Glaucoma - Ask the Expert

In conjunction with Glaucoma Awareness Month - January 2007

Ask the Expert

January 18, 2007: Thursday, FOX Morning Show with Dr. George L. Spaeth, a Wills Glaucoma Service physician. (Video - 262 Kbps 02:19 mintues)

Myopia : genetic, risk factors, emerging treatment

Alpha-C Support Group role in this posting is to lead members to a progamme hosted in the Health Promotion Board Website

To access radio interview : http://www.hpb.gov.sg/web/nmpp/myopia_interview.html

To access radio interview : http://www.hpb.gov.sg/web/nmpp/myopia_interview.html

Plan now to meet it head on ... OLD AGE

In order to achieve anything one needs to plan

and that includes planning for old age

.

--ooOOoo--

.

In seed time learn, in harvest teach,

in winter enjoy

- William Blake

.

--ooOOoo--

.

Source: THE STRAITS TIMES - HOME - THURSDAY - FEBRUARY 1, 2007

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

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

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