Dr Rishi Jain, Medical Director, Allergan an AbbVie Company highlights that since glaucoma is known as the ‘silent thief of sight,’ early diagnosis and treatment can stop the disease progression. Implementation of healthcare education programmes that urge community members to get their eyes tested regularly can help locate those who are unaware or hesitant to seek treatment
Nearly 2.2 billion people across the world have near or distance vision impairment. In almost 50 per cent of these cases, vision impairment could have been prevented.[1] Globally, almost 43 million people are blind,[2] out of which 4.5 million cases are attributed to glaucoma.[3] Glaucoma is a chronic eye disease caused by damage to the optic nerve, the nerve that carries visual messages from the eyes to the brain, resulting in vision loss. Since the disease is largely asymptomatic in the initial stages, the only mode of detection is through a comprehensive eye exam.
In India too, glaucoma is one of the major causes of irreversible blindness. Around 12 million Indians suffer from glaucoma and nearly 10 per cent of them have lost their vision due to this disease. Moreover, over 90 per cent of glaucoma cases continue to remain undetected in the country.[4]
Age (over 60 years) is a major risk factor for glaucoma, though a family history also increases the risk of the condition. The presence of diabetes, heart disease and high blood pressure also enhance glaucoma risk. It is estimated that India’s population of elderly persons will rise from nearly 138 million in 2021 to 194 million in 2031.[5] Hence, the burden of glaucoma is also expected to increase.
Scenario in rural India
The disease burden of glaucoma is not borne equally across India. It is skewed towards low- and middle-income families, older people, and rural communities.
In rural India, ophthalmic care for glaucoma is limited due to numerous factors, such as inadequate disease awareness, as well as lack of basic eyecare facilities. Consequently, most patients with glaucoma (over 93 per cent) in rural India remain undiagnosed. Another population-based assessment showed that only one out of every 2 people with glaucoma had ever consulted an ophthalmologist.[6]
The problem is further deepened due to the absence of effective screening protocols in rural areas. Although recently GSI (Glaucoma Society of India) has released India-specific clinical guidelines for treating glaucoma, still ophthalmologists continue to follow guidelines from the European Glaucoma Society and Asia-Pacific Glaucoma Society to treat patients[7] as the penetration of GSI guidelines is still very low.
Paving a path towards equitable and inclusive eyecare
Since glaucoma is known as the ‘silent thief of sight,’ early diagnosis and treatment can stop the disease progression. Implementation of healthcare education programmes that urge community members to get their eyes tested regularly can help locate those who are unaware or hesitant to seek treatment. Primary prevention of glaucoma consists of a strong collaboration among health workers, NGOs, and the government to build a comprehensive healthcare strategy, set up the required infrastructure and ensure adequate outreach programmes with a particular focus on rural areas. The National Programme for Control of Blindness, a 100 per cent government-sponsored programme, is helping eradicate blindness in India for decades. Though the programme has accomplished significant victory in eradicating cataract-related blindness, glaucoma management is yet to be brought to the forefront of this initiative. [8],[9]
The irrevocable damage and the asymptomatic nature of glaucoma make it a greater public health crisis. The creation of an integrated people-centric eyecare system, based on strong primary healthcare, can be scaled-up in both rural and urban areas to help eliminate glaucoma. People who need eyecare must be able to obtain high-quality treatment irrespective of their geographical space.Initiatives such as awareness videos on wheels, opportunistic eye screening, upskilling of practitioners, updating screening instruments, specialised hospitals, and insurance coverage by the government give the right impetus toward equitable eyecare.
References:
[1] https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment#:~:text=This%201%20billion%20people%20includes,as%20well%20as%20near%20vision
[2] https://www.iapb.org/learn/vision-atlas/magnitude-and-projections/global/
[3] https://www.glaucoma.org/news/glaucoma-awareness-month.php#:~:text=The%20World%20Health%20Organization%20estimates,are%20blind%20due%20to%20glaucoma
[4] https://www.nhp.gov.in/world-glaucoma-week_pg
[5]https://www.mospi.gov.in/documents/213904/301563/Elderly%20in%20India%2020211627985144626.pdf/a4647f03-bca1-1ae2-6c0f-9fc459dad64c
[6] https://daneshyari.com/article/preview/7525810.pdf
[7]https://journals.lww.com/ijo/Fulltext/2022/01000/A_deep_dive_into_the_latest_European_Glaucoma.7.aspx
[8] https://npcbvi.gov.in/Home
[9] https://npcbvi.gov.in/writeReadData/mainlinkFile/Patternofass2017-20.pdf