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Glaucoma in Sub-Saharan Africa
Glaucoma poses a significant public health challenge in Sub-Saharan Africa. It is the 2nd leading cause of blindness after cataract and it is the leading cause (number one cause) of irreversible blindness, it contributes to a high prevalence of irreversible blindness. Factors such as limited access to healthcare services, late diagnosis, and insufficient awareness exacerbate the impact of the disease. The region faces a shortage of specialized ophthalmologists and diagnostic equipment especially in the rural areas, hindering early detection and treatment. Efforts to address glaucoma include awareness campaigns, training healthcare providers, and improving access to affordable medications and surgical interventions.
Glaucoma is asymptomatic until the advanced stage of the disease, as a result many people don’t present early. It is a slowly progressive chronic eye disease.
Symptoms usually start with loss of peripheral vision and severe visual impairment in advanced stages, poor night vision, haloes around light and bumping into objects.
Some patients who have angle closure may present with an acute angle closure glaucoma and that would be treated as an ophthalmological emergency. Acute angle closure glaucoma can cause a rapid deterioration in vision.
This includes elevated intraocular pressure (IOP), however having a normal IOP does not rule out glaucoma. Optic disc changes such as cupping and thinning, visual field defects typically starting with nasal field loss, asymmetrical cup-to-disc ratios between eyes, and potential variations in corneal thickness affecting IOP measurements. Early diagnosis, regular monitoring, and appropriate treatment are crucial to managing glaucoma effectively in this region.
Differential diagnoses for glaucoma include cataracts, refractive errors, chronic uveitis, optic neuritis. These conditions can present with symptoms like glaucoma, such as blurred vision and elevated intraocular pressure. Accurate differentiation requires a comprehensive eye examination, including measurement of intraocular pressure, assessment of optic nerve health, and evaluation of visual fields, which can be challenging due to limited access to healthcare resources and diagnostic equipment in remote areas.
In low-resource settings, investigations for glaucoma focus on essential diagnostic methods including intraocular pressure measurement, gonioscopy to evaluate the anterior chamber angle, visual field testing to assess peripheral vision loss, optic nerve examination for signs of glaucomatous damage, and corneal pachymetry to adjust intraocular pressure measurements. These tools are crucial for early detection and management of glaucoma.
In low-income settings, treatment of glaucoma includes using affordable topical eye drops to lower intraocular pressure such as prostaglandin analogues and beta blockers, performing laser therapy like selective laser trabeculoplasty when appropriate, and considering surgical options such as trabeculectomy or glaucoma drainage devices when necessary.
Another thing that can help with early detection of glaucoma is if optometrists and health workers are trained in identifying optic nerve damage from glaucoma. They can examine the patients' optic nerve and refer to the ophthalmologists/glaucoma specialists.
Family physicians interested can also be taught on detecting glaucoma based on identifying the optic nerve head changes and commence appropriate treatment before referral. Telemedicine and discussing the findings of a patient with the ophthalmologists for advice. Patient education on treatment adherence and regular follow-up is essential, supported by integration with primary healthcare for continuity of care. These strategies aim to effectively manage glaucoma despite resource limitations, ensuring optimal outcomes for patients.
In low-income countries, follow-up after glaucoma treatment involves regular monitoring of intraocular pressure (IOP), visual fields, and optic nerve health. This is crucial for assessing treatment effectiveness and detecting any progression of the disease. Patient education on medication adherence and recognizing symptoms of worsening glaucoma is emphasized, supported by efforts to ensure continued access to care through community outreach and integration with primary healthcare services. These measures aim to preserve vision and improve outcomes for glaucoma patients despite resource constraints.
In Sub-Saharan Africa, prevention and control of glaucoma focus on raising awareness through education, promoting early detection through routine screenings, and implementing cost-effective screening programs like having a robust National Health care scheme for people to get their drugs at almost no cost, that would help in making the eyedrops available and help in limiting the effect of glaucoma.
Access to affordable medications and surgical interventions is crucial, alongside emphasizing long-term management and adherence to treatment. These efforts aim to reduce the burden of glaucoma-related blindness and improve eye health outcomes across the region despite resource constraints.
A 62-year-old woman from a rural village in northern Nigeria, presents with progressive vision loss over six months, primarily affecting her peripheral vision. Diagnosed with advanced primary open-angle glaucoma, she has elevated intraocular pressure and significant optic nerve damage. Her management plan includes prostaglandin analog eye drops, beta-blockers, patient education on glaucoma, and regular follow-ups every three months. Challenges include limited access to medication and ensuring treatment adherence. With appropriate care and community support, her condition is managed to slow further vision loss, allowing her to maintain an active lifestyle.
- Report of the 2030 targets on effective coverage of eye care. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. http://apps.who.int/iris retrieved 2024-08-06
- Olawoye O, Washaya J, Gessesse GW, Balo K, Agre J, Macheka B, Kizor-Akaraiwe N, Pons J, Sarimiye T, Ashaye A, Garba F, Chitedze R, Ibanga A,
- Mahdi A, Ogunro A, Budengeri P, Ajibode HA, Tamrat L, Onakoya A, Okeke S, Giorgis AT, Okosa CC, Fowobaje K, Cook S, Lawrence S, Chan VF, Azuara-Blanco A, Congdon N, Realini T; STAGE Research Group. Glaucoma Treatment Patterns in Sub-Saharan Africa. J Glaucoma. 2023 Oct 1;32(10):815-819. doi: 10.1097/IJG.0000000000002273. Epub 2023 Jul 21. PMID: 37523638.
- Kyari F, Abdull MM, Bastawrous A, Gilbert CE, Faal H. Epidemiology of glaucoma in sub-saharan Africa: prevalence, incidence and risk factors. Middle East Afr J Ophthalmol. 2013 Apr-Jun;20(2):111-25. doi: 10.4103/0974-9233.110605. PMID: 23741130; PMCID: PMC3669488.
- Fatima Kyari, Bola Adekoya, Mohammed Mahdi Abdull, Abdullahi Sadiq Mohammed, Farouk Garba,The Current Status of Glaucoma and Glaucoma Care in Sub-Saharan Africa, Asia-Pacific Journal of Ophthalmology, Volume 7, Issue 6, 2018, Pages 375-386, ISSN 2162-0989, https://doi.org/10.22608/APO.2018392. (https://www.sciencedirect.com/science/article/pii/S2162098923010290)
Author's details
Reviewer's details
Glaucoma in Sub-Saharan Africa
Glaucoma poses a significant public health challenge in Sub-Saharan Africa. It is the 2nd leading cause of blindness after cataract and it is the leading cause (number one cause) of irreversible blindness, it contributes to a high prevalence of irreversible blindness. Factors such as limited access to healthcare services, late diagnosis, and insufficient awareness exacerbate the impact of the disease. The region faces a shortage of specialized ophthalmologists and diagnostic equipment especially in the rural areas, hindering early detection and treatment. Efforts to address glaucoma include awareness campaigns, training healthcare providers, and improving access to affordable medications and surgical interventions.
Glaucoma is asymptomatic until the advanced stage of the disease, as a result many people don’t present early. It is a slowly progressive chronic eye disease.
Symptoms usually start with loss of peripheral vision and severe visual impairment in advanced stages, poor night vision, haloes around light and bumping into objects.
Some patients who have angle closure may present with an acute angle closure glaucoma and that would be treated as an ophthalmological emergency. Acute angle closure glaucoma can cause a rapid deterioration in vision.
This includes elevated intraocular pressure (IOP), however having a normal IOP does not rule out glaucoma. Optic disc changes such as cupping and thinning, visual field defects typically starting with nasal field loss, asymmetrical cup-to-disc ratios between eyes, and potential variations in corneal thickness affecting IOP measurements. Early diagnosis, regular monitoring, and appropriate treatment are crucial to managing glaucoma effectively in this region.
Differential diagnoses for glaucoma include cataracts, refractive errors, chronic uveitis, optic neuritis. These conditions can present with symptoms like glaucoma, such as blurred vision and elevated intraocular pressure. Accurate differentiation requires a comprehensive eye examination, including measurement of intraocular pressure, assessment of optic nerve health, and evaluation of visual fields, which can be challenging due to limited access to healthcare resources and diagnostic equipment in remote areas.
In low-resource settings, investigations for glaucoma focus on essential diagnostic methods including intraocular pressure measurement, gonioscopy to evaluate the anterior chamber angle, visual field testing to assess peripheral vision loss, optic nerve examination for signs of glaucomatous damage, and corneal pachymetry to adjust intraocular pressure measurements. These tools are crucial for early detection and management of glaucoma
In low-income settings, treatment of glaucoma includes using affordable topical eye drops to lower intraocular pressure such as prostaglandin analogues and beta blockers, performing laser therapy like selective laser trabeculoplasty when appropriate, and considering surgical options such as trabeculectomy or glaucoma drainage devices when necessary.
Another thing that can help with early detection of glaucoma is if optometrists and health workers are trained in identifying optic nerve damage from glaucoma. They can examine the patients’ optic nerve and refer to the ophthalmologists/glaucoma specialists.
Family physicians interested can also be taught on detecting glaucoma based on identifying the optic nerve head changes and commence appropriate treatment before referral. Telemedicine and discussing the findings of a patient with the ophthalmologists for advice.
Patient education on treatment adherence and regular follow-up is essential, supported by integration with primary healthcare for continuity of care.
These strategies aim to effectively manage glaucoma despite resource limitations, ensuring optimal outcomes for patients.
In low-income countries, follow-up after glaucoma treatment involves regular monitoring of intraocular pressure (IOP), visual fields, and optic nerve health. This is crucial for assessing treatment effectiveness and detecting any progression of the disease. Patient education on medication adherence and recognizing symptoms of worsening glaucoma is emphasized, supported by efforts to ensure continued access to care through community outreach and integration with primary healthcare services. These measures aim to preserve vision and improve outcomes for glaucoma patients despite resource constraints.
In Sub-Saharan Africa, prevention and control of glaucoma focus on raising awareness through education, promoting early detection through routine screenings, and implementing cost-effective screening programs like having a robust National Health care scheme for people to get their drugs at almost no cost, that would help in making the eyedrops available and help in limiting the effect of glaucoma.
Access to affordable medications and surgical interventions is crucial, alongside emphasizing long-term management and adherence to treatment. These efforts aim to reduce the burden of glaucoma-related blindness and improve eye health outcomes across the region despite resource constraints.
- Report of the 2030 targets on effective coverage of eye care. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. http://apps.who.int/iris retrieved 2024-08-06
- Olawoye O, Washaya J, Gessesse GW, Balo K, Agre J, Macheka B, Kizor-Akaraiwe N, Pons J, Sarimiye T, Ashaye A, Garba F, Chitedze R, Ibanga A,
- Mahdi A, Ogunro A, Budengeri P, Ajibode HA, Tamrat L, Onakoya A, Okeke S, Giorgis AT, Okosa CC, Fowobaje K, Cook S, Lawrence S, Chan VF, Azuara-Blanco A, Congdon N, Realini T; STAGE Research Group. Glaucoma Treatment Patterns in Sub-Saharan Africa. J Glaucoma. 2023 Oct 1;32(10):815-819. doi: 10.1097/IJG.0000000000002273. Epub 2023 Jul 21. PMID: 37523638.
- Kyari F, Abdull MM, Bastawrous A, Gilbert CE, Faal H. Epidemiology of glaucoma in sub-saharan Africa: prevalence, incidence and risk factors. Middle East Afr J Ophthalmol. 2013 Apr-Jun;20(2):111-25. doi: 10.4103/0974-9233.110605. PMID: 23741130; PMCID: PMC3669488.
- Fatima Kyari, Bola Adekoya, Mohammed Mahdi Abdull, Abdullahi Sadiq Mohammed, Farouk Garba,The Current Status of Glaucoma and Glaucoma Care in Sub-Saharan Africa, Asia-Pacific Journal of Ophthalmology, Volume 7, Issue 6, 2018, Pages 375-386, ISSN 2162-0989, https://doi.org/10.22608/APO.2018392. (https://www.sciencedirect.com/science/article/pii/S2162098923010290)
Content
Author's details
Reviewer's details
Glaucoma in Sub-Saharan Africa
Background
Glaucoma poses a significant public health challenge in Sub-Saharan Africa. It is the 2nd leading cause of blindness after cataract and it is the leading cause (number one cause) of irreversible blindness, it contributes to a high prevalence of irreversible blindness. Factors such as limited access to healthcare services, late diagnosis, and insufficient awareness exacerbate the impact of the disease. The region faces a shortage of specialized ophthalmologists and diagnostic equipment especially in the rural areas, hindering early detection and treatment. Efforts to address glaucoma include awareness campaigns, training healthcare providers, and improving access to affordable medications and surgical interventions.
Symptoms
Glaucoma is asymptomatic until the advanced stage of the disease, as a result many people don’t present early. It is a slowly progressive chronic eye disease.
Symptoms usually start with loss of peripheral vision and severe visual impairment in advanced stages, poor night vision, haloes around light and bumping into objects.
Some patients who have angle closure may present with an acute angle closure glaucoma and that would be treated as an ophthalmological emergency. Acute angle closure glaucoma can cause a rapid deterioration in vision.
Clinical findings
This includes elevated intraocular pressure (IOP), however having a normal IOP does not rule out glaucoma. Optic disc changes such as cupping and thinning, visual field defects typically starting with nasal field loss, asymmetrical cup-to-disc ratios between eyes, and potential variations in corneal thickness affecting IOP measurements. Early diagnosis, regular monitoring, and appropriate treatment are crucial to managing glaucoma effectively in this region.
Differential diagnoses
Differential diagnoses for glaucoma include cataracts, refractive errors, chronic uveitis, optic neuritis. These conditions can present with symptoms like glaucoma, such as blurred vision and elevated intraocular pressure. Accurate differentiation requires a comprehensive eye examination, including measurement of intraocular pressure, assessment of optic nerve health, and evaluation of visual fields, which can be challenging due to limited access to healthcare resources and diagnostic equipment in remote areas.
Investigations
In low-resource settings, investigations for glaucoma focus on essential diagnostic methods including intraocular pressure measurement, gonioscopy to evaluate the anterior chamber angle, visual field testing to assess peripheral vision loss, optic nerve examination for signs of glaucomatous damage, and corneal pachymetry to adjust intraocular pressure measurements. These tools are crucial for early detection and management of glaucoma
Treatment
In low-income settings, treatment of glaucoma includes using affordable topical eye drops to lower intraocular pressure such as prostaglandin analogues and beta blockers, performing laser therapy like selective laser trabeculoplasty when appropriate, and considering surgical options such as trabeculectomy or glaucoma drainage devices when necessary.
Another thing that can help with early detection of glaucoma is if optometrists and health workers are trained in identifying optic nerve damage from glaucoma. They can examine the patients’ optic nerve and refer to the ophthalmologists/glaucoma specialists.
Family physicians interested can also be taught on detecting glaucoma based on identifying the optic nerve head changes and commence appropriate treatment before referral. Telemedicine and discussing the findings of a patient with the ophthalmologists for advice.
Patient education on treatment adherence and regular follow-up is essential, supported by integration with primary healthcare for continuity of care.
These strategies aim to effectively manage glaucoma despite resource limitations, ensuring optimal outcomes for patients.
Follow up
In low-income countries, follow-up after glaucoma treatment involves regular monitoring of intraocular pressure (IOP), visual fields, and optic nerve health. This is crucial for assessing treatment effectiveness and detecting any progression of the disease. Patient education on medication adherence and recognizing symptoms of worsening glaucoma is emphasized, supported by efforts to ensure continued access to care through community outreach and integration with primary healthcare services. These measures aim to preserve vision and improve outcomes for glaucoma patients despite resource constraints.
Prevention and control
In Sub-Saharan Africa, prevention and control of glaucoma focus on raising awareness through education, promoting early detection through routine screenings, and implementing cost-effective screening programs like having a robust National Health care scheme for people to get their drugs at almost no cost, that would help in making the eyedrops available and help in limiting the effect of glaucoma.
Access to affordable medications and surgical interventions is crucial, alongside emphasizing long-term management and adherence to treatment. These efforts aim to reduce the burden of glaucoma-related blindness and improve eye health outcomes across the region despite resource constraints.
Further readings
- Report of the 2030 targets on effective coverage of eye care. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. http://apps.who.int/iris retrieved 2024-08-06
- Olawoye O, Washaya J, Gessesse GW, Balo K, Agre J, Macheka B, Kizor-Akaraiwe N, Pons J, Sarimiye T, Ashaye A, Garba F, Chitedze R, Ibanga A,
- Mahdi A, Ogunro A, Budengeri P, Ajibode HA, Tamrat L, Onakoya A, Okeke S, Giorgis AT, Okosa CC, Fowobaje K, Cook S, Lawrence S, Chan VF, Azuara-Blanco A, Congdon N, Realini T; STAGE Research Group. Glaucoma Treatment Patterns in Sub-Saharan Africa. J Glaucoma. 2023 Oct 1;32(10):815-819. doi: 10.1097/IJG.0000000000002273. Epub 2023 Jul 21. PMID: 37523638.
- Kyari F, Abdull MM, Bastawrous A, Gilbert CE, Faal H. Epidemiology of glaucoma in sub-saharan Africa: prevalence, incidence and risk factors. Middle East Afr J Ophthalmol. 2013 Apr-Jun;20(2):111-25. doi: 10.4103/0974-9233.110605. PMID: 23741130; PMCID: PMC3669488.
- Fatima Kyari, Bola Adekoya, Mohammed Mahdi Abdull, Abdullahi Sadiq Mohammed, Farouk Garba,The Current Status of Glaucoma and Glaucoma Care in Sub-Saharan Africa, Asia-Pacific Journal of Ophthalmology, Volume 7, Issue 6, 2018, Pages 375-386, ISSN 2162-0989, https://doi.org/10.22608/APO.2018392. (https://www.sciencedirect.com/science/article/pii/S2162098923010290)
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