Glaucoma in developing countries

Abstract

Objective:To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries.Materials and Methods:Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India) are used to make recommendations.Results:Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases). Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery) can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available.Conclusions:Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use) in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and their monitoring requires reporting of functional outcomes rather than number of operations performed.

Glaucoma: Confrontation visual field test using Bagolini striated glasses — a new screening method for detecting visual field defects

“…Developing countries, in particular, could benefit from such an easy, quick, and affordable method to examine one essential function of the eye -the visual field. In these countries, such as India, even simple diagnostic techniques are often unavailable for most of the population [11]. For large parts of the population ophthalmic eye care facilities are absent or they have limited access [12].…”

“…There are no possibilities for population-based screening of glaucoma. Considering this fact, detection of visual field defects by a quick, easy, and cheap method is the recommended strategy [11]. Due to the financial situation, even in some residency programs routine ophthalmological examinations are performed by using a flashlight [13,14].…”

“…Furthermore, the introduced method is easy to learn, so even non ophthalmologists are able to perform it. This is necessary because, especially in developing countries, ophthalmologists are rare [11]. Hence it would be helpful to have a possibility for all physicians to examine the visual field in such an easy and quick way.…”

A refresher relating to open and closed angle glaucoma

“…However, in regions such as Africa and India, glaucoma remains underdiagnosed. In many countries, there is a shortage of trained medical personnel to treat patients, as well as a lack of available medications to treat patients who are diagnosed [5]. It is important to remember that glaucoma, like high blood pressure, is a disease that can be treated but never really cured.…”

“…In all its forms, glaucoma has been estimated to affect approximately 70 million people worldwide [4]. The true prevalence may be underestimated, as this disease (among others) is underreported in the developing world [5]. Glaucoma accounts for about 8% to 14% of all cases of blindness [6][7][8] with reported rates depending on the criteria used to diagnose these conditions [9].…”