Need for skilled glaucoma surgeons a worldwide issue
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The global population in 2024 is just more than 8 billion. One-half of the world’s population, or at least 4 billion people, reside in emerging countries with less well-developed economies and health care systems.
The incidence of glaucoma is similar in both advanced and emerging countries, approximately 3.5 per 1,000 population, or 14 million with glaucoma in advanced countries and another 14 million in emerging countries. Unfortunately, the patient with glaucoma in an emerging country faces a 50% chance of blindness in their lifetime vs. just more than 10% in an advanced country, making glaucoma one of the leading causes of global blindness behind uncorrected refractive errors and untreated cataract.
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Over the past decade, the treatment of glaucoma has been evolving worldwide from medical therapy toward procedures. This transition has been catalyzed by advances in laser treatment, the development of minimally invasive/microinvasive glaucoma surgery, and the positive impact of cataract surgery on both narrow- and open-angle glaucoma. Even in wealthier countries where topical medications are readily available, surgeons and their patients are frequently choosing a procedure over medical therapy.
There are many reasons for this transition, including challenges with compliance, cost, the ocular surface toxicity of topical therapy, and the improved benefit-risk ratio of laser surgery and MIGS vs. the classic trabeculectomy and tube shunt surgery. Well-done laser surgery and MIGS provide most patients with better pressure control and a lower chance of suffering progressive optic nerve damage and visual field loss. In emerging countries, we can add as a catalyst the lack of available and affordable topical glaucoma medications, making glaucoma a surgical disease.
The primary challenges worldwide are diagnosing glaucoma at an early stage and providing access to a skilled eye care professional. In the U.S., there is one ophthalmologist per 18,000 population and one optometrist per 7,500 population. Vision screening is common in advanced countries, and access to an eye care professional is available to most. Even so, as many as 50% of early glaucoma patients remain without diagnosis and treatment. In emerging countries, the situation is far more challenging, with only one ophthalmologist per 100,000 population to, in the worst case, one ophthalmologist per 1 million population.
In the emerging country environment, volunteers and eye care extenders are needed for diagnosis, and once a patient is diagnosed, a surgical procedure is the therapy of choice. Fortunately, laser therapy, MIGS and even cataract/IOL surgery have enhanced the benefit-risk ratio for glaucoma surgery worldwide. The need for more skilled glaucoma surgeons exists even in advanced countries and is extraordinary in emerging countries. Unfortunately, the training of a skilled glaucoma surgeon is expensive and time consuming. Ophthalmic servant leaders and volunteers do what they can, but the unmet need is large and growing.
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