Poor compliance with treatment regimen is the biggest challenge in managing Glaucoma patients — Omoti

Prof. Afekhide Ernest Omoti is the Chairman, National Eye Health Committee of the Federal Ministry of Health and Social Welfare. He is also the Chairman, Eye Health Committee of the Nigerian Medical Association (NMA).  In this interview with MICHAEL EGBEJULE, the professor of ophthalmology speaks on the causes and effects of glaucoma, emphasising that frequent eye exams are key to early diagnosis and management of patients. Excerpts:

The 2025 World Glaucoma Week was marked from March 9-15. What exactly is glaucoma all about?
Glaucoma is a group of diseases that damages the optic nerve of the eye resulting in vision loss and eventually irreversible blindness if not well managed. The optic nerve is the structure that carries visual information from the eye to the brain. The most important and modifiable risk factor for this damage is high pressure in the eye.
 
Glaucoma is the world’s second leading cause of blindness after cataract. However, glaucoma is the leading cause of preventable irreversible blindness worldwide.
 
Globally, there are an estimated 78 million people diagnosed with glaucoma, and this number is projected to rise to 95.4 million by the year 2030, and 111.8 million by 2040. One in 200 people aged 40 has glaucoma, with the prevalence increasing to one in eight by age 80. Over 7.7 million persons have moderate to severe distance visual impairment or blindness from glaucoma. As the global population ages, the incidence of glaucoma is expected to escalate, making it a growing public health concern.
  
In Nigeria, it is more common in older people, particularly men, and in the Igbo ethnic group. As much as 5.02 per cent of Nigerians have glaucoma and up to 16.7 per cent of blindness in Nigeria is due to glaucoma. Eight in 100 Nigerians over the age of 40 have glaucoma. Nine out of 10 of them don’t know they have glaucoma. Five out of 10 of them will present with blindness in one eye, and two out of 10 will present with blindness in both eyes; 1.2 million people 40 years and above are blind from glaucoma.

How did Nigeria mark the World Glaucoma Week 2025?
  The theme for World Glaucoma Week 2025 is “Uniting for a Glaucoma-free World.” This theme emphasises the importance of early detection, regular eye examinations, and community education to prevent vision loss. The goal is to raise awareness about glaucoma, promote early detection, and encourage people to get tested.
 
In Nigeria, the Federal Ministry of Health and Social Welfare, the National Eye Health Programme (NEHP), the Nigerian Medical Association (NMA), the Ophthalmological Society of Nigeria (OSN), the Nigerian Optometric Association (NOA), the Nigerian Ophthalmic Nurses Association, and the Association of Nigerian Dispensing Opticians (ANDO) were involved in the activities to mark this event in all the states of Nigeria and in various health institutions.

Who is at risk for glaucoma?
 Individuals over 40 but all ages can be affected. People with a family history of glaucoma; people of African, Hispanic, or Asian descent are also at risk. We also have people with high intraocular pressure; this is the only modifiable risk factor. There are other people with thin corneas, people with pre-existing conditions such as diabetes, hypertension, and migraines. Also, we have people with Myopia (near sighted); people who are far sighted (hypermetropia); people with eye injuries and people on prolonged corticosteroid use.

What are the types of glaucoma?
  There are many types of glaucoma that are classified using various criteria. By age, there is congenital glaucoma, infantile glaucoma, juvenile glaucoma, and adult onset glaucoma. By the cause, glaucoma may be primary (where there is no identifiable cause) or secondary (where there is a known cause).
  
By the appearance of the angle of the eye, it may be classified into open angle glaucoma or angle closure glaucoma. And by the level of the intraocular pressure, it may be classified into high-tension glaucoma and normal tension glaucoma. Clinically, it may be classified into acute glaucoma and chronic glaucoma.

What are the symptoms of glaucoma?
  The symptoms depend on the type and stage of the glaucoma. The open-angle glaucoma is by far the most common form of glaucoma in Nigeria. No symptoms are experienced in the early stages. That is why it is called a “sneak thief of sight.” Gradually, patchy blind spots may occur on the side or peripheral vision and eventually loss of side vision with tripping over obstacles or bumping into objects. In later stages, difficulty in seeing things in the central vision may occur. Glaucoma adversely impacts walking, driving, reading, adjusting to light, night vision, seeing peripheral objects, and moving objects coming from the side. Motor vehicle accidents and injuries related to falls are potential serious consequences.

What are the common myths or misconceptions about glaucoma?
  There is no cure for glaucoma. Those advertising various cures for glaucoma are fraudsters and are spreading fake news. Glaucoma can only be managed to prevent blindness. It is a misconception that glaucoma only affects old people. All ages can be affected, but it is more common in old people. It is a misconception that glaucoma only occurs with high eye pressure. Up to a third of cases of glaucoma have normal eye pressures. It is a myth that people with good vision cannot have glaucoma. Anyone can have glaucoma irrespective of his or her visual acuity.
 
It is a myth that “no one in my family has glaucoma, which means I won’t get the disease.” The truth is that while glaucoma can be hereditary, there are many glaucoma patients without a family history of the condition. There’s also the possibility that family members did have the disease but were never examined adequately for glaucoma. That’s why all patients diagnosed with glaucoma should make sure their family members are examined for it.
 
It is a myth that “a person with glaucoma will eventually become completely blind.” If glaucoma is diagnosed early and adequately managed, it does not lead to blindness for most people. Frequent eye exams are the key to early diagnosis. With modern treatment, glaucoma is controllable.
 
It is a myth that “there’s no treatment for glaucoma.” While glaucoma is not curable, it is highly treatable. Many effective treatments are available, including eye drop medications, injectable medications, oral medicines, and laser and surgical procedures to help halt glaucoma progression.
 
It is also a myth that “the symptoms of glaucoma are noticeable.” Glaucoma is known to silently creep up and slowly damage the eyesight of a person. The symptoms of open-angle glaucoma, the most common form of glaucoma, are not quite noticeable at first. So, people with apparently perfect vision may have glaucoma and yet be unaware of it. However, once the damage becomes extensive, symptoms eventually show up. That’s why it’s so critical to have regular eye exams.

What can be done to increase public awareness and education about glaucoma?
  To increase public awareness and education about glaucoma, you can utilise various methods like leveraging social media campaigns, partnering with healthcare providers and community organisations, distributing informative materials, organising awareness events, utilising traditional media outlets like radio and television, and incorporating educational content into existing health programmes; emphasising the importance of regular eye exams, especially for high-risk populations, and highlighting the potential for vision loss if left untreated.

Is there a need for more government funding?
  Oh yes, modern facilities for screening and for making a diagnosis of glaucoma, particularly at the early stages when treatment is most important, are quite expensive. They include the tonometer for measuring the eye pressure, the slit lamp biomicroscope for examining the eye, the gonioscope to help classify the glaucoma, the visual field machine for determination of the visual field defects, the optical coherence tomography machine for imaging the eye, which is invaluable in the early stages of glaucoma, and a number of others. The drugs required for treatment are also becoming more expensive. Many hospitals, even tertiary hospitals, are currently unable to afford these machines. Considering the fact that these hospitals are involved in training ophthalmologists, these machines are absolutely essential. They will, therefore, require increased funding by the government to achieve this.

What are the biggest challenges you face in treating glaucoma patients?
  There are many challenges in the management of glaucoma, ranging from late presentation, difficulties with early diagnosis, appropriate choice of therapy, poor compliance with the treatment regimen, and poor follow-up. The biggest challenge has been poor compliance of glaucoma patients with the treatment regimen. Africans frequently find it difficult to grasp the concept of control rather than cure. The fact that there is no improvement in vision with treatment makes many people unable to comply with the treatment regimen.

What are the latest advancements in glaucoma detection and treatment?
 The latest advancements in detection of glaucoma involve the use of artificial intelligence (AI) integrated with sophisticated imaging techniques like Optical Coherence Tomography allowing for earlier detection.

How important is early detection and patient adherence to treatment in managing glaucoma effectively?
Early detection and patient adherence to treatment are the two most important factors in successful management of glaucoma and prevention of vision loss.

What advice do you give for newly diagnosed glaucoma patients to help them cope and manage their condition?
If you have been newly diagnosed with glaucoma, the most important advice is to strictly follow your eye doctor’s instructions regarding medication usage, regular check-ups, and lifestyle modifications. This includes taking prescribed eye drops as directed, maintaining a healthy lifestyle with regular exercise, and limiting caffeine intake, as these actions can significantly help manage your condition and prevent vision loss. The patient should try to understand the nature of the disease and know the medications they are using.

How often should people get their eyes checked to ensure early detection of glaucoma?
Under 40 years – every two to five years; 40-54 years – every one to three years; 55-64 years – every one to two years; 65 years and above – every one to two years.