A Step Forward To Beat Glaucoma

Blindness In Srilanka

Dr. Lalitha Senarath

Consultant Ophthalmologist, TH Karapitiya

Chairperson

Glaucoma Interest Group

College of Ophthalmologists of Sri Lanka

Introduction

Glaucoma present with many categories.

Open-angle glaucoma is ,the most commonest silent disease

Undiagnosed glaucoma is the top in the list for blindness

The rest is angle closure glaucoma, congenital glaucoma, and secondary

glaucoma.

Disease process where the ganglion cells and fibers of the optic nerve are

irreversibly damaged, It is progressive.

Glaucoma is the leading cause of irreversible blindness which can be

prevented by early detection and treatment.

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POAG

ACG

CGNVG

TRAUMA

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What Causes Glaucoma

People are in DARK

If they don’t know……

❖ what is it and the impact on vision

❖ who are the risk group

❖ Importance of early diagnosis and treatment to save sight years

❖ Utmost importance have life long treatment to preserve the quality

independent life without blindness

Make them aware by Carrying out public awareness through

Electronic medias, media conferences and presentation

Island wide activities to mark world glaucoma week, walk, display banners, and

screening camps open for high risk group

Articles in public papers and magazines

Posters in public places

? who are at

Race – African Americans and Hispanics .Asian descent are at risk of

developing acute-angle glaucoma

Heredity – Family history of glaucoma

Age – People over 60; African-Americans over 40

People with severe myopia/hyperopia

Use of long term steroids

Diabetes may have association.

Hypertension (high blood pressure), Obesity, Vigorous Exercise???

Awareness

Patients are in DARK

If we don’t detect and treat

Early detection by mass public screening program

Lounged island wide mass screening programs at district and provincial level

coordinated by the relevant consultant in charge organized and carried out

by glaucoma interest group COSL.

Importance of conducting district level

screening & CME for medical officers

to facilitate early diagnosis

Importance of Management

Med

ical

Surg

ical

Lase

r

Volunteer Screening

Population

Aware

Less %

Presbyopia check up

By optometrist

To GP

Un aware

Unaware

Huge % %

To Ophthalmologist

Glaucoma suspects

Glaucoma patients

CME for health care workers, GPs, Optometrists

We don’t know

What are common rates

incidence,

progression

disability

In clinical glaucoma

care In our country

???

Global Prevalence The global prevalence of glaucoma for population aged 40-80 years is 3.54%(95% CI,

2.09-5.82). 1

In 2013, the number of people ( aged 40-80 years) with glaucoma worldwide was

estimated to be 64.3 million, projected to be increasing to 76.0 million in 2020. (based

on 50 population based studies).

These estimates are important in guiding the designs of glaucoma screening,

treatment and related public health strategies in Sri Lanka.

(Reference 1- Yih-Chung T et al, 2014)

You are in DARK till you collect enough data

National survey of prevalence of Glaucoma in normal population

Ethical approval - Ethics Review Committee of National Eye Hospital -

Colombo

A population based descriptive study - covering all provinces in Sri Lanka.

In conducting the study cluster sampling will be done (4-5 Grama Niladhari

divisions from each district, n=63 clusters).

Study instruments – structured questionnaire schedule

Support of national level, district level and divisional level health staff will

be needed during the data collection process

Sample will be selected from voters’ list, data will be collected by research

assistants, examination will be done by medical officers and investigations

will be supported by technical staff.

Initiation of national glaucoma survey

pilot study

Pilot study in Galle district

Sample size – 200

Four MOH areas

Sample selected from the votes

list

Data collection, examination,

fundus imaging & IOP & CCT

measurements

Pilot study Rathgama

Galle

Aim and Objectives of the Survey

Aim –

To develop strategies for early identification of glaucoma in risk populations to control

blindness due to glaucoma in Sri lanka

Objectives –

Main objective – To determine the prevalence of glaucoma in Sri Lanka

Secondary objectives - To assess the etiological, demographic and socio-economic risk

factors.

Study outcome and public health implications

OUTPUT

Estimation of burden of glaucoma provincially

Usage of validated study tools / instruments for population screening

OUTCOME

Identification of greater number of people at risk and refer them for further assessment, treatment and follow up

GOAL

Greater coverage of diagnosis and effective treatment on prevention of blindness due to glaucoma in Sri Lanka