International Glaucoma Day

Pagination not final/Pagination non finale
EDITORIALS
World Glaucoma Day, March 6,
2008—What can you do?
Can J Ophthalmol 2008;43:1–3
doi:10.3129/i07-212
G
laucoma is a significant public health concern, consistently ranking among the leading causes of blindness in Canada. Following cataract, glaucoma is the
second leading cause of blindness worldwide, making
glaucoma the number one cause of irreversible blindness.1
According to Statistics Canada’s Canadian Community
Health Survey of 2002–2003, nearly 3 out of every 100
Canadians over the age of 40 self-reported having glaucoma.2 Since only one-half of those affected with glaucoma are aware they have the disease,3 this likely underestimates the true prevalence. Although glaucoma occurs
in all age groups, it is more common in older adults, and
with our aging population, estimates of glaucoma prevalence are increasing. It is predicted that by 2020, 79.6
million people worldwide will have glaucoma, 11.2
million of whom will be bilaterally blind.1
In recent years there has been considerable progress in
the diagnosis and treatment of glaucoma. Technological
advances in optic nerve and retinal nerve fiber layer
imaging and visual field testing make it possible to diagnose
glaucoma in the early stages, when the success of treatment
has a better prognosis. Medical therapies are available and
effective in controlling glaucoma for the majority of
patients,4 while for those uncontrolled medically, laser and
surgical interventions are often successful.
Damage to the optic nerve and visual field caused by glaucoma is irreversible. As damage progresses gradually, often
unnoticed by the patient, early detection and treatment are
of paramount importance to prevent blindness. For individuals with known risk factors of glaucoma, including elevated
intraocular pressure, increasing age, race (African descent),
family history of glaucoma, migraines, low blood pressure,
diabetes, myopia, and hypertension,5 the importance of
routine eye exams cannot be understated.
Despite our better understanding of risk factors for glaucoma, we have yet to see an improvement beyond the 50%
undiagnosed rate of glaucoma. In addition, despite strong
evidence that lowering intraocular pressure can delay the
onset and progression of glaucoma,6–8 reported rates of
non-compliance with glaucoma therapy range from 5% to
as high as 80%.9 This high variability results from different
definitions for non-compliance and the way it is measured.
In a recent Canadian multi-centered study of compliance
among 500 glaucoma patients, 50% of patients surveyed
were either non-compliant or demonstrated an improper
drug administration technique.10
World Glaucoma Day was established by the World
Glaucoma Association to increase public awareness about
glaucoma. The target audience includes patients, the
general public, health care providers, and the government,
and each member has a role to play. Patients should be
made aware of the insidious nature of glaucoma and the
importance of compliance with treatment and follow-up to
minimize their risk of visual loss. Patients also need to
inform family members of their diagnosis so that they too
can be screened for glaucoma. Health care providers,
together with the government, should promote public
awareness campaigns encouraging regular eye exams, especially for those with known risk factors for the disease.
Ophthalmologists should act as leaders by writing articles
for local newspapers, contacting radio stations, or organizing public meetings on glaucoma. Earlier diagnosis and
treatment will reduce visual disability caused by glaucoma,
improving individuals’ quality of life and decreasing costs
of treatment.11 The World Glaucoma Association has set a
goal of reducing the undiagnosed rate of glaucoma from
50% to “No More than 20% by 2020”. This goal is certainly attainable if all parties work together to increase
awareness of glaucoma both among the public as well as
among health care providers, and if we all ensure quality
eye exams are available worldwide.
The Canadian Glaucoma Society has partnered with the
Canadian Ophthalmological Society in developing a campaign focusing on awareness of glaucoma and its risk
factors. The motto of the campaign is “Don’t Get Blindsided by Glaucoma”* and will run for the month of March,
to coincide with World Glaucoma Day on March 6, 2008.
The success of this campaign depends on ophthalmologists
actively participating at a national level, and by developing
local strategies to achieve this goal.
Every journey begins with a small step, but it is the
cumulative number of steps that will determine how far we
will go. As World Glaucoma Day approaches, take that first
step: ask yourself, “What can I do?” and make this campaign a success.
Yvonne M. Buys, MD, FRCSC
University of Toronto and
the Canadian Glaucoma Society
Toronto, Ont.
[email protected]
*Slogan created by David Yan, MD
REFERENCES
1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol
2006;90:262–7.
2. Perruccio AV, Badley EM, Trope GE. Self-reported glaucoma in
Canada: findings from population-based surveys, 1994–2003.
Can J Ophthalmol 2007;42:219–26.
3. Sommer A, Tielsch JM, Katz J, et al. Relationship between
intraocular pressure and primary open angle glaucoma among
white and black Americans. The Baltimore Eye Survey. Arch
Ophthalmol 1991;109:1090–5.
CAN J OPHTHALMOL—VOL. 43, NO. 1, 2008
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Pagination not final/Pagination non finale
Editorials
4. Feiner L, Piltz-Seymour J. Collaborative initial glaucoma treatment study: a summary of results to date. Curr Opin
Ophthalmol 2003;14:106–11.
5. Boland MV, Quigley HA. Risk factors and open-angle glaucoma:
classification and application. J Glaucoma 2007;16:406–18.
6. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular
Hypertension Treatment Study: a randomized trial determines
that topical ocular hypotensive medication delays or prevents
the onset of primary open-angle glaucoma. Arch Ophthalmol
2002;120:701–13.
7. The AGIS Investigators. The Advanced Glaucoma Intervention
Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol
2000;130:429–40.
Le 6 mars 2008, journée
mondiale du glaucome—Que
peut-on faire ?
Can J Ophthalmol 2008;43:1–3
doi:10.3129/i07-212
L
e glaucome est un important sujet de préoccupation
en matière de santé publique. Il se classe toujours
parmi les principales causes de cécité au Canada. Après la
cataracte, c’est la deuxième cause de cécité au monde,
mais aussi la première cause de cécité irréversible.1
L’Enquête sur la santé dans les collectivités canadiennes
en 2002–2003, menée par Statistique Canada, révèle que
près de 3 Canadiens de plus de 40 ans sur 100 ont déclaré
avoir le glaucome.2 Puisque seulement la moitié des personnes atteintes de la maladie en sont conscientes,3 il est
fort probable que la véritable prévalence soit sousestimée. Bien qu’il affecte tous les groupes d’âge, le glaucome est plus fréquent chez les aînés et l’on estime qu’en
2020, 79,6 millions de personnes en seront atteintes
dans le monde et, parmi elles, 11,2 millions seront aveugles des deux yeux.1
De grand progrès ont marqué ces dernières années le
diagnostic et le traitement du glaucome. Les avancées technologiques en matière d’imagerie du nerf optique et de la
couche de fibre nerveuse de la rétine permettent de diagnostiquer le glaucome dès les premiers stages et de mieux
pronostiquer la réussite du traitement. On dispose de
médicaments efficaces pour maîtriser la maladie chez la
majorité des patients,4 alors que pour les autres cas non
maîtrisés, les interventions au laser ou chirurgicales
donnent souvent de bons résultats.
Les dommages au nerf optique et au champ visuel causés
par le glaucome sont irréversibles. Comme ils progressent
graduellement, et souvent à l’insu du patient, il est primordial de les détecter et de les traiter rapidement pour
2
CAN J OPHTHALMOL—VOL. 43, NO. 1, 2008
8. Heijl A, Leske MC, Bengtsson B, et al. Reduction of intraocular
pressure and glaucoma progression: results from the Early
Manifest Glaucoma Trial. Arch Ophthalmol 2002;120:1268–79.
9. Olthoff CM, Schouten JS, van de Borne BW, Webers CA.
Noncompliance with ocular hypotensive treatment in patients
with glaucoma or ocular hypertension: an evidence-based
review. Ophthalmology 2005;112:953–61.
10. Campbell RJ, Trope GE, McIlraith I, Buys YM. Administration
technique and compliance in topical drug therapy of glaucoma.
Proceedings of the Canadian Ophthalmological Society Annual
Meeting; 2006 June 21–24; Toronto, Ontario, Canada.
11. Iskedjian M, Walker J, Vicente C, et al. Cost of glaucoma in
Canada: analyses based on visual field and physician’s assessment. J Glaucoma 2003;12:456–62.
prévenir la cécité. On ne saurait donc minimiser l’importance des examens oculaires réguliers pour les personnes
qui présentent des facteurs de risque de glaucome, notamment la haute pression intraoculaire, le diabète, la myopie
et l’hypertension.3
Nous connaissons mieux ces facteurs de risque, mais il
nous faut quand même voir une amélioration et réduire
davantage le taux de 50 % des glaucomes non diagnostiqués. En outre, s’il est bien établi que la baisse de la pression intraoculaire peut retarder le début et la progression
du glaucome,6–8 les taux signalés d’inobservance de la
thérapie afférente varient entre 5 % et aussi grand que
80 %.9 La grande variabilité des taux dépend de la diversité des définitions de l’inobservance et des façons de
mesurer celle-ci. Selon une récente étude multicentrique
sur l’observance du traitement, menée au Canada auprès de
500 patients atteints du glaucome, 50 % des répondants
n’avaient pas suivi le traitement ou avaient mal appliqué les
modalités de la médication.10
La Journée mondiale du glaucome a été instituée par
l’Association mondiale du glaucome pour sensibiliser
davantage le public à la maladie. Les populations cibles
comprennent les patients, le public en général, les fournisseurs de soins de santé et les gouvernements, chacun et
chacune ayant un rôle à jouer. Les patients devraient
prendre conscience de la nature insidieuse du glaucome et
de l’importance d’appliquer et de bien suivre le traitement
pour minimiser le risque de perte de la vue. Ils doivent
aussi informer du diagnostic les membres de leur famille
afin que ceux-ci se fassent aussi examiner pour le glaucome.
Les fournisseurs de soins de santé, ainsi que les gouvernements, devraient encourager les campagnes de sensibilisation publique incitant les gens à se faire examiner les yeux
régulièrement, surtout ceux et celles qui ont des facteurs de
risque connus de la maladie. Les ophtalmologistes
devraient agir comme chefs de file en écrivant des articles
pour les journaux, en contactant les postes de radio ou en
organisant des rencontres publiques sur le glaucome. Un
diagnostic et un traitement rapides réduiront la déficience