Eyeworld

EW FEATURE 60 by Faith A. Hayden EyeWorld Staff Writer Glaucoma: A global scope F ew eye diseases are as exas- perating for ophthalmolo- gists as open-angle and angle-closure glaucoma. Asymptomatic and often invisible, glaucoma slowly eats away at its victim's vision by nibbling through the outlying peripherals, permanently damaging the optic nerve and retina. Attacking the fringes of eyesight makes the disease difficult to notice without proper screening, such as long-term moni- toring of IOP and visual field testing, causing patients to present late. And when the damage is done, it's done; vision will never be restored. Despite centuries of research, a cure for glaucoma remains elusive. At best, ophthalmologists can stave off blindness with IOP-lowering treatments, such as eye drops, tra- beculectomy, or laser trabeculo- plasty, but these methods are sub-optimal, sometimes having more complications and conse- quences than returns and rewards. It is estimated 60.5 million peo- ple have glaucoma, according to the study "The number of people with glaucoma worldwide in 2010 and 2020" by Harry Quigley, M.D., di- rector, Dana Center for Preventive Ophthalmology, Wilmer Eye Insti- tute, Johns Hopkins University, Bal- timore. Of those 60.5 million, 44.7 million are afflicted with open-angle and 15.7 million have angle-closure. This number is expected to increase to 80 million by 2020, largely due to the aging of the world's population. Glaucoma is second only to cataract as the leading cause of vi- sual disability globally, and it is the No. 1 cause of irreversible and po- tentially preventable blindness. In developed countries, less than half of those with glaucoma are aware that they have the disease, and this figure is even lower in developing countries. "Most of the glaucoma burden is in India and China; it's in Asia," said Ivan Goldberg, M.D., clinical associate professor, University of Sydney, Sydney, Australia, and head of the glaucoma unit, Sydney Eye Hospital, Sydney. "That's as you'd expect because they've got the largest populations. It's also a huge problem in Africa, and it's mostly open-angle glaucoma." Developed countries such as the U.S. have their own struggles with the disease, but they are mostly is- sues with adherence to treatments. Developing regions such as Africa, however, are in dire straits, with glaucoma challenges ranging from the most basic—education and awareness—to the most complex— screening and treatment. "There are no global data for achievements in the fight against vi- sual impairment due to glaucoma," states the International Agency for the Prevention of Blindness (IAPB) 2010 Report. "In addition, over the past 10 years, there have been rela- tively few attempts in developing countries at establishing compre- hensive eyecare programs in the community that include manage- ment of glaucoma." But if the World Glaucoma As- sociation (WGA) has anything to do with it, the next 10 years will be more productive. WGA is an inde- pendent global organization work- ing to solve the world's glaucoma problems through education, train- ing, and research. "WGA has been concerned with the state of affairs with African glau- coma for some time," said Tarek Shaarawy, M.D., associate executive vice president, WGA, and director, glaucoma sector, Geneva University Hospital, Geneva, Switzerland. "The information WGA is getting from Africa is not very optimistic. Glau- coma in Africa is not simply a blind- ing disease, but a disease associated February 2011 GLAUCOMA February 2011 with higher mortality. It's not just effecting quality of life, but life it- self." The African Glaucoma Summit Although glaucoma is a worldwide problem, WGA made the deliberate decision to first focus its efforts on Africa, specifically West Africa, where glaucoma runs rampant. The association worked for years on as- sembling a group of ophthalmolo- gists and healthcare professionals from inside and outside Africa who have a personal interest in resolving the glaucoma epidemic. The fruits of WGA's labor culminated in a 2-day meeting in Accra, Ghana, in August 2010, called the First African Glau- coma Summit. Organized by Leon W. Herndon, M.D., associate professor of ophthal- mology, Duke Eye Center, Duke Uni- versity School of Medicine, Durham, N.C., together with Dr. Shaarawy and Shlomo Melamed, M.D., Israel, as a co-chair of the African Glaucoma Summit, the meeting hosted more than 200 participants from 27 coun- tries in Africa, including the Ghana- ian deputy minister of health, the deputy director general of the World Health Organization, and representa- tives from non-governmental organi- zations that work in Africa fighting blindness. "The purpose of the meeting was to really understand from our African colleagues, to come to them at eye level, to learn from them what the real problems are and what kinds of solutions we should have," said Dr. Melamed, a member of WGA's general assembly. With the African Glaucoma Summit, WGA has taken the first step in tackling Africa's glaucoma problem head on. Eight topics cru- cial to developing practical solutions were thoroughly discussed and each topic was broken out into specific action plans. Topics debated in- cluded: glaucoma education, best treatment options for Africa, incor- porating glaucoma management into existing ophthalmological pro- grams, screening methodology for advanced glaucoma cases, and cen- ters of excellence for glaucoma in Africa. AT A GLANCE • It is estimated that 60.5 million people have glaucoma, and that number is expected to increase to 80 million by 2020 • Developing regions, such as Africa, are in dire straits, with glaucoma challenges ranging from the most basic—education and aware- ness—to the most complex— screening and treatment • Developed nations, such as the United States, have mostly adherence issues; glaucoma pa- tients using eye drop therapy only take about 70% of their medicine • New treatments for glaucoma management are needed worldwide Glaucoma and Vision 2020 V ision 2020: The Right to Sight is a joint program from the World Health Organization and the International Agency for the Prevention of Blind- ness (IAPB) with the goal of eliminating avoidable blindness worldwide by year 2020. The initiative's strategy is built on a foundation of community participation in hosting cost-effective disease control interventions, improving human resources through training and motivation, and developing overall in- frastructure. The IAPB 2010 Report lists glaucoma as the third largest cause of over- all blindness, the second being uncorrected refractive errors. The report pro- vides a number of targets the Vision 2020 initiative should achieve by its end date, including teaching and practicing comprehensive eyecare examination, glaucoma diagnosis by routine case detection rather than population-based screening, initiating glaucoma programs only once diagnostic skills and surgi- cal training are in place, integrating glaucoma care into existing eyecare ini- tiatives, and reporting visual outcomes and complications of surgical interventions, rather than simply the number of operations. The report also lists the remaining challenges, such as further glaucoma research. "There is an urgent need to research effective population-based strategies for glaucoma management," the report states. "It seems that case detection at the primary and secondary center level of the pyramidal model of eye care can detect more glaucoma. The best approach to treating such cases (medical, laser, primary surgery), the eventual impact on blindness, and the cost of achieving this are unknown and need further study." To access the full report, visit www.vision2020.org. GLAUCOMA February 2011 58-81 Feature_EW February 2011-DL2_Layout 1 2/4/11 2:25 PM Page 60

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