"Although the world is very full of
suffering, it is also full of the overcoming of it."

- Hellen Kellier

Searchlight on Glaucoma

Searchlight on Glaucoma from Wills Glaucoma

Read the December 2006 issue of this informative newsletter that provides helpful articles about glaucoma written especially for patients and their families.

Link:

http://www.willsglaucoma.org/searchlight/vol15no3.htm

Eye Supplements, Yes or No?

EYE SUPPLEMENTS, YES OR NO?
A PATIENT’S PERSPECTIVE

Sharon Siddique, PhD
All For Eyes Pte Ltd
Singapore

Whether or not to take vitamin and herbal supplements for eye health confronts everyone with low vision. We need to take this issue seriously because there is evidence that certain vitamin and herbal supplements appear to slow down (but not reverse) eye deterioration caused by eye conditions, such as AMD (age-related macular deterioration), glaucoma, and cataracts. It is up to the individual, in consultation with his/her eye doctor, to decide what is appropriate.

Information (as always) is the key. There are basically three approaches. Some believe that it is sufficient to eat a healthy diet, full of the types of foods that provide nutrients for eyes. Others feel that it is sometimes beneficial to supplement (or “top up”) this healthy diet with a selection of vitamins, minerals, and herbs. In Singapore we can also consider various types of TMs (traditional medicines), which include TCM (traditional Chinese medicine) and Ayurveda (traditional Indian medicine).

HEALTHY DIET

A healthy diet for eyes will include several portions of green, yellow, orange and red fruits and vegetables every day. Fortunately for us, Singapore markets have an abundance of greens (kai lan, yu choy, bak choy, Chinese cabbage, bitter gourd. etc), and yellow vegetables - carrots, peppers, squash, pumpkin, tomatoes and yams. Fruits such as papaya, kiwi, various melons, mango, oranges, pomelo, clementines, starfruit, grapes, persimmons, plums, etc. are plentiful. In Singapore, they are not only easily available, they are also relatively cheap.

So if we eat a healthy diet, is there a reason to take supplements? Some say no. But how many of us actually follow the “healthy diet” described above, on a daily basis? If we have to admit that we fall short of this ideal, it may make sense to consider adding certain supplements to our daily health regime. There is a bewildering number of vitamins, and it is easy to get lost in the terminology. Navigating through the information is challenging. Basically, there are Vitamins, Herbs, and Traditional Medicines (TM) to discuss.

VITAMINS

Antioxidants can help our eyesight because they prevent the damaging effects of oxidation, particularly in the retina. Vitamins A, C, and E are the most effective antioxidants. In addition to the vitamins themselves, there are a number of associated natural extracts (called carotenoids and flavonoids) that are found to be rich in these vitamins, and which may be easier for the body to absorb. Finally, Vitamins A, C, and E are more effective when taken together with certain minerals (zinc and, selenium) and other vitamins (particularly the B complex of vitamins).

Vitamin A and Carotenoids

Carotenoids are a class of highly unsaturated yellow to red pigments occurring in plants and animals. They are the natural extracts from which Vitamin A is derived. Three carotonoids most often mentioned in the context of eyes are beta carotene, lutein, and zeaxanthin. Lutein and zeaxanthin appear to be particularly important to eye health. They have been found to be highly concentrated in the macula of healthy retinas and appear to neutralize free radicals generated when ultraviolet and blue light strikes the retina.

Vitamin C and Flavonoids

Vitamin C is a major antioxidant in the lens of the eye. Flavonoids help the body to absorb Vitamin C, and assist in maintaining the intercellular glue (collagen) that strengthens connective tissue throughout the body. They have antioxidant powers and are essential for strong blood vessels, including the sensitive blood vessels of the retina. The most common flavonoid associated with eyes is rutin. Rutin has also been associated with maintaining healthy pressure levels within the eye. Other flavonoids, such as quercetin and the anthocyanidins, may help protect the lens of the eye from cataracts.


VITAMIN E AND MINERALS

Vitamin E functions mainly as an antioxidant. Vitamin E, also known as tocopherol, is a fat-soluble vitamin, so Vitamin E is carried through the body attached to fat. The body stores vitamin E in fat deposits and in the liver. The minerals zinc and selenium help the body absorb Vitamin E. Zinc is required for the function of certain enzymes in the retina that are critical for vision.

The B-Compound vitamins are needed for maintenance of the nervous system, and proper functioning of the cell and its energy metabolism. It is generally recommended that the B vitamins be taken in tandem, as their specific functions are interrelated. Riboflavin (vitamin B2) is manufactured in the body, and is needed to activate vitamin B6 (pyridoxine), which may ease watery eye fatigue and may be helpful in the prevention and treatment of cataracts. The B vitamins include thiamine (B1), Riboflavin (B2), Niacin (B3), Pantothenic acid (B5), Pyridoxine (B6), Biotin (B7), Folic acid (B9), and Cyanocobalamin (B12).


HERBS

Bilberry, a close cousin to the blueberry, has long been widely used in Europe for eye health. Bilberry is rich in fatty acids, flavonoids, iron, zinc, and selenium. During World War II British Royal Air Force pilots reported improved night visual acuity on bombing raids after consuming bilberry jam. Subsequent claims have been made that bilberry extracts result in improved night visual acuity, quicker adjustment to darkness and faster restoration of visual acuity after exposure to glare. Bilberry has been used in the treatment of glaucoma as well.

The herb Eyebright is great for the eyes. Since the Middle Ages, Eyebright has been a popular herbal eyewash. Eyebright's antibiotic and astringent properties tighten membranes and mucus surrounding the eyes, effectively strengthening and improving circulation. Eyebright contains bitters, essential oils, flavonoids, several B vitamins, and Vitamins A, C, D, and E. Today Eyebright is used for relieving eye problems such as eye strain, pink eye and inflamed, irritated and sore eyes Eyebright is also used for cleansing and purifying the blood, therefore stimulating healthy liver functions.

TRADITIONAL MEDICINE (TM)

We are familiar with Bilberry and Eyebright because they are European, and they are therefore much better marketed. With regard to Asian traditional medications, we are barely scratching the surface of fascinating connections and similarities between European, Chinese and Indian TM in general, and, in our case, as applied to eye health. Here are two examples.

In both Chinese and Indian TM, there is a direct relationship between herbs used for the treatment of liver function, and the eyes. Wolfberries, for example, are the Asian cousin of the European bilberry, and are cheap and plentiful in dried form, found in any Chinese medical hall in Singapore. Called "goji" in Chinese, ancient Chinese medical texts extolled wolfberries for strengthening the eyes, liver, and kidneys as well as fortifying the "qi" (chi) or life force. There are also interesting parallels in Indian traditional medicine. Triphala is a composite herbal preparation containing equal proportions of three native Indian fruits, and it is taken for various eye disorders, as well as cleansing the liver.

The turmeric root is also used to support liver function, as well as eye health, in both Ayurvedic (Haridra) and Chinese (jiang huang) herbal medicine. Turmeric protects against the damaging effects of toxins and free radicals. Turmeric, which is a member of the ginger root family, is a deep yellow colour, and is commonly used in Indian cooking. And hence we return to the diet, which, according to Western health directives, should contain plentiful supplies of eye friendly green and yellow vegetables. It is difficult to find anything more intensely yellow than turmeric!

SUMMING UP

We are fortunate to be in Singapore, where off-the-shelf vitamins and supplements have been tested and approved by the Ministry of Health. There are many Western multi-vitamin supplements which are specially formulated for eyes, as well as herbal preparations and traditional medicines. They are available throughout Singapore, and generally contain various combinations of the vitamins and herbs mentioned above. So investigate this interesting subject, and discuss it with your GP and ophthalmologist. It is up to each of us to take responsibility for doing everything possible to preserve our precious gift of sight.

.

Read about Dr Sharon Siddique : A Clear Visionary at http://www.glaucoma-singapore.org/LowVision/All4Eyes/ClearVisionary.html

Singapore Eye Hospitals explain Glaucoma

Alexandra Hospital
http://www.alexhosp.com.sg/disease_info_details.asp?id=44

The Eye Institute
http://www.tei.nhg.com.sg/eyecare/TEI%20GLAUCOMA%20final.pdf

Tan Tock Seng Hospital
http://ttsh.com/new/clinicalspecial/02_glaucoma.pdf

Singapore National Eye Centre
http://www.snec.com.sg/eye/glaucoma.asp

National University Hospital - Eye Clinic
http://www.nuh.com.sg/eye.html

Singapore Changi Hospital
http://www.cgh.com.sg/ipg/en/main.asp (there is a very good interactive video on glaucoma among others)

How about Medisave Chronic Disease Management Programme for GLAUCOMA?

Source: Today - Wednesday - January 31,2007

Should Glaucoma qualify for the Medisave Chronic Disease Management Programme?

Should we qualify? : YES

Are we presently in the Scheme? : NO

Here are my reasons why Glaucoma should be included:-

• Glaucoma is a chronic disease and has to be managed for life



• It is a progressive disease and thus cost of management increases with time

• Medication is expensive and cost of early-stage glaucoma management exceeds $500 per year and may increase to over $1000 with some cases in a couple of years. This is apart from consultation charges, vison testings, etc

• Cost of surgery for advanced-stage glaucoma management is prohibitive and may need to be repeated with time to prevent blindness

• The disease affects more the aged-population; the elderly who are without a source of income

• Glaucoma carries a stigma on employability; other chronic diseases such as diabetes do not!

• There are presently no subsidy for LOW VISION AIDS

I like to have readers opinion too.

Yours in Alpha-CARE,

Sam Fong

Support Groups at the Various Hospitals

At Changi General Hospital :
http://www.cgh.com.sg/medical/support_index.asp

At Singapore National Eye Centre :
http://www.snec.com.sg/patient/support.asp

Glaucoma Management & Care

Glaucoma Management and Care - A discussion with Dr Jovina See, Head of Glaucoma Services-National University Hospital

Do you know where to get your eyes screened?

If you wish to go for an eye screening and don't know where to go then ...

Click below to find out where you can go :
http://www.alexhosp.com.sg/for_download/Poster_SEE.pdf

Talk - MIGRAINE - Could your eyes be the cause?

Source: TODAY - TUESDAY - JANUARY 30,2007 - HEALTH PROMOTION BOARD HEALTHLINE

If you missed the show, maybe these links will help :

(1) http://www.wstm.com/global/story.asp?s=1230101

(2) http://www.eyeguys.net/ocularmigraine.html

Myopia genetics study tops biomed fund awards

Source: THE STRAITS TIMES - TUESDAY - JANUARY 30, 2007

The following link may throw some light on Myopia and Myopia Genetics : http://webess16.micromedex.com/content/DiseaseDex/000926.htm

How to be a proactive patient

How to be a Proactive Patient - A Discussion with Dr Sharon Siddique,PhD

Visit Dr Sharon Sidduque's All for Eyes Website at : http://www.allforeyes-singapore.com

Xalatan - eyedrops from Pfizer

Pfizer on Xalatan

Look what I found, but ask your doctor first, and secondly our room temperatures are much higher ...

How should I store XALATAN?

•Are you wondering why you have to refrigerate your prescription XALATAN before opening but not the free sample from your eye doctor? There’s a good reason! The expiration date (shelf life before opening) determines whether refrigeration is required. And the expiration for prescription XALATAN from the pharmacy and sample XALATAN from your doctor are different.

•Prescription XALATAN has an 18-month expiration date until you open it. This longer shelf life makes refrigeration necessary until you open it

•Samples of XALATAN have a 12-month expiration date. This shorter shelf life allows doctors to easily store samples at room temperature in their offices

•Once opened, your sample or prescription XALATAN may be stored at room temperature (up to 77°F) for 6 weeks

Source:
http://www.xalatan.com/consumer/questions.asp

Useful Glaucoma Monitoring Booklet from Allergan

This is quite a good record book to keep on your glaucoma progress.

Is there quality life at the end of tunnel vision?

Is there quality life at the end of tunnel vision" - A discussion with Mr Kua Cheng Hock, President of the Guide Dogs Foundation for the Blind

Learn more about how Cheng Hock goes about his daily life with Kendra ... visit : http://www.ab-glaucoma-sin.org/Alpha_Cell/Oct7/LoveMe_LoveMyDog.html

POAG puts pressure on the heart

We search the World for articles that could benefit the patient.

POAG puts pressure on the heart


Click below for access:

http://www.oteurope.com/ophthalmologytimeseurope/article/articleDetail.jsp?id=397605

Glaucoma explained in Chinese by Allergan

The Importance of Sunglasses: A Patient's Perspective

THE IMPORTANCE OF SUNGLASSES:
A PATIENT’S PERSPECTIVE


Sharon Siddique, PhD
All For Eyes Pte Ltd
Singapore
October 2006


THE SUN’S HARMFUL RAYS

In tropical Singapore we are all aware of the damage that the sun can do to our skin. Protective clothing and sun creams are commonly used to try to prevent sunburn, wrinkles, and skin cancer. Unfortunately, we are much less aware of the damage that strong sunlight can do to our eyes. Too much exposure to ultraviolet (UV) radiation can leave the eyes red, teary, strained, and light sensitive. Just as with the skin, damage is cumulative, and can lead to an increased risk of cataracts and retinal damage, including AMD (age-related macular degeneration).

UV radiation is so potentially dangerous because we literally can’t “see” it. It is composed of invisible, high-energy, light rays from the sun that are found beyond the violet/blue end of the visible spectrum. Our eyes are particularly sensitive to damage from ultraviolet A (AV-A) and ultraviolet B (UV-B) light. Children, the elderly, and those of us with eye problems are particularly at risk.

Children’s eyes are more vulnerable because their pupils are larger, meaning more light enters the eye, and reaches the retina. By the age of 18, studies show that more UV light will have been absorbed by a child's eyes than over the rest of his life. And yet we seldom see Singaporean children using sunglasses. As Singapore’s population ages, we are already seeing the effects of long-term exposure to the sun’s harmful rays as the rates of cataract and AMD increase.

Ultraviolet protection is especially important for people after cataract surgery. Since the lens absorbs UV radiation, individuals who have had cataract surgery are at increased risk of retinal injury from sunlight. This is because although the lens implant contains some UV blocking agents, it does not provide the same degree of protection to the macula as the natural lens. Taking certain medications - such as tetracycline, sulfa drugs, birth control pills, diuretics and tranquilizers – also increases the eye's sensitivity to light, and potential damage.

A good pair of sunglasses should protect against harmful UV light entering the eye. Ask before you purchase. Do the lenses provide both UV-A an UV-B protection? Are the lenses polarized, which ensures that they will reduce reflected glare? Do the frames fit snugly to provide the eyes with maximum protection, particularly over and around the rims of the frames? Sunglasses which are specifically designed to fit-over a normal pair of spectacles may be particularly suitable for many spectacle-dependent Singaporeans.

THE CONFUSING WORLD OF COLOURS

There is a big misconception that the darker the lens, the better the protection. In fact, UV coating is colourless. Clear lenses, with no colour-tint, can still be UV-light blockers, and they are very useful in protecting the eyes from impact, debris, dust, chemicals, or after eye surgery. Clear lenses can be used during low light or nighttime activities, and are particularly effective to reduce glare under fluorescent light.

Most sunglasses come in a bewildering range of colours, from common amber and grey, to yellow, red, green, and even orange and plum. Does this mean, then, that the choice of colour is merely cosmetic? Absolutely not. Different colours absorb or transmit specific wavelengths of light. That is why, for example, when we look through red-coloured lenses, the world looks, well, rosy.

So when and why is the choice of colour important? Those of us with eye problems need to pay particular attention to these “colour codes” because by absorbing and transmitting certain specific wavelengths of light, tinted lenses – also called absorptive lenses - can improve our ability to see. For example, glaucoma-sufferers typically perceive the world as being "too dark." As a result, they may show a preference for yellow lenses, which increase the apparent brightness of objects or surroundings. People with macular degeneration may favour an orange, yellow-orange or plum tint. And people with retinitis pigmentosa may prefer an orange or red tint to reduce glare.

The two most commonly available colours for sunglasses are grey and amber. Grey lenses are described as neutral because they do not enhance contrast or distort colors. Choosing lighter shades of grey can help relieve indoor glare, especially under fluorescent light. In general, grey is soothing, sharpens focus, and provides good glare protection. Grey is often the colour of choice for post-op cataract surgery, glaucoma sufferers, diabetics or people who have had corneal transplants.

Amber tints are known for their “blue blocking", protective effect. There is some evidence that the retina may be more sensitive to blue visible light. Blocking the visible blues eliminates much of the scatter created by the shorter wavelengths of light. The result is an apparent increase in contrast and depth perception. Objects appear more clearly defined, and thus amber tints are popular with skiers, boaters, and pilots. They also provide good contrast enhancement, useful for those with macular degeneration, and retinitis pigmentosa.
Yellow is a powerful a "blue-blocker" because the color keeps blue light from entering the lens. Yellow and orange sunglasses make objects appear sharper, with more contrast, but there is some colour distortion. Both yellow and orange are helpful for reading. Yellow is often the choice of those suffering from retinitis pigmentosa and macular degeneration because it provides maximum brightness and good visual acuity. Yellow glasses are great for relieving eye fatigue from prolonged exposure to computer screens. Orange is even more effective than yellow for intensifying backgrounds, allowing the wearer to see objects more clearly.

For normally sighted people, red is a rather uncomfortable color to look through, but it is recommended for certain eye conditions. Red does cut down on blurred vision caused by blues, greens and yellows. Red lenses are good for medium and lower light conditions because they enahnce contrast. Reds and pinks are great in alleviating computer eyestrain, but there is also a certain amount of color distortion. A light or medium tinted lens is good for day-to-day wear. Dark plum is an excellent dark lens, and provides a high amount of glare relief.

Green is a less commonly found colour, but it offers some color contrast with little or no color distortion. Green is also great for glare protection. Because green allows only low levels of visible light to enter the eye, it is a good colour choice for post-op cataract surgery and glaucoma.

SUMMING UP

A final thing to pay attention to in the confusing world of colours is what is called the VLT (visible light transmission). Some types of sunshades come with a colour and a VLT, expressed in percentage terms. Thus, “40% Amber” means that the tint is amber, and that 40% of the visible light is transmitted through the lens. Sometimes the terms “light” (generally over 70% VLT), “medium” (10% to 69% VLT) and “dark” (below 10% VLT) are indicated.

To maximize visual acuity, select the highest visible light transmission (VLT) which is comfortable, and a colour that “feels” good. There is no one correct fit. It depends very much on the conditions under which the sunglasses are going to be used, and the condition of the eyes. Many people require different filter transmissions for cloudy and bright conditions or for inside versus outside applications. In general, the goal is to achieve the maximum visual acuity, while minimizing eye discomfort and strain.

In sum, sunglasses are an ESSENTIAL part of the proactive patient’s vision tool kit. Choose a pair of sunglasses carefully. Decide under what conditions you are going to be wearing them (inside/outside; bright sunny/hazy conditions). Make sure they fit around your eyes to block out glare, that you have maximized your visual acuity with the tint and VLT, and that they are polarized, scratch-proof, and provide 100% UV-A and UV-B protection. Above all, they should fit comfortably – otherwise you won’t wear them. And remember, often our eyes do warn us that they are under stress by tearing, blurring, redness, dryness, and pain. Learn to listen to them.

Maintaining quality of life at a sustainable cost ...

Management of glaucoma

The goal of treatment in glaucoma is to maintain useful visual function and the patient’s quality of life at a sustainable cost.

IOP lowering is the only clinically effective approach in the management of glaucoma.

The target IOP is an estimate of the mean IOP achieved with treatment that is expected to prevent further optic nerve damage. An individualised target IOP range should be set for every glaucoma patient.

The first line of treatment in Primary Open Angle Glaucoma is medical therapy and the choice of the drug depends on the target IOP, the safety profile of the drug, patient acceptance and cost.

The first line of treatment in Primary Angle Closure Glaucoma is a laser iridotomy. A laser iridotomy is also required for the fellow eye. Supplemental medical therapy may also be required.

In the emergency setting of acute angle closure glaucoma, additional systemic drugs like osmotic diuretics and oral/parenteral carbonic anhydrase inhibitors may be employed to rapidly reduce the IOP to avoid permanent, devastating nerve damage.

In Open Angle Glaucoma, laser trabeculoplasty may be used as an adjunct to medical therapy.

Surgery is indicated in patients who fail or are unable to comply with medical therapy and may be combined with cataract removal for enhanced visual rehabilitation.

Trabeculectomy is the primary surgery of choice in medically uncontrolled glaucoma.

Patients who have undergone glaucoma surgery should be advised that there is a lifelong need to be aware of symptoms of infection, which include blurring of vision, pain, redness, discharge and swelling.

Steroid eye drops are a frequently unrecognised cause of glaucoma. They should only be used as short-term therapy and IOP monitoring is vital in such patients.

Source: Ministry of Health (Singapore) : MOH Clinical Practice Guidelines 3/2005

Exercise can help lower IOP?

P: Are there any foods, herbs, vitamins, or exercise that can help lower IOP?

Dr. Rick Wilson: Exercising 20 minutes, four times a week, is said to be equal to one eye drop in its pressure-lowering effect. No vitamins, and so on, lower IOP. Theoretically, vitamin E should help reduce the harmful effects of elevated IOP.

Source: Wills Glaucoma :Target Pressure Chat Highlights August 8, 2004

World's highest incidence of acute angle closure glaucoma

Source: Ministry of Health (Singapore) : MOH Clinical Practice Guidelines 3/2005

The "Dry Eye" Syndrome

WET EYES = DRY EYES?
I went to see my eye doctor at Changi General yesterday, a Monday afternoon of 18th December after I had lunch with my friend Shan Chi. She is a lady and has been my assigned glaucoma doctor since July 2005 -- an adorable ophthalmologist, worth her weight in gold.
Our first discussion was that my eyes tend to tear and sometime the tears would well over the eye lids and run down my cheeks. Looking at my eyes at a distance, she told me that my eyes look dry and that was why I tear. *Are you crazy, doc?*, I thought to myself. No, the doctor is always right and I must check this out.
With this paradox in my hand "crying" out for an explanation, I searched the internet for an answer to satisfy my curiosity. I did a global search on "all symptoms on dry eyes" Here is the explanation:-
Tearing in dry eyes may see m to be perplexing. My eyes are apparently wet yet I have dry eyes. This happens because the eye is not getting sufficient lubrication. The autoimmune system sends a distress signal through our nervous system for more lubrication. This emergency call causes the eye to flood with tears to overcome the dryness. But the generated tears are mainly water with little lubricating properties compared to our normal tears. They are capable of washing out debris but have poor adhesion-lubricating properties. Further, these emergency tears often arrive late, and the eyes need to regenerate more. So even if I *cry me a river*, they are of no help.
Treatment is needed and instilment of formulated artificial tears will help. "Thanks, Doc! And a happy New Year to you" I said. "You take care!" she replied. The door clicked to close.
"So I see: teary eye is the effect; dry eye is the cause."

My friend, Sharon Siddique added:
"I think that the "dry eye" syndrome can also be helped by vitamin/herbal preparations that are ingested. There is a formula called "Bio-Tears" that my ophthalmologist recommends at his clinic. Several patients have had good results, and have been continuing to use it."

Cheers,
Samfong

AIGS World Glaucoma Congress in Singapore

ANNOUNCEMENTS:

17-21 July 2007, The AIGS WORLD GLAUCOMA CONGRESS with an attendance of about 2000 of the world’s ophthalmologists and those specializing in Glaucoma will meet in Singapore and the Glaucoma Society Singapore will be participating in the EXHBITION and likely the IAGPO discussion.

Check this out at:-

http://www.glaucoma-singapore.org/Events/AIGS07/SIN0707.html

The Role of Support Groups in Glaucoma Care

TAN TOCK SENG HOSPITAL : PUBLIC FORUM ON GLAUCOMA - 28th October 2006

TTSH : PUBLIC FORUM ON GLAUCOMA - 28th October 2006

This discussion was presented on 28th October 2006 in Singapore at the Tan Tock Seng Hospital : Public Forum on Glaucoma . There were about 200 participants at the Forum.

For Audio Replay please click : http://www.glaucoma-singapore.org/Alpha_Cell/TTSH/forum28oct2006.html

Alpha-C meeting the challenge of Glaucoma Care

Peer to Peer Sharing

In the sea of knowledge,

we seek to establish a connection between those seeking for information

and those who have the answers sought.

Together we may come to a better understanding

of the "newly discovered" knowledge

that makes the difference.

Is Your Sight Being Stolen?

'You could say that it is like waking up in the
morning and you feel that daylight comes later each year as glaucoma progresses. The leaves on the tree outside my window is a darker green now
compared with a livelier, fresher and brighter green years ago.'
- Sam Fong (left)

Pub Date: May 24, 2006 Pub: ST Author: ELAINEY

Supplement: Mind Your Body

Headline: Is your sight being stolen?

By: Elaine Young

Glaucoma accounts for just over 12 per cent of global blindness, according tothe World Health Organisation. Sometimes called the thief of sight', the disease cannot be prevented. However, it can be caught early and the damage limited. Elaine Young speaks to one man who has been living with glaucoma forseven years and won't let it stop him from reading or driving. Look into the eyes of 62-year-old Sam Fong and there are no obvious signs thathe has failing vision. His eyes are slightly red from the drops he administersdaily, but that is it. He clutches a book that he is in the middle of reading, and he still drives. The recently retired civil engineer has lived with glaucoma for seven years. Mr Fong did not realise he had glaucoma because there was no pain or any other symptom. 'The eye is a very accommodating instrument and doesn't complain,' he said. He learnt he had the disease in 1999 after undergoing surgery to remove cataract in his eyes. It was during the follow-up eye examination that he was told he had chronic primary open-angle glaucoma. Glaucoma is not one but a group of conditions in which the optic nerve suffers damage at the back of the eye. This optic-nerve damage causes loss of vision and, in time, blindness. The reason for the optic-nerve damage comes from high pressure. Eye pressure is maintained by the flow of liquid (aqueous humour) within the eye. In glaucoma, the eye's drainage system becomes clogged so the fluid cannot drain. As the fluid builds up, it causes pressure to build, and damage to theoptic nerve occurs. Once diagnosed with the disease, there is no cure, but lowering eye pressure slows progression and can save vision. Some people are more prone to the disease than others: people who are already myopic, those with a family history of glaucoma, those over 65 years old, those with a previous history of trauma to the eye or long-term use of topical steroid eye drops. Elderly Chinese women are on the risk list, as are African-Americans and diabetics.

A CHRONIC ILLNESS

The eye disease has left 4.5 million people in the world blind. According tothe World Health Organisation, it accounts for just over 12 per cent of all global blindness. In the foreword for the Ministry of Health's clinical practice guidelines for 2005, Professor K. Satku, director of medical services, states that across-sectional population survey of the Tanjong Pagar district reported the prevalence of glaucoma as 3.2 per cent in the Chinese population aged 40 yearsand above in 2000. He said: 'As Singapore's population ages, we can expect the incidence ofglaucoma to rise.' Professor Paul Chew Tec Kuan, head of glaucoma service and senior consultant, department of ophthalmology, National University Hospital (NUH),added: 'There are no good studies of severity and disease spread in Singapore aside from the data from the Tanjong Pagar study. Each glaucoma service of the Singapore National Eye Centre, NUH and Tan Tock Seng Hospital all see tens of thousands of cases a year.' Glaucoma is a chronic illness, said Prof Chew. 'It is analogous to diabetes and hypertension, but those two are well supported and understood. A lot of people don't know what glaucoma is,' he said.' There are different types of glaucoma: primary open angle, acute angle closure, chronic angle closure, secondary and congenital. Dr Lennard Thean, clinical director in the ophthalmology department at NUH,says that over-50s face an increased risk of both open-angled and angle-closure glaucoma. Open-angled glaucoma is caused by progressive blockage of the drainage channels of the eyeball, accompanied by a slow rise in pressure. This type has no symptoms.

THE SILENT DISEASE

Angle closure can be acute or chronic. Acute angle closure is the type that usually affects Chinese women. A sudden blockage of fluid results in a rapid rise in pressure. Symptoms are eye pain,headache, vomiting and blurred vision. Chronic angle closure is like open angle in that it progresses graduallyfrom progressive blockage of the drainage channels, and a prolonged rise inpressure. There are no symptoms. The chronic version is 10 times more common than the painful acute version,say the glaucoma experts at NUH. Added Prof Chew, 'The congenital forms can develop in children, teenagers and young adults, so you can get glaucoma problems at all stages in life.' Secondary glaucoma can be caused by injury to the eyeball. It is relatively rare, says Dr Thean, but things like wakeboarding, mountain biking, being punched in rugby or in boxing can result in glaucoma. The problem with most types of glaucoma, says Dr Thean, is that it can be asilent disease. That's why the doctors call it 'silent thief of vision' because it steals your vision before you realise it. He said: 'By the time you have tunnel vision, it's almost what we callend-stage glaucoma where an extensive amount of damage has occurred - 20 percent or more - and we are just trying to stabilise what we can.' 'We don't want people to think that if they don't have pain, they don't have glaucoma. People with pain will seek help because it is so severe. It's the silent ones you worry for because they lose their sight before they know theyare in trouble,' said Prof Chew. Even though any damage to the eye is permanent, the remaining vision can besaved and the disease controlled. Treatment is in the form of eye drops or,depending on severity, surgery to relieve the pressure on the eye. Tests are carried out every six months on the optic nerve, vision function and eyeball pressure. The cost of eye drops varies from $5 to $40 per bottle. Glaucoma cannot be prevented, but it can be caught early and damage limited.

Glaucoma can be managed

Dr Thean recommends that everyone 50 and over should have annual tests to screen for glaucoma. The disease is irreversible but research is under way, including at NUH, tofind ways to restore the nerves lost using stem cells. Prof Chew said the research is at the preliminary stages and 'there aremany, many steps' before it results in treatments. Mr Fong's glaucoma was detected at a very early stage and his optic nervewas slightly damaged, but the visual field (the range within which objects arevisible to the eye without moving the head) was intact. Prof Chew says that, ifyou catch it early, then controlling it means you are protecting what visionyou have. And Mr Fong uses his medication religiously. But he decided then that if he were to go blind, he wanted to learn to read a book in Chinese before losing his sight. And he has managed to do just that. He thinks 'reading is good for the eyes'. He uses a magnifying glass if the characters are small, but 'other than that, I'm fine'. He also maintains the website of the Glaucoma Society (Singapore). Mr Fong has no patience with self-pitying glaucoma sufferers who resign themselves to inevitable blindness. He acknowledges that 'the greatest fear is going blind, but if you haven't reached that stage, don't pre-empt it by acting as if you are'. 'After seven years, any doctor who looks at my eye will say that it is an advanced stage of glaucoma, but that doesn't prevent me from driving, and that doesn't prevent me from reading a book.' He treats his ailment with two types of eye drops. One is a topical carbonic annydrase inhibitor, which reduces the production of fluid. The other is a prostaglandin analogue, which increases drainage of fluid from the eye. He has a check-up every four or five months. He steers clear of any activity that would increase the pressure in the eye,avoiding exercise that requires the head to be below heart level. Taking one's medication is the most important thing, he said. 'Medication is expensive,gives a bit of blurring vision and causes my eye to sting a little bit sometimes.' His eye drops cost around $70 a month. He applies the drops four times a dayto his left eye and twice a day to his right. He said that in his left eye, he has '50 per cent zero vision, 20 per cent partial vision and 30 per cent acceptable clear vision'. In his right eye, he has '10 per cent zero vision, 30 per cent partial vision and 60 per cent acceptable clear vision'. He has various degrees of clarity at various points and his eyes' response differs to light intensity, colour and shade. 'You could say that it is like waking up in the morning and you feel that daylight comes later each year as glaucoma progresses. The leaves on the tree outside my window is a darker green now compared with a livelier, fresher and brighter green years ago.' Mr Fong suggests that glaucoma not be treated just as a disease, but as a condition that has to be managed. He advises those with the ailment to prove to themselves that they can do things normally, and when the time comes to take a step back, do it, but make it a small step back. He stresses that his eyes still function reasonably well. 'I can still drive a car, see beautiful things and read the newspapers.'

E-mail: elainey@sph.com.sg Website of the Glaucoma Society (Singapore): http://www.glaucoma-singapore.org

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What is Glaucoma?

Glaucoma: The Sneak Thief of Sight

Early detection and treatment can slow, or even halt the progression of glaucoma.

What is Glaucoma?

Glaucoma is a group of diseases that can lead to damage of the eye's optic nerve and result in blindness. It is caused by increased in intraocular pressure (IOP) resulting either from a malformation or malfunction of the eye's drainage structure.

Glaucoma is frequently referred to as the "Sneak Thief of Sight" because it progresses without obvious symptoms.

What is the optic nerve?

A bundle of more than one million nerve fibers. It connects the retina, the light sensitive layer of tissue at the back of the eye with the brain.

How does glaucoma damage the optic nerve?

Glaucoma can cause damage when the aqueous humor (a fluid that inflates the front of the eye and circulates in a chamber called the anterior chamber) enters the eye but cannot drain properly from the eye. Elevated pressure inside the eye, in turn can cause damage to the optic nerve or the blood vessels in the eye that nourish the optic nerve.

Who is at risk?

Although anyone can get glaucoma, some people are at higher risk than others.

• Everyone over age 40
• People with a family history of glaucoma
• Individuals with other eye diseases which may secondarily result in glaucoma or elevated pressure
• There is a strong prevalence in diabetes

Common types of glaucoma

• Open angle glaucoma (chronic)
• Close angle glaucoma (acute)
• Low-tension or normal-tension glaucoma
• Congenital glaucoma (seen in infants)
• Secondary glaucoma (result of injury or trauma)

Signs & symptoms?

Glaucoma is a insidious disease because it rarely causes symptoms. However, certain types, such as angle closure glaucoma and congenital glaucoma do cause symptoms.

Angle Closure (Emergency)

• Sudden decrease of vision
• Headaches
• Nausea & vormiting
• Glare & light sensivity

Congenital

• Tearing
• Light sensitivity
• Enlargement of the cornea
• Loss of peripheral vision

A person with glaucoma may notice that although he sees things clearly in front of them, they miss objects to the side and out of the corner of their eye.

How is glaucoma detected?

• Visual acuity test
• Visual field charting
• Pupil dilation
• Tonometry

Treatment

A wide variety of treatments are available for reducing the intraocular pressure, the only known effective treatment of glaucoma.

Medicine: Medicines are the most common early treatment for glaucoma. They come in the form of eye-drops and pills.

Laser surgery (also called trabeculoplasty). A special lens is held to your eye. A high energy beam of light is aimed at the lens and reflected onto the meshwork, inside your eye. The laser makes 50-100 evenly spaced burns. These burns stretch the drainage holes in the meshwork. This helps to open the holes and lets fluid drain better through them.

Conventional surgery : A new channel for aqueous humor (fluid) to drain into the blood circulation is created. This will enable the intraocular pressure to be maintained at normal tension.

What can you do to protect your vision?

If you are being treated for glaucoma, be sure to take your glaucoma medicine everyday.Routine eye exams with monitoring of intraocular pressure and visual field examination is done.

Retaining Independence

People who have experienced vision loss from glaucoma can retain independence, productivity divices and techniques to carry out their daily activities. Special lenses and techniques help those who have remaining sight to make the best use.

NB. This article is meant for general information only. Please consult an ophthalmologist for any medical advice.