A Call for Action: The burden of Glaucomain sub-Saharan Africa

Globally, World Glaucoma week celebrations began this week and its worth noting that we are currently midway through the events. Every year, the world Glaucoma Association (WGA) sets aside the second week in March to embark on a barrage of activities to create awareness about this silent “Thief of Sight.”

Glaucoma, a group of eye conditions that damage the optic nerve, is the world’s leading cause of irreversible blindness. In Sub-Saharan Africa, the burden of glaucoma is particularly devastating, affecting millions of people, many of whom face early and devastating vision loss. The combination of genetic predispositions, limited awareness, and inadequate healthcare infrastructure creates a unique challenge for glaucoma management in the region, with millions affected and many more at risk.

Prevalence of Glaucoma in Sub-Saharan Africa

It is estimated that approximately 6 million people in Africa are living with glaucoma, with up to half a million already blind. One of the most alarming aspect of glaucoma in Sub-Saharan Africa is that the disease tends to affect individuals at a younger age and with greater severity than in Caucasian counterparts. As a result, many people experience vision loss earlier, often leading to blindness long before they are diagnosed. Unfortunately, in much of the region, awareness about glaucoma is extremely low. Reports indicate that only about 1 in 20 individuals with the disease are aware of their condition, with over 50% being unilaterally blind on presentation.

Understanding the Types of Glaucoma

There are two primary types of glaucoma: Primary Open Angle Glaucoma (POAG) and Angle Closure Glaucoma (ACG). Among these, POAG is the most common form in Sub-Saharan Africa and people of African descent. This type of glaucoma is typically a slow-progressing condition that damages the optic nerve over time, often without noticeable symptoms until significant damage has occurred. ACG, though less common, is more acute and requires immediate attention to avoid irreversible vision loss.

Risk Factors for Glaucoma

POAG, in particular, is strongly associated with genetic predisposition. However, there are several key risk factors that increase an individual’s likelihood of developing the disease:

• African ancestry: Studies have shown that individuals of African descent are more likely to develop POAG.
• Increased intraocular pressure (IOP): High IOP is the most significant risk factor for glaucoma and the only modifiable one.
• Age: People over the age of 40 are at higher risk of developing glaucoma.
• Family history: A family history of glaucoma increases the risk of developing the disease.
• Type 2 diabetes mellitus: Diabetes is known to increase the risk of optic nerve damage, which is a hallmark of glaucoma.
• High myopia (nearsightedness): Individuals with high degrees of myopia are at a greater risk of developing glaucoma.

What’s the Scenario in Glaucoma?

In a healthy eye, a clear fluid known as aqueous humor flows in and out of the eye, helping to maintain its shape and pressure. In glaucoma, the drainage of aqueous humor is impaired, leading to a dangerous buildup of pressure inside the eye. This increased pressure damages the optic nerve, leading to gradual vision loss. In the case of POAG, the damage is usually slow and progressive, often going unnoticed until significant vision loss has already occurred.

Symptoms of Glaucoma

The challenge with glaucoma, particularly POAG, is that it often develops without noticeable symptoms in its early stages. The condition follows a chronic and progressive course, with vision loss occurring gradually and often without pain. By the time many patients seek help, irreversible damage to the optic nerve may have already taken place, leading to permanent blindness.

Barriers to Glaucoma Management in Sub-Saharan Africa

Despite the availability of effective treatments, Sub-Saharan Africa faces numerous challenges in managing glaucoma. These barriers include:

1. Low awareness: The general public’s lack of knowledge about glaucoma often leads to late-stage diagnosis when the disease has already caused significant damage.
2. Poor adherence to follow-up care: Glaucoma is a lifelong condition requiring consistent monitoring and treatment. However, many patients fail to adhere to follow-up visits, which is crucial for managing the disease effectively.
3. High cost of treatment: Glaucoma treatment requires lifelong use of medications and, in some cases, surgery. The costs of these treatments are often prohibitively high, with many patients forced to pay out-of-pocket.
4. Limited access to surgery: While surgery and laser therapies can be highly effective in managing glaucoma, access to these treatments is severely limited in many parts of Sub-Saharan Africa.
5. Uneven distribution of ophthalmic surgeons: The shortage of trained ophthalmic surgeons exacerbates this issue, with the region facing an alarming ratio of 1 ophthalmologist to 1.4 million people, compared to the global average of 1:35,000.
6. Inadequate healthcare infrastructure: The lack of proper healthcare facilities and resources, including trained professionals and surgical equipment, further hinders effective glaucoma management.

A New Dawn for Glaucoma Management in Sub-Saharan Africa

Despite the challenges, there is hope. Through collaborative efforts and strategic actions, it is possible to reduce the burden of glaucoma in Sub-Saharan Africa. The key to this change lies in:

1. Deliberate and intense sensitization: Public awareness campaigns are essential to educating the public about the risks, symptoms, and importance of early detection. This can be done through social media, local radio broadcasts in different dialects, community durbars, and educational seminars.
2. Early recognition: Effective glaucoma screening programs, especially for individuals aged 20 and above, as well as high-risk groups such as those with a family history of the disease, can help with early detection and treatment.
3. Enhanced access to care: Expanding access to affordable and effective treatments, including medications and surgical interventions, is crucial. This requires the active involvement of all levels of the healthcare system, from community outreach workers to specialists.
4. Government policies: Governments need to implement policies that make anti-glaucoma medications, surgical equipment, and low vision aids more affordable and accessible to the population.
5. Research and innovation: Research should be prioritized, with a focus on understanding the genetic underpinnings of glaucoma in Sub-Saharan Africa. This will help identify new ways to prevent and treat the disease more effectively.

Conclusion

The burden of glaucoma in Sub-Saharan Africa is a pressing issue that requires immediate attention and action. By raising awareness, implementing early screening programs, and improving access to care, we can significantly reduce the prevalence of unnecessary blindness caused by glaucoma. Through collaboration and commitment, we can ensure that millions of people do not suffer from preventable vision loss.

As an Ophthalmologist and founder of the Hopeful Sights Foundation, I firmly believe that with the collective efforts of healthcare providers, governments, and communities, we can win the fight against glaucoma in Sub-Saharan Africa and save millions from needless blindness.

About Hopeful Sights Foundation

The Hopeful Sights Foundation is a non-governmental organization committed to improving eye health and combating vision loss through education, community outreach initiatives, and research. Based in Ghana, the foundation extends its efforts across Sub-Saharan Africa.

Author:
Dr. Wendoline Asiedu-Twum
Ophthalmologist & Founder, Hopeful Sights Foundation
E: wendoline@hopefulsights.org/ www.hopefulsights.org