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Glaucoma is the leading cause of irreversible blindness in the world. Damage to optic nerve leads to progressive, irreversible loss of vision. It is largely said to be an invisible disease – why? Let’s find out from Dr Dinesh Kumar Ramesh Chandra, Consultant Ophthalmologist Columbia Asia Hospital – Petaling Jaya
GetDoc: Who are at the high-risk category of getting glaucoma? Is Glaucoma a genetic disease?
Dr Dinesh: Yes, Glaucoma is a heritable disease. If there is a positive family history, then the incidence of Glaucoma is higher. Although abnormal genes cannot skip generations, it is possible for a person carrying a glaucoma gene to remain unaffected. Family history increases risk of glaucoma four to nine times, however it is not inherited every time. Studies say that if your parents have glaucoma, your chance of developing glaucoma is 25%. But if your sibling has glaucoma, your chance is 50%. Some genes have been discovered that have been found to contribute to Glaucoma.
As far as age is concerned, anybody can get glaucoma. There are various types of Glaucoma from such as Congenital Glaucoma – babies who are born with glaucoma, Juvenile Glaucoma, Open Angle Glaucoma, Angle Closure Glaucoma and so on.
Eye examinations are an important part of health maintenance for everyone. Adults should have their eyes tested to keep their prescriptions current and to check for early signs of any eye disease. If people can go to the dentist every year, why can’t they go to an ophthalmologist on a yearly basis? You go to the dentist to make sure your teeth are nice, white and shining, but often one hesitates to go for a comprehensive eye assessment. Optometrist are professionals who determine the refractive power of the eye. But in fact, there are so many other things regarding the eye besides the spectacle power, and many people has misconception that their eyes are working fine after a visit to the optician.
Dr Dinesh Kumar Ramesh Chandra, Consultant Ophthalmologist Columbia Asia Hospital – Petaling Jaya
GetDoc: Can you tell us the difference between eye screening done in the hospital setting and checking the power in an optic shop?
Dr Dinesh: Optician play an important role in. Ophthalmologist and Opticians work closely when it comes to eye care. In an optical shop, the optometrist does a refraction test – this means your eyes are tested for clear focus and whether you need to wear a pair of glasses. Of course recently, optometrists have moved one step further whereby they do have certain high-end equipment with which a photograph of the retina can be taken. In short, diagnosis by an ophthalmologist is much more detailed than that done at an optical shop.
Optical Coherence Tomography at hospital setting (Image source from cardiff.ac.uk)
Hospital screenings are definitely much more comprehensive. We check the pressure; we have camera facilities to take photos. Nowadays we can do Optical Coherence Tomography or OCT, which gives us a cross section of the nerve. We can see the finer details – whether there is any swelling of the nerve, whether there are any bumps on the nerve, and also gives us the thickness of the retina.
In glaucoma patients, the retina becomes thin because the loss of nerve fibres. So based on the analytical graphs, we decide whether the patient has glaucoma or not. These are the tools that are available to us. These are much more advanced tools so it all boils down to the cost factor. So it is definitely better to get your eyes tested in a hospital or any other eye clinic set up.
GetDoc: What is the cause of congenital glaucoma – babies who are born with glaucoma?
Dr Dinesh: Genetics certainly plays a role and several systemic diseases have been implicated as the cause for glaucoma in children. What we do know is that the pressure in the eyes of the baby in question is very high during the gestation period. So the baby is born with abnormally large eyeballs.
Image source from pinterest.com
Many a time parents do not notice the abnormal size of the child’s eyes, they tend to be very happy that the eyes of their child is big. If you have a new-born baby and notice his/her eyes are very bigger than usual, please tell the parents to get the baby checked because it may look normal, but the pressure may be high inside the eye. Also is the child has intolerance to light or squeezes the eye all the time then an eye examination is warranted. If left untreated, it will lead to childhood blindness in few years’ time. Congenital glaucoma is very difficult to treat.
GetDoc: Is it difficult to do an eye check-up for babies?
Dr Dinesh: No, because there are qualified Paediatric Ophthalmologists in the country – eye doctors who are specialised to see children. For normal eye checks, any qualified ophthalmologists would do. But if there is something specially required for the child, then a paediatric ophthalmologist is the best person to visit.
GetDoc: Can external factors like TV, or the fact that a lot of people are spending a lot of time on the screens right now, cause glaucoma?
Dr Dinesh: No. Not that I know of. I haven’t come across any such cases. On the other hand, prolonged exposure to gadgets like iPads, smartphones, etc. does present other implications. A lot of research is being done on the effect of blue light on the eye. The results have not been very convincing to the researchers. Although glaucoma is not caused by usage of phones or tablets, but you can get early presbyopia from prolonged usage. Presbyopia usually occurs at around the age of 40, when people are unable to read or work at the computer and require reading glasses. As mentioned, those who do a lot of near work with their phones and their iPads etc. develop presbyopia much earlier, maybe when they are 35 years old. That is the new trend we are observing now. We are seeing an increasing number of younger people having problems with reading. Some of them need to start wearing reading glasses in their 30s. It used to be around the age of 42-45.
Presbyopia (Image source from contactlenses.co.uk)
We are also seeing more children coming in with visual problems where they need to wear glasses early in life, because they are hooked onto all these gadgets. Of course you are also getting orthopaedic problems too due to gadget usage, because when you play a lot of games, you will get something called “trigger finger”. You also get a lot of problems on the neck, upper back and lower back. Working at computer terminal more than 12 hours a day, in an uncorrect posture, with improper chair which is not ergonomically designed is not healthy for the body. So there’s a whole new syndrome called “computer vision syndrome”, it’s a new spectrum now, new diseases that arise because of these gadgets.
GetDoc: There is no cure for glaucoma, is there any medical advancement/research being done in this field?
Dr Dinesh: Yes. There is revolution in terms of eye drops. There are a lot of new eye drops available in the market these days. We have grown from single medication to combination drops. Patients used to carry few eye drop bottles for different medication, which is very inconvenient. Now we have multiple medications in just one bottle of eye drop, there are two or more different medications combined in the bottle, making it more convenient for patient to apply.
This gives more ease to patient in instilling drops and make them more comfortable in applying the eye drops. It will also reduce the chances of them forgetting their medication. Having just one bottle can ensure the compliance is good.
Reaseach and Therapy for Glaucoma is ongoing. There are no tablets to control glaucoma like antibiotics. Good news for patients is that surgery has advanced quite a bit over the years. Although surgeries provides good pressure control, they do have a lifespan meaning it may not always be successful. As far as possible, we try to avoid surgery, because the medications do a very good job at controlling the pressure. If the medication is not working, we will recommend surgery.
GetDoc: How important is awareness and patient education in Malaysia? And how are we doing in Malaysia so far?
Dr Dinesh: Patient education is very important when it comes to medicine. In general, when we talk about medical conditions, the awareness about it is actually not adequate. Efforts are being put in, but somehow it’s not giving us the result we expect. Massive awareness is needed, especially when it comes to glaucoma. Diabetics seem to better taken care of, since many of them have already been going for eye check-ups. The health clinics do refer their patients for eye check-ups immediately once the patient is diagnosed with diabetes. But as far as eye conditions like glaucoma are concerned, I think the awareness is still lacking. We need to buck up a bit. We are trying to create awareness around the world. Our counterparts in Singapore are very much ahead when it comes to glaucoma awareness, treatment and such.
GetDoc: Any initiatives from hospitals or associations?
Dr: Yes, there is a glaucoma society. We have the Malaysian Ophthalmology Society. They are doing their best to create awareness among the public. A lot of programmes are launched during World Glaucoma Day or World Sight Day. During these times, almost all the hospitals will have free eye screening or free check-ups. Of course, private practices/stand-alone clinics also do on-and-off free eye-screening in shopping malls. Basically just to create as much awareness as we can to the general public. The relevant information is already there, but dissemination of information is where we are lacking.
GetDoc: So how can we do better?
Dr Dinesh: I think we can really utilise social media, like Facebook or WhatsApp to our benefit given their reach. But as doctors, we have laws and ethics to abide to. I feel social media is a good platform to pass on valuable information since almost everybody has WhatsApp these days. Elderly people are also quite familiar with WhatsApp. So I think that will be a good way to disseminate information. Besides that, the information should be disseminated in different languages as well, not only in English. It will be good if information is disseminated in the 4 main languages – Tamil, Malay, Mandarin and English.
Thank you very much Dr Dinesh for the insightful interview. We hope our readers take this seriously and get their eyes checked regularly as well.
by Qian
Qian's interest in healthcare industry came about after her father was diagnosed with bladder cancer. This experience has led her to become a strong believer in empowering individuals to take charge of their own health. View all articles by Qian.
