EyeWorld Asia-Pacific June 2011 Issue

32 June 2011 EW GLAUCOMA 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 crucial to developing practical solutions were thoroughly discussed and each topic was broken out into specific action plans. Topics debated included: glaucoma education, best treatment options for Africa, incorporating glaucoma management into existing ophthalmological programs, screening methodology for advanced glaucoma cases, and centers of excellence for glaucoma in Africa. “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 important was sharing ideas, sharing experiences, and looking forward to how we can make things better. There was a candid exchange of ideas; everyone learned from everyone.” Glaucoma challenges in devel- oping 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 basics. 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-dominated approach to blindness prevention is partly to blame. “The diagnoses of glaucoma requires more than a flashlight and a visual acuity chart, as opposed to cataract,” said Dr. Quigley. “You only need to have a technical expertise to remove the cataract.” Glaucoma, however, is a much more complicated disease, and current surgical treatments have significant potential for complications, which is why education and training was one of the most important topics deliberated at the Summit. Experts 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 glaucoma 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 tailored 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 available 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 education,” 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 tomography [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 analyze computerized visual fields is another goal that came out of the African Glaucoma Summit. Along those same lines, the panelists decided 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 vancomycin in all trabeculectomy cases because studies throughout the continent have shown that it improves the success rate of the surgery. Another key decision was to establish five centers of excellence throughout Africa in all major regions: North, South, East, West, and Central. Quality centers of excellence are already located in these areas so new construction isn’t required, only additional resources. “I think with further improvements in training, things that can be done for glaucoma in developed countries can be done in centers of excellence and in the capitals of any developing country,” Dr. Quigley said. “As further research makes glaucoma easier to diagnose and as longer- term treatments that don’t involve daily eye drops, for example, begin to be developed, it will be much more practical to do things in the developing world that we’re doing well in developed countries.” Panelists and attendees of the African Glaucoma Summit didn’t simply muse over what could be done, they decided what would be done and developed action plans based on the results of the discussions. At the end of the meeting, a committee was designed for each topic to propose routes to take in order to begin the action plans recommended. The committees will report on their progress at the World Glaucoma Congress in Paris in June. “All we need to do right now is follow up on this,” Dr. Melamed said. “We need to do the things we decided upon, repeat, and make sure that all we talked about is carried out.” The African Glaucoma Summit covered an enormous amount of Glaucoma and Vision 2020 Vision 2020: The Right to Sight is a joint program from the World Health Organization and the International Agency for the Prevention of Blindness (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 infrastructure. The IAPB 2010 Report lists glaucoma as the third largest cause of overall blindness, the second being uncorrected refractive errors. The report provides 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 surgical training are in place, integrating glaucoma care into existing eyecare initiatives, 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: A global continued from page 31