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What is one cost-effective way of reducing visual loss from glaucoma in aging populations around the world?
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Needs different around the world
 Thomas W. Samuelson |
The prevention of vision loss from glaucoma is a complex topic. This is especially true when viewed from a global perspective. Effective strategies in developed countries may be completely ineffective in less developed countries. For example, pharmaceuticals may play an important role in regions where medications are readily available and have virtually no role elsewhere. Moreover, the mechanism of glaucoma varies from one part of the world to another. Open-angle glaucoma is far more prevalent in European-derived individuals whereas angle-closure plays a much greater role in the Asian world.
Given this heterogeneity, as well as the fact that the question at hand allows only one effective method, my recommendation would be to exploit the link between cataract and glaucoma. Considerable evidence is mounting suggesting that cataract surgery improves IOP control in open-angle glaucoma. Undoubtedly, this is even truer in narrow or closed-angle glaucoma. Given that a large percentage of the world’s population is of Asian heritage, along with the fact that angle-closure is responsible for much of the manifest glaucoma and glaucoma-related blindness in these countries, timely cataract surgery likely would be of tremendous value not only in restoring visual function, but also in reducing the incidence of glaucoma, or at least lessening its morbidity.
Clearly, this would not prevent all glaucoma, and safer glaucoma specific procedures, sustained drug delivery, screening and education are still in great need.
Thomas W. Samuelson, MD, is OSN Glaucoma Section Editor and in private practice at Minnesota Eye Consultants.
Depends on type of glaucoma
 Keith Barton |
If I consider only primary open-angle glaucoma, bearing in mind that most people in the world who lose vision from glaucoma live in developing countries, then the answer would be surgical. Trabeculectomy has a moderately high success rate in those who are naïve to topical medical therapy. However, with many new devices currently under development for the treatment of glaucoma, this choice might change in the future.
If, however, I consider all glaucomas, most visual loss from glaucoma globally is probably the result of angle closure. It seems likely therefore that cataract surgery would be the single cost-effective treatment that could produce the greatest reduction in the development of visual loss from glaucoma in aging populations around the world.
Keith Barton, MD, FRCP, FRCS, FRCOphth, is Glaucoma Service Director and Consultant Ophthalmologist, Moorfields Eye Hospital.