Year : 2019 | Volume
: 9 | Issue : 2 | Page : 61--62
To reduce the number of blinded by glaucoma
Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
Prof. Tetsuya Yamamoto
Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-Shi 501-1194
|How to cite this article:|
Yamamoto T. To reduce the number of blinded by glaucoma.Taiwan J Ophthalmol 2019;9:61-62
|How to cite this URL:|
Yamamoto T. To reduce the number of blinded by glaucoma. Taiwan J Ophthalmol [serial online] 2019 [cited 2019 Jun 15 ];9:61-62
Available from: http://www.e-tjo.org/text.asp?2019/9/2/61/259553
Glaucoma remains a significant burden to eye health worldwide. An estimated 4.6 million people suffer from glaucoma in Japan alone, where an estimated 28.6% of government-designated, visual disability is attributable to glaucoma. However, there is reason for hope in the prognosis of glaucoma, and the author estimates that there may be a 50% reduction in these numbers within 20 years, based on two strong trends. First, there is a rise in advanced imaging methods, such as optical coherence tomography, in daily ophthalmic practice, enabling earlier and more accurate diagnosis of glaucoma even by nonglaucoma specialists. This has made possible earlier intervention in glaucoma worldwide. Second, recent surgical interventions now complement both established and emerging medical protocols such as the standard drugs, Rock inhibitors, and nitric oxide-donating drugs. These provide more effective management of intraocular pressure (IOP) and fewer side effects, which has led to more individualized and better-tolerated therapies. Further, recent advances in surgical techniques make possible earlier intervention in milder cases previously not considered for surgery. For example, the so-called micro (or minimally)-invasive glaucoma surgery (MIGS) is now indicated in early glaucoma cases, mainly as an adjunct to cataract surgery. In the current issue of Taiwan Journal of Ophthalmology, Prof. Masaki Tanito (Japan) discusses MIGS surgery, especially ab interno trabeculotomy-related glaucoma surgery, concluding that the new techniques can be good options for early-stage open-angle glaucoma, developmental glaucoma, and glaucoma in elderly patients.
MIGS comprises a variety of glaucoma techniques, from trabecular meshwork abrasion, trans-trabecular meshwork bypass, and uveoscleral outflow bypass, to filtering surgery. Even cycloabrasive procedures may be included for consideration. The only common feature among the MIGSs is that they are less invasive, although the degree of IOP reduction does among the methods. Importantly, the level of invasiveness depends on the technique employed. Although long-term outcomes are not reported, and the level of invasiveness is not clearly characterized, MIGS is gaining more acceptance in ophthalmology. The author remains concerned about the effect of MIGS on visual field progression because the magnitude of IOP reduction reported so far is less than that of traditional glaucoma surgery. There is a clear need to investigate the efficacy of MIGS critically from the perimetric perspective.
In any case, a significant number of glaucoma patients will lose their sight. Unfortunately, too many patients still consult an ophthalmologist in the late stages of this disease, and the majority of them complain little about their vision at presentation, despite the presence of severe visual field defects including a threat to fixation. They do not realize that, by that point, there has already been significant permanent loss of vision. This is a tragedy. Although we can reduce the rate of visual field progression via our more sophisticated glaucoma treatment armamentarium, the ocular condition gradually worsens. What can be done? The World Glaucoma Patient Association designated a week each March as World Glaucoma Week in order to raise public awareness. This year, World Glaucoma Week was March 10–16. The Japan Glaucoma Society also promotes a “Light Up in Green” campaign during World Glaucoma Week as a public awareness program, in addition to public events, such as free ophthalmic examinations, lectures, and symposia on glaucoma. “Glaucoma” literally means “green-colored intraocular morbidity” in Japanese. Thus, ordinary Japanese people can rather naturally bring to mind glaucoma when they encounter green light messages and imagery as part of this campaign. Thus, we lit up landmarks and medical facilities in green light during the campaign period, with over 150 facilities participating. We hope and expect that our “Light Up in Green” campaign will help enlighten the public to both the threat and opportunities associated with glaucoma in the modern era. At the very least, we must continue to take such concrete and broad steps to inform the public about this disease.
Of course, while no single step is enough, the journey of a thousand miles must begin with that crucial single step. Our ultimate goal is the complete elimination of visual loss caused by glaucoma. Even with the advent of many new treatment modalities for reducing IOP, we must take the long view and continue to raise awareness, innovate, and compassionately and effectively intervene for the benefit of all our patients and their loved ones. May it be so.