Abdul Qayyum, 50, has not been able to purchase Rs65 pilocarpine eye drops for his glaucoma because the medication isn’t available in the market.

The Islamabad resident has suffered from glaucoma for some time. He said he was willing to pay many times the original cost of the eye drops, which are the most effective treatment for glaucoma, but is unable to find them in the market.

“The government and regulatory departments should ensure the availability of such an important medicine; it is a basic need for patients, not a luxury item,” he said.

Mr Qayyum added that there are alternative eye drops available - at almost 12 times the cost of the ones he uses - but they are not as effective as pilocarpine eye drops. “Patients are trying to get the drops, but it has been heard that the company stopped manufacturing because manufacturing at such a low cost was not viable for it,” he said.

He said he has contacted a number of pharmacies, asking them to keep a bottle or two aside for him if they receive stock of the medication.

Glaucoma causes damage to the optic nerve and worsens over time, and is often linked to a build-up of pressure inside the eye. The condition tends to be hereditary, and may not show up until later in life. If the damage caused by glaucoma to the optic nerve continues, it can lead to permanent vision loss, and glaucoma can lead to permanent blindness within a few years if untreated.

Prof Dr Yaseen Durrani, a senior ophthalmologist, told Dawn that there are two kinds of glaucoma: open angle and closed angle. Most eye drops available in the market are for one of the two kinds of glaucoma, he said, but pilocarpine drops are effective for both.

Patients feel uncomfortable when they start using the drops, but once they get used to it, they get a lot of relief, he added. “Pilocarpine drops are made from the extract of a plant found in the West. In Pakistan, they are only manufactured by Ethical Laboratories Lahore, but they have stopped manufacturing it or they have reduced production, because it was not viable for them to manufacture at such a low price,” he said.

He added that there are a number of eye drops available in the market, but they cost over Rs800 but are either ineffective or become ineffective over time and require that patients change them.

“On the other hand, pharmaceutical companies give incentives for their products, so most well-reputed institutions have stopped suggesting pilocarpine drops. But patients keep finding them because of their effectiveness,” he said.

Dr Durrani added that Diamox eye drops, an affordable medication with the drug formula acetazolamide, is also rarely available in the market.

Glaucoma causes damage to the optic nerve and worsens over time, and is often linked to a build-up of pressure inside the eye

“If a person is over 40 or has diabetes or hypertension, or there is glaucoma in their family, he should contact doctors. But one needs to understand that glaucoma can be controlled with medicine, but it cannot by removed with medicines.The only solution is to prepare artificial drainage in the eye, as natural channels are blocked. If untreated, absolute glaucoma can happen, which means complete blindness,” he said.

An artificial valve, called the Ahmed Glaucoma Valve, can be used to restore a patient’s vision.

“It is unfortunate that the Ahmed Glaucoma Valve, which was invented by a Pakistani scientist and is identified by his name across the globe, is not manufactured in Pakistan,” he remarked.

Dr Waseem Khawaja from the Pakistan Institute of Medical Sciences (Pims) said the Drug Regulatory Authority of Pakistan (Drap) is responsible for ensuring the availability of medicines at affordable prices.

“People face problems because of the unavailability of medicines, and their problems worsen day by day because they stop taking medicines for various reasons, such as the cost or availability of medicines,” he said.

Dr Khawaja said most people with glaucoma have no early symptoms or pain, and should visit their doctor every year in order to get diagnosed and begin treatment.

Ministry of National Health Services spokesperson Sajid Shah told Dawn that whenever such information is brought to the ministry or to Drap’s knowledge, a report is sought from the company that contains details about the number of medications manufactured by that company.

“Sometimes, companies don’t profit from some medicines but since they profit from other medicines we push them to continue manufacturing. We will check if the company has been manufacturing the eye drops. However, sometimes companies are manufacturing medicines but wholesale dealers stop the supply in the market so they can sell on the black market,” he said.

“As the matter has come to our knowledge, we will check it and it will be ensured that the eye drops are supplied in the market,” he added.

Published in Dawn, May 6th, 2018