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"Glaucoma is a common problem ignored by many”

“Eye patients do not have to travel outside the country for cataract and glaucoma surgeries”

Naimul Haq
The Starhealth last week spoke to a leading ophthalmologist Dr Deen Mohammed Nurul Huq who is now serving as Associate Professor at the Sir Salimullah College at Mitford Hospital. He joined this profession in 1984 and obtained his fellow college of physician and surgery (FCPS) in 1991 and since then he has been working as a surgeon in different institutes including National Institute of Ophthalmology (NIO). He also practices as a senior consultant at the Ahmad Medical Centre in the city. Dr Deen is an expert on phaco and glaucoma surgery and talked about the common problems of the eye diseases or defects. Dr Deen performs, on average, 200 surgeries both in public and private hospitals.
Dr Deen said, "For those who are blind, the gift of sight is the greatest gift of all. I believe that sight is a basic human right, and that everyone - including those in the world's poorest countries - should have access to the treat-
ment and eye care that they need. This is my motto and today with the modern machinery in hand we can confidently say that eye patients do not have to travel abroad for cataract and glaucoma surgeries.”
Starhealth (SH): What is glaucoma and what are the treatment regimes?
Dr Deen Mohammed (DM) explained. "Glaucoma" is the term for a diverse group of eye diseases, all of which involve progressive damage to the optic nerve. Glaucoma is usually, but not always, accompanied by high intra-ocular (internal) fluid pressure. Optic nerve damage produces certain characteristic defects in the individual's peripheral (side) vision, or visual field."
SH: What are the types of glaucoma? How do they vary?
DM: There are three basic types: primary, secondary and congenital.
Primary glaucoma is the most common type and can be divided into open angle and closed angle glaucoma.
Open angle glaucoma is the
type seen most frequently in the Bangladesh. It is usually detected in its early stages during routine eye examinations.
Closed angle glaucoma, also called acute glaucoma, usually has a sudden onset. It is characterised by eye pain and blurred vision.
Secondary glaucoma occurs as a complication of a variety of other conditions, such as injury, inflammation, vascular disease and diabetes.
Congenital glaucoma is due to a developmental defect in the eye's drainage mechanism.
SH: How is glaucoma detected?
DM: Early detection of open angle glaucoma is extremely important, because there are no early symptoms. Routine eye exams, common after age 45, are a major factor in early detection. People with a family history of glaucoma should be checked at intervals in their 30s or even earlier to establish a baseline.
SH: Does high intraocular pressure inevitably cause blindness?
DM: No. Glaucoma is a lead-
ing cause of blindness, but high pressure within the eye does not inevitably cause sight loss. In some cases, pressure may be elevated without any detectable abnormal change in vision. Conversely, damage can develop in some eyes even when intra-ocular pressure is not above "normal."
SH: When is surgery necessary? What happens in glaucoma surgery?
DM: When medication and laser surgery fail to control progression of glaucoma, a surgical procedure known as a filtering operation is recommended to create an artificial outlet for fluid from the eye, thus lowering intra-ocular pressure. Requiring use of an operating microscope and a local anesthetic, this procedure is performed in the hospital and now being done in the country frequently.
Examine your eye for pressure every six months after age 30
"There are different types of eye diseases but most patients I receive come with complain of cataract, which is quite a com-
mon disease of the old age. But more importantly I have noticed that people are not aware of glaucoma, which is another major problem.
I want to give emphasis on one particular thing that is every people after age of 30 should check for pressure of his or her eyeball. Once the damage is done by the pressure exerted on the optic nerves it is very hard to bring back vision. So it is my advice to all that everyone after the age of 30 should check for pressure of their eye ball.
SH: What is being done to bring all people under the eye care facilities?
Bangladesh also endorsed vision 2020 targets like in other countries in November 2000. Vision 2020 aims at bringing all people under the eye care facilities or in other words everyone should have the access to eye care facility.
We can treat all the preventable blindness. In Bangladesh Sight Savers International has been actively working to the goal of achieving the targets of vision 2020. Helen Keller Intentional,
Islamia Eye Hospital, BIRDEM, Jiban Tori, Bangladesh National Society for Blindness, (BNSB) all these have been working in preventing blindness in the country. But the admirable works they are doing has no coordination which is why I believe progress is not up to the expectation.
facts
There are about 13 lakh people or one per cent of the total populations of the country who are visually impaired or functionally blind, according to World Health Organisation's.
Out of this 13 lakh functionally blind people about 80 per cent are visually impaired due to cataract or cloudy layer naturally formed on the eye lens during old age preventing clear vision. And the good news is such obstruction due to natural process is reversible by simple method. In fact, it is noticed that after surgery patients often gets better vision compared to pre-cataract situation.