12th of May 2020

Can you live a normal life with glaucoma?

People with glaucoma who manage it well can live a normal, independent life. A big problem with glaucoma is that in the early stages, people with glaucoma live their lives largely unaffected by the condition while it is all the while progressing silently. Problems with vision can at first be subtle and many people are able to manage life well with mild to moderate visual impairment. Visual loss can even go unnoticed until it becomes severe, at which point much of the damage caused by glaucoma is irreversible.

As a doctor treating hundreds of individuals with glaucoma, my goal is to pick up on early changes and use timely and effective interventions to prevent loss of vision.  Nothing warms my heart more than to hear how my patients’ vision has become stable and that they are getting on with normal lives, being productive at work, enjoying their time with family, friends and having great experiences.

How is this possible? Surely glaucoma causes debilitating blindness?

Let’s discuss the nature of glaucoma. Glaucoma is a chronic disease of the optic nerve, the crucial nerve for all vision to travel from the eye to the brain. In glaucoma the eye pressure builds up which slowly, silently, progressively and irreversibly damages parts of the optic nerve.  Piece by piece, gradually over time, progressive glaucoma results in the loss of vision. Early detection is the absolute key to helping avoid visual loss for patients with glaucoma to save their sight. When I see patients with glaucoma who ask me “How can I save my eye-sight”? my answer is that while I cannot undo  damage already done by glaucoma,  what I can do is to stop damage from getting worse by controlling the eye pressure.

I am grateful that we can detect glaucoma at its early stages. When my patients get a diagnosis of glaucoma at an early disease stage, I am able to keep them seeing well throughout the course of their lives.

The key to finding silent cases of glaucoma is to get your eyes tested. This is especially important for people with a family history of glaucoma. We are very lucky in Australia to have a robust healthcare system, exemplified in our recent Covid 19 response. Optometrists are eye health professionals, trained to pick up glaucoma on your routine regular eye test. If your optometrist suspects you may have glaucoma, you will be referred to see an Ophthalmologist, a specialist eye physician and surgeon who can confirm your glaucoma diagnosis and manage your glaucoma care. Glaucoma Australia, a not-for-profit organisation, encourages eye health awareness and regular eye checks. I am very proud to be President of Glaucoma Australia, an organisation whose goals are to help raise glaucoma awareness, to support early glaucoma detection and prevent glaucoma blindness.

And what about people affected by glaucoma damage who have sustained significant loss of vision before glaucoma is diagnosed? Life can be hard, and I am inspired by the courage and fortitude of my visually impaired patients. Organisations like Vision Australia can help with modifications around the home, reading aids and sometimes walking canes to help keep people safe and able to achieve most of the tasks of daily life. With good support from family, clinicians and the appropriate use of visual aids and home modifications, visually impaired individuals can still enjoy many of the great things of life and have a large degree of independence. For people who are at the working age of life, visual impairment from glaucoma might mean a change in occupation – this is particularly relevant for commercial drivers (eg bus or truckdrivers) for whom a full range of vision is required for a commercial driving licence.

How else does glaucoma effect our lives?

Fear of going blind is a true psychological burden for many people with glaucoma, even those that see very well now. At some stages in the journey this can provoke anxiety and be quite disconcerting for the individual. We must remember that glaucoma runs in families, and younger or newly diagnosed people with glaucoma may have seen an older relative lose vision from glaucoma. The implications for themselves of losing their sight because of glaucoma can be frightening. People with glaucoma  are not just concerned for themselves in regards to their fears of going blind– they also don’t want to become a burden for loved ones. Sometimes these fears are disproportionate – I know many fine people with mild or moderate glaucoma, who I know will diligently keep visiting me and look after their eyes well through life, and will therefore most likely see very well into the future. However they have great fears of going blind. That’s why communication is so important – I believe listening to these concerns and discussing them is a core part of my role as a glaucoma specialist Ophthalmologist. Their optometrist and Glaucoma Australia can provide additional key support as well.

People with more advanced glaucoma have trouble adjusting from light to dark environments (eg moving from a dim to light room) and the elderly can have an increased risk of falls and fall related injury and disability. That’s why it is so important for people with glaucoma to be careful when out walking, and to keep one’s home environment safe and free of obstacles.

Driving is a concern for people with more advanced glaucoma – thankfully the requirements for a personal licence is not a strict as a commercial licence. Still, some people with more advanced glaucoma have to rescind their licence, which can often be a blow to independence. Being adaptable eg learning to become more familiar with public transport and online shopping helps with this difficult transition (and yes, it is often still possible to use a computer for even those with advanced glaucoma). People with glaucoma who can no longer drive themselves due to advanced visual loss or blindness are entitled to subsidised taxi fares.

Undoubtedly glaucoma can affect one’s life, and once glaucoma is detected it does not go away. Thankfully with our current eye healthcare system in Australia we are detecting glaucoma earlier and earlier, which has large implications for preventing loss of vision. However, it is a concern that for some, glaucoma still goes undetected and presents at an advanced stage where less sight can be saved. I believe strongly that with the improved treatments and encouraging more widespread uptake of screening tests available today, the impact of glaucoma tomorrow will be lessened. I am confident that the large majority of my patients will live rich and full lives despite having glaucoma.

 

 

NON J QUERY