Europe burdened by glaucoma but situation can be changed

The World Glaucoma Day inspired glaucoma specialists around the world to rally local support in order to undertake an enormous task: to reduce the number of people who are unnecessarily going blind from a treatable condition. Certainly, the prevalence of glaucoma-related blindness varies from country-to-country, with less developed countries accounting for the greater percentage of patients blinded by glaucoma. However, the fact remains that unnecessary glaucoma-related blindness affects every country. It is a public health problem on a huge scale and action needs to be taken in order to bring about change.

World Glaucoma Day marked a significant step in the battle for change. From public awareness-raising initiatives through to political campaigns, people around the world united to reduce the burden that glaucoma afflicts upon society.

Ophthalmology Times Europe spoke with Professor Roger Hitchings, President of the European Glaucoma Society (EGS), about their activities around World Glaucoma Day, what needs to be done on a European and a global scale, and his hopes for the future.

OTE: How is the EGS trying to bring about change?
RH: What we're trying to do is maintain a European perspective. We really must tackle this problem at the political level, by aiming to change public health policies around Europe. In order to do this, we are lobbying Members of European Parliament (MEPs), the aim being for us to make a presentation to these MEPs about the burden of glaucoma.

We hope that this presentation will coincide with the EGS quadrennial meeting, which is taking place in Berlin this June, as well as with the issuing of the latest version of the EGS glaucoma treatment guidelines. We believe that these three activities, will raise a great deal of publicity and awareness.

OTE: What do you hope will be achieved from these initiatives?RH: Firstly, glaucoma is not dramatic; because of the way in which it slowly causes visual loss and because of the overlapping fields of vision, much early visual loss passes unnoticed. It is all too frequently undiagnosed, misdiagnosed or diagnosed late everywhere - in the UK, in Europe, everywhere.

So, one of our biggest problems is getting people to recognize the condition and to seek a diagnosis. The tragedy is that it is treatable. The second tragedy is that half of sufferers at any one time are undiagnosed, and a subsidiary tragedy is that an awful lot of people receive treatment because they've been told they have glaucoma when they really don't have it at all. They simply have mildly elevated intraocular pressure. To tell someone they have glaucoma causes fear, stress, and anxiety so an accurate diagnosis is essential.

What we are trying to do is to heighten awareness of the condition, of the way it affects patients, of the cost of late diagnosis and also of the ways in which it can be identified at an earlier stage. By addressing all of these issues, we hope that the burden of late diagnosis will be reduced.

OTE: Where does the responsibility lie?RH: I think the responsibility is in fact a public health one, and lies with people that make public health policies. That's one reason why, in the UK for example, we targeted the Houses of Parliament, and why we're targeting MEPs in Europe. It is a public health issue and policy needs to be directed to improving diagnosis at primary care level.

In the UK, most optometrists make the initial diagnosis but, despite this, because they're yet to be seen as primary care providers, half of cases remain undiagnosed. In other words, the system isn't working very well.

Elsewhere in Europe it's even worse because the onus lies on the patient to make an appointment with an ophthalmologist once they have symptoms. By the time they have glaucoma-related symptoms, it's often late in the course of the disease. At least optometrists have a chance of picking it up early.

That's the case we want to make: there needs to be a change in the system of identifying early glaucoma throughout the community.

OTE: Who are the people who present late?RH: They are in lower socioeconomic groups, they're people who have lots of other concerns about life, for example money worries, which distracts them, or they are people who have a low level of literacy or education.

If they present late, they're more likely to get visual disability. If they present late, they're more likely to go blind. If they present late, it's much more expensive to treat them and despite treatment they remain more likely to suffer from visual disability.

OTE: How effective do you hope the campaigning will be?
RH: Ultimately, it's a resources issue. We need to convince the policymakers to provide more resources to reduce this burden. The resources I am referring to are primary care outlets, not necessarily specialist optometric or ophthalmic outlets, but outlets that are able to test patients in much the same way as in breast cancer screening, for example. We need to implement glaucoma screening and diabetic screening programmes on a European and global scale.

OTE: How likely do you think that this change will happen in the future?
RH: Once you make an economic argument, that's when the policymakers will start to question whether it is cheaper to leave everything as it is, or whether they need to do something about it.

The UK Royal National Institute of Blind People (RNIB) produced a document a year or so ago, which investigated the direct and indirect costs of glaucoma on society. The Institute found that if just 10% of patients were diagnosed early in the disease, the UK could save around £500 million per year. You can have a very effective screening programme for just one-tenth of that cost. This is a very simple economic argument that can be rolled out across Europe.

OTE: How important was World Glaucoma Day?
RH: The fact that it was a global initiative was newsworthy in its own right. The fact that different countries with different problems, with different ethnic and educational groups, and different income levels, all took part in an initiative at the same time made it important.

Each region in the world has its own specific problems with the provision of healthcare, and with the affordability and availability of healthcare. But the key thing is the approach was targeted accordingly.

Europe is much more homogenous than a number of other regions in the world. In Europe we have a fair idea of where the problems lie and what needs to be done. At the end of the day, if it can be seen as a regional issue, then there can be regional funds. If it's seen as a national issue, we want to get national funds.

OTE: How can people get involved?
RH: The most important messages to get across are:

• Glaucoma is treatable

• Glaucoma is undiagnosed

• Glaucoma causes fear of visual disability

• Glaucoma at the moment is not being diagnosed at the primary care level

If people want to do something about this, then they need to put resources into it from a political level, they need to be self aware from a personal level and, from a primary care level they need to have appropriate instruments available for testing. These measures will at least identify those people who will need to be examined more carefully.