First World Glaucoma day, March 6, 2008: tackling glaucoma challenges in India.

Glaucoma is the second leading cause of preventable blindness in India. It is also the leading cause of irreversible blindness in the country.1 It has been estimated that approximately 12 million Indians will be affected by the year 2010.2 With a rapidly growing ageing population, this figure will increase to 16 million by 2020.2 Another cause for concern is that the vast majority of glaucoma cases are undiagnosed.3-9 It has been reported that glaucoma seems to affect the quality of life to a greater degree in India than in the West.10

Population-based studies suggest that more than 90% of glaucoma cases in the country remain undiagnosed. This is in contrast to 40-60% rates of undiagnosed disease in more developed countries.3-8 These high rates of undiagnosed glaucoma translate into significant rates of glaucoma blindness.3-9 It is sobering for ophthalmic professionals to realize that 45% of those diagnosed to have glaucoma in the Aravind Comprehensive Eye Survey (ACES) had undergone an ophthalmic evaluation in the past.5 Among those who were diagnosed to have primary open angle glaucoma (POAG) prior to their examination in the Chennai Glaucoma study (CGS), a significant number actually had primary angle closure glaucoma (PACG), possibly because those diagnosed either did not undergo gonioscopy or were misdiagnosed on gonioscopic examination.9 These figures point to poor diagnosis rates for those who undergo an ophthalmic evaluation. This may be related to an incomplete ophthalmic evaluation or poor examination skills.11 A recent article highlights the state of ophthalmic education in the country; the continuing poor standards of education do not bode well for future diagnosis.12

There have been exciting advances in glaucoma diagnosis and management techniques. Newer diagnostic modalities such as optic nerve head and retinal nerve fiber layer analyzers and perimetric devices are now commonly available throughout the country. The entire gamut of glaucoma medication is available for use. However, while the prices are competitive by international standards; they are still unaffordable to a large proportion of the Indian populace.

These problems are further compounded by poor levels of awareness of glaucoma among the public.13 Less than 1% of the rural population interviewed in the Andhra Pradesh Eye Diseases Survey (APEDS) had any degree of awareness of glaucoma. A substantial improvement in awareness levels would, hopefully, improve diagnosis rates.

There is a paucity of data from India regarding compliance with glaucoma medications and follow-up of patients once they have been diagnosed to have the disease. Unpublished data suggests that compliance rates with medication are poor among glaucoma patients in India (P Sathyan, personal communication)

Some of these problems are not unique to the country but are common across the world. Increasing awareness about the disease could result in better disease detection rates and patient compliance. It is with this in mind that the World Glaucoma Association (WGA) and the World Glaucoma Patient Association (WGPA) have joined forces to launch a global initiative aimed at raising awareness of glaucoma through an annual World Glaucoma Day. March 6, 2008 has been selected to be the first World Glaucoma Day. This event will be conducted worldwide. The event will be commemorated by local, regional and national initiatives and events organized by willing groups and individuals around the world. A number of activities are planned in different locations around the world such as media campaigns, issue of commemorative stamps, screenings in public places and institutional events (open-door day at eye clinics and universities, with lectures addressed to professional and lay audiences). All these events, together with supporting material, general information on the disease and useful links, will be listed at http://www.wgday.net/

The Glaucoma Society of India and its members have planned a media campaign targeted at the print media. A number of members/institutions are planning local events such as open house for the patients and setting up of patient awareness groups.

The World Glaucoma Association has set a goal of reducing the undiagnosed rate of glaucoma from 50% to ″No more than 20% by 2020″. The undetected disease rates are even higher (90%) in India. However, this goal is attainable if we work together to increase awareness of glaucoma both among the public as well as among healthcare providers. We also need to ensure that quality eye examinations are available and performed by all eye care professionals in the country.

Your Participation

We all can participate in the World Glaucoma Day. In addition to the events described above, a number of innovative ideas have been planned. One national ophthalmology journal will publish a special glaucoma issue; other scientific journals will publish editorials on glaucoma, and a group of volunteers will run in the Geneva annual marathon under the World Glaucoma Day colors.

We will be able to achieve our goals only by active participation of as many persons as possible both nationally and at local levels. Any idea or event that could maximize the impact of this initiative is welcome, please take a moment to visit either http://www.wgday.org/ or http://www.wgday.net/ and fill out the Intent Form and tell the world how you will contribute to the success of the first- ever World Glaucoma Day.