Glaucoma Worse in Blacks-Dr. Idris

Dr. (Mrs.) Modupe M. Idris is a Consultant Ophthalmologist and the HOD, Ophthalmology Department, Lagos State University Teaching Hospital, LASUTH, Ikeja. In this chat with FRANCIS OGBONNA, the eye care professional speaks on the common diseases practitioners face and their treatments.  Excerpts…

I know in your field that there is an area of study or practice referred to as Optometry. What is the difference between Optometry and Ophthalmology?
An ophthalmologist is primarily a medical doctor, who after five years of studying medicine, goes ahead to specialize in ophthalmology, which takes another six years. So it is like having or going for a second degree.  An Optometrist on the other hand is one who goes into the university to study Optometry. They are not medical doctors and they are exposed strictly to the optical part of Ophthalmology. No doubt they are experts, but Ophthalmology covers all aspects, including the Optical, medical and surgical aspect of the profession.

How long have you been in Practice?
As a medical doctor, I have practiced for over 22 years, but as an Ophthalmologist almost 18 years. Combined I would say about 32 years.

In all of these years, which would you say is the most common eye disease?
Well the most common eye disease we encounter is Refractive Errors-which includes myopia, hyperopia, presbyopia and astigmatism. They are common across all ages of patients who come for consultation. The second is cataract. The good thing about cataract is that unlike before where people leave their aged parents who have the disease at home saying “they have seen enough life, they do not need to see more”, people are more informed now and know that with a simple surgery it can be corrected and the patient goes back to lead a normal life.   

What is the major cause of cataract?
The most common cause of cataract is old age. Other likely causes are trauma; drugs, especially for young men who take drugs like anabolic steroids to build their muscles; metabolic disorders etc. A child can also have cataract, which is referred to ‘congenital cataract’. It is usually present at birth and may occur as a result of the mother’s exposure to radiation while pregnant, especially during the first few months of pregnancy. Use of certain drugs by the mother during pregnancy can also cause it.

Is surgery the only remedy for cataract?
For now surgery is the major way you could correct cataract. Recent technology anyway has made the process less cumbersome and very effective. It has also helped in reducing recovery rate. Now, patience can return back to work a day or two after undergoing surgery to remove the cataract.

Is it all old people that can develop cataract or is it hereditary?
Well if we line up say one hundred persons, 80 years and above, at least 99% of them will have cataract at least at on stage or the other. It may not be matured in all of them, but they will have traces of cataract in them. It’s like gray hair, which is synonymous to old age.

Are there foods or things someone who may say I don’t want to have cataract when I’m 80 need to stop eating or avoid so as not to contract cataract when he or she is old?
Really and honestly, I don’t think so. It is an aging thing. You can’t say if you eat certain things or avoid them you won’t grow old.

Let’s talk about Glaucoma; I know this is another common eye disease?
Wow! That is a very important area in ophthalmology, because Glaucoma causes irreversible blindness. And in most cases most people are not aware that there is anything wrong with their eyes, until it is discovered. We don’t have the culture here in Nigeria of going for regular eye checkups, so people don’t know they have this challenge until it is too late. In most cases it is just an accidentally finding.

What is Glaucoma in the first instance?  
Glaucoma is a group of eye diseases in which the pressure within the eye is high enough to cause damage to the optic nerves. The nerve is the pipe that sends sensations from the eyes to the brain. Now there are different kind of Glaucoma, but the most common type in this environment is what you call ‘primary open-angle’ glaucoma, because the angle is open there is impairment to the drainage of the fluid within the eyes. As a result of this pressure mount and this pressure impact the nerve negatively causing damage. Because it (Glaucoma) doesn’t give warnings as it were, when the patient eventually finds out about its presence in their eyes, it has damaged about 60% of the nerves already. And the damage is usually irreversible, so that is why we always advise that every adult go for regular checkups…

At what stage of adulthood. Would you peg it at say 40 years and above?
In fact I’ll say forty (40) years, especially in this our clime is too late. Let’s just say once you are 35 years and above, you should start checking your eyes at least once in a year. There are other risk factors, like family history, if there is a family history of blindness, even if you don’t know the cause, please always have your eyes checked.  If you also have the history of hypertension or diabetes in your family, you need to do that also. Hypertension and diabetes also affects these nerves. Also those that wear glasses as a result of short-sightedness are prone to having primary open-angle glaucoma. So if you have all these then you must have your eyes checked on a regular basis.

How frequently?
At least once in a year.

So does this mean that the saying that unnecessary exposure of the eyes to dust causes glaucoma is just a myth?
Yes! The major risk factors here are high eye pressure, refractive errors, high blood pressure, diabetes, positive family history, age, race etc., you can’t really change much of these can you?

Race? Are you saying that the black race is more susceptible to glaucoma?
No, it is worse in blacks.

Why is that so?
Maybe due to late pigmentation. Among all those causes listed above, the only thing we may be able to change or manage is your eye pressure.

What could cause these pressures on the eyes?
When you cough in certain ways, lift up heavy stuffs, but glaucoma causes these pressures majorly. Hopefully, we have seen some people on medication who improve, but it’s just that damage has already been done to the nerves. Actually there is a lot of work on glaucoma still going on.

One of the reasons people are not open to surgeries of any kind is because of the cost. Is cost also a cause for worry in your field?
To tell you the truth, eye surgery is expensive. It is expensive in terms of consumables, in terms of equipment. Let me remove the manpower that we produce here, there is nothing else about eye surgery consumables that is manufactured here. For the equipment you pay cash-down before you are supplied from abroad. You can’t get any of the equipment on hired-purchase. And if anything should happen to the equipment that the locally trained technicians can’t handle then you have to get in touch with the manufacturers. Of course the cost of all these are factored into the cost of surgeries.

How much those the average cataract operation cost?
For private clinic it begins from N100,000, while for public hospitals say from N35,000.

Thanks a lot ma for your time.
You are welcome.