Glaucoma prevalence is increasing. Epidemiological projections published in 2014 indicate that the number of people (aged 40 to 80 years) with glaucoma is estimated to increase by 18.3% to 76 million in 2020 and by 74% to 111.8 million in 2040 (versus 2013). Most of this increase is projected to be due to significant increases in Asia and Africa. Asia will continue to have the highest number of people with primary open angle glaucoma and primary angle closure glaucoma in 2040: increasing by 18.8 million (79.8%) and 9.0 million people (58.4%), respectively, from 2013. In Africa the number of people with glaucoma will increase by 130.8% (10.9 million) from 2013 to 2040.
The glaucoma challenge is complicated by a number of factors. Importantly, in its most common form, primary open angle glaucoma, it is a disease without symptoms until late stages. Early detection and the prevention of visual impairment from glaucoma is thus made more difficult. There is also the issue of the number of optometrists and ophthalmologists in many countries, particularly in regions where growth in the number of people with glaucoma is highest. The human resource deficit in optometry and ophthalmology adds to the problems of access to care; not just by geography, but also by gender or social and economic disadvantage.
Is telemedicine one of the solutions for glaucoma? Telemedicine can contribute to many aspects of care. In glaucoma’s case, glaucoma detection, diagnosis and ongoing care and monitoring includes technology. Resource settings will vary, but typically glaucoma care is an intensive user of technology: intra-ocular pressure measurement, pachymetry, anterior segment imaging, gonioscopy, retinal photography, fundus and optic disc assessment, optic disc and retinal nerve fibre imaging and analysis (optical coherence tomography or other techniques) and perimetry. Outcomes of these technologies lend themselves to telemedicine approaches. There is of course a resource cost involved with technology; this is gradually reducing with the advent of lower cost and portable technology, which also provides an opportunity to expand the social and geographic reach of screening and diagnostic services.
Telemedicine provides the opportunity for increased detection of people with early glaucoma. It allows trained technicians to undertake screening procedures which are technology based across differing communities. The results can be sent to optometrists and ophthalmologists to determine required actions and follow-up. Similarly, the need for ongoing review of glaucoma management and the detection of progression uses the same technology, and could use the same pathways. Telemedicine can also provide an opportunity to maintain greater contact with people with glaucoma, promoting compliance through improving health education and health literacy.
To use telemedicine efficiently for glaucoma care requires analysis of the significant body of current research into telemedicine approaches for glaucoma screening and management. We have a challenge to find the growing number of people who have glaucoma. We will also need to ensure that we develop the post-screening referral and management pathways in parallel with screening programmes, and include telemedicine pathways. Telemedicine in glaucoma care is an opportunity for all eye care practitioners, optometry, ophthalmology and others, to work collaboratively towards the goal of reducing visual impairment from glaucoma in the future.