IBADAN, Nigeria — Disease surveillance has significantly improved in Nigeria. Authorities now issue monthly reports on diseases of public health significance, such as Lassa fever and yellow fever, and recently undertook one of the largest HIV surveys globally.
But even though more than 4 million Nigerians are visually impaired, eye health has not enjoyed the same attention. Just one national survey has been carried out, led by the London School of Hygiene and Tropical Medicine more than a decade ago.
The issue has been neglected in part, health experts said, because of its close relationship with poverty and illiteracy. Due to lesser access to services, visual impairment among those who cannot read and write stands at 5.8% nationwide, according to the survey, against 1.5% among those who can.
“Unlike HIV and other infectious diseases that affect everyone irrespective of their education level, conditions that can result in blindness preferentially affect the poor Nigerians who rarely visit hospitals that have eye health experts,” said Dr. Aanu Olufunke, an optometrist who runs a private eye clinic in the city of Ibadan.
Part of the problem is the low number of ophthalmologists working in Nigeria — just 300, according to the president of the Nigerian Medical Association, for a population of almost 200 million.
But there is also the challenge of donor funding. Among the causes of blindness, the national survey identified cataract, a condition that is relatively simple to treat, as responsible for 43% of cases. That was followed at about 17% by glaucoma, a condition involving damage to the optic nerve that can be stalled but not reversed, making it a less attractive proposition for donors.
Glaucoma has quietly become the leading cause of irreversible blindness in Nigeria, and there are suggestions that the number of sufferers is rising. Dr. Justice Nzerem, secretary of the Nigerian Optometric Association, described a glaucoma “epidemic.” Along with other specialists who spoke to Devex, he believes it is more common than officially reported. “The prevalence is high. When I screen five persons, three of them could have glaucoma,” he said.
Need for outreach
At the eye clinic of Babcock University Teaching Hospital in Ogun state, Dr. Abimbola Omotosho sees hundreds of patients each week — but most cases of glaucoma are recorded during outreaches to rural communities.
“People come to the hospital when they feel pain and discomfort. For glaucoma, this is not the case. Many patients with glaucoma don’t know they have it,” she said. As a result, it often isn't diagnosed until significant damage to the optic nerve has already happened.
“If the glaucoma has caused 40% damage, it cannot be restored … This is not good enough for many Nigerian donors who believe that seeing immediate change is good for publicity.”— Dr. Abimbola Omotosho, Nigerian ophthalmologist
Patients diagnosed at the clinic usually have a relative with the condition, or have been referred for eye screening by another department. But for Nigerians living in rural areas, their chance of being diagnosed hinges on the inclusion of glaucoma screening in the array of services offered by outreach organizations — which it rarely is.
Outreach groups including the Muslim Medical Students’ Association, Oak Health Foundation, and African Development and Empowerment Foundation told Devex a lack of financial and logistical support greatly limited their ability to provide screening and treatment services. There are no publicly available funds for those organizing outreach activities, they said, meaning most of the work is done by hospitals.
On top of the lack of government funds, they described a lack of interest in glaucoma from local and international donors due to its poor prognosis.
“If the glaucoma has caused 40% damage, it cannot be restored. What we can only do is to prevent subsequent damage. This is not good enough for many Nigerian donors who believe that seeing immediate change is good for publicity,” Omotosho told Devex.
Cataract treatment, by contrast, which offers immediate results, enjoys support from a number of local philanthropists and organizations. “Videos of patients thanking the sponsors for restoring their vision is sweet music to [their] ears,” she said.
But glaucoma patients need to take medication for the rest of their lives. With no donor offering subsidies, many patients aren't able to support the cost
“Because of this, we see many patients not being consistent and derailing on treatment. They may try other spiritual or esoteric options, and will only return when further irreparable damage has been done,” Omotosho said.
Little by little
In the absence of a concerted effort from central government or national donors to tackle glaucoma in Nigeria, isolated efforts are emerging with the aim of reaching as many individuals as possible.
The state government of Lagos runs the “Blindness Prevention Programme,” launched in 2000 in response to the high prevalence of preventable eye disease in the state — much higher than in most industrialized countries, it explained in a statement.
Its efforts started with free eye screening, then incorporated surgical expeditions. Now it has developed a comprehensive eye care system, including integration into mainstream health care services and the introduction of an eye screening program in schools.
Outside government, organizers of free health outreach activities are also increasingly working to incorporate eye screening.
“When we see someone with glaucoma on such outreaches, we refer them to the hospital where they will be properly treated. Because many of them are poor, we often have to greatly reduce the cost — even at that, not all of them will stick to the treatment plan and the reasons are quite understandable,” said Adeola Onakola, a consultant ophthalmologist.
Dr. Ozy Okonokhua, president of the Nigerian Optometric Association, stressed the need for more interest from government and donors, but added that individual citizens also need to start visiting eye clinics regularly.
“Nigerians like waiting for things to go wrong or until ... there is an obvious effect before they walk into an eye clinic or hospital. But the only way to prevent glaucoma is to seek health care whether a person [feels] sick or not,” he said.