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Abstract #10094 Published in IGR 6-1
Glaucoma management in developing countries: medical, laser, and surgical options for glaucoma management in countries with limited resources
Thomas R; Sekhar GC; Kumar RSCurrent Opinions in Ophthalmology 2004; 15: 127-131
PURPOSE: Most people affected by glaucoma live in developing countries. Recent trials and reports provide sound evidence for the management of glaucoma. This review extrapolates relevant articles to the developing world. RECENT FINDINGS: The predictive value of gonioscopy for progression of primary angle closure suspects (PACS) to primary angle closure (PAC) is only 22% (95% CI: 9.80-34.2). PACS are not uncommon; laser peripheral iridotomy (LPI) is not indicated or feasible in all cases. 28.5% of PAC progress to primary angle closure glaucoma; the number needed to treat (NNT) for LPI to prevent progression is only 4. Laser peripheral iridoplasty controls acute angle closure glaucoma (AACG) faster than medical therapy alone. Primary lens extraction has also been suggested as treatment for AACG after control of the acute attack. A five-year NNT for ocular hypertension (OH) of 20 is too high to allow treatment of all OH. High-risk OH and primary open angle glaucoma (POAG) have an NNT of five to six and merit treatment. Latanoprost and brimonidine are effective in lowering IOP in Asian eyes with POAG, but primary surgical therapy may be a more viable option. For cataract and coexistent glaucoma requiring filtration, trabeculectomy combined with the Blumenthal technique of cataract surgery may be as effective as trabeculectomy combined with phacoemulsification. SUMMARY: The principles of glaucoma management should be the same the world over. Considering the paucity of resources and competing opportunity costs, countries with limited resources have to extrapolate available information in a sensible and cost-effective manner.
Dr. R. Thomas, L.V. Prasad Eye Institute, L.V. Prasad Marg, Banjara Hills, Hyderabad, India. ravithomas@lvpei.org
Classification:
11.1 General management, indication (Part of: 11 Medical treatment)
12.1 General management, indication (Part of: 12 Surgical treatment)
