Unveiling the challenges in glaucoma management
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Unveiling the challenges in glaucoma management

We need to spend time with our patients and explain them in detail about their disease and how we are going to fight it together

Post by on Thursday, March 10, 2022

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Every year ophthalmologists across the globe celebrate 2nd week of March as ‘World Glaucoma Week.’ The solo purpose of celebrating this week is to educate and spread awareness among general masses about the silent thief of vision, Glaucoma.

Glaucoma (Kala Motiya/Eye Pressure Disease) as we all know is a neurodegenerative disease of 2nd cranial nerve, the optic nerve. Glaucoma is now a public health issue globally because it is the third leading cause of vision loss after cataracts and uncorrected refractive errors.

In this write up, I want to stress upon the challenges we, both doctors and patients, face in management of glaucoma and why sometimes, despite timely diagnosis of disease, we end up with progression.

So, suppose, I’ve a patient in my OPD whom I screened for and diagnosed Glaucoma. The disease is luckily in earlier stage so our progression, our fight against the disease is better. After explaining the disease and its course to the patients I start him/her on medical treatment (eye drops). The patient is on regular follow up with me, but after a year or so fails to follow up; I see the same patient again in 3 years time, but unfortunately this time he comes with advanced glaucoma with significant drop in his quality of vision.


This patient is a “drug defaulter” who stopped the prescribed medications on his own. But again, why?

In my experience there are 4 main reasons why we have so many drug defaulters in glaucoma and why we are losing battle with glaucoma despite timely diagnosis sometimes.

Reason 1: Glaucoma is an asymptomatic disease

Glaucoma is symptomless at early stage, there is no pain, no visual drop. Being a silent disease it works like slow poison for your eyes.


Patients with glaucoma are not reminded by the symptoms of the disease regarding the importance of taking prescribed medication. This leads to poor adherence to medications, which worsens the disease.

Reason 2: Irreversible nature of Glaucoma

Many patients fail to understand this irreversible nature of glaucoma and often question that if they have been on regular treatment for so many years why the disease is not cured. Hence out of disappointment they stop the treatment. Patients have to realize we can only prevent glaucoma and not reverse it.





Reason 3:  Cost of medication

Glaucoma medication are little heavier on the pocket, unfortunately, and most of those medications are to be continued lifelong. It becomes a financial burden on patient and hence he discontinues.


Reason 4: Cosmetic problem

Sometimes some anti-glaucoma medications can give rise to redness of eyes or dark circles around eyes which become a matter of concern especially with female patients. Without weighing pros and cons patients discontinue treatment.


Discussing these 4 points, I want to emphasize that a doctor’s relationship with his glaucoma patient is a lifelong one, just like the disease. Doctor-Patient communication and bonding has to be strong, mutual trust has to be there. We need to spend time with our patients and explain to them in detail about their disease and how we are going to fight it together.

I have always practiced by a principle “A patient has the right to know about his disease”. A patient educated and counselled properly about his disease stands a better chance of winning than a patient who is left ignorant.

Wishing you all health and peace.


(Dr. Shazia Shafi is senior consultant, sharp sight eye hospitals)

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