Surgery preferable to medical therapy for most of world's glaucoma patients, clinician says

SAN DIEGO — For the majority of patients around the world, particularly those in developing countries, glaucoma surgery is the only viable therapeutic option, according to a presenter here.

Tarek Shaarawy

Tarek Shaarawy, MD, from the University of Geneva, acknowledged that his position "might sound extremist" to many of those in the audience at the American Society of Cataract and Refractive Surgery's Glaucoma Day.

Yet, compared to medical therapies, surgery offers several advantages, he said. Glaucoma is the leading cause of irreversible blindness worldwide, and the second leading cause of blindness. While "no holy grail has been found after years of research," clinicians are charged with preventing progression, Dr. Shaarawy noted.

Among its advantages, surgery is proven to reduce IOP, eliminates compliance challenges seen with medical therapy, reduces diurnal fluctuations in IOP and is economically more accessible to most patients, Dr. Shaarawy said.

Regarding the reduction of IOP, "low IOP is more likely to be achieved with surgery when compared with medications or lasers," he said.

"You're essentially resetting the biological clock of the eye altogether to a different standard," he added.

Surgery is also more economical, according to Dr. Shaarawy. Worldwide, the average cost per day for glaucoma medications is US$1, while 50% of the world's population earns less than US$2 per day. This point is underscored by the fact that 90% of the world's glaucoma population lives in developing countries, he said.

"These patients are ten times more likely to go blind than those in industrialized countries," Dr. Shaarawy said.

In countries such as Africa, the mortality rate of the visually impaired is roughly four times that of the sighted, he added.

Dr. Shaarawy said one major drawback of glaucoma surgery, as compared to medical therapy, is the incidence of localized complications that can result. The challenge for surgeons is to stay abreast of new, improved surgical techniques that will enable them to continually improve their outcomes and reduce complications, he noted.