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Eye Health Issue 39 CComommmunityunity EEyyee HHeeaalltthh AN INTERNATIONAL JOURNAL TO PROMOTE EYE HEALTH WORLDWIDE SUPPORTING VISION 2020: THE RIGHT TO SIGHT EDITORIAL: THE ADULT GLAUCOMAS Gordon J Johnson MD FRCS FRCOphth Professor and Director International Centre for Eye Health Institute of Ophthalmology 11-43 Bath Street London, EC1V 9EL, UK here is little doubt that the glaucomas Tnow constitute the second cause of global blindness, after cataract. With the ageing of most populations, new surveys suggest that even Harry Quigley’s 2000 projection of 6.7 million blind due to glau- coma was an underestimate.1 Yet glaucoma has not been included as one of the priority conditions for disease control in the first 5- Primary angle-closure glaucoma is more common in East Asians while primary open angle year programme of the Vision 2020 initia- glaucoma occurs more often in Africans and Europeans Photos: Pak Sang Lee tive. Why is this? Although it is agreed that the burden of must be a ‘good thing’ and should be glaucoma, and so meet the rigorous require- blindnessdueto differenttypesofglaucoma encouraged. However, at present there is no ment for a satisfactory screening test. is high, the problem has been that we have single inexpensive, practical and valid In the meantime, we need simple and not had either reliable ways of detecting screening test. practical methods of detecting those people these diseases or straightforward ways of Maria Papadopoulos and Peng Khaw with moderately advanced chronic glauco- treating them in large populations, within refer to a number of new devices for obtain- ma who need immediate treatment. Colin prevention of blindness programmes. In the ing images of the optic nerve head or the Cook has outlined a practical approach to past few years, however, there have been retinal nerve fibre layer in POAG. Although case detection in Africans, developed from some rapid developments which are chang- they involve sophisticated technology and his extensive experience in KwaZulu-Natal. ing our perspective. at present are expensive, it is quite pos- It must be pointed out that the criteria for It would seem self-evident that screening sible that further refinements of these types the ‘either-or’ decision as to whether a per- of populations for primary open angle glau- of instruments may turn out to be the son should be referred for further investiga- coma (POAG) Ð the common form in popu- most cost-effective method of screening tion, and for deciding whether treatment is lations of African and European origin Ð large populations for primary open angle needed, are not the same as the criteria for case-definition of glaucoma in an epidemio- logical study. The common form of glaucoma in East Editorial: The Adult Glaucomas Gordon J Johnson 33 Asian populations is primary angle-closure Primary Open Angle Glaucoma Maria Papadopoulos & Peng T Khaw 35 glaucoma (PACG). From his studies in Primary Angle-Closure Glaucoma Paul J Foster 37 Singapore, Paul Foster found that patients The Secondary Glaucomas R Krishnadas & R Ramakrishnan 40 with PACG were more likely to be blind in Glaucoma Case Finding at least one eye than those with POAG.2 and Treatment Colin Cook 43 PACG appears to be the largest cause of Ocular Injuries in Ethiopia Abebe Bejiga 45 irreversible blindness in Asia. The risk of an Trachoma Control in eye developing angle-closure between the Southern Africa Erika Sutter & Selina Maphorogo 47 trabecular meshwork and the peripheral iris 33 Ed i t o r i a l is usually indicated, in turn, by the depth of in the next 5-year strategy for Vision 2020. Communi ty the anterior chamber in the optic axis. During the next 3 to 4 years we, therefore, These anatomical features form the basis need to be refining our methods for screen- for practical screening tests, either at the ing (or case-detection) and for treatment so EEyyee HHeeaalltthh slit-lamp or by ultrasound, so that a true that they can be applied to very large num- Volume 14 Issue No. 39 2001 screening programme in those populations bers of people. at high risk now seems a real possibility. The secondary glaucomas account for References up to 25Ð30% of all glaucoma in some 1 Quigley H A. Number of people with glaucoma surveys. Eyes with secondary glaucoma worldwide. Br J Ophthalmol 1996; 80: 389Ð393. are also more likely to be blind than those 2 Foster P J, Oen F T S, Machin D, et al. The suffering from POAG. Drs Krishnadas and prevalence of glaucoma in Chinese residents in Singapore. A cross-sectional population survey Ramakrishnan outline the main causes of of the Tanjong Pagar District. Arch Ophthalmol International Centre secondaryglaucoma.Thesecanbegrouped 2000; 118: 1105Ð1111. for Eye Health under 4 mainheadings:neovascular, uveitic, Institute of Ophthalmology lens-related and traumatic. The relative ✩ ✩ ✩ University College London importance of these forms will vary from 11Ð 43 Bath Street location to location. Since they are all London EClV 9EL usually associated with a high intraocular pressure and reduced vision, the cases can Tel: (+44)(0)207 608 6909/6910/6923 Fax: (+44)(0)207 250 3207 bedetectedatprimaryandsecondarylevels Eye Health E-mail: See box using the protocol outlined by Cook. Web-site: www.jceh.co.uk Because of the burden of blindness Now available on-line World Health Organization caused by the glaucomas and the progress ww w .jc e h . c o . u k Collaborating Centre for that is being made in controlling some of Prevention of Blindness the other major causes of blindness, it is On-line edition by OAS I S/ X a l t Editor likely that the glaucomas will be included Dr Murray McGavin Nurse Consultant Ms Susan Stevens Administrative Director Ms Ann Naughton Eye Health Editorial Secretary Mrs Anita Shah The Journal of Community Eye Health is pub lished four times a year. Editorial Review Committee FREE TO DEVELOPING COUNTRY APPLICANTS Dr Allen Foster 2001/2002 Subscription Rates for Applicants Elsewhere Dr Clare Gilbert Professor Gordon Johnson 1 Year: UK£25 / US$40 2 Years: UK £ 4 5 /US $ 7 0 Dr Darwin Minassian (4 Issues) (8 Issues) Dr Ian Murdoch Dr Daksha Patel To place your subscription, please send an international cheque/banker’s order made Dr Richard Wormald payable to UNIVERSITY COLLEGE LONDON or credit card details with a note Dr Ellen Schwartz of your name, full address and occupation (in block capitals please) to: Dr David Yorston Journal of Community Eye Health, International Centre for Eye Health, Language and Communication Consultant Institute of Ophthalmology, 11Ð43 Bath Street, LONDON, EC1V 9EL, UK Professor Detlef Prozesky Tel: 00 44 (0)20 7608 6910 Fax: 00 44 (0)20 7250 3207 E-mail: [email protected] Website: www.jceh.co.uk Consulting Editors Dr Harjinder Chana (Mozambique) Dr Parul Desai (UK) Readersareaskedtousethefollowing specifiedE-mailaddressesonly whencontacting Dr Virgilio Galvis (Colombia) Professor M Daud Khan (Pakistan) the Journal or other Departments at ICEH: Professor Volker Klauss (Germany) Journal mailing list requests Ð [email protected] Dr Susan Lewallen (Canada) Dr Donald McLaren (UK) Journal editorial Ð [email protected] Dr Angela Reidy (UK) Resource Centre (information service) Ð [email protected] Professor I S Roy (India) Professor Hugh Taylor (Australia) Research enquiries Ð [email protected] Dr Randolph Whitfield, Jr (Kenya) Courses Ð [email protected] Typeset by Regent Typesetting, London © Journal ofCommunity Eye Health, Printed by InternationalCentre for Eye Health, London The Heyford Press Ltd. Articles may be photocopied, reproduced or translated provided these are not used On-line edition by for commercial or personal profit. Acknowledgements should be made to the OASIS/Xalt author(s) and to the Journal of Community Eye Health. ISSN 0953-6833 34 Community Eye Health Vol 14 No. 39 2001 Review Article What’s New in Primary Open Angle Glaucoma? M Papadopoulos MBBS FRACO Consultant Ophthalmic Surgeon P T Khaw PhD FRCP FRCS FRCOphth FIBiol Professor of Glaucoma and Wound Healing & Consultant Ophthalmic Surgeon Director, Wound Healing Research Unit Glaucoma Unit and Department of Pathology Moorfields Eye Hospital and Institute of Fig. 1: Image obtained using Heidelberg Retinal Tomograph (HRT II) Ophthalmology Photos: T Garway-Heath Bath Street, London EC1V 9EL, UK ised programmes for serial visual field prevent further glaucoma damage?’ has rimary open angle glaucoma (POAG) analysis (PROGRESSOR), which assess recently been addressed by a multicentre, Pinvolves a spectrum of disorders typi- progression of disease by accounting for prospective clinical trial.1 Patients with fied by a characteristic optic neuropathy test variability are available. Other modes advanced POAG and IOP consistently less and field loss in eyes with open drainage of testing which involve motion detection than 18 mmHg after surgery (mean IOP angles. It is currently a leading cause of may enable earlier diagnosis. 12.3 mmHg) were found to have no visual blindness worldwide, and in the future field progression after 8 years of follow up. should become even more important as B. Treatment The clinical implication is that we should populations age throughout the world. aim for a low normal target IOP range in Recently, we have witnessed a number of Medical patients with moderate to severe glaucoma. exciting advances in glaucoma. Develop- The introduction of sustained release, once The use of the antimetabolites, 5- ments have occurred regarding diagnosis, a day form of β blocker or pilocarpine has Fluorouracil (5FU) and Mitomycin-C treatment, genetics and the relationship of provedusefulintermsof better compliance (MMC), topreventsurgicalfailurehasbeen intraocular pressure (IOP) to disease pro- and convenience. However, prostaglandin the greatest advancement in glaucoma gression. analogues, which increase uveoscleral out- surgery over the last two decades. Single, flow, have had the most significant impact.
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