 Welcome back and celebrate the breakfast and plus TV Africa March 6th to 11th, 2022 is being marked as the World Glaucoma Week. A global initiative of the World Glaucoma Association and is said to be a unique initiative that puts a spotlight on glaucoma as a leading cause of preventable irreversible blindness worldwide. Through a series of engaging worldwide activities, patients, eye care providers, health officials and the general public contribute to site prevention. In 2013 it was estimated that there were 64.3 million people aged between 40 and 80 years with glaucoma worldwide projected to increase to 76 million by the year 2020 and 111.8 million by the year 2040. An estimated 1.2 million adults in Nigeria had glaucoma in 2012. What exactly is glaucoma? What do we need to know about its prevention and treatment? We're glad to say we have joining us this morning to shed light on this Dr. John Samsady. He's the chairman of the Nigerian Optometric Association Lagos Chapter. Dr. Samsady, nice to have you. Thank you for having me. Good morning. Good morning. Usually people would make some mistakes between the word optician and optometrist. What's the difference very quickly? Actually you have the opticians, the optometrists and the ophthalmologists. The optometrists are primary eye care providers like your eye care physicians where you have the first point of call for eye care related issues. The ophthalmologists are medical doctors who are surgeons which regards specifically to the eye. The opticians are like your technicians when it comes to fixing your lenses basically and other new areas. You just try to shed light on those basic areas. The other specialties and subspecialties in the eye care industry as well. Fantastic, fantastic. So let's look at glaucoma. The stats we gave out are pretty old stats but you were telling me before we came on set that we had some updated stats. So what are we looking at as far as the figures in Nigeria are concerned? Wow, you know, when it comes to Nigeria it's always a, you've just got to be very, very careful, you know. As 2019, that was before the pandemic year 2020, it was about 76 million people who were either suspect or were on treatment for glaucoma. Now this does not capture the, and this is talking about just adults within the range of 40 and 80. We have what we call infant eye glaucoma, we have what we call juvenile glaucoma and other forms of glaucoma, you know. And so this just tells you, and it gives you a rough picture of the statistics in terms of those that are affected by this condition, glaucoma, which is the number two leading cause of blindness and the number one leading cause of irreversible blindness in the world today. And that is why we dedicate a whole week to, you know, creating debates, forums and trying to raise awareness and sensitization on the need for people to be proactive when it comes to their eye health. So you said as of 2019, 76 million adults between the range of 40 and 80. That's in Nigeria? Global enough, yes. Okay, okay. So let's get back to the basic, what is glaucoma? Glaucoma, like I said, is the leading cause of irreversible blindness. When I mean irreversible, I mean irreversible. When one is hit with glaucoma, nothing can be done. I normally define glaucoma because I understand that the audience, the different classes of people, so let me break it down. As you mean glaucoma, the eye is like 100,000 naira, let me make it, you know. And that 100,000 naira, you have an unrobber that goes in and takes 50,000 naira. Now, here we have the EFCC, the police, you try to go rescue that money. The 50,000 that has been stolen cannot be recovered. What you can do is to make sure you protect the remaining 50,000 naira. Now that's how deadly glaucoma is. Whatever glaucoma steals cannot be gotten back. And the thing is that one of the crazy forms of glaucoma is called open angu glaucoma, which is actually called the silent thief of sight. It doesn't come with any symptom. That's how bad it is. So you have the closed angu glaucoma, it comes with a lot of pain. It's a medical emergency. So usually when people have that pain, they have to go to the clinic unless for those who are still crazy and still go on orthodox stuff. For the open angu glaucoma, we make a lot of noise about it because people never know they have this until 80% of their vision is lost. People usually come for some other things like glasses and other complaints because one, we do not have that culture of regular medical examination, not to talk of IK examinations. People don't have that at the back of their heart. No. So most times we need to keep on with this advocacy, trying to make them understand. Now I'm hoping that this week as we go on different channels to try and send this message across, you have a percentage of people who will go do the right thing because like I always say, the doctor is your friend. It's not your enemy. Sounds like the police is your friend. Let's just stay with the fundamental now. What are the causes of glaucoma? If you want to talk about those who can get it, I mean, is it limited to a particular set of person in terms of age, is it a respect of anyone? Can a baby get glaucoma from Beth? What really causes glaucoma? Glaucoma is primarily hereditary. It's not because you didn't eat well, it's not because you didn't exercise well or sleep well. Those kind of big contributory, but the primary cause is hereditary. And also, it also affects people of the African race, especially the open and glaucoma. So anybody who is, as we use the word black, which I don't like, but of African descent, is at risk of having glaucoma. So we all have the risk? We are all at risk. Just by being an African. The reason is this. People who are not supposed to know why are melanin pigmentation. So because of the dense melanin pigmentation, there's the part of the eye inside. It's called the trabecular meshwork. Whenever it is clogged because of the density of the melanin pigmentation, it becomes difficult for the outflow and inflow of the aqueous fluid, which is what causes the buildup of pressure that causes damage to the optic nerve, which is at the back of the eye, because glaucoma ideally is a group of diseases, neuropathic in nature, that affects the optic nerve. The optic nerve is the second cranial nerve, which is the, how will I put it now, like a lifeline when it comes to your eye, because the brain is a huge part of what you, in terms of what you see, what you visualize, because the truth is, vision is something you cannot downplay. The reason why we can enjoy our conversation is because we can see each other. We can appreciate color. We can appreciate depth perception. But once you begin to tamper with those things, it begins to, people become a bit suspicious. So you can see someone who has lost his sight has become suspicious of everything in his environment. They begin to develop other sensory mechanisms, like hearing, smelling, to be able to adapt to the changes in the environment. So sight contributes 80% to what we enjoy in nature. So that is why, you know, this topic of glaucoma is something we cannot downplay. Now for the age question, now, predominantly 35 to 80, I say 35 because all statistics say 40. 35 to 80 are usually more at risk. But the truth is everybody can have glaucoma, whether it's a baby, that's why we have what we call infantile glaucoma, congenital glaucoma. You have juvenile glaucoma, glaucoma can, open-hand glaucoma can show up in just any age range. We've had cases of six-year-olds, nine-year-olds, 12-year-olds, 22-year-olds losing their vision as a result of glaucoma. So there is no age that is spared. Like I said, just being an African puts everyone at risk. Not so good news, but the good news is that if there is early intervention, it can be nipped at the board. So early intervention then therefore brings us to the point of the symptoms. I mean, I don't know if you're right, but if I hear glaucoma, I think I've seen something white in someone's eye. No. You know. So what are the symptoms? So that could be cataract. What do you need to know? Usually. Now, there are other forms where you get whiteness, like where the cornea is scarred and leukocorea, and then cataract usually. But the truth is, all these diseases, you cannot just look at someone and make a diagnosis. Most times, they're wrong. It's always good for diagnosis to be done by an eye care provider and eye care professional, whether you're an optometrist or you're a thermologist. You can't do that at home because you just see some people, they're in the bus. You say, oh, you have cataract. Oh, you have conjunctivitis. No, but usually, just like he mentioned, you find out that you have some persons who have some kind of faded whiteish cover, more like you have, how do you call it now? Cataract. Yeah, cataract. And usually, you could actually say, okay, that's cataract because it looks like a transparent covering. Well, you could just say you have a night problem. Go see your eye care provider. Because you do this once you tell somebody in our client that you have cataract. The next thing they're going to do is to get breast milk or get urine to put in the eye. Yes, those practices are still prevalent today. Sadly, you know, they put olive oil, that's anointing oil, engine oil, all kinds of things. Engine oil. Yes. See water. I mean, just last week, we had to deal with two cases of that. And these people are even enlightened. So you're wondering if people who are university graduates can still go through this deceit. How much more people who are in the rural suburban area, what would they be going through? So just looking at someone is not enough to make a diagnosis. For instance, glaucoma diagnosis cannot be done at... At a glance. You can do that. If you are your effector as a person, are there things you can look out for to say I need to go check myself in? Well, like I said, for closed-down glaucoma, yes. It comes with sharp pain. Usually it's a medical emergency. So because of the pain, vomiting, blood vision and all that, depending on those, he has to do something about it. But for open-and-glu glaucoma, there is no obvious sign or symptom. Now, that is why we are making noise about it. Now, I'll use this very old illustration. You know, in those days, for those that lived in the village, where there were a lot of rats. Ratus ratus navigicus. So, you know, when they are sleeping, the rats will go and start eating around the leg, the feet. And then the person, if we're blowing, will eat it. But the time he wakes up, the damage has been done. But it's when you put your foot on the ground, wow, that huge gap. If you've never experienced it, you will never... I have experienced it, so I know during boarding school then, you know. So that's how glaucoma is. It does the damage without any sign, without any symptom. The only symptoms you can talk about for open-and-glu glaucoma is a gradual loss of vision. But there's no way, most times, for that person to know. Like I said, people come and discover they have open-and-glu glaucoma when they come for other reasons. Maybe they are 40 and above, and they have what we call press biopia. They are beginning to have problems with reading things at close range. When they come, and if it's a detailed eye examination, the person is going to... And that's why I use the word detailed eye examination, because I'm not talking about eye screening. I'm talking about detailed, comprehensive eye examinations. I'm making emphasis on that, because most people will tell you, oh, they came to my church to check our eyes. They came to my mosque. In fact, now we hear they do what we call compound screening. So they go from house to house, knocking on people's door to do screening. Now, that is due to economic reasons. Most of these people have become desperate, so they are looking for ways to collect money from people. That is not a detailed eye examination. In fact, when you see the instruments and the equipment used for eye examination, you know there's no way you can bring that to a church. You can be on a long scale basis and have effective treatment. Because there was somebody who went through one of these popular eye screening. He's an elite, about 62. Unfortunately, by the time he got to the clinic, he was already 60%. There was already 60% loss of vision in one eye and about 20% loss in the other eye. And all this while, they've given him a pair of reading glasses. And he thinks that he's had his eyes examined. That is why we are making this emphasis. The doctor is your friend. And even when people talk about the fund aspect of it, oh, it's not affordable. It's not this. How cheap is your vision? How expensive is your vision? Because those are the things you want to look at in terms of saying, how do I want to pay attention to this? I need to make time out. I need to scale out these things on the scale of privacy. Look, vision is very, very important. So if that's the case now, is there a possibility of glaucoma being treated? Yes, it can be managed. It cannot be cured. It can be managed. Glaucoma cannot be cured. I make emphasis, it cannot be cured. You cannot reverse it. But like I said, if 40% of damage has been done, remember, whenever it steals, you cannot recover what has been stolen because it's an optic nerve. Usually most neves cannot be regenerated when it is damaged. So if 40% has been lost, you cannot recover that other 60%. What the doctor or the eye care provider will now have to do is to make sure with either drugs or surgeries or both, they preserve what you have left. That's why we say they can be managed, but it cannot be cured. So if anybody comes about tarting as of now that he has a cure for glaucoma, now that person needs to be cured. Let me ask you this one now. We see a lot of persons who just wake up and suddenly they go blind. Would you say that some of this blindness, I mean, most of it, because you say it's a thief, he comes gradually and then one day you wake up you're blind all of a sudden. Not that you were born blind, but that happens. We say that that's the case. We say that's the case of glaucoma. Yes, sometimes, like I said, glaucoma is the leading cause, which means there are other causes. Sometimes it could be a combination of causes. So you could have glaucoma, you could have what you call amoroses, fugas, you could have ocular hypertension, blindness, a lot of diabetic retinopathy, a whole lot of other things. But the emphasis today is on glaucoma. Really, people can wake up and see they've lost their vision as a result of glaucoma. Because remember, it's very, very inciduous. It's very, very unassuming. So it comes in, the person doesn't know it's there. Somebody can have it for 40 years and not know he or she has it. This is the reason glaucoma usually damages the peripheral vision before. So it leaves the person what we call tunnel vision. So when the person is looking straight ahead, he still sees. But the truth is there's a test we use in the clinic it's called the visual field test, perimetry. So it's a very detailed test. It will tell us how much of the fields have been damaged. Usually it starts from what we call the M fibers to the M fibers and gradually begins to eat in. Now, if somebody that tells me, that leads me now to what we call testing. We talked about the screening. Most of the time, what they do in screening is just that chart, the visual equity chart which they call the ABC chart. Now that's a very, very important test. But it in and of itself is not enough to diagnose glaucoma. You can't diagnose glaucoma using a VHR. So the doctor does what we call ophthalmoscopy. That's what we call the direct and indirect method for doing ophthalmoscopy where the doctor looks into the eye. Sometimes it looks like a torch light but it's not a torch light. It comes in, he's actually looking at the structures to see how well formed it is. It's unnecessarily coped at the blood vessels archinomally. Then he measures tonometry, what we call the pressure of the eye. They're different instruments. Right now we have what we call the gold standard. Of course, we have more what we call the airport for measuring the pressure. The normal pressure in the eye should be between 10 millimeters of mercury and 21 millimeters of mercury. That's the standard for measuring. But now, this measurement varies from individual to individual because there's also another test called the pachymetry test which is a scan that helps us to measure the thinness or the thickness of the conure. The conure is this transparent film in front of the eye. It's actually colorless. What you see most of the time is the color from the eye reflecting on it. Now, when they measure the thinness, sometimes if the eyes are too thin even 17 millimeters of mercury or 15 millimeters of mercury may be dangerous for that particular individual. Why? Because of the thinness. So there are many factors that come into play. There's also what you call the OCT the ocular coherence tomogram. I mean, most doctors like it because it's a bit objective and it gives detail in terms of the analysis of the eye-to-brain relationship and sometimes it helps you with diagnosis, even prognosis of not just glaucoma but a lot of eye care related cases. So these are some of the tests that people need to look out for when they go for an eye examination. Not just testing you for glasses, please. Not just testing you for glasses. You want a detailed comprehensive. Sometimes I always advise once you are 30 years to 35 years insist on having what we call a dilated eye examination. What's that? It's a long story. Not necessarily a long story but eye drops are put in the eye which forces the pupil to open up from 3 millimeters to 2 millimeters Now when that happens the doctor is able to have a very good view as to what is happening inside. That's the word dilated. Yes, that's the word dilated. It's cycloplegic but it's more dilated. Interesting that dilated could also apply to the eyes. So you're saying you can never have no symptoms enough especially with the ocular ocular. So you're advocating for regular eye checks. Where do people, and when you go for the eye check, don't just go to check for your reading. Do, if you can, a dilated eye test. Once you are between 30 and 35 insist on a dilated eye examination. So where can people who do not have the funds, because of course it talks about funding being an issue. Where can they go to get tested? Now beautifully, we thank God at least the government facilities to a large extent now. You have a lot of them getting specialization. I mean, as a chairman I've had to visit some of the eye care institution we have in Lagos State. And I find out that they're trying to do most of their beginning to be very discontent with the status quo. So they're beginning to want to push. Most of them install the perimeters now, so that they can do visual fit, perimetry on them. These machines are very, very expensive. So that is why you go to an average private clinic. The truth is nobody is providing funding. Like you said in your morning show, the other person is shutting down, but may your vision not shut down. So that's why it's not cheap. The truth is it comes at a price. Even in the general hospitals, but at least it's much more accessible. So you could get in some health centers. I used to work in a health center in one of the LCDS. And even as a single optometrist there, I attended over 50,000 cases in about five years. I still have my statistics and figures. Now dealing with the government, we're not going to bring that topic for another day. But the truth is doctors can only go so far. They can only go so far because you give your best and that's what is affecting the medical world today where you have a lot of people migrating outside the country because they felt we're giving our best. We're doing so much and we're not being appreciated. There's really nothing in terms of budgetary and policy for sustaining the healthcare system. So you have a lot of middle managers or what we call doctors who have practiced between four years and ten years living the country. Now that's a huge problem because what you now have is an influx of new doctors into the system which they need training and experience. They need training and experience. Over time. Because for you to have practiced for four years, five years, twenty years, now that's some. You live without experience. Yes and then you just you know and these guys are very smart. They just come in offer you and it's tempting. I'm telling you when you see some of this. I hope we're not going to lose you to that. You can promise. I'm here and I mean I love my country. I've had the opportunities been exposed but I'm still here which means there is still hope and so many other people who you know want to make things right but you know there needs to be this cooperation between the private and the public system. This PPP arrangement because if you live it for the private, everything is going to go very expensive. If you live it for the government, things will fall apart so there needs to be this collaboration where things can really you know make things work. Okay. So let's as we go sit down now. Because we're looking at I mean we understand now that you're saying that this is sometimes it's not necessary but doesn't mean that it can't be attributed to some of the practices maybe not sleeping early like you have mentioned but mostly it's hereditary and because of that you've also mentioned that there's no cure to this and one of the things that you have recommended it's because you're saying that it's genetic therefore that's need for regular checkup apart from regular checkup. Are there all the practices are there all the things that one can you know engage in to just manage the entire you know manage because you're saying that at this point it can be managed can be cured so what can one behave your practices apart from medical checkup that could also help. Okay. So now we're talking about the primary or primordial level of intervention now which is the best level of intervention but like I said for glaucoma it's a little bit beyond that. So lifestyle, lifestyle there are things that can aggravate you know the experience if someone has glaucoma so if someone suddenly becomes diabetic or hypertensive now for instance for high blood pressure could even speed up the pressure in the eye you know there's a direct relationship from studies that have been found out so when the BP goes up there's also a tendency for the intraocular pressure the intraocular pressure now just means the pressure inside the eye intra eye pressure just like you have the high blood or the blood pressure the blood pressure inside the body. Now which means if you try to be healthy so we could reduce the mortality or the morbidity rate when it comes to glaucoma so we always advocate it right as usual foods high in vitamin A and vitamin C you want to go for a lot of dark green vegetables I always say people always say oh I have it in my goosey have it in my obonno but you know the way we make our foods here you know we boil the nutrients out of them so it's good when these things come whole fruits when they come raw as much as possible that's where you can get the full benefits of the chlorophyll and the greens and the riboflavin for instance in the reds because you know fruits have colors so you have the reds the greens the yellows so the greens the reds those things really help with the eye there is this very important antioxidant it's called lutein and tagzin team recently discovered that helps so it's found in things like you know carrots but you know how much carrots can you really eat because I'm always very careful when you tell people to go eat something so now somebody here this man he goes to buy a basin of carrots and say when I eat carrots you go no no no we're just saying have a balance of everything eat right sleep right okay exercise safely now because people who have glaucoma you don't want to go and start doing certain kind of heavy exercises that can aggravate injuries and things like that so you want that's why I said exercise safely look for what suits your particular body type because somebody may be into muscle training you may not need that you may just need aerobics and things like that so look for what suits that particular individual but like I said the number one cause of loss of vision in my own estimation is ignorance which is what we are trying to bust here now when people are aware and then they take the needed steps the necessary steps to you know mitigate it we have solved that problem because if I know that look I need to have a detailed eye examination which means I need to have a budget okay and I need to do something about it so I approach an eye care provider trying to know who the right eye care provider is that's what we talked about you know going to the general hospitals the health center there are loads of private in fact in Lagos registered there are over 400 eye care private providers that do the right things okay okay we have to go it's been an interesting conversation and of course I'm sure listeners are better informed now about Glockoma viewers rather are better informed now about Glockoma John, Dr. John Samsely is the chairman of the Nigerian automatic association in Lagos state and he's been a guest this morning on the first discussion on the breakfast Dr. Samsely thank you for your time thank you for having me thank you many thanks for coming thank you we appreciate what I said we step on the brakes when we return it will be time for us to look at our second conversation of course hints that Victor Moses might just be making a return back to the national team that's the Super Eagles stay with us as we have mighty join the conversation