Glaucoma Around the World
Chat Highlights
March 10, 2004

Norma Devine, Editor

On Wednesday, March 10, 2004, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma Around the World."

Moderator:  Glaucoma patients from all over the world visit this website.  Most of the visitors live in Canada, the U.S., and the U.K., in that order.  What help is available for people with glaucoma in developing countries?  

Dr. Rick Wilson:  Clearly, those who are better off financially surf the Internet and ask questions.  Occasionally, they find a way to come to the U.S., but often are constrained by lack of money to see the best doctors they can make contact with. 

P:  Does the treatment of glaucoma vary from country to country?  

Dr. Rick Wilson:  The developed world usually develops the treatments,  and there is general agreement on many issues. Some countries have a greater incidence of congenital glaucoma, and  treatment there may be slightly different.  For instance, in India,  a trabeculectomy may be combined with a trabeculotomy.  

P:  Do you know if there would be any help available at the medical school at St. George's University in Grenada, in the Caribbean, for an indigent, 24-year-old woman with a severe eye problem that has been undiagnosed and untreated for many years?  

Dr. Rick Wilson:  I don't know, unfortunately.  On several islands, such as St. Lucia, there's often a resident from a medical school's ophthalmology department in the U.S., who can provide better care, often at no cost, than might be available on the island.  

P:  Do "Doctors Without Borders" make visits to the Caribbean Islands?

Dr. Rick Wilson:  Sorry, I don't know. They have been more active in the Balkans during the war and in Rwanda and other countries in Africa. 

P:  Are trabeculectomies and shunt surgery performed in developing countries?

Dr. Rick Wilson:  Yes, although it depends greatly upon the local doctors and infrastructure.  Missionary teams may augment the care, either in select locations or periodically.

P:  Does climate influence glaucoma?

Dr. Rick Wilson:  Not that I can tell.  Genetics greatly influences glaucoma.  As we discussed before, angle-closure glaucoma in Caucasians is about 0.15%, in Chinese about 1.5%,  and in the Inuit about 2.5%.

P:  I know that my pressures vary seasonally.  I wonder, however, what other variables, such as temperature, environmental conditions, fluid intake or loss through perspiration, may exist. 

Dr. Rick Wilson:  All good thoughts.  IOP (intraocular pressure) increases with age in our population (but not in the Japanese) and is related over a two-year period to concomitant increases in blood pressure.  IOP is higher, on average, in women, in the morning, in winter, and is inherited.  IOP varies with heart beat, respiration, blood pressure, and IOP increases with Valsalva's maneuver and lid squeezing.  Squeezing the lids together hard can raise the eye pressure to almost 70 mm Hg.

P:  If India has a higher rate of congenital glaucoma, does that mean the glaucoma is genetic or environmental?

Dr. Rick Wilson:  I can't tell for sure if there is a higher rate, or whether the few doctors for the huge population see a normal incidence of congenital glaucoma funneled down to them.  It seems logical that since the climate in such a large country as India  (where the terrain ranges from rolling plain along the Ganges, to deserts in the west, and the Himalayas in the north) genetics would play a larger role than the environment.  In Brazil, I have been told that the incidence of glaucoma is high, and not just because of the fewer number of doctors per population.  

Moderator:  In what parts of the world are the various types of glaucoma prevalent?

Dr. Rick Wilson:  Japan has a very high prevalence of normal-tension glaucoma; Scandinavians and South African blacks and Mongolians have a high prevalence of pseudoexfoliative glaucoma, and China has an inverse proportion of angle-closure glaucoma, compared to the U.S. 

P:  Are some characteristics of normal-tension glaucoma different in Japan than in other countries?

Dr. Rick Wilson:  As far as I know, it is similar to what we see here.  To my knowledge, the etiologic factors that make it so prevalent in Japan are not known. 

P:  Is diet a factor in glaucoma in developing nations?

Dr. Rick Wilson:  I don't know if we know enough to be able to discern the answer to that question.

P:  I'm amazed, Dr. Rick, that you are expected to be an expert on such a wide array of topics.

Dr. Rick Wilson:  True.  I try, but the body of knowledge out there is expanding exponentially.

P:  In North American we are fortunate to have access to glaucoma specialists, even though that can sometimes require a bit of a journey. What is the situation for patients in developing countries?

Dr. Rick Wilson:  Usually there are no specialists unless you live  in a developed country like India, and have the money to see them.  I have worked at missionary hospitals in Kenya and Ghana in Africa, at indigent hospitals in Honduras and Brazil, and taught in China and Korea -- to name those that come easily to mind.

P:  Thank you, Dr. Wilson, for this wonderful chat room.   Participating in it has helped me.  

Dr. Rick Wilson:  Happy to have you join our virtual community.  We all try to support one another.  Have a great week everyone.

End of highlights for March 10, 2004.

On March 17, Dr. Wilson discussed "Cutting Surgery Complications" in the Chat room. Click here for highlights of that meeting.

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