Glaucoma in developing countries.

Autor/Urheber	Ravi Thomas
Institution	Wolters Kluwer Medknow Publications
Titel	Glaucoma in developing countries.
Quelle	In: 0301-4738; 1998-3689; doi:10.4103/0301-4738.100546; Indian Journal of Ophthalmology, Vol 60, Iss 5, Pp 446-450 (2012)(2012) PDF als Volltext kostenfreie Datei
Sprache	englisch
Dokumenttyp	online; Zeitschriftenaufsatz
DOI	10.4103/0301-4738.100546
Schlagwörter	Diabetes-related blindness; diabetic retinopathy; key informant; rapid assessment of avoidable blindness; retinopathy of prematurity; tele-ophthalmology; Blindness; disability; equity; health economics; health policy; health and development; social exclusion; Community eye health; prevention of blindness; ophthalmogical residency; VISION 2020; Visual impairment; inequality; social class; income; educational status; gender and ethnic groups; Advocacy; effective service delivery; enabling environment; stakeholders; resources; Avoidable blindness and visual impairment; impact; scaling up; Global blindness; prevalence; visual acuity; Comprehensive eye care; eye care model; pyramidal model; optometrist; optometry regulation; eye health; India; Economics; market; government; cost; Millennium development goals; eye care services; planning rapid assessment methods; Avoidable blindness; cataract surgical rate; corneal blindness; Compliance; services; Human resource development; service delivery; social entrepreneurship; uncorrected refractive error; cataract extraction; cataract; coverage; data aggregation; population; Case detection; comprehensive eye examination; developing countries; glaucoma; integrated approach; training requirements; Ophthalmology
Abstract	Objective: To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries. Materials and Methods: Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India) are used to make recommendations. Results: Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases). Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery) can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available. Conclusions: Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use) in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and their monitoring requires reporting of functional outcomes rather than number of operations performed.
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