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Education Committee Highlights WGC-2017 -part 2

The Education Committee carefully selects presentations from the World Glaucoma Congress 2017 in Helsinki for your benefit. This month a summary by Eytan Blumenthal of five interesting talks discussing how to challenge glaucoma in very low-income populations

Session 1: Advanced glaucoma in low-income populations

Five interesting talks discussing how to challenge glaucoma in very low-income populations.
First, Dr. Philippin discussed various approaches on how to raise public awareness in general and patient awareness in particular.

Dr. Catherine Green discussed how to train eye care providers, highlighting the fact that money alone will not solve the problem, and that attention should be addressed to how and not only to what must be learned, and concluded with a description of the “Pacific Islands project”.

Dr. Sheila Marco from Kenya next highlighted the role of technology, concentrating on equipment needed for diagnosis, distinguishing what might be considered a must and what is merely “nice to have” in their setting.

Dr. Tony Realini discussed what sustainable effective treatment options are, highlighting the limitations of each option in the low-income population setting. One promising option discussed is the SLT with its safety profile. Efficacy data from a low-income environment is presented.

Last, Dr. G Chandra Sekhar concluded the session discussing cost effective glaucoma programs. One such screening & treatment program is described in detail, based on a structured system of referrals from Vision Guardians to Vision Centers to Secondary Eye Care Centers, utilizing telemedicine and even “Drone slit-lamps”.

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Session 2: Africa Symposium

Five fascinating lectures discussed the unique constraints and opportunities of managing glaucoma in the African continent.
First, Dr. Neeru Gupta discussed the magnitude of the problem in sub-Saharan Africa and introduced Dr. Eddie Kgao Legodi who overviewed initiations as well as the WOC scheduled for 2020 in South Africa.

Dr. Olusola Olwoye discussed the main barriers to glaucoma care in Sub-Saharan Africa, including the prevalence of the disease, scarcity of resources, issues related to diagnosis, management, awareness and finalized her talk with a discussion of what lies ahead?
Next; Dr. Keith Martin characterized the major management challenges, including: late presentation, adherence to treatment, the level of training of trained personnel, identifying avoidable/preventable blindness, and ways of bringing in support and knowledge.

Dr. Dan Kiage discussed the surgical approach and the unique considerations in Africa separately for each of the glaucoma surgical procedures.
Last, Dr. Fatima Kyri discussed lessons learned from the treatment of glaucoma in Nigeria, and described a framework for treating glaucoma in this country, as well as implications for better controlling glaucoma.

Dr. David Friedman concluded the session.

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Session 5: Biomechanics in glaucoma

Dr. Cynthia Roberts opened the session with an in depth discussion of corneal biomechanics as it pertains to measuring IOP and understanding measurement artefacts. Newer tonometers are discussed in the context of corneal biomechanics.

Dr. Michael Girard described the biomechanics of the optic nerve as it pertains to glaucoma pathogenesis. Biomechanics of the optic nerve head and deformations were modeled using OCT, MRI & animal data incorporated into a finite-element model. Implications related to the concept of “stiff” dura, sclera and optic nerve are described.

Dr. Darryl Overby next discussed the biomechanics of the trabecular meshwork, presenting a hypothesis of outflow homeostasis involving an active mechanism regulating trabecular meshwork resistance, involving concepts such as trabecular meshwork stiffnes, shearing forces, nitrous oxide and feedback mechanisms.
Last, Dr. Paul Kaufman discussed in depth the biomechanics of presbyopia as it pertains to glaucoma. Beyond a loss of lens elasticity with age, a restrictive aging of the muscle is shown to be secondary to scarring within the ciliary muscle, all leading to presbyopia. A case is made that the ciliary muscle and choroid form an elastic network that extends from the TM to the optic nerve region, mobilized by accommodation, and relevant to the pathogenesis of glaucoma.

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