The Silent Thief of Sight
One of the most astonishing outcomes of investing in eye health in a developing country is that a condition which is ruining a life can be fixed relatively easily, and the results are - pardon the pun - so visible.
Witnessing an elderly farmer with cataracts, unable to work due to limited vision, but now able to see again the very next day after a 15-minute operation, or a young girl with trachoma triachiasis whose pain and discomfort is relieved by a minor lid-surgery, is incredibly satisfying for all those involved – you get almost instant results.
What is Glaucoma?
Glaucoma is more complex. It is irreversible – it cannot be cured, though it can be controlled. The leading cause of irreparable blindness worldwide, it is a group of eye diseases characterised by progressive structural damage to the optic nerve and visual field loss.
According to the International Agency for the Prevention of Blindness (IAPB), it has been estimated that by 2020 there will be approximately 80 million people with glaucoma globally, an increase of about 20 million since 2010. The burden is largely in sub-Saharan Africa, where about 4% of adults aged 40 and above have the condition.
„I’m excited about the opportunities for improving glaucoma care services, working with Light for the World as they partner with 3 African countries to support glaucoma care programmes in the public health context. The programme is very important as it will span across institutional strengthening and training for high level skills, approaches to earlier diagnosis in the communities and enhancing public awareness for glaucoma."
Dr Fatima Kyari, IAPB West Africa Chair, Glaucoma Specialist and Glaucoma Advisor to Light for the World, Nigeria
It has been referred to as ‘the silent thief of sight’ as diagnosis is often late because patients may not even know they have it: the most common form of glaucoma in Africa, primary open-angle glaucoma, is typically not painful but still results in gradual vision loss.
In Nigeria for example, the Nigerian National Survey of Blindness and Visual Impairment (2009) reported that 5% of survey participants aged 40 and above had glaucoma, but that 94% of them were unaware they even had the condition.
Why is addressing it so difficult?
There are many challenges linked to glaucoma – a lack of public awareness leads to late diagnosis when the damage has already been done, treatment is not straightforward, the specialist ophthalmologists and health centres needed are limited and the cost of medication and care is high. All this is compounded by socioeconomic deprivation and the fact there are currently no publications on models of glaucoma care in Africa.
As it’s impossible for full sight to be restored (though it’s possible to stop the disease in its tracks with proper treatment), it’s a condition which does not easily lend itself to a simple happy ending, and as such it’s an oft-neglected problem.
“I am so delighted that Light for the World is addressing glaucoma – it is so neglected.”
Dr Clare Gilbert, Professor of International Eye Health in the International Centre for Eye Health (ICEH) of the London School of Hygiene and Tropical Medicine (LSHTM), UK
But this is unacceptable given the amount of people it affects, and the effect it has on their lives. Although it is a difficult disease to manage, it is potentially just another avoidable cause of blindness in Africa which can absolutely be taken on – and we want to be part of the solution.
What is Light for the World doing to help?
Light for the World has strong links with Ministries of Health, particularly in our focus countries of Burkina Faso, Mozambique and Ethiopia. With their support, for the first time, we have developed a broad and targeted multi-country programme to systematically tackle the complexity of the disease in the rolling out of glaucoma services in our countries of intervention and beyond.
More specifically, Light for the World will:
- Develop the first Glaucoma Implementation Manual for Sub-Saharan Africa based on the International Council of Ophthalmology (ICO) Glaucoma Guidelines with high-level Glaucoma experts, including from international eye health organisations such as the ICO, the International Agency for the Prevention of Blindness (IAPB), the scientific community and major international training institutions, and , among others. It will be disseminated for use by specialised ophthalmologists to set up glaucoma clinics continent-wide
- Train 6 ophthalmologists (respectively two from Ethiopia, Burkina Faso and Mozambique) to subspecialise in glaucoma
- Establish and equip 6 Glaucoma Centres within existing public eye departments to improve diagnostics and treatment (2 for each of these three countries)
- Facilitate the training of 63 national general ophthalmologists by the Glaucoma subspecialists, so they have the skills to diagnose and treat glaucoma
- Facilitate the training of 38 allied ophthalmic personnel (mid-level ophthalmic staff, such as ophthalmic clinical officers) in glaucoma diagnosis, counselling and referral to the specialised centres
- Build awareness among both the public and health authorities of the disease and its complications.
A big thanks to the Else Kröner Fresenius Foundation for making this programme possible.
This is an ambitious plan, and we need your help to implement it.
Please join us in the fight against this neglected and complex disease affecting millions.