Liberia: Glaucoma: ‘The Silent Thief of Sight’ Many Liberians Are Unaware Of

By Alaskai Moore Johnson

The thought of going blind is frightening, yet this is the reality for many Liberians who are unknowingly battling with glaucoma. 

The disease, which is the leading cause of irreversible blindness across the country, is something that most Liberians are unfamiliar with. 

“It is a silent attacker that catches people off guard and then results in potentially irreversible blindness,” says Dr. Niranjan K. Pehere, an ophthalmologist at the Liberia Eye Center at the JFK Medical Center.

The treacherous aspect of this disease, according to Pehere, is its asymptomatic nature, as it leaves people completely unaware until it reaches an advanced stage. 

The prevalence of Glaucoma, Pehere says, is relatively high in Liberia, with approximately 7% of the eye patients the clinic sees annually affected — and the cases are often very advanced — with treatment only intended to preserve the remaining vision.

“If we go by the data in our clinic, 7% of the patients that come to us, have glaucoma,” says Pehere who is just one of the few ophthalmologists in Liberia, a country with a population of over 5 million people.   “If we compare this with other clinics, I mean clinics outside Africa, it is usually three to four percent.”

“So this indicates that there is a lot more glaucoma in the communities. The thing about glaucoma that we see here, almost 70 to 80 percent of cases are very advanced in both eyes and somebody has to escort them to the clinic.

“We then sadly have to give the bad news that it is already in the advanced stage and there is nothing we can do about it; so that is the current scenario of glaucoma over here,” Pehere says.

The disease, known as the silent thief of sight, is estimated to affect a considerable number of Liberians who are unaware of their condition because of its asymptomatic nature.  

The challenge then is the limited awareness of the disease and its risk factors. This means many Liberians may not realize that they have the condition until it has progressed to the point of vision loss. 

The problem is also compounded by the limited access to quality eye care services for the vast majority of the population as there are only a few eye doctors.

“Glaucoma though does not have a definitive cure, if detected early enough, can be managed effectively by trained eye doctors. If appropriate measures are not taken to control the disease, one might just suddenly go blind which is sadly irreversible,” says Dr. Benetta Collins Andrews, a Specialist Pediatrician, and the current Chairperson at the Liberia Medical and Dental Council, who joined Pehere in the interview to promote awareness as part of activities marking World Glaucoma Week in March. 

“The percentage of glaucoma in the country would be higher than the clinic data of 7% but it is still a matter of concern considering that most cases are in the advanced stage,” says Dr. Andrews. 

“Also, the percentage is just for people that the clinic sees, so just imagine the number of people who are sitting at home if they were coming to check their eyes.”

Globally, glaucoma is the second leading cause of blindness worldwide. It is estimated that more than 70 million people worldwide have glaucoma, and this number is expected to increase to 111.8 million by 2040. The disease causes damage to the optic nerve and can lead to irreversible blindness if not detected and treated early. 

The prevalence varies by age, ethnicity, and geographical region, with higher rates reported among people over 50 years of age and those of African descent.

Data also from the Liberia Eye Center, which is run by L.V. Prasad Eye Institute of India shows that the eye center sees approximately 15,000 patients annually. Of those patients, 3000 to 4,000 are cases of glaucoma with most in advanced stages.

The eye center also sees many patients with other eye diseases, such as cataracts, which is the most common age-related eye disease. Other common eye issues include dryness in the eye and pterygium, which is a flesh growth on the eye's surface, and patients with retinopathy, including hypertensive retinopathy, which is due to blood pressure problems. 

The risk of getting glaucoma, according to experts, is higher among certain groups of people. This includes those with a history of glaucoma in the family, adults over 50 years of age, African race, myopia (shortsightedness), and diabetes mellitus.

However, the risk factors had not scared ophthalmologists at Liberia Eye Center, which is run by the LV Prasad Eye Institute, India, from taking on the challenge of fighting back against glaucoma in Liberia. 

According to Pehere, glaucoma can also affect young people in their 20s or 30s, and even newborn babies, and it tends to be serious as it progresses faster leading to blindness. 

One aspect of the fight is a commitment to early detection. Glaucoma is notoriously difficult to diagnose, but the ophthalmologists, optometrists, and other eye care professionals at  Liberia Eye Center are using the latest technology, including Automated visual field tests and Optical Coherence Tomography (OCT) to detect the disease in its early stages. 

Screening high-risk individuals, such as those with a family history of glaucoma, is also a paramount concern. The goal is to ensure that no one falls through the cracks.

Once a case is diagnosed, patients receive a personalized treatment plan that is tailored to their needs and preferences. The Liberia Eye Center offers a range of treatment options, including eye drops, laser therapy, and surgical interventions, and Pehere and his team work closely with each patient to determine the best course of action. 

They also offer ongoing support and education to help patients manage their disease and maintain their vision. And while eye care is expensive, the Liberia Eye Center takes care of every one of its patients as part of its philosophy that everyone who requires treatment should receive it, irrespective of their ability to pay for it and the complexity of the disease. They achieve this through a three-tier payment system, which is intended to determine patients' ability to pay for an eye care service so that no one is turned away “due to their financial circumstances.” 

The impact of the three-tier payment system has therefore been profound. Patients who were once struggling with vision loss and the fear of blindness have been able to manage their disease and maintain their independence even if they are unable to pay for the treatment.

But the Liberian Eye Center's impact doesn't stop there. Pehere and his team have continued to raise awareness about glaucoma and the importance of early detection -- and for this year's glaucoma weeks, health workers across the country were offered free screening.

The initiative, which was jointly carried out with the Liberia Medical and Dental Council, aims at screening several health workers including doctors, medical students, and residents at the Liberia College of Physicians and Surgeons, and the West African College of Surgeons.

"Many of us equate checking how much one can read on the vision chart and changing glasses as eye check-ups. But that’s not a comprehensive eye check-up which can pick up several eye diseases at an early stage when they can be effectively managed to save further consequences on vision," Pehere says.

In this light Andrews shares her story:  “So, in my experience, just knowing that you can be diagnosed early and be saved from full-blown blindness is something that just overwhelmed me.”

“I had broken my glasses and came to change them but was encouraged to go through a comprehensive eye examination. I can now serve as an ambassador to tell others about the benefit of routine comprehensive eye examination to prevent irreversible blindness”

And so Andrews is encouraging all health workers and the general public to take advantage of the excellent services at the Liberia Eye Center to do their comprehensive eye examination from which she herself is a beneficiary. 

One step at a time, the Liberia Eye Center keeps on going in the fight against the disease, reaching out to more people. 

Robin Dopoe and Winston Parley contributed to this article.