Glaucoma: Understanding and Tackling the Silent Threat in Sub-Saharan Africa
PHARAON HEALTHCARE AFRICA
PHA: Leading Pharma in Sub-Saharan Africa & the Middle East. Marketing, sales, education, regulation, distribution.
Glaucoma is a progressive eye disease that damages the optic nerve, leading to characteristic changes in the optic disc and visual field defects. Elevated intraocular pressure (IOP) is a significant risk factor, contributing to the distinctive optic nerve damage, loss of retinal ganglion cells, and thinning of the retinal nerve fiber layer associated with glaucoma. The disease can be categorized into two main types based on the anterior chamber angle: open-angle and closed-angle glaucoma, each with unique risk factors, epidemiology, natural history, and management approaches. Additionally, glaucoma can be classified as primary or secondary, depending on its underlying cause. [1]
?
The Burden of Glaucoma in Africa
Africa bears a significant burden of glaucoma, with the disease being approximately twice as prevalent on the continent as it is globally. If untreated, glaucoma can lead to permanent vision loss and blindness, emphasizing the importance of timely management. Awareness and knowledge are critical in preventing the irreversible damage caused by glaucoma. [2]
The World Health Organization recommends glaucoma screenings every 2–4 years for individuals under 40, every 2–3 years for those aged 40–60, and every 1–2 years for those over 60. However, awareness and accessibility to glaucoma screening vary widely across African nations. [2]?
In 2021, the prevalence of glaucoma in Africa was estimated at 4.2% for primary open-angle glaucoma (POAG) and 1.09% for primary angle-closure glaucoma (PACG) [3,4]. POAG is particularly insidious, often remaining asymptomatic until the disease has significantly progressed. It is also reported to be more prevalent among individuals of African descent. [5,6]
?
Challenges in Managing Glaucoma in Africa
Glaucoma is the second leading cause of irreversible blindness worldwide, accounting for about 8% of global blindness and roughly 15% in the African region. [7] Several factors contribute to the high prevalence of visual impairment from glaucoma in Africa, including socio-economic conditions, limited access to healthcare, and low awareness and early detection rates. [8]
?
In Sub-Saharan Africa (SSA), medical therapy is the preferred first-line management for glaucoma, with 69% of physicians favoring this approach. However, laser therapy is often underutilized, even in centers where it is available. Comparative studies on glaucoma treatments in SSA are necessary to develop evidence-based guidelines and programs to reduce glaucoma-related blindness. [9] Despite the availability of effective interventions, their widespread adoption is hindered by low per capita income levels and high treatment costs. [10]
?
领英推荐
Recent Initiatives and Future Directions
Recent efforts to improve glaucoma management in SSA have led to the creation of a new multi-country practical toolkit based on the International Council of Ophthalmology Glaucoma Guidelines. Developed by a consortium of African experts and published in 2021, this toolkit provides practical steps for diagnosing glaucoma, assessing the risk of disease progression, and making management decisions, along with specific treatment and referral guidance. [8,11]
?
Enhancing awareness, detection, management, and capacity for glaucoma care are crucial strategies for slowing the progression of glaucoma in SSA [12]. Proposed solutions include:
?
?
Conclusion
Glaucoma in SSA poses a significant challenge. Many communities are unaware of the serious implications of glaucoma and face limited access to specialists, making early detection and management difficult. Socio-economic barriers further limit access to treatment for those who have been diagnosed. Stakeholders must collaborate to develop a strategic plan aimed at reducing the burden of blindness from glaucoma in SSA.
?
References