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Editors Selection IGR 11-1

Screening and Education in Nepal

Comment by Jim Standefer on:

22974 A novel approach to glaucoma screening and education in Nepal, Thapa SS; Kelley KH; Rens GV et al., BMC Ophthalmology, 2008; 8: 21

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Thapa et al. (19) have designed a three-pronged approach to screen for and educate about glaucoma in Kathmandu, Nepal. The screening was conducted in two different locations; it was combined with an outreach, population-based cataractscreening project and also, as part of the Tilganga Eye Center-hosted Glaucoma Awareness Week. In addition to these two screenings, the authors describe two comprehensive glaucoma education programs. All persons had a pressure measurement using a Perkins applanation tonometer. Patients 50 years of age and older were examined by an ophthalmologist and received a dilated fundus exam and FDT perimetry. Patients below 50 years of age were examined by a trained ophthalmic assistant and, if there was apparent anterior segment pathology and/or decreased vision, were referred to a screening clinic ophthalmologist. Patients with shallow anterior chambers detected using the oblique flashlight and/or the van Herick, were referred to the TEC for gonioscopy. All patients screened at TEC during Glaucoma Awareness Week also had OCT testing and optic disc photography.
While acknowledging that certain aspects of this model need more validation, the authors suggest that it may serve as a framework for other developing countries. However, several points must be taken into consideration. First of all, the article mentions more than once that all or some of the screening and education is financed by outside private donors whose generosity may come to a halt. Other developing countries may not enjoy sources of donated funds. Some other concerns and suggestions: the screening of persons under the age of 50 did not include examination of the optic disc as a required part of the screening; some developing countries, such as Nigeria, have many young men in the 30 to 50 age group who present with advanced bilateral glaucoma. Do the relatively low yields of the three 1-day screenings justify the large amount of person time and associated travel expenses, even if financed by private donors? Compliance and follow-up are universal concerns for glaucoma clinics. In many developing countries, the ophthalmologist has only one opportunity to both diagnose and treat a patient. Taking drops is almost always temporary once the patient realizes that there is no improvement in vision and, over time, trabeculectomies often fail. A possible answer is suggested by Crowston and Taylor in the Glaucoma Opinion section of Glaucoma Review, Vol. 10-4, page 12, ‐ treating the newly-diagnosed glaucoma patient with laser trabeculoplasty instead of drops is very cost-efficient and skirts the compliance issue as well.

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