A Question of Faith

As May 5 approaches, ophthalmologists are asked to keep a close eye on their Muslim glaucoma patients. The reason? Ramadan, the ninth – and according to belief, the holiest – month of the Islamic calendar. Commemorating the first revelation of the Quran to the Prophet Muhammad, Ramadan is annually observed with a month of fasting.

Although the dates shift depending on visual sightings of the crescent moon, it has been decided that Ramadan will fall between May 5 and June 5 this year. So what is the issue? A study has found that 63.7 percent of Muslims believe that the application of eye drops breaks fasting, with only 34.2 percent of Muslim glaucoma patients claiming they would continue taking their medication during this period (1). But that’s not all.

“Even more worryingly, many of these patients stop using the drops altogether when they don’t perceive any change to their sight. Of course, this is because changes are only apparent to the individual when significant sight loss has occurred, but the patient doesn’t always know that,” explains Subhash Suthar, Development Manager at the International Glaucoma Association (IGA). “It’s distressing when patients realize that their vision has been damaged by stopping drops during a follow-up appointment with their ophthalmologist or optometrist.”

So how do we support patients during this period? “We want to reassure the Muslim community that drops can be taken before dawn and sunset (known as Suhoor and Iftar), when food and drink can be consumed,” says Subhash. “We also suggest that patients close the tear duct – punctual occlusion – when taking eye drops as this means that fluid stays in the eye and does not drain into the throat and, as such, cannot be tasted. This is achieved by putting finger pressure at the corner of the eye next to the nose immediately after instilling drops.”

The IGA has been working with the Muslim Council of Britain (MCB) to raise awareness of this issue among patients and ophthalmologists. Omer El-Hamdoon, MCB’s Deputy Secretary General, has confirmed that all Islamic schools of thought agree that taking eye drops does not invalidate the fast. He adds that, although the chance of eye drops reaching the throat is unlikely, it can be avoided entirely with punctual occlusion (see Figure 1).

Professor Ejaz Ansari, Lead Clinician and Head of Glaucoma Services at Maidstone and Tunbridge Wells NHS Trust, has been working with the MCB and the IGA to promote the protocol. “Advanced glaucoma, post-op patients, PXF and secondary glaucoma cases are most at risk,” says Ansari. “I encourage doctors to remind their patients to continue taking drops during Ramadan.”

El-Hamdoon has the final word: “Islam advocates that people take care of their bodies – and that means protecting your sight.”