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Glaucoma surgery not factor in blindness

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By Abraham Adekunle

Ophthalmologist explains why patients decline it due to irrational fear.

According to the Nigeria National Blindness and Visual Impairment Survey, between 1.1 to 1.4 million adults in Nigeria have glaucoma. Most of these people are not even aware that they have the disease. In other words, one in every 20 Nigerians aged 40 and above has it. Of this figure, one in five is blind. Glaucoma is the second leading cause of blindness worldwide and the leading cause of irreversible blindness. It accounts for eight percent of all blindness, affecting an estimated 3.12 million blind people.

The prevalence of the incidence of the disease in sub-Saharan Africa and, by extension, the whole of Africa itself shows that it is a matter of concern. Relevant population-based surveys of the sickness (and of blindness and visual impairment in the region) indicate that it affects about four percent of adults who are 40 years and above. It also accounts for 15 percent of blindness in the region. The surveys show as well that Africa accounts for the highest incidence and prevalence of the disease.

Patients often decline undergoing glaucoma surgery.

Apart from the occurrence of this illness, many patients decline being operated on as a means of rectifying the defect. A professor of ophthalmology, Adeola Onakoya, has revealed that the surgery does not result in blindness. Regardless, fear still makes many patients decline surgical intervention in management. This was in an interview with news correspondents on July 19, 2023, in Lagos. Glaucoma is a disease that damages the eye’s optic nerve and usually happens when fluid builds up in the front part of the eye. That extra fluid increases the pressure in the eye, damaging the optic nerve.

She noted that compliance and acceptance of treatment were critical in reducing progression and blindness from glaucoma. She maintained that elevated intraocular pressure (IOP) is the only known modifiable risk factor in glaucoma management. According to her, IOP control is achieved through medical, surgical or laser therapy. She said that over 70 percent of patients are on medical treatment in Nigeria, but less than 50 percent of patients adhere to it. “Glaucoma is a lifelong disease where compliance with treatment for a lifetime is required to prevent blindness,” she said.

Some factors responsible for poor compliance of patients.

Onakoya said that evidence-based studies have shown that 1mm IOP rise results in a cumulative 10 percent reduction in the visual field. She noted that surgical intervention assures the stability of the disease to an extent. However, in about 70 percent of cases, additional medical therapy would be required to achieve the target IOP. As well, between 70 and 80 percent of patients in Africa and Nigeria have advanced glaucoma which requires aggressive therapy to lower its IOP.

In considering some of the factors responsible for poor compliance, she highlighted prohibitive costs, side effects, difficulties with drug storage, non-availability of drugs, counterfeit drugs, forgetfulness, complex regimen, and poor understanding of the disease. To resolve some of the listed impediments to treatment compliance, Onakoya appealed to pharmaceutical industries to give rebates on medication to improve adherence. She noted that some pharmaceutical industries in Nigeria have been at the forefront to ensure the availability and affordability of anti-glaucoma medications.

Specialist suggests ways to combat these issues to the government.

For these issues to be resolved, the professor urged the federal and state governments to provide rebates and Subsidies on anti-glaucoma drugs as well as the fees paid for surgery. She appealed to the government to improve the acquisition of equipment, Infrastructure and adequate personnel. Her argument is that the majority of patients pay out-of-pocket to access care. This is concerning in the sense that 70 percent of Nigeria’s health expenditure are out-of-pocket. This is in sharp contrast to the National Health Insurance Act, which covers 90 percent of the formal sector which comprises the elite.


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