Eyeworld

78 | EYEWORLD | WINTER 2026 G UCOMA does OCT scans. "What we need is to be able to screen and say, 'There's something suspicious here, and you need to go see someone else,'" she said. "What's important is to be able to screen effectively and identify when a patient is at risk so we can send them to the appropriate specialist." Strategies in the U.S. and abroad When Dr. Smith travels for mission trips in other countries, teaching MIGS is part of those efforts. This began around 2018, training surgeons to put in glaucoma drainage implants in Nigeria. "This has really helped to multiply the number of surgeons in the country," she said. Certain MIGS procedures will work well in limited resource settings, including those that aren't too much more than the cost of a needle or a suture. "We have patients with moderate to severe disease who do well with MIGS proce- dures that are geographically appropriate," she said. "They don't cost too much, they're easy for surgeons to learn, and the equipment and tools they need are easily and readily available in the hands of a properly trained surgeon." The cost of the procedure varies depending on the country; it doesn't apply all around, so that's an important factor to consider as well. In order to help as many patients as pos- sible when traveling abroad, Dr. Smith noted a strategy of taking care of patients and do- ing surgeries under a training umbrella. "We created a course that will teach didactics in the mornings and do hands-on training in the after- noons," she said. "With this training, we're leav- ing the most experienced people with a learned skill because we're only there for a short period of time." This allows her to perform surgeries on patients in need but also to leave behind capable physicians to teach more people and treat patients. She noted that a number of professional societies offer resources for these patients to help them afford the treatment they need. The problems exist everywhere, she said. There are people who are underinsured, and there are foundations or entities that help reach these people when they show up. The resources are available so it's important to find them online. Access and patients in need of care is also a problem that Dr. Smith encounters domes- tically. She described helping a patient at her practice in Texas who was blind in one eye with a pressure of 30 mm Hg and on a number of drops. She told the patient that she needed to perform surgery that would take out her natural lens and reopen the drainage angle, but the patient was very concerned with the cost of the procedure. "I never look at a patient's ability to continued from page 76 Sharing gonioscopic findings with a colleague in Owerri, Nigeria Source: Oluwatosin Smith, MD Meeting with Dr. Sanduk Ruit after a weeklong glaucoma surgical update at Tilganga Institute of Ophthalmology in Kathmandu, Nepal Source: Oluwatosin Smith, MD

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