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The “silent thief of sight”: glaucoma treatment and management

A female doctor, wearing a white jacket, glasses and mask is carrying out an eye exam on a male patient, as part of glaucoma treatment.
Jean François Bouda, a doctor in law, who teaches at the University of Ouagadougou in Burkina Faso, is examined by Professor Zabsonre. The exam reveals that he has 40 percent and 60 percent of vision in each of his eyes. “If I am not careful, I may gradually lose the use of my eyes” he says. “I will follow my treatment scrupulously, respect the appointments and follow the prescriptions as recommended. My health, my independence and my job are at stake.”
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Glaucoma, the primary cause of irreversible blindness worldwide, presents a tremendous challenge. Find out how Light for the World’s pioneering glaucoma treatment programmes work to create sustainable solutions.

What is glaucoma?

The term ‘glaucoma’ relates to a group of conditions, characterised by progressive optic nerve damage and loss of visual field. Unlike many other eye diseases, eyesight lost due to untreated glaucoma cannot be restored. But vision loss can be prevented by timely intervention. 

Glaucoma is a disease that affects the nerve of the eye and about five in a hundred people suffer from this condition. The nature of this disease is that the earlier you find it, the better you are able to hold it in its early stages, because there is no treatment that can reverse the damage to this nerve.

Dr. Immaculate Emoru, Ophthalmologist Mulago National Referral Hospital, Uganda

Most forms of glaucoma do not show symptoms in the early stages, before vision loss has occurred. 

For the best outcome, patients suffering from glaucoma must be identified early, receive appropriate counselling and be referred to ophthalmologists who are trained in glaucoma treatment and diagnosis. Family members of those with glaucoma are also encouraged to get examined.

A challenging context

There are many challenges to treating glaucoma across Sub-Saharan Africa. Including inadequate training of eye health professionals and lack of equipment and awareness. 

“There is no single simple screening test to detect glaucoma early at community level,” says Dr. Geoffrey Wabulembo, Expert on Eye Health and Neglected Tropical Diseases at Light for the World. 

“This is compounded by the low awareness level among non-ophthalmic health workers and the community at large.”

A woman is smiling, wearing a white headdress, after receiving glaucoma treatment. She stands in front of a wall, with drawings of children.
After suffering from persistent headaches, Assabie Bademaw was diagnosed with glaucoma. Her sight was lost in one eye, but through surgery – at Gondor Hospital Department of Ophthalmology in Ethiopia – eyesight in her other eye was saved. “Now I am glad that it can be contained with the surgery, and proper follow-up and medication,” said Assabie. “I will make sure I have maintained the sight I have because it means the world to me. It means freedom for me.”

A collaborative approach to glaucoma treatment

Building on our eye health work in Burkina Faso, Ethiopia and Mozambique, in 2019, Light for the World launched a game-changing pilot programme to build up and strengthen glaucoma services in dramatically underserved regions, funded by Else Kröner Fresenius Foundation. 

At the time, neither Burkina Faso nor Mozambique had an ophthalmologist who was certified in glaucoma sub-specialty training. 

But over four years, we collaborated closely with national Ministries of Health and training institutions – as well as International Agency for the Prevention of Blindness, West African College of Surgeons, International Council of Ophthalmology, International Centre of Eye Health and The College of Ophthalmology for Eastern, Central and Southern Africa – with the aim of creating long-lasting sustainable change, embedded into national healthcare. 

Quality and accessible eye health services

Light for the World published the first ever Toolkit for the Management of Glaucoma in Sub-Saharan Africa, used to train eye health providers in glaucoma detection and treatment, and to simplify the management of glaucoma. The first of its kind, it contains guidelines to support ophthalmologists’ decision-making for appropriate glaucoma treatment.  

Based on this toolkit, we have trained nine ophthalmologists to specialise in glaucoma, 22 ophthalmologists have received glaucoma surgery training, and 118 general ophthalmologists have received glaucoma care training.

I enthusiastically salute the new Glaucoma toolkit! Let’s hope that with the toolkit now available to all, enough resources will be mobilised to initiate pilot glaucoma control projects in as many countries as possible.

Professor Daniel Etya’ale MD, former VISION 2020 Global Coordinator for Africa

“The toolkit includes practical steps for raising awareness among health workers and the community, as well as guidelines for establishment of a glaucoma service in the health system” says Dr. Wabulembo. “If implemented across different countries, the kit would provide important benchmarks in treatment protocols, equipment investments and human resource requirements.” 

Seven eye health departments were equipped with crucial infrastructure for glaucoma treatment and diagnosis. A permanent surgical simulation lab was set up at Addis Ababa University Hospital to host intensive glaucoma surgical trainings for 12 general ophthalmologists from all over Ethiopia and Mozambique. Three trainings completed in 2023, financed by Novartis XOVA

Finally, we targeted health authorities, as well as the general public, to raise awareness about the effects of glaucoma. We worked alongside each National Eye Health Programme, as well as national ophthalmological societies, to create accessible information on glaucoma.

A school girls is sitting at a desk, wearing a red shirt, after she received glaucoma treatment. Her teacher stands next to her, wearing a dark green t-shirt.
Berenice Imelda’s teacher noticed she was having difficulty reading and writing in school. After several visits to hospital, she was supported by Light for the World and long-term treatment for advanced glaucoma was prescribed at Yalgado Ouedraogo University Hospital Centre in Burkina Faso. Berenice Imelda has regained her confidence. She is now able to play with her friends, loves to cook and attends an inclusive school.

Working in partnership with the Ministry of Health, we endeavor to reach out to outlying districts. That is our main approach – trying to reach those that are difficult to reach.

Dr. Geoffrey Wabulembo

Glaucoma treatment and management: creating sustainable change

Together with our partners, we have worked hard to lay the groundwork for equitable and sustainable quality glaucoma treatment and care

In the coming years we plan to enhance glaucoma management by strengthening expertise and improving access to eye health services in Burkina Faso, Ethiopia and Mozambique, with efforts expanded to Uganda. 

We hope to further promote and roll out the Glaucoma Toolkit and to build sustainable local expertise on glaucoma within East Africa, working closely with national, regional and international ophthalmological associations and eye health networks to create sustainable change. 

“Light For the World’s approach is successful because of the collaborative and consultative approach in all undertakings of improving glaucoma management,” says Dr. Wabulembo.

If you are interested in partnering with us to expand our glaucoma programme – including a glaucoma fellowship programme and World Glaucoma Week awareness raising and treatment campaigns – get in contact with Dr. Geoffrey Wabulembo.

Geoffrey Wabulembo

Expert on Eye Health & Neglected Tropical Diseases

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