point that i made him understand that the medication he was given was for Glaucoma treatment and that he ought to have gone back for review afterward to continue with the treatment. Once he understood that Glaucoma management is a lifetime chronic situation and that his vision loss is due to the death of the optic nerve hence irreversible, he was quite sad and almost cried. My only worry was that he is quite young and had his whole future ahead of him, his vision could have been maintained or saved earlier if only the education had gone right or he had gone back for review.

My second patient was a bit different in that she, a 40 year old woman who was diagnosed with glaucoma and was educated well about the condition decided to stop the treatment because she was tired of using eyedrops every single day of her life and felt like she needed a break. Unfortunately the break caused her intraocular pressure to shoot up with one eye around 35mmhg and the other 40mmhg. After staying away from the medication for about a year she also realized that her vision has become very very bad and now coming for consult to find out what's happening.

After propping and asking questions she finally decided to come clean about her glaucoma diagnosis and how she felt tired with the drug. I made her understand that she has caused her own damages and that her vision loss is irreversible however we ought to bring down the pressures to save the rest of her sight and that she cannot get fed up of the drugs because thus what's literally keeping her from going blind. (Just so you know, ideally the pressures within the eye ought to stay below 20mmhg and above 10mmhg).

Now these weren't the only situations i met where patients visual loss could have been prevent if they had remaind compliant with their medication or just gone for review. I do not know who may be reading this today or who my reader may now who is diagnosed with this condition, however what i wish to send across is that Glaucoma is a life long condition that ought to be managed on a daily basis.

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You should never stop using your drugs unless otherwise instructed by your Optometrist or Ophthalmologist. When in doubt please always speak to a professional, do not change your medication for any reason unless approved by your eyecare provider and always do well to learn more about your diagnosis by reading wide so you can ask more questions. As Healthcare providers, we are here to serve you and so do not be afraid to ask what you need understanding about.

It is quite a pleasure to share this with you today and i do hope that this saves someone's sight, somewhere, somehow, someday. Stay safe and have a happy Midweek. Love, Nat.