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Multicenter Study
. 2023 Oct 1;32(10):815-819.
doi: 10.1097/IJG.0000000000002273. Epub 2023 Jul 21.

Glaucoma Treatment Patterns in Sub-Saharan Africa

Olusola Olawoye  1   2 , Jennifer Washaya  3 , Girum W Gessesse  4 , Komi Balo  5 , Jeremie Agre  6 , Boniface Macheka  7 , Nkiru Kizor-Akaraiwe  8   9 , Jonathan Pons  10 , Tarela Sarimiye  1 , Adeyinka Ashaye  1 , Farouk Garba  11 , Richard Chitedze  12 , Affiong Ibanga  13 , Abdull Mahdi  14 , Adunola Ogunro  15 , Patrick Budengeri  16 , Haroun Adetunji Ajibode  17 , Lemlem Tamrat  18 , Adeola Onakoya  19 , Suhanyah Okeke  20 , Abeba T Giorgis  21 , Chimdi Chuka Okosa  22 , Kayode Fowobaje  23 , Stephen Cook  24 , Scott Lawrence  25 , Ving Fai Chan  2 , Augusto Azuara-Blanco  2 , Nathan Congdon  2   26 , Tony Realini  27 ; STAGE Research Group
Affiliations
Multicenter Study

Glaucoma Treatment Patterns in Sub-Saharan Africa

Olusola Olawoye et al. J Glaucoma. .

Abstract

Prcis: Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma. Laser therapy was underutilized where they were available. Physicians were more likely to recommend surgery in severe glaucoma, laser therapy in mild glaucoma, while recommendation of medical therapy did not depend on glaucoma severity.

Purpose: To characterize treatment patterns for newly diagnosed glaucoma in sub-Saharan Africa (SSA).

Methods: This was a multicenter cross-sectional study of adults newly diagnosed with glaucoma at 27 eye care centers in 10 African countries. In addition to demographic and clinical data, physician treatment recommendations (medication, laser, surgery, or no treatment) were recorded. Statistical analyses were performed using STATA version 14.0.

Results: Data from 1201 patients were analyzed. Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma (69.4%), with laser (13.2%), surgery (14.9%), and no treatment (2.5%) recommended to the remaining patients. All sites had medical therapy available and most (25/27, 92.6%) could provide surgical treatment; only 16/27 (59.3%) sites offered laser, and at these sites, 30.8% of eyes were recommended to undergo primary laser procedures. As glaucoma severity increased, the laser was recommended less, surgery more, and medications unchanged. Patient acceptance of medical therapy was 99.1%, laser 88.3%, and surgery 69.3%.

Conclusions: Medical therapy for first-line glaucoma management is preferred by most physicians in SSA (69%). Laser therapy may be underutilized at centers where it is available. These findings underscore the need for comparative studies of glaucoma treatments in SSA to inform the development of evidence-based treatment guidelines and of programs to reduce glaucoma blindness in SSA. Strategic approaches to glaucoma therapy in SSA must address the question of whether medical therapy is the most optimal first-line approach in this setting.

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Conflict of interest statement

N.C. received funding from Orbis International, Zhongshan Ophthalmic Center, Sun Yat-sen University, Bayer, Ulverscroft Foundation (UK), and Belkin Laser. He also serves as a paid consultant for Belkin Vision, a company selling devices for the treatment of glaucoma. O.O. received funding from the Consortium for Advanced Training and Research in Africa (CARTA). She is a CARTA fellow. The remaining authors declare no conflict of interest.

References

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    1. Abdull MM, Gilbert CC, Evans J. Primary open angle glaucoma in northern Nigeria: stage at presentation and acceptance of treatment. BMC Ophthalmol. 2015;15:111.
    1. Olawoye O, Kizor-Akaraiwe N, Pons J, et al. Clinical characteristics and stage at presentation of glaucoma patients in sub-Saharan Africa. J Glaucoma. 2022;31:717–723.
    1. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.
    1. Canadian Ophthalmological Society Glaucoma Clinical Practice Guideline Expert Committee. Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of glaucoma in the adult eye. Can J Ophthalmol. 2009;44(suppl 1):S7–S93.

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