For World Glaucoma Week, Desiree Murray on formation of the Association of Caribbean Glaucoma Surgeons …
For World Glaucoma Week 2018, my blog highlighted the challenges in preventing blindness and visual impairment from glaucoma in Trinidad and Tobago . These include a lack of awareness in the community and health provider inattention, which result in suboptimal access, uptake and delivery of glaucoma care and a low glaucoma surgical rate. I wrote then that the solutions included community involvement and medical education. Since that time, I have been involved in three major initiatives to strengthen the eye care system in Trinidad and Tobago and the wider Caribbean:
- The Association of Caribbean Glaucoma Surgeons (ACGS) was founded in July 2018 to address these needs.
- An Ophthalmic Nursing Certification Course run jointly by the University of the West Indies School of Nursing and Orbis was held 1st to 5th July 2019.
- A Webinar Series for Ophthalmic Nurses in the Caribbean, facilitated by Orbis, was commenced on 8th August 2019 and will run until 19th March 2020.
The Association of Caribbean Glaucoma Surgeons
Our logo depicts an optic nerve with an inferior notch. The lighthouse, commonly seen decorating our Caribbean shores, represents our commitment to shining the spotlight on glaucoma. The ACGS seeks to eliminate glaucoma blindness in the Caribbean through advocating for universal access to international standard glaucoma care; promotion of evidence-based practice; encouraging regional scientific research and glaucoma education for patients and colleagues. As the founding President (Trinidad and Tobago), I am supported by a dedicated team of glaucoma surgeons including Dr. Dawn Grosvenor (Vice President, Barbados) and Dr. Shailendra Sugrim (Secretary, Guyana). Other members include representatives from Curacao, Suriname, Antigua and the United States of America.
Ophthalmic Nursing Certification Course
The 3-day course (1st-3rd July, 2019 and 3rd-5th July, 2019) was designed to prepare registered nurses for the ASORN (American Society of Ophthalmic Registered Nurses) certification exams. The content was delivered by Dr. Elethia Dean and Nurse Noreen Smith.
Caribbean Nurse Webinar Series
The series commenced on 8th August 2019 with nurses from Trinidad and Tobago, Guyana, Barbados and Jamaica in attendance. Webinars are scheduled to run until March 2020, covering a wide range of topics including Care and Handling of Instruments, Glaucoma Filtration Surgery and Visual Fields. A 1-hour lectures is held twice per month and are then made available on the Orbis Cybersight website.
Glaucoma in the Caribbean
Glaucoma accounts for the largest percentage of blindness in people aged 40–84 years in Barbados (28.4%) and those aged 40 years and older in Trinidad and Tobago (32%) [2, 3]. In Suriname, it is the second most common cause of blindness in people aged 50 years and older (23.8%) and the most common cause of blindness in Surinamese men (41.4%) . I believe that in the Caribbean, glaucoma is largely a surgical disease because our patients present with more aggressive disease and at a younger age than in most other parts of the world. Late presentation, unreliable supply and high cost contribute to poor adherence and failure of medical treatment, which favour surgical intervention . Ten-year data from the Collaborative Initial Glaucoma Treatment Study (CIGTS), using all available follow-up through 9 years after treatment initiation, showed that initial surgery was beneficial for subjects with more advanced visual field loss at presentation . This landmark publication highlights the importance of surgical intervention as an option for lowering intraocular pressure (IOP) to prevent glaucoma blindness in the Caribbean.
Lower target IOP is associated with better preservation of vision . Surgical intervention achieves long-term stable low IOPs and increases the odds of preserving visual field where adherence to medical treatment is poor. Trabeculectomy with adjunctive use of antifibrotic agents remains the best option to preserve visual function in many of our patients . Continuing medical education and professional development of doctors, nurses and other eye care professionals will ensure sustainable development of strong eye care teams, including operating theatre teams. As a university lecturer and sitting president of ACGS, I am committed to this goal. I am immensely grateful to the University of the West Indies and to Orbis for their support.
The ACGS is a newly formed association. We intend to apply to the World Glaucoma Association (WGA) for membership status in 2020. We hope that the WGA will provide mentorship and guidance to propel us even further along the path to eliminating glaucoma blindness in the Caribbean, by increasing community involvement and facilitating continuing professional development of eye care providers.
- https://www.iapb.org/news/challenges-preventing-blindness-visual-impairment-glaucoma-trinidad-tobago/. Accessed 25th February, 2020.
- Hyman L, Wu S-Y, Connell AMS, Schachat A, Nemesure B, Hennis A, et al. Prevalence and causes of visual impairment in the Barbados eye study1 1The authors have no proprietary interest in the articles or devices mentioned herein. Ophthalmology. 2001;108(10):1751-6.
- Braithwaite T BD, Deomansingh F, Fraser A, Maharaj V, Bridgemohan P, Sharma S, Singh D, Ramsewak SS, Bourne RR; for the NESTT Study Group. . The National Eye Survey of Trinidad and Tobago: Prevalence and Causes of Blindness and Vision Impairment. West Indian Med J 2015;64(Suppl. 3):14.
- Minderhoud J, Pawiroredjo JC, Themen H, Bueno dM-VA, Siban MR, Forster-Pawiroredjo CM, et al. Blindness and Visual Impairment in the Republic of Suriname. Ophthalmology. 2015;122(10):2147.
- Murray D, Shah P. ReGAE 12: preventing glaucoma blindness in the Caribbean through implementation of the Moorfields Safer Surgery System and skills transfer from the UK to Trinidad and Tobago. . Clin Ophthalmol. 2018;12:1775-84.
- Musch DC, Gillespie BW, Lichter PR, Niziol LM, Janz NK. Visual Field Progression in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology.116(2):200-7.e1.
- Heijl A. Glaucoma treatment: by the highest level of evidence. The Lancet. 2015;385(9975):1264-6.