Fabian Lerner Professor and Head of Ophthalmology, University Favaloro School of Medical Sciences and President-Elect World Glaucoma Association University Favaloro School of Medical Sciences
For World Glaucoma Week, Dr Fabian Lerner discusses glaucoma in Latin America—a region where prevalence is poorly understood…
Little is known about the prevalence of glaucoma in Latin America, as very few population-based studies are published in the literature. Moreover, there is no “one” population in Latin America, as, even within a country there are several ethnicities. However, without scientific evidence, we may say that the prevalence for each ethnicity may resemble what is found in similar populations outside Latin America (i.e: LALES study or Proyecto VER). Both open-angle and angle-closure glaucoma are seen in the region.
Lack of awareness
When it comes to glaucoma, awareness–or the lack of it–is a problem. Even the support from local authorities usually varies, but is never enough nor continuous. Unlike cataract, glaucoma isn’t much on the radar of health officials.
Different associations do organize a “Glaucoma screening day” during World Glaucoma Week that also creates awareness. A few years ago, an important awareness campaign was organized that was mostly carried out through social media (and was even a “trending topic”). It continued for 2 years in several countries in the Latin America region. Unfortunately, a lack of resources prevented it from continuing.
Public hospitals play an important role in diagnosing and treating patients as only the affluent can afford to go to private/HMO´s practices/clinics. Also, many services/clinics have the same state of the art diagnostic equipment as in the first-world countries, but in rural or poorer areas this is not the case. Most ophthalmologists in the region are city-based and the rural areas again suffer. However, all is not lost for ophthalmologists living away from big cities. Different educational resources are available these days for them, like virtual continuous medical education over the internet.
Most medications available in the rest of the world are also available in Latin America, both original as well as generic formulations, oftentimes produced by local pharmaceutical companies. Coverage of treatment varies and, in some countries, costs may make treatment impossible.
In Argentina, some drugs are available for free, for people in retirement. As in many regions worldwide, compliance is a problem in Latin America as well. The reasons for this are similar: the nature of the disease (asymptomatic), the side effects of topical medications, costs, difficulties with eyedrop instillations, and others. Laser trabeculoplasty (LTP), both argon and selective are available in several centers. However, in most cases, medications are the first course of treatment, and LTP is usually used when medical treatment is not enough, fails or has adverse effects. Thus, effectiveness is not as high as when LTP is used as a first-line treatment.
The most popular surgical procedure is trabeculectomy. This is done both by general ophthalmologists and glaucoma specialists. If coverage or budget allows, glaucoma drainage devices are used as well when indicated. Minimally invasive glaucoma surgery (MIGS) procedures are slowly being introduced in some countries. However, cost is a major issue that may prevent the uptake of such technologies. In recent years cyclophotocoagulation with micropulse technology has also been introduced in Latin America for those in need of this treatment.
Although we are better than before, continuous awareness and education are needed in order to make early diagnosis and begin appropriate treatment. This will avoid irreversible visual impairment and blindness.