Glaucoma: How to save your sight

Glaucoma is infamous as ΄the sneak thief of sight΄: the most common types give no warning they are slowly, progressively destroying a person΄s vision. Because usually the vision at first is affected to the side, patients notice little, if anything. By the time an individual realizes something is wrong, there may have been considerable damage.

Why write a book about it? And why dedicate it to all patients with glaucoma, to their relatives and friends, to the general community as well as to ophthalmologists, other doctors and eye health care practitioners who wish to be familiar with management of this group of diseases?

Undisturbed, glaucoma blinds people. It respects neither gender nor education; it ignores wealth and privilege. We have no cure for it and we cannot reverse the damage that it has caused. Glaucoma affects about 2% of people over 40 years of age. It is not rare. It is the commonest cause of irreversible and preventable visual disability everywhere.

But most of the time we can control it. Successful protection of vision depends in part on how much damage has been done when first detected and how aggressive the disease is for an individual patient. So the earlier glaucoma is diagnosed, the less damage that has been caused, the better the long-term outlook.

Early detection requires informed communities whose members seek eye examinations as well as knowledgeable and appropriately equipped eye health care professionals who recognize subtle warning signs and arrange timely ophthalmological confirmation and initiation of effective treatment. This requires access to a worthwhile health system.

Even in developed societies, about 50% of patients with glaucoma have not been diagnosed and are not on treatment. Half of these undiagnosed people have been seen by an eye health care practitioner in the last two years.

We wish to enlighten our readers with quality information to minimise visual disability from glaucoma.

Ivan Goldberg
Remo Susanna Jr.

Preface

1. Introduction

2. Improved care

3. The seven ΄sins΄ in glaucoma

4. Glaucoma treatment

5. Most common myths in glaucoma

6. Other forms of glaucoma worth knowing about

7. Glaucoma and cataract together

Appendix 1: How to instil eye drops

Appendix 2: How to do the best-possible visual field test

About the authors

Frequently asked questions

Assoc Prof Anne Brooks, President of ANZGIG and Glaucoma General Clinic, Royal Victorian Eye and Ear Hospital, Melbourne

This is an excellent well written book which fills a great unmet need in glaucoma education for patients. It is easy to read, full of important information and a must for people with glaucoma and their families but also of great wider general interest. I highly commend this book.

A comprehensive patient’s guide for minimizing visual disability from glaucoma
Reviewed by Nahum Goldmann*

This impressive, well written, highly practical and timely book is a necessary read for people afflicted with glaucoma, as well as their relatives and friends. For a novice, on whom this critical topic has just been imposed upon, it covers virtually all complex health and medical issues that are necessary to control, or at least to slow down, the negative effects of this debilitating disease. Even health professionals with a solid knowledge of glaucoma would likely learn something new.

As explained in the Preface, glaucoma is not that rare, afflicting 2% of people over 40. The most common types of glaucoma give no warning that this sneaky disease slowly but increasingly destroys person’s vision. By the time one recognizes that something is wrong, it is irreversible and there is no known cure. But this book also offers hope. With early detection and aggressive treatment the damage can often be slowed down. For patients and health care workers, the book provides vital information on how glaucoma blindness can be prevented or treated.

In Chapter 2 ‘Improved care’, demonstrates that even in advanced countries, like Sweden or the US, the depressing statistics for glaucoma blindness has not changed much within the last 40 years. This book is aimed at enhancing understanding and assisting in a meaningful interaction between patients and their physicians. The authors believe that this situation could substantially improve with more patients’ knowledge and initiative to become involved in their own care.

Chapter 3 cover in much details ‘seven deadly sins’ that can contribute to visual disability from glaucoma, namely non diagnosis; failure to recognize progressive damage; inaccurate diagnosis (as the same term in fact covers various diseases that are sometimes difficult to differentiate and hence properly treat); failure to treat aggressively more severe phases of disease; insufficient reduction in the eye pressure; treatment delays (in some cases glaucoma might evolve quite rapidly); and neglecting the treatment.

Even though reducing eye pressure often slows the disease’s progression, regretfully a large share of patients often abandons or uses irregularly tedious and expensive ongoing treatments. Also covered are risk factors due to gender, genetic variations for various populations, family history (for persons with a close relative afflicted by glaucoma, the risk of having glaucoma increases ten-fold!), as well as certain medical conditions, like high-blood pressure or diabetes, and use of some medications. Regretfully, sometimes no treatment can help a particular patient or even an experienced clinician might be deceived by the course of this disease.

The book provides clear explanations and numerous colored illustrations that demonstrate the complex physiology of glaucoma. It explains modern diagnostic tests, as well as charts and equipment typically used for glaucoma treatment within developed countries. As the book rightfully says, glaucoma patients require more precise and agile ongoing monitoring testing methods. There is an acute need for simple, flexible and accurate continual monitoring of the intraocular pressure (IOP) of glaucoma sufferers. In particular, we should be on lookout for inventors who can develop a technology capable of being used at home by the patients themselves, without the intervention of medical staff. Such a device should monitors IOP 24 hours per day over several days and, ideally, not require direct contact with patient’s eyes, while being cost-effective.

Chapter 4 covers glaucoma treatment, such as various types of medications, laser surgery, possible complications and procedures. Chapter 5 answers frequently asked questions; whereas chapters 6 and 7 is dedicated to relevant physiological conditions. Useful appendices give pragmatic step by step advice on how to administer eye drops or to prepare for the visual field test.

Overall, this valuable book is a ‘must have’ reference both for the patients and health experts. Its only shortcoming is the lack of electronic edition that could be read to visually impaired patients by their electronic gadgets or being translated on the fly to many non English speaking readers.

*Goldmann’s latest book is ‘Effective Decision Making: A Primer in Information Retrieval’

Geoff Pollard, National Executive Officer, Glaucoma Australia

A diagnosis of glaucoma can be a confusing time. The eye health professional and the person with glaucoma can be thrust into a complex ‘information dance’ with much information being provided at the time when it can be least absorbed. The clinician thinks “I’ve done my job” whilst the patient’s take home message is “what did they say about glaucoma, will I go blind?”

Glaucoma: How to Save Your Sight! is a book written for such a time. It provides quality information to assist the person with glaucoma to understand their disease whilst dispelling some of the myths that may de-rail a successful treatment outcome of minimizing visual disability from glaucoma. I recommend this book to those wanting an in-depth understanding of the disease process and what they can do to enhance their own glaucoma patient journey.