Bulletin of the World Health Organization

Glaucoma is second leading cause of blindness globally

The urgent need for more public health action to tackle glaucoma is underscored by the work of Swiss ophthalmologist André Mermoud, known as the ‘glaucoma pope’, whose charity Vision for All provides free eye health care for poor patients in India, where it has built and operates an eye hospital, and in central Africa.

IN FOCUS
1 November 2004

Andre Mermoud (2003)
Patient being examined for glaucoma with a fundoscopy at the ophthalmic hospital in Mori, Andhra Pradesh, India

Glaucoma is becoming an increasingly important cause of blindness, as the world’s population ages.

New statistics gathered by WHO in 2002, and published in this edition of the Bulletin (Resnikoff et al., p. 844–851), show that glaucoma is now the second leading cause of blindness globally, after cataracts.

Glaucoma, however, presents perhaps an even greater public health challenge than cataracts: because the blindness it causes is irreversible.

WHO officials are looking into ways to address the problems caused by glaucoma which was until now estimated to be the third leading cause of blindness.

“It is a major problem, we’ve been concerned about this for some time and we are now working hard to address this important cause of blindness,” said Dr Robert Beaglehole, WHO’s Director of Chronic Diseases and Health Promotion in Geneva.

“It highlights the growing problem created by chronic eye diseases, including diabetic retinopathy and age-related macular degeneration,” Beaglehole said.

The urgent need for action is underscored by the philanthropic work of Swiss charity Vision For All. André Mermoud, the group’s director, is the Head of the Glaucoma Unit at the Jules Gonin Eye Hospital at the University of Lausanne in Switzerland has become known as the ‘glaucoma pope’ for his work on the disease.

Mermoud told the Bulletin that governments and public health officials face “a really big task” to improve treatment for glaucoma.

“Something has to be done,” Mermoud added. “Especially in Africa, it will be essential to train hundreds of eye doctors.”

Glaucoma is the general term for a group of similar diseases. In primary open angle glaucoma, the channels that drain fluid within the eye become blocked, causing the pressure within the eye to rise. It causes gradual loss of vision. There are few symptoms so that people may not notice for a long time that they are losing their sight.

In angle closure glaucoma, there is a similar build up of fluid within the eye, but the onset is much more sudden. Symptoms include headaches, blurred vision and pain in the eye.

People of Asian descent are much more likely to suffer from angle closure glaucoma, while those of African or European origin are more likely to develop primary open angle glaucoma.

In Southern India, studies have shown a prevalence of glaucoma of 2.6% and 90% of these cases have never been diagnosed before, compared to about 50% previously undiagnosed when similar studies are done in Europe. In African populations, the prevalence is 1–2%, but can rise to about 10% in the Caribbean.

There are several other types of glaucoma, which are less common.

The paper by Resnikoff et al. reports that about 37 million people worldwide in 2002 were blind. More than 82% of all blind people are 50 years and older.

There are several reasons why glaucoma has now become the second leading cause of blindness, experts say. One is age. As a population grows older, the prevalence of glaucoma rises.

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“It is a major problem, we’ve been concerned about this for some time and we are now working hard to address this important cause of blindness. It highlights the growing problem created by chronic eye diseases, including Diabetic Retinopathy and Age Related Macular Degeneration.”

• Dr Robert Beaglehole, WHO’s Director of Chronic Diseases and Health Promotion in Geneva.