Apprehending the Silent Thief of Sight

Chintan Desai,

Vice President, Surgical for Asia Pacific, Alcon

Globally, glaucoma is the second leading cause of blindness after cataracts. It affects more people in Asia than anywhere else in the world and even more will be affected as the population ages. Yet, even as the numbers grow, there are far too many people who are unaware of the risks and who don’t have access to ophthalmological services.

Glaucoma is a 'silent thief of sight’. It refers to a group of eye conditions that damage the optic nerve, caused by abnormally high pressure in the eye. Most of the time, patients of the slow-moving condition do not present any symptoms even as permanent vision loss slowly accumulates – and before they know it, the disease has already stolen nearly half their vision.

This issue is especially acute in the region, with two-thirds – an estimated 49.9 million people1 – in the world suffering from glaucoma in Asia. And with the aging population across the region, this number is expected to reach 76.8 million by 2040.

While blindness from cataracts – the other major cause of vision loss among older people – can be reversed, glaucoma blindness cannot.

The good news is that preventative methods can slow or even stop further vision loss. Medication, laser surgery or surgery can all make a huge difference, especially if the disease is caught in its early stages.

Raising awareness of the condition, investments in research and innovation and training ophthalmologists can prevent and improve our response to this silent thief.

Catching Glaucoma in time

Public education and awareness are our first line of defense.Since glaucoma does not present symptoms at an early stage, individuals (particularly those above the age of 40 or with a family history of the disease) should schedule regular eye examinations.

That’s currently much easier in some markets than in others.There is a generally low level of awareness and limited access to screening facilities and tests required for the early detection of glaucoma, especially in remote areas of Asia.

In India, for example, the rate of undiagnosed glaucoma cases is a staggering 90 per cent in 2013. This is in stark contrast to the 40 per cent- 60 per centrate in the developed world.

There is also a lack of skilled eye care professionals across the region. To put this in perspective: developed countries have a mean of 76 ophthalmologists per million people, while Cambodia has about that many2 for an entire country of 15 million.

It doesn’t have to be this way.

Improving access to care

The key to addressing the issue of glaucoma care in underserved communities is two fold: training and distribution.

We all know the popular proverb “give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime”. Eye diseases like glaucoma require competent diagnostic skills and life long follow-up care to ensure that the pressure is controlled to a level that preserves the optic nerve and vision.

Training efforts should be focused on upskilling ophthalmologists within the communities so that they are proficient in the latest techniques and technologies and are able to provide appropriate diagnosis and treatment for patients.This way, we can create a multiplier effect and ensure sustainable impact.

Of course, we must also equip these ophthalmologists with fishing rods. It is equally important to ensure availability of quality eye care products and equipment so that eye care professionals have the necessary tools.

For example, at Alcon we are driving professional education and development of glaucoma specialist and ophthalmologist. We are looking to partner with societies like APGS (Asia Pacific Glaucoma Society) to leverage the virtual symposium and wetlab experience to educate surgeons on the latest surgical technique and real-world clinical evidence, with some of the top glaucoma surgeons in the region.

Investment in new technologies and treatments

While a precise cause and successful cure remains elusive for glaucoma, research and development to improve our scientific understanding of its mysteries has been essential in advancing treatment options.

Traditional glaucoma surgeries, such as trabeculectomy and glaucoma drainage devices are effective, but they are associated with risks such as double vision, eye infections, exposure of a drainage implant, swelling of the cornea, and excessively low intraocular pressure.

Research and technological innovation have led to the advent of minimally-invasive glaucoma surgery (MIGS), which reduces the incidence of complications and broadens the available treatment options to manage this condition. Among the array of MIGS, the Hydrus® Microstent is a recent FDA approved device, designed to bypass the trabecular meshwork and provide a scaffold for Schlemm’s canal. The device is proven efficacious with an established safety profile for the treatment of open-angle glaucoma.

Research and development into management of the disease – from better diagnostic equipment and longer-lasting medications to nerve regeneration and stem cell rejuvenation – can help us make strides towards more effective treatment options that may one day lead to a cure.

A health problem we can fix

Glaucoma has a significant impact on quality of life even with moderate severity, and its irreversibility makes this a major public health problem.

The international Agency for the Prevention of Blindness estimates that moderate to severe vision lost cost US$411 billion in 2020 globally, with US$160 billion of that total coming fromAsia.

As the population in Asia Pacific and around the world continues to age, it is time we place due attention to this condition. Through regular vision screenings, training of eyecare professionals, providing access to medical infrastructure and continuous research and innovation, we can effectively battle this silent thief of sight.

Disclaimer: The writer of this article has expressed his views based on his/her experience in the medical device industry for more than two decades. This article is intended for informational purposes only. This material is not intended to substitute for professional medical advice, diagnosis, or treatment.

References:

  1. https://iovs.arvojournals.org/article.aspx?articleid=2147366#:~:text=The per cent20projected per cent20number per cent20of per cent20people, per cent3B per cent2050.3 per cent25 per cent2C per cent202040
  2. https://brienholdenfoundation.org/international-program/where-we-work/cambodia/#:~:text=Eye per cent20care per cent20workforce per cent20development,support per cent20optometry per cent20development per cent20in per cent20Cambodia.
Chintan Desai

Chintan Desai, Vice President, Surgical for Asia Pacific. As part of Alcon's Surgical International Leadership team, he focuses on solidifying Alcon's growth and market leadership across APAC.Chintan has worked in various geographies and brings diverse experience that spans multiple areas, including Finance, Supply Chain, Sales, and Project Management, and multiple Medical Device categories, including consumables, equipment, and services. abhijit.ray@aventior.com

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