EyeWorld Asia-Pacific June 2011 Issue

31 EW GLAUCOMA June 2011 A worldwide perspective on a most challenging and exasperating ocular condition F ew eye diseases are as exasperating for ophthalmologists 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 monitoring 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, trabeculectomy, or laser trabeculoplasty, but these methods are sub-optimal, sometimes having more complications and consequences than returns and rewards. It is estimated 60.5 million people have glaucoma, according to the study “The number of people with glaucoma worldwide in 2010 and 2020” by Harry Quigley, MD, director, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Md., USA. 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 visual disability globally, and it is the No. 1 cause of irreversible and potentially 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, MD, clinical associate professor, University of Sydney, Sydney, Australia, and head of the glaucoma unit, Sydney Eye Hospital, Sydney, Australia. “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 US have their own struggles with the disease, but they are mostly issues 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 visual impairment due to glaucoma,” states the International Agency for the Prevention of Blindness (IAPB) 2010 Report. “In addition, over the past 10 years, Glaucoma: A global scope by Faith A. Hayden EyeWorld Staff Writer Shlomo Melamed, MD, on the podium with several colleagues as panelists at the First African Glaucoma Summit Source: Shlomo Melamed, MD there have been relatively few attempts in developing countries at establishing comprehensive eyecare programs in the community that include management of glaucoma.” But if the World Glaucoma Association (WGA) has anything to do with it, the next 10 years will be more productive. WGA is an independent global organization working to solve the world’s glaucoma problems through education, training, and research. “WGA has been concerned with the state of affairs with African glaucoma for some time,” said Tarek Shaarawy, MD, 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. Glaucoma in Africa is not simply a blinding disease, but a disease associated with higher mortality. It’s not just effecting quality of life, but life itself.” 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 assembling a group of ophthalmologists 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 Glaucoma Summit. Organized by Leon W. Herndon, MD, associate professor of ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA, together with Dr. Shaarawy and Shlomo Melamed, MD, Israel, as a co-chair of the African Glaucoma Summit, the meeting hosted more than 200 participants from 27 countries in Africa, including the Ghanaian deputy minister of health, the deputy director general of the World Health Organization, and representatives from non- governmental organizations 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 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 awareness— to the most complex— screening and treatment • Developed nations, such as the United States, have mostly adherence issues; glaucoma patients using eye drop therapy only take about 70% of their medicine • New treatments for glaucoma management are needed worldwide continued on page 32