The most common cause of blindness in Poland is glaucoma, but almost half of the patients do not know that they suffer from it. Moreover, of those who have it, only 8 to 16 percent receive treatment. Why each of us should be tested for glaucoma, and if it is detected, strictly follow the doctor's instructions, we talk to Dr. Barbara Polaczek-Krupa, an eye disease specialist at the Ophthalmology Center Targowa 2.
Glaucoma , if not properly treated, causes irreversible blindness. It is a disease that does not forgive mistakes. The only really effective method of fighting glaucoma is prophylaxis - tests carried out on appropriate equipment by an experienced diagnostician. What myths still circulate about the disease, and why, despite advances in diagnosis and pharmacotherapy, still so many people lose their eyesight as a result of glaucoma? These questions are answered by Barbara Polaczek-Krupa, MD, PhD, specialist in eye diseases from the Ophthalmology Center Targowa 2.
What you don't know about glaucoma
- Doctor, what is glaucoma really?
Generally speaking, glaucoma is a group of chronic, slowly progressing neuropathies, i.e. atrophy of the optic nerve. It leads to the death of nerve cells and a gradual loss of vision, most often unnoticed by the sick person until the late stages. In the definition of glaucoma, it is worth noting that it is not a single disease, but a whole group of neuropathies that differ in their causes, course, prognosis, and hence treatment. Hence the importance of proper diagnosis, which is a very difficult matter even for an experienced physician. The common denominator of the different types of glaucoma is that untreated or poorly treated, it always leads to complete and irreversible blindness.
- Why talk about glaucoma?
The first reason is that knowledge about what glaucoma is is still very small - so small that the average Pole often confuses it with cataracts. And yet it is glaucoma that has been the first cause of total and irreversible blindness for many years, both in Poland and in highly developed countries, and there is no indication that this will change. In Poland - based on general statistics - it is estimated that 750-800 thousand people suffer from glaucoma. people, i.e. about 2% of the population, and diagnosedthere are only slightly more than half of glaucoma cases: 420,000 According to CEESTAHC forecasts, the number of detected cases of the disease will increase to 600,000. in 2035. In the world, 67-70 million people suffer from glaucoma (approx. 1% of the population). WHO forecasts an increase in the incidence of 80 million people by 2022, and 11 million people will lose their eyesight from glaucoma during this time. This means a double increase since the 1990s from the level of 5.2 million (WHO, 1994). Secondly, this trend can be stopped and even reversed, but only if we continuously educate the public, patients and doctors. Because the basis of the fight against glaucoma at every stage is prevention, i.e. specialist examinations performed in advance and regularly.
- What should prompt us to undergo glaucoma screening? Symptoms or common sense?
If we want to avoid irreversible loss of vision, we should definitely be referred to a doctor by common sense, not ailments, because if a patient presents with glaucoma symptoms, the chances of successfully stopping the disease progression significantly decrease. It is worth emphasizing that the first symptom of glaucoma is often a sudden loss of vision. Of course, it is only sudden for the patient, because in order for it to happen, the disease process must have been going on for at least ten years.
- Why does the patient not notice before that something is wrong with his eyesight?
He does not notice because glaucoma does not worsen visual acuity, it only impairs the field of vision. It begins to narrow them down from the nasal parts, from the circumference. Since the peripheral parts of the visual field are not directly involved in visual acuity, the patient cannot notice that something is wrong. The physiology of our brain also works to its disadvantage - when one eye sees worse, the other tries to compensate for it. And if visual field examination is not performed, these changes may be unnoticeable for a long time. Only when the visual field defects begin to cover the center, then there is a sharp deterioration of vision, prompting the patient to visit a doctor. Unfortunately, it is also a signal that glaucoma is already very advanced and treatment will not bring the expected results.
- So the lack of symptoms is the greatest danger associated with this disease?
Yes, as many as 90% of glaucoma cases are asymptomatic for a long time, which means that about 50% of glaucoma patients are unaware of their disease.
For us, doctors, these are particularly depressing data, because we know that thanks to modern drugs and with the proper involvement of the patient, we could save the eyesight of 85% of patients in whomglaucoma is detected early.
It is the lack of symptoms that causes 90% of patients to be diagnosed accidentally, during mandatory employee examinations, selection of glasses, during visits to an ophthalmologist for another, often quite trivial reason, because e.g. something fell into the eye. As many as 70% of cases are detected too late for effective treatment. Moreover, because glaucoma is not associated with symptoms such as pain or a noticeable deterioration in vision, sick people are not only unaware that they are losing their eyesight imperceptibly because they do not examine themselves, but also - even if they know that they are sick. - do not undertake treatment. Why? The most common arguments are: I can see well, why should I treat myself? And - I will go to the doctor when my eyesight deteriorates. In addition, a large proportion of patients who still go to the office do not follow the doctor's instructions. This is most often due to the fact that when treating glaucoma, the patient usually does not subjectively experience improvement in vision, and often even experiences minor ailments, e.g. pinching of the eyes after using the drops.
- Doctor, how can we improve these depressing statistics?
Only through the multi-pronged education of both society and physicians. The main issue is prevention, i.e. in the case of glaucoma - regular examinations. The diagnostic palette includes the entire set, a dozen or so different tests, but they usually do not need to be performed at once, and not always all of them. The Polish Ophthalmological Society has developed guidelines for the management of glaucoma. By following these guidelines, a clinician can diagnose or rule out glaucoma only on the basis of all major tests required for the diagnostic procedure: stereoscopic evaluation of the II nerve head, tonometry, gonioscopy, and perimetry. Currently, these tests can be performed using modern, non-contact and highly precise laser techniques, unfortunately they are available only in highly specialized, mostly private, glaucoma clinics. It is worth emphasizing after the guidelines that the interpretation of these data must always be made by a specialist doctor and verified with a slit lamp examination. Under no circumstances should the patient interpret the results himself. Preventive examinations should be performed regularly. After the age of 40 even people who do not have glaucoma should be examined at least once every two years. In people at risk or suspected of glaucoma - correspondingly more often. Sick people are already diagnosed often, even several times a year.
- Looking at the statistics, you get the impression that patients choose blindness over treatmentat your own request.
In fact, a large proportion of patients diagnosed with glaucoma are passively waiting for the development of events - they think they can manage treatment, and as long as they do not feel discomfort, it is not so bad. Only that, as I said, if ailments arise, it is too late for effective treatment. Of all diagnosed patients, only about 10 percent are treated - statistics show that there are about 125,000 in Poland. registered patients, but prof. Jerzy Szaflik, during the conference on the occasion of the World Glaucoma Day in 2009, estimated the number of glaucoma patients treated regularly at 65,000.
- What is the most important thing in the treatment of glaucoma from the doctor's point of view?
Early diagnosis and patient cooperation during many years of treatment. Managing a glaucoma patient is a unique challenge for the doctor. Glaucoma varies individually, you need a lot of experience of the attending physician in the field of this disease. Diagnostics is an essential element in the treatment of glaucoma. The quality, class of the equipment on which the tests are performed, as well as the experience and skills of the doctor-diagnostician are the factors that determine the credibility of the results. It is particularly important, and at the same time extremely difficult, to make the patient aware of the need to follow the doctor's instructions. For a patient who is already diagnosed with glaucoma, the doctor must find time to explain why he or she should be treated, even if there are no symptoms. It happens that patients do not understand what the disease and its treatment are. Treatment of glaucoma is not aimed at subjectively perceived improvement in the quality of vision by a sick person, but at developing such a procedure that will give the best possible chance of protecting the patient from blindness, often over a long period of time. There are studies (European Glaucoma Society, EGS) which show that there has been no improvement in patient-doctor cooperation for several years. The doctor prescribes treatment, the patient does not follow the recommendations. The problem concerns up to 70% of all cases in the population of people undergoing treatment, and therefore the most aware.
Important8 truths about glaucoma
- Glaucoma is so dangerous that it does not cause any symptoms until the late stages (usually, because there are exceptions). This is a very insidious disease.
- Glaucoma is also dangerous because we go to the doctor because of a subjectively perceived ailment, and not an objectively dangerous disease.
- The only really effective form of fighting glaucoma is prophylaxis.
- The only effective prevention is research.
- Research must becarried out in welfare. If I start to experience glaucoma symptoms, I am in the end stage of the disease and I will not save my eyesight.
- Tests must be carried out by an experienced diagnostician using appropriate equipment. Unfortunately, an ordinary ophthalmological examination is not enough.
- The glaucoma patient must follow the doctor's instructions. Even the best drug will not work if it is not taken.
- The patient risks a lot if the above points do not break through to his awareness. Glaucoma does not forgive mistakes. Glaucoma blindness is irreversible.
We can improve glaucoma statistics by focusing on three things: education, education and education. At the same time, different educational activities should be undertaken with regard to people with undiagnosed disease or in society in general, different towards patients who are already diagnosed but not undergoing treatment, and different towards regularly treated patients. We propose a program that lists the tasks to be performed in particular groups in more detail. And so we think that:
- on a general scale, the following are necessary:
- educating the public, patients and doctors about the disease and its consequences - disseminating preventive examinations - it is not enough to perform 1-2 types of examinations. According to the guidelines of PTO and international societies "diagnosis or exclusion of glaucoma can only be carried out on the basis of the results of all major tests required in the diagnostic procedure" - preventive examinations should be performed regularly; after the age of 40 even people who do not have glaucoma should be performed at least once every 2 years, in people from risk groups with suspected glaucoma - more often, respectively.
- in the population of people diagnosed but not undergoing regular treatment it is necessary:
- patient education, this is how they understood what the disease and its treatment is about - educating doctors, that is, first of all, disseminating the golden diagnostic standard and realizing that it is wrong to make a glaucoma diagnosis on the basis of a single test
- in the population of patients receiving regular treatment, the following should be promoted:
- conscious choice of a doctor - managing a glaucoma patient is a unique challenge for a doctor - glaucoma is individual, you need a really large experience of the attending physician in the field of this disease - conscious choice of facility - in the treatment of glaucoma, diagnostics - quality is a necessary element , classthe equipment on which the tests are performed, as well as the experience and skills of the doctor-diagnostician are factors that determine the credibility of the results. The patient should also be made aware of the need to follow the doctor's recommendations. Even if the patient does not feel any improvement (it is not about improving the sensations, but stopping or slowing the progression of the disease).
Prof. Iwona Grabska-Liberek
Untreated glaucoma can lead to atrophy of the optic nerve and, consequently, to blindness. The disease is usually detected by chance. What are the causes of glaucoma and how to recognize its first symptoms? Listen to our expert prof. Iwona Grabska-Liberek, head of the Department of Ophthalmology at the Clinical Hospital W. Orłowski in Warsaw.
The text uses data from WHO, the Polish Association of the Blind and the Polish Ophthalmology Society