Profile of Glaucoma in the Eastern Region of Saudi Arabia

Introduction

Eyes are precious. It is our gateway to the world and ideally, we would want to protect them for as long as we can. However, unfortunately, a minimum of 2.2 million people in the world have some visual impairment or blindness, according to the World Health Organisation (WHO, 2019a) estimates. Of this population, about at least a billion cases could have been saved or is still waiting to be addressed. Today, among all eye conditions, glaucoma is the world’s leading cause of irreversible blindness (Tham et al 2014). The exact reason for the development of glaucoma is unknown. The condition develops and advances so gradually and unnoticed that it is often called the silent thief of sight (Shiley Eye Institute). In this eye disease, fluid pressure in the eye increases, which gradually damages the optic nerve, causing partial or complete blindness if left untreated (Newman 2017). Treatments usually include medications and surgery. However, early detection is the key to successful management of glaucoma (Stamper 2017). 

Given that glaucoma is the leading cause of blindness globally, it surely calls for serious attention, both to lower the health and economic burdens on countries and to improve the quality of lives of people living there (Trope 2011). The social and economic burden of glaucoma is particularly considerable in Saudi Arabia (Malik et al 2017). However, the type of glaucoma varies in this country as compared to the western countries. One study revealed that about 5.2% of the patients in the Kingdom of Saudi Arabia who report eye problems, had glaucoma (Al-Shaaln et al 2011). The subtype of glaucoma called the primary congenital glaucoma (PCG) is particularly common in the Kingdom than other subtypes. PCG is a kind of severe glaucoma in which the intraocular fluid pressure is increased right from birth and there is no other external or systemic condition causing glaucoma. PCG is 10 times more common in Saudi Arabia than in the West (Malik et al 2017). The reasons behind this are often attributed to the genetic structures resulting from societies supporting consanguineous marriages. In the Kingdom, 90% of PCG cases are hereditary, having autosomal recessive inheritance and high levels of penetrance (Abu-Amero, Osman & Mousa 2011). Autosomal recessive disorders like PCG occur often in societies with high consanguinity rates. Saudi Arabia, having a consanguinity rate as high as 65% in some regions, is susceptible to new births with PCG. In the country, PCG is a leading reason behind childhood blindness. Most of Saudi Arabia’s glaucoma cases are found in the population below 15 years (Ministry of Health SA 2016), unlike in other countries where glaucoma is usually related to old age (65 years or above). 

The above understanding is further discussed in this paper. It will describe the epidemiology and risk factors of glaucoma. The magnitude of the issue and control and prevention strategies will also be highlighted. Finally, the paper will propose an intervention program to address the glaucoma problems in Saudi Arabia. 

Glaucoma – Epidemiology 

Definition

Glaucoma is a set of optic neuropathies, characterised by progressive or gradual damage of the retinal ganglion cells (Weinreb, Aung & Medeiros 2014). These cells are neurons of the central nervous system that have their axons in the optic nerve and cell bodies within the inner retina. There is a tiny space in the frontal portion of the eye that is called the anterior chamber. Clear liquid passes through this chamber. The liquid is responsible for providing nourishment to the surrounding tissues and for keeping them clean (Newman 2017). Sometimes, the liquid flows too slowly out of the eye, thus causing fluid build-up and consequently, pressure increase inside the eye. If this situation goes undetected and untreated, the optic nerve and other parts of the eye may become damaged, causing vision loss (Newman 2017). Glaucoma generally affects both the eyes; however, one may be more critical than the other.

Based on the causes, glaucoma is divided into two broad kinds – (i) primary and (ii) secondary. In primary glaucoma, the causes are not identified and in secondary glaucoma, there is usually an identified cause like diabetes, tumour, cataract, etc. (Newman 2017).