Glaucoma Around the World
Chat Highlights
March 5, 2008

On Wednesday, March 5, 2008, Dr. Michael Pro, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma Around the World".

Moderator: Welcome back to chat Dr. Pro. Thank you for joining us.

Dr. Pro:  Thank you. Before we begin, I'd like to add some follow-up information to our last chat two weeks ago. There was a question about the clinical trials of Memantine as a neuroprotective agent for glaucoma patients. It seems there was no significant benefit compared to patients receiving placebo. Therefore, the study failed to meet its primary endpoint and to sufficiently replicate the results of the first Phase Three trial.

Moderator: Thank you doctor. Tonight our topic is “Glaucoma Around the World.” Can you start by telling us a little bit about World Glaucoma Today tomorrow?

Dr. Pro:  Right, in fact I prepared a few lines about the World Glaucoma Day.

World Glaucoma Awareness

In an effort to combat one of the main causes of blindness around the globe, the World Glaucoma Association and the World Glaucoma Patient Organization have announced the first annual World Glaucoma Day, to be observed on March 6, 2008.

From the website www.wgday.net: March 6th, 2008 will be the first ever World Glaucoma Day (WGD), a joint global initiative of the World Glaucoma Association (WGA) & the World Glaucoma Patient Association (WGPA).

The ultimate goal of the World Glaucoma Day is to enhance global glaucoma awareness through novel as well as through traditional communication strategies and events. Rather than have a single large event held in conjunction with a major Ophthalmic conference, World Glaucoma Day was designed to be the sum total of local activities aiming at increasing glaucoma awareness, such as newspaper articles, radio and television coverage, and public glaucoma "screening" camps.

Moderator: Thank you!

P:  If it is world glaucoma day 6th March how has it been promoted worldwide? It is the 6th March here [this chatter is connecting from Australia. - ed.] today and I have heard nothing promoting it in the media or anywhere else.

Dr. Pro:  Good point, I guess in many respects this site is part of the answer. I hope that we have helped to increase awareness at least in this chat community.

P:  I listen to Irish radio on the internet and World Glaucoma Day was mentioned today.

Moderator: Congratulations to Ireland for getting the word out.

Dr. Pro:  I wanted to send a few lines about different types of glaucoma in other countries.

Pseudoexfoliation glaucoma:

Most common in Scandinavian populations. In the Reykjavik Eye Study 40% of individuals 80 years or older had pseudoexfoliation syndrome. But it is seen in other populations. In a prospective study on Ethiopian patients who were undergoing cataract surgery the prevalence of XFS was 39.3% (90 of 229 eyes).

Pigment dispersion syndrome:

Risk factors: Young age (20-45 years), Male. Myopia, White, 1 - 1.5% of all glaucoma. PDS seen in 2.45% of whites screened, but not seen commonly in Asia or Africa.

Angle Closure Glaucomas:

Data gathered over the past decade from Mongolia, Singapore, and Taiwan give some insight into the impact of glaucoma on East Asian populations. These studies suggest that primary angle-closure in Sino-Mongolian people is at least three times more common than in Europeans. The age-adjusted rate of POAG (open angle glaucoma) was similar to that found in European-derived populations, but PACG (angle closure glaucoma) was more common among Chinese, indicating that there is a large burden of glaucoma in the Chinese people (data from a population-based study in Liwan District, Guangzhou.)

Open Angle Glaucoma:

POAG is more prevalent in African-derived than European-derived populations. The prevalence of POAG in African-Caribbean populations is particularly high, approximately 7% in Barbados and 8.8% in St. Lucia, West Indies, as compared to 1% in most white populations.

Moderator: Thank you, Dr. Pro. That's an informative overview.

P:  Can you tell us about different glaucoma surgeries in development around the world?

Dr. Pro:  Sure, in general the standard glaucoma surgery is the trabeculectomy, but in some areas techniques are different. In fact some countries are more aggressive than we are in the U.S. For instance in Singapore cataract surgery is now performed in the immediate period following an attack of angle closure.

P:  Why would cataract surgery immediately after and angle closure attack?

P:  I had my lens removed during a angle closure attack, in both eyes; it's working so far.

Dr. Pro:  Well, the underlying cause is forward displacement of the iris and closure of the angle from the intraocular lens. Therefore it makes sense to perform cataract surgery in both the eye that had the attack and the non-involved eye.

P:  Is cataract incidence higher and/or more severe in equatorial regions?

Dr. Pro:  In general it is more severe because equatorial countries are generally poorer and often have limited access to care.

P:  What other techniques vary around the world?

Dr. Pro:  Well, I would say that the best data come from Europe. There, it seems that the rates of glaucoma surgery and types of glaucoma surgery similar to here, although non-penetrating glaucoma surgery has been more popular in Europe than in the U.S. In the developing world the amount of glaucoma far outstrips available surgeons and clinics, and the burden of blindness is far too high.

P:  By non-penetrating glaucoma surgeries are you referring to laser surgeries?

Dr. Pro:  No, non-penetrating glaucoma surgeries refers to canaloplasties and deep-penetrating sclerectomies. These surgeries presume to increase aqueous outflow but do not create a bleb, and so may be safer.

P:  How affective are the non-penetrating glaucoma surgeries.

Moderator: Does the data from other countries show these to be valuable tools? Is that why they do more?

Dr. Pro:  So far the data comes from a few individuals and their data looks good. But, the surgeries may be more technically difficult and other doctors have not been as successful, so uptake has been slow, especially for the deep sclerectomy. I think these surgeries will find a place in the U.S. too, but maybe only in certain groups; for instance, in people who have dirty jobs and couldn't have a bleb, or in persons who are obligate contact lens wearers.

P:  Are there programs like Doctors Without Borders that help provide glaucoma services in developing countries?

Dr. Pro:  Yes, some help comes through medical missions. Have you heard of ORBIS? It is a surgically equipped airplane that goes to developing countries. Specialists perform different types of ocular surgery and train local ophthalmologists in the procedures.

Moderator: ORBIS International, a non-profit humanitarian organization, strives to eliminate avoidable blindness and restore sight in developing countries. ORBIS has permanent offices dedicated to preventing blindness in Africa, China, India, Bangladesh and Vietnam. ORBIS also conducts regional work on blindness prevention and treatment in Latin America and the Caribbean.

P:  What can you tell us about medications in development around the world?

Dr. Pro:  The U.S. actually leads in drug development. We have a strong pharmaceutical industry here, so some new drugs are in trials. I am excited about a new class called Rho kinase inhibitors. These molecules may improve outflow in patients with open angle glaucoma; we don't know how it works.

P:  I imagine there are problems with affordability and distribution of glaucoma medications in the developing world.

Dr. Pro:  Yes, no doubt; as there are with many other medications.

P:  When we were in Papua New Guinea we could get glaucoma medications, but they were usually out of date off the shelf. We used to have to get them sent up from Australia. Do developed countries offload out of date medications to third world countries?

Dr. Pro:  I'm not surprised, but sorry to hear that.

Moderator: Those are all the questions we have tonight. Thank you, Dr. Pro.

Dr. Pro:  Good night.

Moderator: We appreciate your time and will see you in two weeks mate

On March 19, Dr. Pro discussed "Adherence to Medical Therapy" in the Chat room. Click here for highlights of that meeting.

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