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ICO Leader Letter

March 2010, Volume 7, Number 3

1. Glaucoma, A World Priority

Some of the brightest minds of world ophthalmology have dedicated their lives to advancing the knowledge of glaucoma, and fortunately, specific goals and strategies to enhance the treatment of glaucoma are being implemented in many countries.

Affecting an estimated 67 million people globally, glaucoma is a high priority worldwide and will become even more prevalent as the world's aging population increases, and especially for those in developing regions. But glaucoma is different in many populations and parts of the world, and requires unique and locally appropriate strategies.

What can we do now to decrease vision loss related to glaucoma? To acknowledge World Glaucoma Week (March 7-13, 2010), we share local perspectives on this question from three glaucoma specialists. While these opinions are those of the authors and not the ICO, we thought they might stimulate new thinking, debate and discussion.

Please let us know your reaction and ideas by replying to this email.

- Rubens Belfort, MD, ICO Director for Communications

2. What is the top priority for decreasing vision loss caused by glaucoma in your part of the world?

South America

Up to 75 % of glaucoma cases in South America may be undiagnosed. Only 50% of those diagnosed have access to, or are able to follow treatment. A vast majority of cases are in developing countries where it is difficult to maintain continuous treatment or to purchase the effective, but very expensive, new glaucoma medication. This explains the lack of impact of recent glaucoma progress on the extent of glaucoma blindness in the region.

Currently none of the South American countries has a public health policy or program focused on the management of glaucoma. Ideally, a glaucoma blindness control program should be developed at the public health level with the participation of both ophthalmologists and primary eye care providers. This would establish the standards for diagnosis and treatment adjusted to local needs. Incorporating glaucoma into WHO eye care priorities would strongly support initiatives at governmental and non-governmental organizations.

In practice, I might suggest making use of limited resources by first identifying those at high risk of blindness. Glaucoma is an asymmetric disease, and we could target those who have lost vision in one eye (easy to detect), hoping to catch and treat glaucoma in the other eye before it eliminates functional vision of the individual.

- Eugenio Maul, MD, Chile, World Glaucoma Association Advocacy Committee Member

Asia

In Asia, we have a high prevalence of angle closure glaucoma (ACG) and normal tension glaucoma (NTG). In addition to its higher prevalence, ACG is one of the leading causes of blindness and low vision in Asia, although it is preventable and treatable. Prevalence of NTG is high especially in far eastern Asian countries and the number of undiagnosed NTG patients there may be up to 90%.

Among the different regions in Asia, we have great disparities in accessibility to eye care facilities, quantity and training of eye care workers and ophthalmologists, availability of equipment, technology, and effective glaucoma medication. We need to adjust screening, diagnosis and treatment of glaucoma to local situations and to improve government understanding of the burden of glaucoma.

Our first priorities should be to increase the efficiency of screening for those predisposed to ACG and NTG, and to improve training, including gonioscopy.

- Makoto Araie, MD, PhD, Japan, World Glaucoma Association President

The Middle East and Africa

The Middle East African Region is very disparate. Some countries have the human resources, infrastructure and the necessary equipment to diagnose and manage glaucoma, while others suffer from extreme poverty. For this reason, it is very difficult to identify only one top priority for fighting visual loss due to glaucoma.

I think there should be five main priorities in the Middle East and Africa region:

• Adequate infrastructure: Ensure that training institutions and eye units are accordingly equipped
• Affordability and availability of anti-glaucoma drugs: Set national strategies to increase availability and affordability
• Availability of skilled personnel: Identify, support, (re)train and recruit personnel
• Patient education: Develop culturally sensitive strategies to target those most at-risk
• National glaucoma guidelines and policies: Update the glaucoma strategy section in existing national plans and oversee its development and implementation

In conclusion, if I could choose one thing to help address glaucoma and other eye issues in this region, it would be to improve and increase political commitment at the national and international levels.

- Amel Ouertani, MD, Tunisia, MEACO Vice President and ICO Advisory Committee Member

3. Glaucoma at WOC 2010 - Glaucoma Subspecialty Day and Other Sessions

The World Ophthalmology Congress in Berlin will offer a wide range of presentations in glaucoma, covering everything from translational research and current management, to new and exciting developments. Seven symposia will cover normal-tension glaucoma, exfoliation syndrome, angle-closure, optic nerve assessment, imaging modalities, predicting glaucoma progression, surgical management and managing advanced glaucoma. At the Glaucoma Research Society Symposium, patients will speak on the impact of glaucoma on their lives.

Glaucoma Subspecialty Day on June 6 will offer additional practical topics such as new approaches to gathering information about glaucoma, decisions for changing therapy, childhood glaucoma and glaucoma care in developing countries. For more details on the Glaucoma Subspecialty Day program see: www.woc2010.org/scientific-program/subspecialty-day-program/glaucoma-subspecialty-day.html.

Be sure to see the full-length documentary, "Going Blind," by Joseph Lovett, which will be available throughout the Congress via video on demand.

- Robert Ritch, MD, ICO Advisory Committee Chair

4. Glaucoma Resources

• Atlas of Gonioscopy: www.gonioscopy.org
  Uses videos to teach gonioscopy. Includes basic examination techniques and more advanced techniques, such as indentation and the corneal wedge.


• International Glaucoma Review Web site and Journal: www.e-igr.com
  Official website of International Glaucoma Review (IGR) and official journal of the World Glaucoma Association.


• ICO International Clinical Guidelines on Glaucoma in English:
  icoph.org/guide/guidelist.html and Portuguese: icoph.org/guide/languages.html#portuguese


• World Glaucoma Day and Week: www.wgday.net

5. ICO Yasuo Tano Fellowship

In recognition of the one-year anniversary of the passing of Yasuo Tano, MD, former ICO Treasurer and President of the Asia Pacific Academy of Ophthalmology, the ICO has established the ICO Yasuo Tano International Fellowship to be awarded each year as part of the ICO Fellowship Program.

In addition, the Japanese Ophthalmological Society (JOS) has created the World Ophthalmology Congress (WOC) Tano Travel Grant to send 80 young Japanese ophthalmologists to Berlin for the WOC 2010 and to Abu Dhabi for WOC 2012. They also plan to assist doctors from developing countries in their travel to Tokyo for WOC 2014. For more information, write to info@po.nichigan.or.jp.

I also remind you that the deadline to apply for the next round of ICO International Fellowships is March 31, 2010. For more information on how to apply, go to archive.icoph.org/fellow.

- Veit-Peter Gabel, MD, ICO Director of Fellowships

6. Make Your WOC 2010 Hotel and Travel Arrangements

Now is the time to plan your trip to Berlin for WOC 2010. Hotel rooms in various price categories can be booked via HRS, the worldwide hotel reservation service.

The Star Alliance Member Airlines are the Official Airline Network for WOC 2010. You can save up to 20% on air travel if you choose to fly with airlines in the Star Alliance Network. The Deutsche Bahn AG (German Federal Railways) is also offering savings on train travel.

Complete details and information is available on the WOC 2010 Web site travel page: www.woc2010.org/hotels-and-travel/hotel-reservation.html.

• The WOC 2010 Advance program is now available at
  www.woc2010.org/scientific-program/advance-program.html
• Find WOC 2010 on Facebook
  Become a fan! www.facebook.com/WOC2010Berlin
• Help Promote WOC 2010
  Please add a link to the Congress, www.woc2010.org, to your Web site. Download promotional tools from www.woc2010.org/downloads.html. [Username: WOC2010 Password: See_you]

7. Next ICO Meetings and World Ophthalmology Congress (WOC)

• ICO Board of Trustees: June 4, 2010, Berlin, Germany
• ICO General Assembly: June 5, 2010, Berlin, Germany
• World Ophthalmology Congress®: June 5-9, 2010, Berlin, Germany (www.woc2010.org)
• Other future ICO Meetings: archive.icoph.org/lead/icomeet.html

More News

For more news of the ICO and international ophthalmology and resources for ophthalmologic leaders, see the ICO’s Web site at www.icoph.org.

Request for Other News and Resources

Do you have other news of international ophthalmology or know resources (particularly on the Web) that would be valuable to ophthalmologic leaders? Please let us know at leader@icoph.org.

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