Glaucoma Control Strategies in Sub-Saharan Africa: A Review of the Clinical and Health Economic Evidence

Smith, Andrew F.; Negretti, Guy S.; Mascaro, Aaron; Bokre, Desta; Baker, Helen; Dhalla, Kazim; Murdoch, Ian

doi:10.1080/09286586.2018.1501499

Cited by 15 publications

(16 citation statements)

References 62 publications

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“…It starts at younger ages, and the progression is more pronounced. These factors and the limited diagnostic and therapeutic possibilities, especially in rural areas of Africa, are the reasons why glaucoma-related blindness is more common in Central Africa than in other parts of the world [29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Ocular Morbidity—A Critical Analysis to Improve Outpatient Services in an Eye Department in a Sub-Saharan Megacity

Mukwanseke¹,

Kilangalanga²,

Lutete³

et al. 2021

JCM

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The aim of this study was to analyse outpatient services in an ophthalmic clinic of a church-run hospital providing secondary level care in an African megacity, paying special attention to the poorest users of the services. The range of examination was reviewed from 500 patient records of all ages consecutively chosen on random days attending the outpatient department for the first time in order to optimize workflow and to analyse the offered treatment modalities. Mean age was 41.9 ± 21.9 years, and 53.6% of the patients were female. Of the patients, 74.8% presented with visual impairment. The most frequent findings were refractive errors (35.8%), presbyopia (21.2%), allergic conjunctivitis (14.0%), cataract (13.2%) and glaucoma (6.4%). Patient management consisted of optical treatment (49.6%), surgery (11.4%) and medical treatment (39.0%). These results show the importance of the demand in refractive services and the need to train specific service providers. Knowing the frequencies of common conditions enables more appropriate diagnostic and treatment strategies, e.g., the importance of refractive errors, and should lead to improvements in training, staffing, therapeutics and patient outcomes. This approach can be applied to many other outpatient services and should be evaluated in light of the city’s impoverished health outreach and educational situation.

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Section: Discussionmentioning

confidence: 99%

Ocular Morbidity—A Critical Analysis to Improve Outpatient Services in an Eye Department in a Sub-Saharan Megacity

Mukwanseke¹,

Kilangalanga²,

Lutete³

et al. 2021

JCM

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“…Trabeculectomy, the main surgical procedure for treating glaucoma, can effectively reduce IOP; however, the operation has a long learning curve, is offered in relatively few eye units across sub-Saharan Africa, can have clinically significant complications, and has a low uptake in some populations. 8 , 9 , 10 , 11 , 12 Selective laser trabeculoplasty (SLT) is a rapid outpatient procedure used to reduce IOP. SLT increases aqueous fluid outflow from the eye, which drains through the trabecular meshwork.…”

Section: Introductionmentioning

confidence: 99%

Selective laser trabeculoplasty versus 0·5% timolol eye drops for the treatment of glaucoma in Tanzania: a randomised controlled trial

Philippin

Matayan

Knoll

et al. 2021

The Lancet Global Health

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Background Glaucoma is a major cause of sight loss worldwide, with the highest regional prevalence and incidence reported in Africa. The most common low-cost treatment used to control glaucoma is long-term timolol eye drops. However, low adherence is a major challenge. We aimed to investigate whether selective laser trabeculoplasty (SLT) was superior to timolol eye drops for controlling intraocular pressure (IOP) in patients with open-angle glaucoma. MethodsWe did a two-arm, parallel-group, single-masked randomised controlled trial at the Eye Department of Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Eligible participants (aged ≥18 years) had open-angle glaucoma and an IOP above 21 mm Hg, and did not have asthma or a history of glaucoma surgery or laser. Participants were randomly assigned (1:1) to receive 0•5% timolol eye drops to administer twice daily or to receive SLT. The primary outcome was the proportion of eyes from both groups with treatment success, defined as an IOP below or equal to target pressure according to glaucoma severity, at 12 months following randomisation. Re-explanation of eye drop application or a repeat SLT was permitted once. The primary analysis was by modified intention-to-treat, excluding participants lost to follow-up, using logistic regression; generalised estimating equations were used to adjust for the correlation between eyes. This trial was registered with the Pan African Clinical Trials Registry, number PACTR201508001235339. Findings 840 patients were screened for eligibility, of whom 201 (24%) participants (382 eligible eyes) were enrolled between Aug 31, 2015, and May 12, 2017. 100 (50%) participants (191 eyes) were randomly assigned to the timolol group and 101 (50%; 191 eyes) to the SLT group. After 1 year, 339 (89%) of 382 eyes were analysed. Treatment was successful in 55 (31%) of 176 eyes in the timolol group (16 [29%] of 55 eyes required repeat administration counselling) and in 99 (61%) of 163 eyes in the SLT group (33 [33%] of 99 eyes required repeat SLT; odds ratio 3•37 [95% CI 1•96-5•80]; p<0•0001). Adverse events (mostly unrelated to ocular events) occurred in ten (10%) participants in the timolol group and in eight (8%) participants in the SLT group (p=0•61). Interpretation SLT was superior to timolol eye drops for managing patients with open-angle high-pressure glaucoma for 1 year in Tanzania. SLT has the potential to transform the management of glaucoma in sub-Saharan Africa, even where the prevalence of advanced glaucoma is high. Funding Christian Blind Mission, Seeing is Believing Innovation Fund, and the Wellcome Trust.

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“…A further six additional questions were selected for inclusion by the professionals in the consensus meeting. These were in the domains of near vision, distance vision [2], role limitations and well-being [2].…”

Section: Plos Onementioning

confidence: 99%

“…There is currently, for example, little understanding or consensus as to which glaucoma detection and treatment strategies are likely to be the most cost-effective in terms of the greatest number of sight years gained on a sustainable cost basis. Moreover, a recent literature review conducted by Smith et al (2018) determined that while a myriad of effective glaucoma control interventions exist in many urban centres throughout SSA, their widespread use and diffusion across SSA remains challenging principally due to their high cost and the lack of publicly funded eye health investments in glaucoma screening, detection and treatment alternatives [2]. This current situation across much of SSA exists despite the clear urgency of the problem at least as recognized by the global Vision 2020 coalition on blindness prevention and treatment [3].…”

Section: Introductionmentioning

confidence: 99%

The cost and quality of life impact of glaucoma in Tanzania: An observational study

et al. 2020

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To determine the cost and quality of life impact imposed by glaucoma in Tanzania, East Africa. Methods An expert panel of eye health professionals was convened to agree current glaucoma practice in Tanzania. In addition a structured patient survey was developed and administered. Supplemental cost and quality of life information was collected using cost questionnaires and validated quality of life measures, including the EQ5D and VFQ-25. Results Key findings include following. Non-adherence is a major issue, especially in rural settings where over 50% of the patients may fail to return for review. Whilst medical therapy is overwhelmingly the first line treatment, the cost of maintaining this represents up to 25% of a patient's income. There is an impact of glaucoma on patients general well-being as determined by the EQ-5D and more tellingly on visual function with particular impact on role limitations as determined by the VF25. Despite our sample being taken in a private clinic and thus containing a much larger proportion of professionals than the general population, one third of the population earned Tanzanian Shillings (TZS) 170,000 per month which is below the minimum wage. Conclusion These findings are of great importance for health care planners seeking to determine costeffective, acceptable methods of both identifying and treating this major cause of preventable blindness.

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Glaucoma Control Strategies in Sub-Saharan Africa: A Review of the Clinical and Health Economic Evidence

Abstract: While effective glaucoma control interventions exist, their widespread use and diffusion across SSA remain challenging principally due to low per capita income levels and high glaucoma treatment costs.

Cited by 15 publications

References 62 publications

Ocular Morbidity—A Critical Analysis to Improve Outpatient Services in an Eye Department in a Sub-Saharan Megacity

Ocular Morbidity—A Critical Analysis to Improve Outpatient Services in an Eye Department in a Sub-Saharan Megacity

Selective laser trabeculoplasty versus 0·5% timolol eye drops for the treatment of glaucoma in Tanzania: a randomised controlled trial

The cost and quality of life impact of glaucoma in Tanzania: An observational study

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