IT'S called 'the sneak thief of sight,' and it strikes African-Americans at a higher rate than any other race. In fact, a staggering I in every 13 Blacks has glaucoma--a total of about 1.5 million persons of all ages and conditions. Because of a prevalence of other risk factors, Blacks are four to six times more likely to develop the disease than Whites. Not only that, Blacks develop it on average 10 years earlier than Whites and are about 10 times more likely to go blind from it.
The disease, which has not received the attention and publicity of diseases like diabetes, heart disease, and hypertension, has taken the vision of some 120,000 people now living in the United States.
One of the major problems is that many people think glaucoma automatically leads to blindness. Although it is true that there is no cure and that vision impaired by the disease cannot be restored, the progression of the disease, if caught early and properly treated, can usually be halted and sight preserved for a lifetime. The New York-based Glaucoma Foundation, which is leading a national campaign for a greater understanding of the disease, says 90 percent of the people who are blind as a result of glaucoma lost their sight needlessly.
Dr. Kevin C. Greenidge, chairman of the Department of Ophthalmology at the SUNY Health Science Center at Brooklyn and a board member of the Glaucoma Foundation, says that there have been many advances in recent years in treating the disease. 'We're finding that glaucoma may be a different disease in people of African descent requiring more aggressive therapies' he says. 'Our main aim is to lower the pressure buildup within the eye to slow progression of the disease and save sight.'
Anyone, at any age, can develop glaucoma. Infants can be born with the disease, and it can develop in small children. The Glaucoma Foundation says 6 percent of the population over 65 has glaucoma. The more significant risk factors a person has the greater the likelihood that the disease will set in at an earlier age.
Dr. Greenidge says 'diabetes is a risk factor, and hypertension is a risk factor, and being African-American is a risk factor--and if you have those three--there is a significant chance that you may develop glaucoma and you need to be checked on a regular basis. And if you add to that a family history of glaucoma, you probably have a 50-50 chance of getting glaucoma, if not greater.'
A serious problem here is that people, particularly African-American people, wait too long to seek medical attention. 'More than 80 percent of the patients who come into my office for the first time are already almost legally blind,' he says. 'The only thing we can do at that point is to prevent things from getting worse. We can never make it any better.' Experts say people of all incomes and backgrounds wait too long before seeking treatment. 'We're not talking about granny who just doesn't put on her reading glasses,' Dr. Greenidge says. 'We are talking about the movers and shakers of the world. Glaucoma happens so slowly and so insidiously that many times people don't realize they are losing their vision until the disease has progressed greatly.'
To understand the danger and the need for early treatment, one must have some understanding of how the eye operates. Each eye is controlled by fibers that make up the optic nerve, which carry visual images to the brain. The front compartment of the eye is filled with a watery fluid that nourishes the cornea and the lens, providing them with oxygen and vital nutrients. The fluid also provides the necessary pressure to help maintain the shape of the eye. This pressure is called intraocular pressure. When this pressure is too high, it can put extreme pressure on the optic nerve, damaging it and leading to glaucoma. Most, but not all glaucoma diseases, are characterized by increased fluid pressure in the eye.
Because there are usually no early symptoms, glaucoma must be detected through a comprehensive and painless eye exam. During the exam, the doctor checks fluid pressure in the eyes, examines visions at various distances, and dilates pupils with drops to inspect the optic nerve. Corneal thickness is also measured, and, if needed, the patient's visual field will be checked to measure side vision.
In the early stages, glaucoma is usually treated with daily eye drops to lower the pressure on the eye. Eye drops can actually delay or prevent the onset of glaucoma in people with elevated eye pressure. When eye drops are ineffective, surgery may be needed.
When 72-year-old Louise Hackett was told she had glaucoma about 10 years ago, she was overwhelmed with emotion. 'I cried,' says the Washington, D.C., resident. 'People treat you bad enough when you can see. Lord knows how they would treat you when you're blind.'
But once the retired domestic worker realized that having glaucoma wasn't a death sentence or a guarantee that she would go blind, she took on the disease relentlessly. Her medical regimen includes regular doctor visits and eye drops three times a day. As a result, her vision has been stable for the last decade.
This proves, among other things, that there is life after glaucoma, says her eye doctor, Dr. Leslie Stiff Jones, director of glaucoma services at Howard University Hospital and assistant professor of ophthalmology at the Howard University Medical School. 'Glaucoma,' she says, 'is not like cataracts in which you have surgery to remove them and you kind of don't have to worry about it again.'
One of the main concerns for Dr. Jones and other physicians is the lack of compliance. 'People often don't take their drops or they start taking them right before they go to the doctor' she says. 'So compliance is a big problem. Drops are a nuisance. You have to pay for them, and you have to remember to take them.'
New research in genetics and nerve cells offer promise for a cure for glaucoma. Some of this research shows that upright vigorous exercise can lower eye pressure. The degree and duration of pressure reduction depends on the intensity and time span of the exercise. Other studies indicate that glaucoma patients who exercise at least three times a week can reduce their pressure levels by an average of 20 percent. As with any exercise regimen, experts recommend consulting with a doctor first.
Support groups can play an important role in helping patients understand the vision-threatening disease and how to manage it. But there is no substitute for regular visits to the eye doctor and taking prescribed medication.
When it comes to 'the sneak thief of sight,' Dr. Greenidge says people should remember one thing: 'If you ask 100 patients to list their six senses, and include walking in that, even though walking is not a sense, most people would say their most precious function is vision, and being able to walk is a result of good vision. 'Some say,' he adds, 'they would rather die than to live blind. But the good news is that you don't have to go blind as a result of glaucoma. If you get early treatment, and if you follow your doctor's orders, your eyes should be working just as well when you're 70 as they did when you were 30.'
TYPES OF GLAUCOMA
OPEN-ANGLE GLAUCOMA affects 2.5 million Americans and accounts for 19 percent of all blindness among African-Americans compared with 6 percent in Caucasians. It occurs gradually, with no symptoms of discomfort or pain. There is a slow buildup of pressure within the eye, damage to the optic nerve, and gradual loss of peripheral vision.
ANGLE-CLOSURE GLAUCOMA, which causes a rapid increase in eye pressure, is more common among farsighted people and those of Asian descent.
SECONDARY GLAUCOMA can develop in people who experience an eye injury, or who have an inflammation or tumor, or an advanced case of cataracts or diabetes. Physicians can manage this by treating the condition that caused it.
PIGMENTARY GLAUCOMA is an inherited condition and is more likely to affect individuals at a younger age.
NORMAL TENSION GLAUCOMA may account for up to one-third of the cases of open-angle glaucoma in the U.S.
WHO'S AT RISK
Everyone should be concerned about glaucoma and its effects. It is important to have your eyes checked regularly because early detection and treatment are the only ways to prevent vision impairment and blindness. The following conditions may put you at greater risk:
People over the age of 45
While glaucoma can develop in younger patients, it occurs more frequently as we get older.
People who have a family history of glaucoma
Glaucoma appears to run in families. The tendency to develop the disease may be inherited. However, just because someone in your family has glaucoma does not mean you will necessarily develop the disease.
People of African descent
African-Americans have a greater tendency for developing primary open-angle glaucoma than people of other races.
People who have other conditions
People with diabetes, nearsightedness, or previous eye injury are at greater risk.
Doctors recommend that people under 45 with none of these risk factors should get their eyes checked for glaucoma every four years, and that people over 45 with risk factors should get an exam every to years. Those older than 45 with no risk factors should get eye exams every two years. And people over 45 with risk factors should get an exam every year
