Managing a patient with open-angle glaucoma: a case study.

How would a panel of experts manage the case presentation of Mr AA

Managing cataract surgery in patients with glaucoma

Cataract and glaucoma can co-exist. Learn about cataract surgery in patients with previous trabeculectomies, and when (and how) to combine cataract and glaucoma surgery

Ophthalmologists' practice patterns and challenges in achieving optimal management for glaucoma in Nigeria: results from a nationwide survey.

PURPOSE OF THE STUDY: Glaucoma, a chronic non-communicable disease, and leading cause of irreversible blindness worldwide is a public health problem in Nigeria, with a prevalence of 5.02% in people aged ≥40 years. The purpose of this nationwide survey was to assess Nigerian ophthalmologists' practice patterns and their constraints in managing glaucoma. STUDY DESIGN: Ophthalmologists were sent a semistructured questionnaire on how they manage glaucoma, their training in glaucoma care, where they practice, their access to equipment for diagnosis and treatment, whether they use protocols and the challenges they face in managing patients with glaucoma. RESULTS: 153/250 ophthalmologists in 80 centres completed questionnaires. Although 79% felt their training was excellent or good, 46% needed more training in glaucoma diagnosis and surgery. All had ophthalmoscopes, 93% had access to applanation tonometers, 81% to visual field analysers and 29% to laser machines (in 19 centres). 3 ophthalmologists had only ophthalmoscopes and schiøtz tonometers. For 85%, a glaucomatous optic disc was the most important feature that would prompt glaucoma work-up. Only 56% routinely performed gonioscopy and 61% used slit-lamp stereoscopic biomicroscopy for disc assessment. Trabeculectomy (with/without antimetabolites) was the only glaucoma surgery performed with one mention of canaloplasty. Poor compliance with medical treatment (78%) and low acceptance of surgery (71%) were their greatest challenges. CONCLUSIONS: This study indicates that a systems-oriented approach is required to enhance ophthalmologist's capability for glaucoma care. Strategies to improve glaucoma management include strengthening poorly equipped centres including provision of lasers and training, and improving patients' awareness and education on glaucoma

Improving services for glaucoma care in Nigeria: implications for policy and programmes to achieve universal health coverage.

Glaucoma in Africa is sometimes referred to as the silent thief of sight. In Nigeria, glaucoma is common, it is serious, ophthalmologists face many constraints in managing it, people do not even know they have it until it is advanced, patients do not understand or comply with treatment after they are diagnosed and the poor are more likely to be glaucoma blind. Available evidence indicates that the health system in Nigeria is failing to meet the needs of patients with glaucoma. Based on evidence, we propose future directions for improving services for glaucoma care in Nigeria, and the implications for policy and programmes to control glaucoma blindness, using a health system-oriented approach. Three complementary strategies are required: (i) strengthening clinical services for glaucoma-by developing models of glaucoma care, improving clinical treatment options, making medicines and equipment available, financing glaucoma care and training eye care workers; (ii) introducing initiatives for earlier detection of glaucoma in the clinic and approaches in the community and (iii) strengthening health system governance. Glaucoma is a complex disease to manage and addressing it as a public health problem is challenging. However, we need to change the paradigm to recognise that glaucoma is a potentially avoidable cause of blindness in Africa

Medical treatment of open-angle glaucoma.

Most guidelines that exist for the treatment of primary open-angle glaucoma (POAG) – such the National Institute for Health and Clinical Excellence (NICE) guidelines (page 47) – recommend medicine as initial therapy, though laser treatment may also play a role.None of these guidelines are based on research done in Africa, however, and there also is no evidence yet on the relative effectiveness of different glaucoma medications in African populations.For medicines to be effective at controlling POAG, they must be used every day for the remainder of the patient’s life

Multilevel Analysis of Trachomatous Trichiasis and Corneal Opacity in Nigeria : The Role of Environmental and Climatic Risk Factors on the Distribution of Disease.

Funding: Jennifer L Smith was supported by the International Trachoma Initiative through a grant from the Bill and Melinda Gates Foundation. Anthony Solomon is a Wellcome Trust Intermediate Clinical Fellow (098521). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Minimum requirements for a glaucoma programme.

A successful glaucoma health care programme must provide a timely diagnosis as well as life-long monitoring and treatment of glaucoma

The basics of good postoperative care after glaucoma surgery.

Glaucoma patients are treated by lowering the intraocular pressure (IOP) to a level that it is not harmful to the optic nerve. This prevents or delays loss of vision. Lowering of the IOP can be achieved through use of eye medication, surgery or laser procedures. The most common glaucoma surgery is trabeculectomy