In parts of the world where people have limited access to ophthalmic care, MIGS and cataract procedures are able to provide long-term treatment when follow-up is unlikely.
According to a 2014 study by the American Academy of Ophthalmology (AAO), worldwide prevalence of glaucoma is expected to skyrocket, from 64.3 million in 2013, to 111.8 million by 2040.1 Whether due to lack of diagnosis or limited treatment, patients in the developing world will disproportionately suffer from preventable blindness due to glaucoma.1,2
Fortunately, new technology in combination with charitable missions has the chance to make a real difference for the future of glaucoma patients around the globe. There are many challenges to treating glaucoma in developing countries, particularly in the rural areas. Frequently, patients have never had an eye examination, and are even less likely to have ever seen an ophthalmologist.3
In the United States, those prescribed ocular hypotensive medications have dismal adherence rates.4 We can expect that to be the case in developing countries as well, particularly because adherence is closely tied to health literacy, and rural populations generally have little understanding of a chronic disease with no immediate manifestations.5
Transformative power of MIGS
The same technology that is transforming glaucoma care in the developed world has the potential to make a major impact in these disadvantaged populations. One of the greatest benefits of microinvasive glaucoma surgeries (MIGS) is that they are designed to provide continuous, sustained lowering of pressure, and can help reduce the burden of topical medications. They also have high-safety profiles, and are ideal in areas where medical follow-up is unlikely.
Stuart Sondheimer, MD
Dr. Sondheimer is a board-certified ophthalmologist in Skokie, IL. He specializes in LASIK and cataract surgery. Dr. Sondheimer has volunteered with SEE International since 2008, traveling to volunteer humanitarian clinics in Vietnam, El Salvador, Honduras, and Panama. Dr. Sondheimer did not indicate any relevant financial disclosures.
1. Tham et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121:2081–2090.
2. Robin A, Grover DS. Compliance and adherence in glaucoma management. Indian J Ophthalmol. 2011; 59(Suppl1):S93–S96.
3. Thulasiraj RD, Nirmalan PK, Ramakrishnan R, et al. Blindness and vision impairment in a rural south Indian population: the Aravind Comprehensive Eye Survey. Ophthalmology. 2003;110:1491–1498.
4. Nordstrom BL, Friedman DS, Mozaffari E, Quigley HA, Walker AM, “Persistence and adherence with topical glaucoma therapy,” Am J Ophthalmol. 2005;140: 598-606.
5. Muir KW, Santiago-Turla C, Stinnett SS, et al. Health literacy and adherence to glaucoma therapy. Am J Ophthalmol. 2006;142:223–226.
6. Ahmed IIK, Katz LJ, Chang DF, et al. Prospective evaluation of microinvasive glaucoma surgery with trabecular microbypass stents and prostaglandin in open-angle glaucoma. J Cataract Refract Surg. 2014;40:1295–1300.
7. Belovay GW, Naqi A, Chan BJ, et al. Using multiple trabecular micro-bypass stents in cataract patients to treat open-angle glaucoma. J Cataract Refract Surg. 2012;38:1911–1917.