Welcome to Week 4

Management of glaucoma has seen many advances in diagnostic technology together with therapeutic options. All these need to be considered at a local level, in line with context-specific requirements relating to affordability, effectiveness, acceptance and ability to apply in practice.

Below is an adapted summary of the study which looked at ophthalmologist’s practice patterns and the challenges faced in achieving optimal management in Nigeria. Below are some of the findings from the paper :

Kyari F, Nolan W, Gilbert Ophthalmologists’ practice patterns and challenges in achieving optimal management for glaucoma in Nigeria: results from a nationwide survey

A study undertaken in Nigeria, looked closely at ophthalmologists and their practices. Survey responses were received from 153 ophthalmologists representing 80 centres, which provided insights into the available skills, productivity and training in glaucoma care provision across the country.

How participants in the study examined their patients with glaucoma:

• 96% performed cup-to-disc ratio assessment
• 94% measured intraocular pressure
• 88% assessed visual fields
• 56% performed gonioscopy on all patients
• Fewer than 20% of ophthalmologists routinely performed optic nerve head imaging or assessed corneal thickness*

Among those providing data about their previous 10 glaucoma patients:

• 54% patients were offered glaucoma surgery as primary intervention,
• 35% of patients accepted it and 28% actually underwent surgery (ie, approximately half of those patients offered surgery had surgery).

This paper provides a glimpse into the challenges that need to be overcome in glaucoma care provision and the authors categorised these into provider-related, patient-related and health systems-related challenges.

Provider-related challenges included fear of surgical complications, their inability to offer a cure or improve patients’ vision and the uncertainty of postoperative outcomes. Difficulties in postoperative care were also reported.

Patient-related challenges included poor compliance with medical treatment, low acceptance of glaucoma surgery, poor awareness and understanding of glaucoma, poor access to care, late presentation, and poor compliance with follow-up.

Health systems-related challengesof equipment and medication, cost of treatment and the need for more training in early glaucoma diagnosis and glaucoma surgery.

As you go through this week, consider the evidence, the practicalities and the possibilities that need to be explored to provide high-quality glaucoma care.

We have created tools that can be downloaded and used along with a detailed audio from Heiko Philippin on glaucoma care.

Please continue to share your thoughts and experiences.