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Sunday / July 14.
HomemitwocentsDetecting Glaucoma: It’s Over to You

Detecting Glaucoma: It’s Over to You

Over the ages scientists have discovered cures for many life-changing diseases. Yet still, a cure for glaucoma continues to elude us all. So it’s over to you to make an early diagnosis.

Populations residing in developed nations – like ours – are usually the first to benefit from scientific break throughs. Back in the 1950s and 60s, polio – a simple virus that can cause suffering of the most miserable kind – was a serious issue in Australia, especially in the country areas.

I had relatives who became disabled from contracting the contorting germ. Salk vaccines, first tested in 1952 and delivered en masse in 1956 by needle, were replaced by the oral version Albert Sabin, concocted in the 1960’s. I recall vividly the cherry red fluid on the ‘new’ fangled plastic disposable spoon, which we queued up for at Wagga Primary School. None of us ever developed the disease while some older relatives suffered in rigid metal callipers.

It takes longer to eradicate diseases of this kind in developing nations – wealth, education and sheer numbers present major hurdles. It wasn’t until December ’07, that India celebrated the final throes of the polio virus. The World Health Organisation held a largely symbolic ceremony in Delhi. Several Pakistan and Indian national team members ladled the life-saving anti-polio serum brew so that a number of six-month-old babies – regarded as the ‘last’ potential victims of the disease in India – could be inoculated.

The global eradication of small pox represents a triumph for twentieth century medicine that transcends international borders and religions

The Battles Continue

In Pakistan polio still exists in pockets – mostly in the rural areas, but in some of the more desperate parts of the big cities as well.

In Africa the final battle continues. Even in the poor Muslim areas there is nothing but co-operation with house-to-house search and destroy missions carried out against the virus.

This is in stark contrast to some atrocities in North West Pakistan and neighbouring Afghanistan bad-lands. In the former North West Frontier Province, polio is not the only danger. Tragically, aid workers have been slaughtered by the Taliban who believe immunisation is against the will of Allah – the reasoning being that God’s will determines everyone’s fate. If you catch a disease you deserve it and the consequences that accompany it – ergo, medicine and the purveyors of such comforts, subvert God’s will and must be eliminated (often that means beheading). Mainstream Muslim communities were appalled. The noble attempt to end humanity’s suffering results in man suffering even more.

The global eradication of small pox represents a triumph for twentieth century medicine that transcends international borders and religions. Diphtheria, cholera and gonorrhoea are close to kaput because human endeavour, across vast spaces and involving significant multinational resources, has worked. The battle against diabetes rages from the wealthy western nations such as the USA, through Australia and onto the nations of the sub-continent. Diseases cause enormous personal and community loss.

Leading the World

Australians feel they are among the world leaders in health and medicine. As optometrists we have access to the latest technology and the latest drugs. The prescription and use of therapeutic medicines allow citizens, our patients, to battle disease and illness to a degree that many billions of others do not. Eye care professionals fight many human conditions.

Glaucoma is a disease that is routinely checked for by optometrists and ophthalmologists. It is an insidious disease that sneaks up from behind with very soft feet and then stamps out vision permanently. Limiting and ending useful and productive lives.

When optoms see their patients, they should be sure to check the optic nerve. And ensure there are systems in place for the follow up of glaucoma… After all, nearly half of patients being treated for glaucoma don’t continue with their medication after 12 months according to the World Glaucoma Conference in 2011. In Australia, 50 per cent of glaucoma was undiagnosed!

In January 2012, Dr. Mark J Walland from the Royal Victorian Eye and Ear Hospital had this to say:

“General practitioners are exhorted to examine the optic disc, but are hampered by deficient equipment. Ophthalmologists diagnose and manage glaucoma but are referral-dependent and thus see a selected sample. Optometrists are perfectly positioned to intercept undiagnosed glaucoma cases, through ensuring that every general eye examination includes an assessment of both disc and IOP, and is most specifically sought where there is a family history of the condition.

“Therapeutic training and endorsement mean that optometrists should expect to take an ever greater role in the management of eye disease, but can only do so if at the outset an accurate diagnostic assessment of the patient has been made. The tried and trusted use of a simple condensing lens at binocular slit lamp examination is a sound start, but with the tacitly recognised ‘technophilia’ of optometrists, and the carnival of new technologies for examining the optic disc and peripapillary nerve fibre layer, there really is no longer any excuse for so much glaucoma to remain hidden.

“Vision loss from glaucoma is preventable. Current therapies are effective if the diagnosis is made early enough. Many treatable patients continue to lose visual field because case-detection strategies are incomplete or suffer from a lingering and inappropriate fixation with elevated IOP as the sole diagnostic criterion. Remember: The moment one feels it necessary to check the IOP, it has automatically become necessary to check the optic disc as well. Diagnosis of glaucoma solely on the basis of an IOP measurement is simply not good enough.”

Eradication is the Goal

The value of minimising, preventing and even eradicating human suffering is a dream as much as a goal. Through very real sacrifices of human lives poliomyelitis and some of its relatives may soon be consigned to the rubbish bin of evolution.

It would be yet another dream for glaucoma and its life and lifestyle limiting consequences to join that party. But until science and research deliver a ‘cure’ we rely on the diligence of our local practitioners to get it right.