Research Agenda for Global Blindness Prevention:

Clinical Conditions: 5. The Glaucomas

Research opportunities:

• PACG
  
  
• Primary Open Angle Glaucoma

Collectively, glaucomatous optic nerve damage accounts for a significant amount of global visual impairment and blindness.

Of the many types of glaucoma, only primary angle closure glaucoma (PACG) is sufficiently prevalent (primarily in "Asian" eyes), and opportunities for intervention sufficiently promising, to have engaged the Committee's considerations.

Until such time as the potential cost-benefit advantages of intervention for the other glaucomas becomes competitive with those for cataract, trachoma or onchocerciasis, they are left to future consideration.

Indeed, there is considerable concern that even if cost-effective strategies become available for identifying patients with open-angle glaucoma, the complications associated with surgical intervention and failure to produce immediately discernible benefits could well lead unsophisticated populations to become discouraged from seeking any surgical interventions (including cataract surgery).

PACG

Strategies that may make preventing PACG more relevant in third-world settings:

Short- to Medium-Term:

• Develop practical techniques for effectively screening populations to identify eyes at high risk of visual impairment and blindness from angle closure glaucoma
  
  
• Determine the value of laser iridotomy as long-term prophylaxis in those who never previously suffered angle closure
  
  
• Evaluate the cost-efficiency of screening and prophylaxis interventions in populations of varying risk

Primary Open Angle Glaucoma

Only with the discovery of better tools and techniques will POAG become a practical target for population-based intervention in third world settings. This is, by necessity, a medium- to long-term research agenda.

• To become relevant to third-world populations, screening techniques are needed that identify subgroups at particularly high risk of disease (genetic markers?)
  
  
• Early treatment/prophylaxis interventions must make a long-term difference in the risk of glaucomatous visual impairment and blindness
  
  
• Epidemiologic studies may identify environmental/behavioral factors that contribute to (seemingly) societal variations in risk
  
  
• Simplified and sensitive measures of progression of optic nerve damage would dramatically improve the ability to test alternative interventions and improve the benefits of intervention/ management
  
  
• New and novel treatment approaches, particularly neuroprotection (beyond medical and surgical approaches targeting IOP), would offer new options for control of blinding disease

Next: 6. Diabetic Retinopathy and Age-Related Macular Degeneration

Also see: Table of Contents of the Research Agenda for Global Blindness Prevention