DEFINITIONS AND OVERVIEW
Sight is central and fundamental to basic human existence, the loss of which through the out-set of any degenerative disease such as Glaucoma, portends a serious short-change to an individual’s whole- being and existence. Thus Glaucoma, identified as one of such degenerative diseases, has been tagged as the “silent thief of the eye or the silent blinder”. It is one of the leading causes of irreversible blindness particularly for people over sixty years of age. It is estimated that over eighty million people worldwide have Glaucoma.1 In Nigeria, it is estimated also that the Glaucoma scourge afflicts between 1.1 to 1.4 million adults, the majority of whom are not even aware that they have this dreaded disease. One in every twenty Nigerians aged forty years and above has Glaucoma.2 Glaucoma remains a public health problem accounting for 8% of world blindness. It ranks as the second leading cause of blindness globally.3
Within the scientific field, numerous definitions have been ascribed to Glaucoma, each trying to draw a more succinct meaning to buttress the health impact of this disease on the individuals, who is unfortunate to be afflicted with this Non-communicable disease. In simple parlance, Glaucoma is placed among the group of eye conditions that can predict or cause much-dreaded blindness. Glaucoma is a condition that damages an individual’s eye optic nerve.4 This gets worse over time. The initial diagnosis of Glaucoma usually traces this disease to the damage inflicted to the nerve that connects the eye to the brain, which usually occurs due to high eye pressure. This optic nerve sends high-sensitive visual information from the eyes to the brain which in turn translates to good vision. Aside from the huge pressure on the eyes, Glaucoma has variously been diagnosed as occurring even within normal eye pressure but for reasons yet to be medically understood, this nerve damage remains associated with increased pressure in the eye. When the eye makes excessive fluid or the eye’s fluid drainage system ceases to function properly, the eye pressure usually increases thus leading to ineffective functioning of the eyes. Glaucoma is erroneously associated with old age but such a fallacy has been scientifically debunked since it is proven that this disease can occur at any age in an individual’s life span. Thus, Glaucoma is generally identified as a chronic, progressive eye disease which leads to visual field loss and most of its victims in Nigeria, are already blind.
SYMPTOMS AND CAUSES OF GLAUCOMA
Many forms of Glaucoma show no early warning signs and symptoms. So the symptoms of Glaucoma variedly depend on the type and stage of the patient’s condition. A clear understanding of the various types of Glaucoma gives an indication of the type of symptoms one should look out for. From open-angle Glaucoma, Acute-angle Closure Glaucoma, and Normal-tension Glaucoma to Pigmentary Glaucoma, the symptoms point to the same set of symptoms-a gradual and systematic loss of vision. The cumulative symptoms vary from a gradual loss of side vision, blurred vision, severe eye pain, eye redness, constant headaches, and associated difficulty seeing things clearly within one’s central vision. In children, Glaucoma shows early manifestation through easily noticeable symptoms like increased eye blinking, tears dripping and display of cloudy eyes. Although some children may be born with Glaucoma, some develop it in the first few years of their lives.
Glaucoma though a non-communicable disease, in the majority of cases, tends to run in families. This is more pronounced within the rural areas of the eastern parts of Nigeria.[1] Overwhelmingly, sundry health issues such as damage to the optic nerves which pile enormous pressure on the eyes may in turn cause these nerves to experience fewer blood flows, thus laying the foundation for the onset of steady but gradual loss of vision and eventual blindness. There are close risk factors associated with Glaucoma every individual must take conscious steps to avert. The major risk factors border on the age and ethnic origin of potential victims. People of the Black, Asian or Hispanic race with ages over fifty-five, tend to be unduly prone to the vagaries of Glaucoma. Added to these, certain medical conditions such as hypertension, diabetes and sickle cell anaemia, can create a condition precedent towards the onset of Glaucoma.
PREVENTION AND TREATMENT OF GLAUCOMA
The timely adoption of early preventive measures to avert the onset of Glaucoma remains the better option than resorting to any form of treatment. A recourse to regular comprehensive eye examinations helps to detect Glaucoma in its early stages before grievous damage is done to the eyes. This must be followed by the regular usage of prescribed eye drops. It is recommended that a family eye history should always be in focus as Glaucoma tends to run in certain families. In some cases, it is equally recommended to wear eye protection gadgets to prevent any serious injuries to the eyes that could trigger Glaucoma. Although there is no lasting treatment for Glaucoma, once detected, the treatment options lie along the paths of surgery which embodies cataract surgery, laser surgery and of more importance, the use of physicians’ recommended medicines.
GLAUCOMA: A HEALTHCARE CHALLENGE IN NIGERIA
Glaucoma is one of the leading causes of irreversible blindness in Nigeria today. This trend is directly impoverishing the Nigerian populace particularly the middle and low-income earners, who spend substantial levels of their earnings on the treatment of Glaucoma. Glaucoma poses a significant public health concern for the nation as this disease throws disability on a large segment of the Nigerian population who are directly rendered unproductive by the menace of this non-communicable disease. Glaucoma puts restrictions on the affected patients’ quality of life and directly impairs their performances in a broad spectrum of socio-economic activities. The consequence of these impairments is increased loss of earnings, poverty and squalor particularly, within the lower strata of Nigerian society. The irreversible nature of Glaucoma and the continuing deterioration in vision, put the patients in a quagmire of hopelessness and downturn stress for the rest of their lives. Thus the unanticipated loss of vision can cause social and psychological anxiety, which in a situation where the patient is unattended to, maybe the unguarded avenue to suicide.
Various factors have been identified as contributing to the prevalence of Glaucoma in Nigeria, particularly, within the rural areas of the country where poverty is more widespread. Amongst these factors are issues associated with the high cost of treatment, inadequate numbers of well-equipped and professionally manned eye clinics, lack of screening and early detection mechanisms, and poor and delayed levels of referrals where appropriate. The cumulative effect of the Government’s ineptitude in the provision of adequate healthcare infrastructure coupled with the lack of inertia on the part of the patients who are constantly engrossed with the fear of loss of vision exacerbates the Glaucoma scourge in Nigeria.
However, the challenges of Glaucoma are not unsurmountable. A two-pronged confrontation of this dreaded menace is all that is needed to breach the surge of Glaucoma in Nigeria. On the part of the victims both potential and real, there is the need to maintain a regular eye screening routine to aid in the early detection and treatment of Glaucoma. The often resort to the much cheaper and easily available traditional healers should be aborted, as this avenue, in the long run, causes more physical harm and further delays the patient from receiving adequate medical attention in order to avert irreversible blindness. The government and the healthcare personnel, are saddled with more holistic responsibilities of establishing enough eye clinics staffed with properly trained healthcare personnel. Proper lines of communication should be established between the eye clinics and the patients. This, of course, presupposes that the government must have put in place enough eye clinics stuffed with enough medicines. The government on its own should make available enough funds to subsidize the high cost of eye surgery which in most cases, is always the last option in the treatment of Glaucoma. Public enlightenment must be put on high alert by the various tiers of government to dissuade largely the rural populace from clutching to their superstitious and socio-cultural beliefs that every form of disease particularly Glaucoma, is a Divine visitation which must be welcomed at the expense of irreversible blindness.
GLAUCOMA AS A DISABILITY: THE LEGAL FRAMEWORK FOR THE PROTECTION OF THE RIGHTS OF PERSONS WITH DISABILITIES IN NIGERIA
The inadequate legislative framework in diverse sectors of the Nigerian enclave is the major problem in the protection and enforcement of the Rights of Persons with Disabilities in Nigeria. Poor governance coupled with a lack of infrastructure and effective implementation machinery, have led to the accumulation of the problems and difficulties of living with disabilities in Nigeria. Earlier legislation in the form of a Disability Decree, in 1993 came into force under the military government of General Ibrahim Babangida. Similar attempts were made by the senate in 2008 when the “Discrimination against Persons with Disabilities (Prohibition) Bill” and “Discrimination and Related Offences (Prohibition and Punishment) Bill” which never became laws and could not address the Disabilities Rights in Nigeria were tabled before the hallowed chambers.
Nigeria ratified the Convention on the Rights of Persons with Disabilities (CPRD)6 which became a benchmark and a right-based framework to address issues on the promotion, protection and enforcement of the Rights of Persons with Disabilities in Nigeria. The constitution of the Federal Republic of Nigeria, 1999 provides a framework that details how Persons with Disabilities should be treated without discrimination in any form or manner. Unfortunately, the provisions of sections 42 and 17 (3) of the 1999 Nigerian Constitution which affirmed a justiciable right to non-discrimination, omitted disability as one of the prohibited grounds for prohibition.7 In furtherance of the protection, promotion and enforcement of the Rights of Persons with Disabilities, a Bill titled “An Act to ensure full Integration of Persons with Disabilities into the Society and establish a National Commission and vest it with the Responsibilities for their Education, Healthcare, Social, Economic and Social Rights (Establishment) Bill, 2018” was passed into law by President Mohammadu Buhari in 2019. This law forbids any form of discrimination and harmful treatment against Persons living with Disabilities, further emphasizing that “No Person with Disability shall be subjected to prejudices or harmful practices, including those based on sex, age, religion or tradition in any area of life”.8
Further, the Act states “No Person with Disability shall be discriminated against on the grounds of his/her disability by any person or institution in any manner or circumstances whatsoever”.9 This law in total compliance with its intentions and purposes, established a National Commission for Persons with Disabilities. The primary functions of this Commission are to ensure the enforcement and promotion of the Rights of Persons living with Disabilities, thereby abolishing all forms and manners of discrimination against such persons. In total compliance with its mandate, this commission receives and addresses all manners of complaints addressed in favour of the rights and positions of Persons living with Disabilities in Nigeria.
CONCLUSION
It is a modern-day fallacy to believe that all things (diseases) without remedy, should be without regard. Glaucoma, though a non-communicable and incurable disease, is preventable. This draws us to the maxim that prevention is better than cure. This part of prevention is a dual responsibility between the government and the potential victims of Glaucoma. The government must channel enough funds towards the establishment of numerous eye clinics flooded with medicines. The people particularly, those living in rural areas should embrace modern and scientific treatment options in the prevention and management of Glaucoma. It is possible to make Nigeria a Glaucoma-free society.
1 Ngozika E. Ezinne et al. Prevalence and clinical profile of glaucoma patients in rural Nigeria- A hospital-based study.
<https://doi.org/10.1371/journal.pone.0260965> accessed 24/03/2023 @ 2:30pm.
2 Adedayo O. Adio and Alfred A. Onua. Economic burden of glaucoma in Rivers State, Nigeria.
<ncbi.nlm.nih.gov/pmc/articles> accessed 24/03/2023 @ 2:36pm.
3 The Johns Hopkins University. <Hopkinsmedicine.org> accessed 24/03/2023 @ 2:40pm.
4 Mayo Clinic. <https://www.mayoclinic.org/diseases-conditions/glaucoma/symptoms-causes/syc-20372839>
5 Ngozika E. Ezinne et al. Prevalence and clinical profile of glaucoma patients in rural Nigeria- A hospital-based study.
<https://doi.org/10.1371/journal.pone.0260965> accessed 24/03/2023 @ 2:30pm.
6 United Nations General Assembly Convention on the Rights of Persons with Disabilities, December 13th, 2006
7 CFRN 1999, S.42. This section outlawed all forms and manners of discrimination against any Nigerian
