Treating glaucoma globally

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Ophthalmologists cannot continue to neglect glaucoma internationally considering the numbers of individuals becoming blind, related Mildred Olivier, MD.

By Lynda Charters; Reviewed by Mildred Olivier, MD

Chicago-With the fourth anniversary of the devastating earthquake in Haiti, Mildred Olivier, MD, said it is important to remember the toll glaucoma takes on developing nations.

The earthquake caused enormous numbers of traumatic eye injuries, and ophthalmologists working with the American Academy of Ophthalmology’s Task Force on Haiti Recovery, and from other countries of the world, quickly responded. However, chronic eye disease continues to take an unrelenting toll in Haiti and other developing nations.

“Glaucoma is rampant, unaddressed for millions of the most vulnerable people in the world,” said Dr. Olivier, professor of surgery at Rosalind Franklin University of Medicine and Science/Chicago School of Medicine, and associate professor of ophthalmology at Midwestern University, Hoffman Estates, IL. “We are aware of the logistical, tactical, and medical impediments that stand in the way of delivering treatment to those who desperately need it. We must also realize that finding solutions to these problems rests on our shoulders.”

Struggling to resolve the dilemma

While ophthalmologists fight many causes of blindness in developing countries, glaucoma has not been a prime target, she said.

However, as the second leading cause of blindness in the world, the impact of glaucoma is global. There are high incidence rates in regions of the Americas, Southeast Asia, the Eastern Mediterranean, Africa, Europe, and the Western Pacific. The statistics are staggering, with great increases in blindness from glaucoma expected by year 2020.

Dr. Olivier said we cannot continue to neglect glaucoma internationally considering the numbers of individuals becoming blind.

Nevertheless, according to Dr. Olivier, ophthalmologists have considered glaucoma impractical to treat in disadvantaged and remote settings.

In wealthy nations, pharmaceutical management of glaucoma is the most popular approach. But in developing nations, even if patients could afford drug treatment, there are no delivery systems to distribute them or storage facilities to maintain them.

Additionally, patients with primary open-angle glaucoma experience no symptoms in their early stages, so they may be reluctant to devote scarce resources to acquiring and using medication. In the absence of a way to treat glaucoma in such areas, little emphasis has been placed on screening and detection.

Dr. Olivier believes that must change.

Recommendations

Surgery as a first line of intervention should be considered and warrants further study, as suggested by the Collaborative Initial Glaucoma Treatment Study, she said.

While glaucoma surgery is not taught routinely in residency programs in other countries, that could change. Techniques to consider include:

·      Diode laser trabeculoplasty

·      Selective laser trabeculoplasty

·      Micropulse laser trabeculoplasty

·      Argon laser trabeculoplasty as primary treatments

Together with Eve Higginbotham, MD-who is the Vice Dean for Diversity and Inclusion at the Perelman School of Medicine, University of Pennsylvania, Philadelphia-Dr. Olivier has also conducted preliminary studies of the effectiveness of primary transscleral cyclophotocoagulation as a primary intervention for addressing glaucoma. Dr. Olivier also called for greater innovation in the development of delivery systems for glaucoma medications, citing the success of Vermectin (ivermectin, Merck Sharpe and Dohme) in fighting onchoccerciasis.

Detecting and treating cataract in disadvantaged and remote areas has been quite successful, noted Dr. Olivier.

She has found in her own medical missions to Haiti that the same opportunities can be used to screen for and diagnose glaucoma.

“We can screen for glaucoma at the same time that we look for cataracts with only minor additions of equipment,” Dr. Olivier said. “We can integrate local health care providers into the process so that we pass our own skills on to those who can continue the efforts long after we depart. Opportunity is the intersection of innovation and science.

“By recognizing our own individual potential to help address the epidemic of untreated glaucoma in the world, we can find many ways to help,” she continued.

Possible future innovations include a slow release medication implanted in the eye, contact lens delivery system, and/or nanotechnology, she noted.

“Someone can dare to think outside of the box,” Dr. Olivier said. “Let’s pick up the gauntlet that our knowledge and skills suit us to accept. Let’s make a mark by bring an end to glaucoma because it is so difficult to treat as a cause of blindness internationally. Let’s make a change.”

Mildred Olivier, MD

E: molivier@midwestglaucoma.com

Dr. Olivier is a consultant to Santen Pharmaceuticals and lectures for Lumenis.