What is practical in glaucoma management?

Abstract

This article addresses some important issues in the detection and management of glaucoma using examples from the developing world, particularly drawing on experiences and research in sub-Saharan Africa.

A Population-based Study of Care-seeking Behavior in Rural Tanzanians With Glaucoma Blindness

“…It also contrasts with a report from South Africa in which over 75% of those blind in one or both eyes from glaucoma were undiagnosed. 13 These findings probably reflect the services available in Kilimanjaro Region where regular outreach clinics, strategically located to ensure that most of the population has access, are staffed by teams from the hospital including personnel with enough skill to diagnose and treat glaucoma. 10 Mid-level ophthalmic personnel (ophthalmic nurses and cataract technicians) may be trained to recognize advanced optic nerve cupping but it is difficult to envision a role for "primary eye care" in diagnosing even advanced glaucoma.…”

“…8,13 We cannot be certain whether the unoperated patients had disease too far advanced to benefit from surgery at the time they first presented or whether doctors did not offer surgery. It is important to recognize that this study only included patients who were blind.…”

Glaucoma in the developing world

“…1 2 In east Asia, angle closure glaucoma predominates, whereas in Africa, the Indian subcontinent, and in Hispanic populations open angle forms are more common. 1 3 Treatments vary depending on the type of glaucoma and the setting.…”

“…Black people also have higher failure rates of conventional trabeculectomy than white people. 2 5 This may be related to racial differences in the wound healing response, which predispose black people to increased scar formation at the surgical site 5. Good evidence from randomised controlled trials and case control studies shows that adding antimetabolites such as mitomycin C and fluorouracil to trabeculectomy in African patients can improve success rates.…”

“…Good evidence from randomised controlled trials and case control studies shows that adding antimetabolites such as mitomycin C and fluorouracil to trabeculectomy in African patients can improve success rates. 2 9 However, there is a learning curve to their use because of increased risks of wound leak, low intraocular pressure, and infection. Regular postoperative follow-up is important, especially in augmented trabeculectomy, as manipulation of the operation site—such as suture removal or adjustment or breaking down of scar tissue—may be needed to maintain the function of trabeculectomy 10.…”