Chat Highlights
International Glaucoma
December 13, 2000

Norma Devine, Editor

On Wednesday, December 13, 2000, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "International Glaucoma." 

Moderator:  Hello, Dr. Wilson. The topic tonight is "International Glaucoma."

Dr. Wilson:  Hello, team.

P:  What can you tell us about glaucoma in other countries?  

Dr. Wilson:  Worldwide,  five to seven  million people are blind from glaucoma.   In Nigeria, 10% of  the population has glaucoma.  Of that 10%, 91% are blind in one eye, 34% in both eyes.

Moderator:  How does that compare with glaucoma in the U.S.?

Dr. Wilson:  In the U.S. population under the age of 60, about  0.5 to 1% have glaucoma; over 75 years of age, about 6 to 8% have glaucoma. 

P:   I can see why some in Nigeria have no chance of being diagnosed, and even if they were,  how could they afford the drugs?

Dr. Wilson:  Glaucoma is a surgical disease in much of Africa, where I have worked for that very reason.  Drugs are often unavailable or too expensive or spoil too quickly in the heat.

Moderator:  What is being done to help those nations with high glaucoma rates?

Dr. Wilson:  The World Health Organization is helping with glaucoma awareness programs and helping train regional doctors to take care of the problem locally.  The interesting thing is the variety of glaucoma.  In China, the ratio of open-angle glaucoma to angle closure glaucoma is the opposite of what it is here, where most patients have open angle glaucoma.  Angle closure glaucoma  is also more prevalent than open angle among the Alaskan and Greenland Inuit.  In Japan, the most common form of glaucoma is Normal Tension. 

P:   I understand that glaucoma patients are much younger in Nigeria.

Dr. Wilson:  The glaucoma population is much younger in Africans and African Americans.  I heard that African-Americans are 19 times as likely to have glaucoma before age 50 as Caucasians.

P:  Wouldn't that point to a genetic basis?

Dr. Wilson:  Yes, it would and does. 

P:   Why is the incidence of normal-tension glaucoma high in Japan?  Do they treat it differently than in the U.S.?

Dr. Wilson:  No one knows why the Japanese have such a high prevalence of normal-tension glaucoma. It is treated mostly the same there as in U.S.

P:  There's a high rate of glaucoma in  New Brunswick, Canada, where I live. We have one doctor to cover 200 miles,  and when I  need an operation I  have to travel 850 miles, one way.  I feel as if  I live in a third-world country

Dr. Wilson:   Sounds close to being Third World. 

P:  Third World or the end of it? :)

P:  There doesn't seem to be a lot of new research for new glaucoma treatments.  In Canada, the ratio compared to AIDs or cancer research is small.  Is that  because of lack of funds, or not enough interest in glaucoma?  

Dr. Wilson:  Probably both.

Moderator:  I remember learning in this chat room that the British try surgery first.  Can you tell us more?

Dr. Wilson:  Studies in Britain, Scotland and elsewhere found that performing surgery on first diagnosis is more effective in stopping field loss than medicine and lasers. The surgery lowers IOP lower and more steadily than the other two.

P:  How long were the patients studied?

Dr. Wilson:  At least four years, as I remember.  It is interesting that surgery works significantly better on eyes that have not had a lot of strong, irritating medications. 

P:  Why is that?

Dr. Wilson:  Because the medications cause a change in the cellular composition of the conjunctiva, the top layer of the eye. With an influx of inflammatory cells caused by the medication, the surgical wound heals faster and with more scar tissue, both of which are harmful to the trabeculectomy.

P:   What type of surgery do they do in Great Britain? 

Dr. Wilson:  Trabeculectomy.

Moderator:  Do you know the ages of the patients in the British study? Do you think a younger person would be better off to have surgery first?

Dr. Wilson:  I don't remember the age of the patients. One would think that younger patients would do better over the long term with surgery, although it is less effective in this age group than in older patients.

P:  I had early onset glaucoma, so I have been using all kinds of drops for 20 years. That can't be good!

P:  My daughter, who is 18 years old, has been on drops almost all her life.

P:  Is Glaucoma Awareness Month observed only in the U.S.?

P:  I never heard about that month here in Brazil. 

P:  Nor I in British Columbia, Canada.  I first heard about it in this chat room.

Dr. Wilson:  The one I know of in the U.S. is national, but there may well be an international one as well. 

On December 20th, Dr. Wilson discussed "Technology & Glaucoma" in the Chat room. Click here for highlights of that meeting.

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