Eyeworld

EW FEATURE 61 "The enthusiasm at the meeting was overwhelming," Dr. Shaarawy said. "It was not a meeting where people would come and give a talk on the optic nerve. What was impor- tant was sharing ideas, sharing expe- riences, and looking forward to how we can make things better. There was a candid exchange of ideas; everyone learned from everyone." Glaucoma challenges in developing countries When attempting to get a handle on the extensive glaucoma problem in Africa, experts have to almost start from scratch and focus on the ba- sics. In some African countries, for example, glaucoma management and detection are not routinely taught or practiced in residency training programs. According to the IAPB 2010 Report, the cataract-dom- inated approach to blindness pre- vention is partly to blame. "The diagnoses of glaucoma re- quires more than a flashlight and a visual acuity chart, as opposed to cataract," said Dr. Quigley. "You only need to have a technical ex- pertise to remove the cataract." Glaucoma, however, is a much more complicated disease, and cur- rent surgical treatments have signifi- cant potential for complications, which is why education and training was one of the most important top- ics deliberated at the Summit. Ex- perts decided on a number of education-related action plans with a focus on training the trainers. "We want to create a generation of African trainers who are on par with the standards of the rest of the world," Dr. Shaarawy said. "I think the key for human progress in glau- coma is education. If we train one good surgeon in every country, he will be able to train many more." But before residency programs can be improved, these developing countries need access to proper training materials specifically tai- lored to their needs. European and North American education materials don't take into consideration the available resources in developing countries, which results in residents learning about technologies they don't have access to. "There are methodologies avail- able in Europe, North America, and Asia that are very costly and might not be cost effective in all situations, and this has to be reflected in educa- tion," Dr. Shaarawy said. "We are putting more emphasis on teaching technologies that are available or will be available in the foreseeable future versus educational materials like DVDs and even websites that bring attention to things Africans don't really need." However, WGA can't let these countries fall perpetually behind in new technological advances. "Africans are frustrated by the fact that they are not exposed to new technologies," Dr. Melamed said. "When we come in and start talking about optical coherence to- mography [OCT] and computerized visual fields, the African doctors say, 'Well, that's very interesting, but we don't know what you're talking about. We've never seen anything like that.' " Teaching residents in these countries about OCT and how to an- alyze computerized visual fields is another goal that came out of the African Glaucoma Summit. Along those same lines, the panelists de- cided that for the purpose of being really productive, patients with only extremely severe glaucoma should receive priority treatment. "In Africa the issue is not what to do with a patient with a pressure of 22 and good fields; you don't touch that patient. That patient is not the problem. It's those patients that you see with a pressure of 39, and their visual field is deteriorating; those are the patients you have to pick up early and operate on," Dr. Melamed said. Other results from the Summit include encouragement of the use of glaucoma drainage devices on shunts in virgin eyes and use of van- comycin in all trabeculectomy cases because studies throughout the con- tinent have shown that it improves the success rate of the surgery. Another key decision was to es- tablish five centers of excellence throughout Africa in all major re- gions: North, South, East, West, and Central. Quality centers of excel- February 2011 GLAUCOMA Shlomo Melamed, M.D., on the podium with several colleagues as panelists at the First African Glaucoma Summit Source: Shlomo Melamed, M.D. continued on page 62 58-81 Feature_EW February 2011-DL2_Layout 1 2/4/11 2:25 PM Page 61

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