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.

Another reason is the reduced importance of trachoma as a cause of blindness.

This is due to several factors including the Global Elimination of Trachoma Project, which WHO launched with partner organizations, as well as better access to health care and information, and to eye care system development, and improved data.

In their paper Resnikoff et al. found that the world population aged 50 years and over had increased by 30% since 1990. In developed countries, the increase in people over 50 was 16% but in developing countries, excluding China, it was 47%, while in China itself the increase was 27%.

Ophthalmic experts say angle closure glaucoma is reaching “epidemic proportions” in China and other parts of Asia, but there are few reliable data from these countries.

Mermoud identified the lack of trained ophthalmologists as a major factor limiting the diagnosis and care of people with glaucoma in developing countries. In Europe, he said, there is one ophthalmologist for every 10 000 people; in India, there is one for every 400 000 people; and in Africa, one or less for every million.

“Within one million people, you will have 10 000 cataracts every year, and about 1–2% of people — that is, between 10 000 and 20 000 — will have chronic glaucoma. Yet there will be only one doctor to treat them,” Mermoud said.

“Even when people do reach a doctor, they don’t have the money to pay for medicines and eye drops which they may need to take for the rest of their lives. And although surgery to unblock the channels in the eye would be the ideal treatment, it does not work so well in African and Asian patients as in people of European descent for reasons of rapid scarring of the tissues,” Mermoud said.

Mermoud is carrying out research to develop surgical procedures that will be more effective in people with glaucoma from Africa and Asia.

His charity has also established a hospital in the village of Mori, in Andhra Pradesh, in India, which is now one of the biggest eye hospitals in the country. It has two operating theatres and 50 beds.

Although the hospital was built only three years ago, it is now well on the way to being self funding. The poorest patients are treated free, those on middle incomes are asked for an affordable contribution and the wealthiest — who are attracted by state-of-the-art surgical techniques — pay the most, thus financing the treatment of those who pay less or nothing at all.

The hospital also has a bus equipped as a mobile diagnostic unit. Cataract and glaucoma are the most common conditions treated at the hospital; patients with more complex conditions are referred to an associated hospital, the L.V. Prasad Eye Institute in Hyderabad.

Vision for All has also begun working in the Democratic Republic of the Congo, in Lubumbashi and in Brazzaville in Congo, Mermoud said.

To tackle the growing problem of glaucoma, Mermoud said public health officials needed to increase the number of ophthalmologists, particularly in Africa, and to train those already in place, in countries such as India, in the diagnosis and treatment of glaucoma.

More work is needed to make medicines more affordable and more resources are needed for research to develop surgery that will be more ef- ficient on African and Asian patients, Mermoud said.

■ Sharon Kingman, London

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

• André Mermoud, Head of the Glaucoma Unit at the Jules Gonin Eye Hospital at the University of Lausanne, Switzerland.