V2020 - The role of tackling Glaucoma in reducing avoidable blindness

Heiko Philippin.
Author:Heiko Philippin
Posted on: Wednesday, 1st July, 2015

Glaucoma is the second leading cause of blindness worldwide, after cataract.  But unlike cataract, the blindness caused by glaucoma is irreversible.  That’s why identifying the condition early and treating it effectively is vital to save sight.

In this blog, the second in our series showcasing how CBM is helping achieve the Vision 2020 targets towards eliminating avoidable blindness, CBM glaucoma specialist Heiko Philippin, who is based in Tanzania, East Africa, talks about his work treating glaucoma in Africa. I started working at KCMC in Tanzania in December 2009. Each year, we carry out around 2,500 glaucoma examinations, some of the patients come repeatedly – so 1000-1500 patients with glaucoma each year.  Around 100 or less would be children with paediatric glaucoma. The main challenges are that patients present late - there are numerous different reasons for this – and that treatment options can be limited. CBM is supporting the management and treatment of glaucoma at a number of different levels.  Treating glaucoma is challenging – the condition requires life-long treatment and follow up.  In large parts of Africa, we do not have all of the treatment options available as in Europe for example, though at KCMC we have a reasonable amount of treatment options, especially now also with the new laser treatment. The appropriate treatment option depends on the age group, the stage of glaucoma and the amount of eye pressure reduction which is necessary. We usually start with eye drops or laser, if these are not feasible or not enough then surgical options come into place, mainly a procedure called trabeculectomy. Shunts, which reduce the pressure, are usually only used in desperate cases. The choice of eye drops is limited in Africa compared to in Europe.  In a lot of areas in this region, we only have one type of drop available, while in Europe there are 6 different groups of eye drops available. Over the years things have definitely improved in larger urban centres, though. At KCMC we can offer 4 different types of eyedrops, but this is not common. The second group of treatment is laser - this is also limited - and the last treatment option is surgery. The most common is trabeculectomy; we can offer our services at similar  standards as in any other country. The next improvement is that we are planning to offer tubes (shunts) which reduce the eye pressure. Aravind in India has now developed a low cost shunt. Often the patient will have tried eye drops and laser before this option CBM has helped with the procurement of eye drops, which are often not part of standard procurement, and has helped finance larger equipment, which would not be possible otherwise. CBM has also supported training – I have received specialist training and now offer fellowships in Glaucoma to doctors in Sub Saharan Africa. CBM also offers training to ophthalmologists  including the treatment of glaucoma. I am currently running a trial for a treatment called Selective Laser Trabeculoplasty (SLT), thanks to a joint grant from Standard Chartered’s Seeing is Believing programme and CBM. SLT has been in use in the UK and elsewhere for several years, but this is the first time it is being trialled in Sub-Saharan Africa. We want to find out if the laser treatment is equal or better than the standard treatment which is currently available here. If it is equal or better, then the laser treatment will offer pressure reduction for one or probably more years without the need for the patient to come back every few months for eye drops. Patients are often not able to take the eye drops for different reasons, so we are hoping that the overall treatment of glaucoma will improve. Of the patients I see, 100 or less are children. They often have a different type of glaucoma, they can have congenital glaucoma or secondary glaucoma due to other eye problems, both are challenging to treat. I see a lot of patients who are blind according to the WHO definition – visual acuity of less than 3/60 – roughly they could count  fingers up at a distance of 3 meters. If you use this definition then a lot of my patients I see are legally blind. Glaucoma patients who have low vision or even have no visual function left, who cannot differentiate between light and darkness we refer to the low vision department, where we advise on low-vision devices so that they are able to do daily activities better. We can also assist for example in using a cane so they can move around more safely, and we refer them to CBM partners,  Tanzanian Society for the Blind.

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