Functional burden of glaucoma highlighted in keynote lecture

GLAUCOMA is a chronic, debilitating disease which is widely under-diagnosed and the functional burden of the disease is not fully appreciated, according to Roger Hitchings MD, who presented a keynote lecture at the 2013 SOE Congress. 'When someone becomes blind, and particularly with late presentation, and especially in the so-called developing world, they cannot work. Their life expectancy falls, they have loss of social standing and women who have lost vision as a result of chronic glaucoma suffer a loss of authority in their households because they are now dependant on others. In looking at the functional burden of glaucoma we see that it is under-diagnosed, it has a significant effect on quality of life, it is extremely costly to treat, especially if it presents late, and there is a significant reduction in social status as well as a reduction in life expectancy,' he said. Dr Hitchings noted that glaucoma is a typically painless disease resulting in an insidious loss of vision, and one which has a significant effect on a patient's quality of life as well as incurring significant costs to national health systems. Looking at the epidemiological data, Dr Hitchings said that an estimated 285 million people are visually impaired in the world, based on data from 39 countries, with 39 million classified as legally blind. Of those blind patients, 43 per cent are due to uncorrected refractive errors, 33 per cent due to cataract, and 12.3 per cent due to glaucoma. 'This makes it the commonest irreversible cause of blindness in the world today,' he said. The majority of patients in the major population studies were unaware that they had glaucoma when the condition was diagnosed, said Dr Hitchings. 'No matter which study we look at, the message to emerge is how common it is for glaucoma patients in population screening to be discovered when they were unaware of the disease. So late presentation is a major problem,' he said Factors implicated in late presentation include the patient's socioeconomic status, with those from poorer backgrounds and with no access to a car more likely to present late. In the UK, the time to the last visit to an optometrist was a factor, while other studies identified the failure of the optometrist to diagnose glaucoma and a negative family history of glaucoma, as playing a role in late presentation. Glaucoma has the potential to negatively impact on many aspects of a patient's quality of life, said Dr Hitchings. Studies show that glaucoma patients have a threefold increase in the risk of falls and a sixfold increase in the risk of car accidents.