Addressing Glaucoma in the Developing Countries of the Asia Pacific Region: An Opportunity to Transition From Disease-Specific Responses to Integration of Eye Care.

The Asia Pacific region accounts for more than 50% of global blindness. Although most attention has appropriately been focused on cataract, the most prevalent and treatable cause of global blindness, other conditions including glaucoma contribute significantly to visual impairment. The population attributable risk percentage for glaucoma suggests that it is a significant public health problem, and generally, case detection rather than population-based screening is the most appropriate strategy to identify disease. Glaucoma management requires the full range of comprehensive ophthalmic examination skills and therefore allows the diagnosis of most other potentially blinding conditions as well: these skills should be part of residency training in all developing countries in the region. A comprehensive examination on all patients presenting to an eye clinic not only detects glaucoma but also provides the opportunity to expand existing cataract-centered programs toward the larger goal of prevention of blindness from any cause. Local efforts to improve residency training can be supplemented by regional support such as assistance in curriculum development and assessment of trainees. Assistance in glaucoma training would involve in-country diagnostic and surgical training with extended stays to teach postoperative care, supplemented by possible fellowships in developed countries. Although these changes will not have a large impact on blindness from glaucoma in the short term, they have the potential to develop a framework and skill set that is required for long-term reduction in morbidity from blindness of all causes, including glaucoma.