By Bob Shepard
Glaucoma is a silent disease. It does not hurt, symptoms are slow to develop, and most people do not notice any loss of vision until it is too late. A project by ophthalmologists at the University of Alabama at Birmingham will examine whether a partnership with community-based optometrists will improve detection and treatment of glaucoma, especially for high-risk populations.
Glaucoma is a disease of the optic nerve, the cable that connects the eye to the brain. The nerve breaks down in some people, usually older adults, causing irreparable vision loss.
“Glaucoma is much easier to treat when it is found in the early stages, and less likely to lead to blindness,” said Christopher Girkin, M.D., professor and chair of the UAB Department of Ophthalmology. “It’s like a river that ends in a waterfall. We want to catch people who are well upstream of the waterfall, where the river is moving slowly and it is easier to save them. Once they are at the top of the falls, it is much more difficult to prevent them from going over the edge.”
Glaucoma is the second-leading cause of blindness worldwide, and the leading cause of blindness in African-Americans, who are four or five times more likely to develop the disease than are people of European descent. Age, family history and race are risk factors for glaucoma. Access to health care is also an issue, especially with older, rural and disadvantaged populations.
“Our current model of eye care is simply not reaching one of the most at-risk populations for glaucoma: older African-Americans,” said Girkin. “Historically, this is an underserved population less likely to seek professional eye-care services in a standard clinical setting. So we’re going to see if we can take appropriate vision care to them.”
UAB has launched a pilot program, funded by a two-year, $1.9 million grant from the Centers for Disease Control and Prevention, to install sophisticated imaging machines in the offices of two central Alabama independent optometrists who are located adjacent to Walmart Vision Centers, with a centralized image-reading center housed at UAB.
The imaging devices, optical coherence tomography machines, provide high-resolution images of the back of the eye. An optometrist can detect the earlier stages of glaucoma in those images, even before symptoms appear. Images of a patient’s eyes are electronically transmitted from the imaging machines at the optometrist’s office to the UAB center for confirmation of the diagnosis. UAB’s trained glaucoma specialists can then confer with the optometrist on complex cases to determine an appropriate treatment regimen. Patients who undergo the glaucoma testing also receive a dilated comprehensive eye exam and educational materials about glaucoma.
Sonia Nduna visited one of those optometrists, Frank LaRussa, O.D. The Birmingham woman grew up knowing she was at risk for glaucoma. Her father had it, and she was told as a child that the shape of the back of her eye put her at risk. As an adult, she got regular eye exams. One day, she accompanied her mother to LaRussa’s office.
“I brought my mother in for a checkup and thought I’d get my eyes checked too,” Nduna said. “Dr. LaRussa said the pressure in my left eye was very high.”
LaRussa’s examination determined that Nduna had glaucoma, which was confirmed with the imaging program. Nduna, just 45 years old, is young for the onset of the disease. She is now on medication, taking drops to control the pressure in her eyes, that will preserve her sight.
“It’s good that we discovered it early because you can’t feel glaucoma,” Nduna said. “You don’t notice the change, and there’s no pain.”
Girkin and LaRussa say the outreach program is an effective blend of UAB’s highly regarded glaucoma service and LaRussa’s community-based practice.
“With this program, we’re bringing education, detection and glaucoma treatment directly to the patient,” LaRussa said.
Girkin is a nationally recognized expert in glaucoma and has been studying the use of ocular imaging techniques in the diagnosis of the disease for 15 years.
“This is an excellent example of the value of translating technology that has been evaluated and fine-tuned in the research setting and employing it in the field for the betterment of patients,” he said. “This provides better access to care and better delivery of care within these hard-to-reach populations.”
Knowing for years that she was at risk meant Nduna was not afraid of a diagnosis of glaucoma.
“To me, not knowing was the scariest thing,” she said. “I urge others to take advantage of this opportunity. It’s convenient. Just come in and get your eyes checked.”
Girkin hopes the combination of sophisticated imaging, expertise from UAB and easy access to health care will lead to an increase in early detection of glaucoma in high-risk groups, as well as increased compliance with treatment programs.