Glaucoma surgery won’t cause blindness, ophthalmologists tell patients

Leading eye experts in the country have allayed the fears of glaucoma patients of going blind after undergoing surgery.

The ophthalmologists, in separate exclusive interviews with PUNCH Healthwise, stated that while the fear of going blind was valid, glaucoma surgery could not cause blindness, rather it would delay the onset of blindness and retain their current level of vision.

They also asserted that the surgery would  not improve their vision or reverse blindness.

According to the National Eye Institute, Glaucoma is a group of eye diseases that could cause vision loss and blindness due to damage to the optic nerve.

The symptoms are mostly unnoticeable until gradual vision loss sets in, but it can be detected early through an eye test.

Previous studies conducted by ophthalmologists who spoke to PUNCH Healthwise showed that the fear of going blind was the most common reason glaucoma patients refused surgery.

The Chairman of the National Eye Health Committee at the Federal Ministry of Health, Professor Afekhide Omoti, said about 1.4 million Nigerians have glaucoma and one in five persons above 40 years old will experience glaucoma.

He also said it was the second leading form of blindness in Nigeria after cataracts and the leading cause of irreversible blindness.

Although there is no cure for glaucoma, medical, laser and surgical treatment are the methods of treatment.

The risk factors are age, genetics, hypertension, short-sightedness, migraine and familial history of glaucoma.

The experts urged persons with a family history of glaucoma and adults above 40 years to see an ophthalmologist every year.

Speaking with PUNCH Healthwise, Omoti, who is a professor of Ophthalmology at the University of Benin, Edo State, stated that there was currently no cure for glaucoma, adding that it was the leading cause of irreversible blindness.

He further noted that although glaucoma caused irreversible blindness, surgery was one of the ways to delay the onset of blindness.

“It is a blinding disease, no doubt because the pressure in the eye is high and it gradually destroys the optic nerve which carries vision from the eyes to the brain. Until the nerve is damaged to over 70 per cent before the individual begins to feel the symptom that something is wrong. So for many people when they are told that they have glaucoma, it is not surprising that they would be afraid of blindness,” he said.

The eye surgeon further noted that glaucoma had no cure and could be treated with drugs which are mostly eye drops, laser and surgery.

“All the kinds of treatments aim to reduce the eye pressure to a level where no further damage occurs. If you use eye drops, the pressure drops but once you stop the eye drop, the pressure rises again. But there are issues with the eye drops, such as the compliance of the drugs administration, the menace of fake drugs and the ability to abide by the required temperature storage and exposure.

“Lasers are not so commonly available and not effective for black people but they work. But the recommended treatment we rely on in Africa is surgery,” he said.

The researcher in Glaucoma and Anterior Segment Disorders, however, noted that in a study he conducted, only 32 per cent of glaucoma patients would accept to have surgery at the initial state and only a few would go through with the surgery, citing fear as one of the major reasons for rejecting surgery.

Omoti further stated, “Many might have seen patients who after the surgery went blind but it is not as a result of the surgery. It is also possible that as a result of complications during surgery, the patient’s vision drops further or goes blind. Still, surgery is the most reliable way to keep the eye pressure low enough to prevent further deterioration in vision. But many would rather want to err on the side of caution and decide to use an eye drop instead of undergoing surgery. But the eye drop is useful for someone who can afford them and can be relied on to take them as and when due.”

He asserted that the eye drops could neither improve vision nor proffer a cure for the condition.

Omoti then stated that the fear of going blind after the surgery was not justified, stating that the chance of it happening was low.

He said, “Surgery is such that you are creating a hole in the eye to allow fluid to drain out and to make the eye softer so that blood can flow in easier. After surgery, the patient still needs to be monitored.

“Another major reason people may be afraid of glaucoma surgery is that they know that if they do the surgery, their sight will not improve so they refuse to do it. However, surgery in the short term may be expensive but in the long run, cheaper than eye drops. The surgery helps to retain the current level of vision for a much longer period as there is no cure for glaucoma-induced blindness.”

The eye surgeon further noted that the treatment was difficult in people from the black race, noting that in Nigeria, people from the South East had a higher risk of glaucoma due to some genetic traits that were found through research.

Also, a professor of Ophthalmology at the Osun State University, Michaeline Isawumi, stated that the fear of blindness was common in patients with advanced glaucoma.

She further noted that although surgery was done to maintain the current level of vision and prevent it from deteriorating, many patients still expected improved vision after surgery.

The researcher on Childhood Eye Diseases and Blindness further noted, “However, a patient with advanced glaucoma usually has very constricted visual fields. So, if care is not taken, the remaining constricted or narrow field of vision could be wiped off and the patient goes blind after surgery.

“Surgery cannot improve vision but most patients expect improvements after surgery, which can never occur especially in advanced glaucoma. Other post-surgical complications such as infections of the inner eye (endophthalmitis) and cataracts could occur which can lead to blindness. These are usually not very often and not common. However, the cataract can be operated upon and the patient’s vision can be restored. This is only possible in patients who do not have advanced glaucoma with previously narrow fields of vision.”

Isawumi, who is the Dean of Clinical Sciences at OSU, noted that glaucoma was a condition that was better prevented, calling for a yearly eye check with an ophthalmologist for persons above 40 years.

“Then for patients with a family history of glaucoma, every adult member of that family should visit the Ophthalmologist every year for a checkup. This should continue for three to four generations since there is a family history. It should be made known to generations to come.

“To prevent blindness among glaucoma patients, they must be steadfast with their drugs, having them in stock all the time. At least two to three doses of the drugs must always be on the ground,” the don advised.

Another Professor and Consultant Ophthalmologist at the Lagos State University Teaching Hospital, Ikeja, Bola Adekoya, stated that the fear of surgery was a valid concern medical practitioners put into consideration during conversations with patients in need of surgery.

She noted that the affordability, availability and reliability of the effectiveness of the medical treatment, which is the use of eye drops, made surgery the recommended treatment plan.

The don stated “For the majority of our patients, because in most of our centres we don’t have all the required lasers, surgery is usually the next step, which is required to ensure that we stabilise the vision.

“The patient’s concerns are valid but we see that the benefit far outweighs the risk of not having surgery because if we don’t do a further intervention like surgery, there is an almost 100 per cent guarantee that if the pressure is not well controlled, the patient would lose their vision along the line. So, the fear of surgery is valid but if they don’t undergo surgery, they further lose vision.”

She explained that the benefits and the surgical process were clearly explained to the patients but the ultimate decision was the patients.

The ophthalmologist also said that the patients were properly counselled and at times referred to dedicated counsellors to ensure that their fears were allayed.

The Researcher on Glaucoma further noted that most patients declined to have surgery and left but returned months later with deteriorated vision.

“With each deterioration of vision, that person’s visual capacity is reduced, so that makes the surgery a higher risk than when they still had a higher level of vision. No matter how little vision is in the eye, if a patient needs surgery and the medical treatment being undergone is not controlling their pressures very well, they need surgery because the alternative is the finality of blindness,” Adekoya said.

The ophthalmologist also noted that glaucoma was more severe in Blacks than in Caucasians and urged patients with a familial history of glaucoma to present early to the eye centres.Glaucoma surgery won’t cause blindness, ophthalmologists tell patients