Losing Vision, Losing Time: Glaucoma Challenges in Rural India

Glaucoma poses a serious threat in rural India due to late diagnosis and limited care. In conversation with FE Healthcare, Dr. Asim Kumar Sil, Medical Director, Vivekananda Mission Asram Netra Niramay Niketan, West Bengal, discusses the challenges associated with diagnosing glaucoma in the rural areas.

 

What are the challenges in diagnosing glaucoma in the rural areas? 

 

Glaucoma has certain specific challenges. The first challenge is that most of the glaucomas are asymptomatic. The patients cannot identify glaucoma themselves, and when the patients come to us with symptoms, it is quite late. Presentation of glaucoma in rural areas is very late. Often, there is no appropriate eye care facility for the treatment of glaucoma in the rural areas in most parts of India. 

 

If we think of the eye care providers, many of us do not actively look for the presence of glaucoma. It is often detected by opportunistic screening. For instance, if a person comes for refraction or foreign body or any kind of allergy or for minor problems, it is the responsibility of the treating doctor to ensure that the patient is not suffering from glaucoma. The vision loss in glaucoma is irreversible, and if it is not picked up in time and treated adequately, we cannot bring back the vision.

 

In cataract, the vision worsens. We remove the cataract, and after successful implantation of an intraocular lens, the patient gets back the original vision. Another big challenge is that the medicines are very costly. Some patients need more than one. Patients need even three medicines. And that adds to their financial burden. Many patients with advanced glaucoma have to keep their eye pressure under control. They need to spend about ₹1,000 per month for medication. This is not possible for many of the people living in rural areas, and especially for the elderly and people who depend on others for their income. And in rural areas, in many places the antiglaucoma medicines are not freely available. 

 

How can the problem of glaucoma be mitigated?

 

Glaucoma is a condition that can be prevented by a number of ways, the most important one being spreading awareness among the common people that everyone above 35 years of age should have an eye check-up at the earliest, even if there is no problem. Also, those people who are engaged in screening should actively look for the signs of glaucoma. At the primary healthcare level where there are no doctors, optometrists must see the patients.

 

What is the importance of family history in glaucoma screening, and how does the government support treatment options for glaucoma patients in India?

 

The awareness should be there that glaucoma runs in families. If the father or mother has glaucoma, then their siblings and their children should also have an eye check after the age of 35 years to rule out any possible presence of glaucoma in their eyes.

 

The surgery for glaucoma is supported by the national program. But initially we treat the patients with drops, mostly eye drops. If the patient's intraocular pressure is not controlled by drops, we perform surgery that is supported by the government. 

 

What steps should the government take to improve glaucoma screening and treatment at the primary and district healthcare levels, and why is early genetic diagnosis particularly important for childhood and juvenile glaucoma?

 

The government should make sure that primary health centers have at least optometrists who are trained to conduct glaucoma screening. Furthermore, hospitals at the district level should have all the necessary equipment for the diagnosis and treatment of glaucoma. Thus the government is a key stakeholder in this.

 

Timely intervention is of utmost importance here, since glaucoma in children under 18 is the fastest progressing kind of disease in this age group. A genetic test is especially important in the case of a positive family history. First, this step provides a permanent record of the child's condition. If there is any change, treatment can begin in a timely and effective manner. To sum up, the introduction of genetic analysis in government healthcare policies at least in the case of juvenile and childhood glaucoma is a must for its proper management and treatment.