Improving Treatment in Africa
Glaucoma is often diagnosed late, leading to people already presenting with blindness when they are first seen. After being detected, glaucoma requires life-long follow-up which is often challenging. Treatment is complex and needs to be monitored regularly.
There is currently a paucity of evidence for treatment and follow-up strategies specifically tailored for African countries.
Improving Glaucoma Care in Tanzania
This project, based in Tanzania, will include two initiatives:
1. Developing a training course for eye health staff in the community to promote earlier detection of people at risk of irreversible sight loss from glaucoma and improve follow-up and treatment
2. Developing effective ways to increase awareness and knowledge about glaucoma among patients and their relatives
Dr. Einoti Matayan, an ophthalmologist working at the Kilimanjaro Christian Medical Centre Eye Department, will undertake a PhD as part of the programme, becoming the project manager and local principal investigator for the studies.
The project will involve:
• baseline studies to understand health-seeking behaviour, knowledge, attitudes and practices of people at risk of glaucoma or with manifest glaucoma and their relatives
• mapping of current glaucoma care options and different types of eye care cadres and their range of work
• training relevant staff to detect patients with glaucoma and improve accessibility and affordability of follow-up examinations
• equipping eye centres with appropriate devices
• developing knowledge materials (for example leaflets, patient reminders etc)
The long-term impact of the project and its results will be improved detection, treatment and care of people with glaucoma in this region, which can then provide a template for the rest of Tanzania and elsewhere.
Acknowledgments
We would like to thank Christian Blind Mission for the funding for this project and their continued support.
Laser treatment for Nigeria
This study, based in Bauchi, Nigeria evaluates the feasibility and effectiveness of 3 types of laser for patients with glaucoma. It compares SLT (Selective laser trabeculoplasty) with MLT ( Micropulse laser trabeculoplasty) in patients with high intraocular pressure due to glaucoma. In patients for whom pressure remains high following this laser they are offered a third laser (Transcleral cyclodiode laser) which treats the ciliary body and reduces the production of aqueous humor.
This study will provide information on how effective, safe and acceptable initial laser treatment is for glaucoma in this population who present with very advanced glaucoma. It may provide an alternative to glaucoma surgery which is challenging in this region due to poor uptake and acceptance by patients and difficulty with long term follow up.
Acknowledgements
We would like to acknowledge Velux Siftung Foundation for their support for this project
Glaucoma Toolkits
ICEH have been integral to the development of a Toolkit for Glaucoma Management in Sub-Saharan Africa, and a subsequent Nigerian Glaucoma Guideline and Toolkit.
These toolkits are designed to guide ophthalmologists, glaucoma specialists and glaucoma care team members to set up integrated glaucoma care services in their own context, while strengthening health systems sustainably. They were created through collaboration with a broad range of stakeholders and experts in the field.
Recent activities have included using the guidelines to train doctors in glaucoma management in Nigeria, inviting 36 doctors from Nigeria’s 36 states to a workshop on the guidelines and its clinical recommendations. Twelve doctors then stayed on for surgical simulation training in glaucoma. In parallel, 8 ophthalmic nurses from 4 eye centres in Nigeria underwent training on diagnostic testing for glaucoma patients. They obtained skills in visual field testing, intraocular pressure measurement and OCT optic nerve imaging.
These toolkits have been made possible in part by the work of ICEH’s Glaucoma Network.
Acknowledgements
We would like to thank the Worshipful Company of Spectacle Makers and Global Health Partnerships (formerly THET) for funding, and Light for the World, COECSA, the West African College of Surgeons and National Eye Health Programme of Nigeria and Ministry of Health for their continued collaboration and partnership.