EW
GLAUCOMA
51
is dependent upon a host of factors,
among them an understanding
of the consequences of untreated
glaucoma, the local availability of
medications, the ability to afford
medications, and the need for trans-
portation from remote villages to
cities or towns where medications
may be available, among others. A
therapy with a duration measured in
weeks or months rather than hours
could make a huge difference. Inci-
sional surgery can provide enduring
disease control, but the barriers to
surgical glaucoma care in the devel-
oping world are seemingly insur-
mountable. Lacking local surgical
expertise, visiting surgeons must be
relied upon to perform the proce-
dures, but rarely can such providers
remain onsite long enough to ad-
dress the inevitable complications
that arise in the first few postopera-
tive weeks. There is another issue
with surgery: "Glaucoma surgery
does not improve vision," said Dr.
Ritch, "so word-of-mouth works
against us when patients return to
their villages and tell neighbors that
the surgery didn't help them."
Finally, once the local providers
are trained and have therapies avail-
able that meet the special needs of
developing world realities, we will
need to develop effective screening
tools to identify and treat the vast
majority of glaucoma patients who
remain undiagnosed. This last task is
not specific to the developing world
and will have a global impact in all
economic regions of the world.
EW
Editors' note: Dr. Kocur has no finan-
cial interests related to his comments.
Dr.
Ritch has financial interests with
Aeon Astron (Leiden, the Netherlands),
Sensimed (Lausanne, Switzerland),
iSonic Medical (Paris), Allergan
(Irvine,
Calif.), and Ocular Instruments
(Bellevue, Wash.).
Contact information
Kocur:
kocuri@who.int
Ritch: ritchmd@earthlink.net
February 2011
May 2014
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There were 60
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