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The 1^st African Glaucoma Summit

August 6-7, 2010, Accra, Ghana

Shlomo Melamed, Leon Herndon, Tarek Shaarawy (Co-organizers)

The meeting was very successful, with 222 participants from 27 countries in the continent. The summit was organized and sponsored by the World Glaucoma Association (WGA), through its World Glaucoma Projects Committee (WGPC). This unique event was attended by the Ghanaian Deputy-Minister of Health, the Hon Robert Joseph Mettle-Nunoo, and the Deputy Director General, WHO, Dr A. Asamoah-Baah who both addressed the audience, recognizing the importance of Glaucoma in Africa and the need to carry forward the message of the real need to improve Glaucoma education and management in the continent.

Glaucoma in Africa poses a very difficult and complex public health problem. The prevalence of Glaucoma is very high and its clinical manifestation is more aggressive, especially in Sub Saharan Africa. Poor recognition of Glaucoma as well as lack of means to diagnose on time and offer efficient treatment makes the situation worse. That is why WGA has decided to make Glaucoma in Africa the focus of its international educational effort, and the meeting in Ghana is a first step in that direction.

The 1^st Glaucoma in Africa Summit was a unique meeting. The basic idea was to have face to face discussions with our African colleagues and reach practical solutions to the challenge of enhancing recognition, education and management of Glaucoma in the continent. There were 8 topics relevant to this challenge which were thoroughly discussed. Specific committees were nominated at the conclusion of the meeting with a designated role to propose routes to take, within a strict time table (6 months), in order to improve the status of Glaucoma.

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The topics discussed were

Topic # 1 - Glaucoma Education
Moderated by : Dr. Tarek Shaarawy (Switzerland), panelists:Drs. Adeyinka Ashaye (Nigeria), Karim Damji (Canada), Seth Fiadoyor (Ghana), Ali Khalifa (Egypt), Dan Kiage (Kenya), Shlomo Melamed (Israel) and Christine Ntim-amponsah (Ghana)

Action plans recommended:

1. Train a new generation of trainers in Glaucoma sub-specialty.
2. Propagate monographs for undergraduate training in different medical schools.
3. Develop Education Committees at the level of Glaucoma Associations in different countries.
4. Provide training materials and resources from other countries, e.g : Goniscopy lenses from Aravind Eye Center in India to Africa.
5. Facilitate grouping and collection of resources through Ophthalmological Societies, to be presented in 3 languages (English, French, Portuguese).
6. Encourage Sandwich Programmes between Africa and West and between African countries.

 

Topic # 2 - Best Choices of Treatment for Glaucoma in Africa
Moderated by : Dr. Shlomo Melamed (Israel), panelists: Drs. Ellen Ancker (South Africa), Peter Egbert (USA), H.G. Hassan (Tanzania), Ali Khalifa (Egypt), Sheila Marco ( Ethiopia), Christine Ntim-Amponsah (Ghana) and Adeola Onakoya (Nigeria).

Action plans recommended:

1. Trabeculectomy should be the Gold Standard of treatment.
2. All cases should have anti-metabolites.
3. There is a need for more information on on Laser Trabeculoplasty results in Africa.
4. Selected patients may benefit from combined trabeculectomy and cataract surgery.
5. The use of Glaucoma Drainage Devices or Shunts may be beneficial especially in virgin eyes.
6. Research of novel surgical techniques and new drugs in Africa should be encouraged.

 

Topic # 3 - How to incorporate Glaucoma Management into existing Ophthalmological Programmes
Moderator: Dr. Don Budenz (USA), panelists: Drs. Stephen Akafo (Ghana), Peter Egbert (USA), Daniel Etya'ale (IAPB, South Africa), Kunle Hassan (Nigeria), Joseph Konde (Democratic Republic of Congo), Sola Olawoye (Nigeria) and Rengaraj Venkatesh (India).

Action plans recommended:

1. Develop and empower each level of health care.
2. Train health care workers to screen at primary level before referral to ophthalmologist.
3. Opportunistic Screening is more relevant in the African setting.
4. Management of cases detected during screening should be considered.

 

Topic # 4 - Screening Methodology for Advanced Glaucoma Cases with imminent risk of blindness
Moderator: Dr. Ellen Ancker (South Africa), panelists: Drs. Claire Gilbert (Sightsavers, United Kingdom), Leon Herndon (USA), Sola Olawoye (Nigeria), Seth Wanye (Ghana) and Boateng Wiafe (AOEU,Ghana).

Action plans recommended:

1. Counseling should form an integral part of Glaucoma Screening Management.
2. Increase awareness of Glaucoma through Media.
3. Set up an efficient Referral System.
4. Ensure Inter-professional Integration and Development of the best African Practice.

 

Topic # 5 - "Centers of Excellence" for Glaucoma in Africa
Moderator: Dr. Ian Murdoch (United Kingdom) , panelists: Drs. Adeyinka Ashaye (Nigeria), Khaled Ben - Amor (Tunisia), Don Budenz (USA), Abeba Giorgis (Ethiopia), Joseph Konde (Democratic Republic of Congo), Alan Robin (USA), Tarek Shaarawy (Switzerland) and Rengaraj Venkatesh (India).

Action plans recommended:

1. A special committee will recommend at least 5 locations for establishing Centers of Excellence in different regions in Africa.
2. These centers will adopt a Business Model for their activities.
3. Teaching and appropriate research should be entrenched.
4. Social and leadership roles should be developed.
5. Diagnostic and Therapeutic Tools are important components of these centers.

 

Topic # 6 - How to enhance Awareness of Glaucoma in Public, Government and among Health Care Professionals
Moderator: Dr. James Clarke (Ghana), panelists: Dr. Harry Abutiate (Ghana), Daniel Etya'ale (IAPB, South Africa), Abeba Giorgis (Ethiopia), H.G. Hassan (Tanzania) and Rengaraj Venkatesh (India).

Action plans recommended:

1. Glaucoma should be included in Vision 2020 Program.
2. Research should be carried in Centers of Excellence and local hospitals.
3. National Strategy for glaucoma Management should be developed in different countries.
4. Glaucoma Team should comprise of: Ophthalmologist, Pharmacist, Nurse, Optometrist and councellor.

 

Topic # 7 - How to establish permanent, viable direct Communication Routes with our African Colleagues - All hail the Communication revolution
Moderator: Dr. Karim Damji (Canada), panelists: Drs. Ellen Ancker (South Africa), Peter Egbert (USA), Michael Gyasi (Ghana), Dan Kiage (Kenya), Daniel Laroche (USA), Shlomo Melamed (Israel), Christine Ntim-Amponsah (Ghana) and Boateng Wiafe (Ghana).

 

Topic # 8 - How to involve Community and Industry Support in our Program?
Moderator: Dr. Leon Herndon (USA), panelists: Drs. Pazit Pianka (Lumenis), Harry Abutiate (Ghana), Daniel Etya'ale (IAPB, South Africa), Clare Gilbert (Sightsavers, United Kingdom), Michael Gyasi (Ghana), Kunle Hassan (Nigeria ) and Alan Robin (USA).
Action plans recommended for the latter two sessions::

1. Establish communication needs for all members of eye care team.
2. Develop Glaucoma Website.
3. Establish resource centres for post-graduate training.
4. Encourage linkage between African Ophthalmology Forum and Glaucoma Associations.
5. A "National Glaucoma Task Force" (NGTF) was formally established with Dr. Ellen Ancker and Dr. Khaled Ben Amor as co-chairs. This Task Force will focus on better communication among African Glaucoma teams and improvement of professional exchange in the continent.

 

Discussion of all topics was very vivid, involved panelists as well as many participants from the audience (Clinicians as well as NGO representatives) and was carried out in a very friendly atmosphere. We were especially moved by the passion and commitment to the subject of our African colleagues and Faculty alike.
All three of us, as co-organizers of the summit, would like to thank so many bodies and people who were essential to the success of the meeting. Thanks to WGA , WGPC members, our Ghanaian colleagues (Prof. Christine Ntim-Amponsah, Dr. Edith Dogbe and Dr. Stephen Akafo), all faculty members (speakers and panelists), all participants, WHO and NGO representatives , participants from Industry ( Alcon, Lumenis, Allergen, MSD and Pfizer) and the local organizing company (Creative Trends).

We all recognize that enhancing Glaucoma education and management in Africa is a great challenge. We are all very encouraged by what has been achieved so far in the summit and we look forward to the implementation of the meetings' proposals in the near future.