World Glaucoma Day sets sight on disease awareness

Ophthalmologists in more than 34 countries around the globe are busy planning events for World Glaucoma Day on March 6th to alert people to the devastating effects of glaucoma and the importance of having their eyes examined.

The effort, led by members of the World Glaucoma Association (WGA), is one more attempt by physicians worldwide to make people aware that glaucoma is a blinding disease that largely can be prevented and treated.

The incidence of glaucoma-related blindness is "infuriating," said George N. Lambrou, MD, of the Athens Institute of Ophthalmology, Greece. "Glaucoma has reliable diagnostic methods and cheap and effective treatments so that the incidence of glaucoma-related blindness could be significantly reduced if only patients would know about it and would care about getting screened and treated adequately," Dr Lambrou said. "It is not an exaggeration to say that the main reason for glaucoma blindness is oversight, or, to be more provocative, sheer ignorance."

More than 310 events are being planned at more than 52 sites, with more being added daily to a worldwide database being kept by Dr Lambrou, who also is the executive vice chairman of the World Glaucoma Patient Association (WGPA), a co-sponsor.

Some ophthalmologists are planning free laser treatments; one ophthalmologist is running in the Geneva Marathon in Switzerland under the colours of the WGA; and a Colombian ophthalmologist is providing complimentary laser treatments to poor patients. Some countries, including Antigua/ Barbuda and Dominica, are issuing commemorative postage stamps; Israel will rubber-stamp all letters posted on March 6th with the day's logo.

Glaucoma to affect nearly 80 million by 2020
The number of glaucoma cases is staggering. Physicians are frustrated by the number of people worldwide who do not know they have the disease and do not know they may be at risk.

According to Dr Lambrou, specialists have predicted that by the year 2020, 79.6 million people worldwide will have glaucoma, and 11.2 million of these people will be blind in both eyes. In developed countries, only 50% of those with the disease are aware they have it; in underdeveloped countries, 90% or more of people with glaucoma are unaware that they have the disease or even have heard of it.

Robert Ritch, MD, holder of the Shelley and Steven Einhorn Distinguished Chair in Ophthalmology at the New York Eye and Ear Infirmary (NYEEI), said with some frustration that he recalls being at a national meeting in 1978 and hearing that a survey of 1,001 people across the United States showed that 30% had never heard of glaucoma, and 50% had heard of it but had no idea what it was. Only 5% of people surveyed had an accurate understanding of glaucoma, he said.

"Now it's 30 years later, and everyone's still saying the same thing," said Dr Ritch, one of four specialists coordinating the World Glaucoma Day activities. He also is a professor of clinical ophthalmology, chief of the glaucoma service, and surgeon director at NYEEI. "It's an issue that's been there all along. People need to be aware of it."

Global ignorance is to blame
The situation is not much different in developed countries around the world, according to ophthalmologists. Most people do not know the risk factors and do not receive annual eye examinations.

In Canada, for example, a national study by the Environics Research Group found that seven in 10 Canadians are unaware of the risk factors associated with glaucoma, said Yvonne M. Buys, MD, associate professor of ophthalmology, University of Toronto, and president, Canadian Glaucoma Society.

"The study suggests that those Canadians most prone to developing glaucoma are unaware of their risk, potentially putting themselves in serious danger of irreversible eye disease," Dr Buys said.

Meanwhile, Glaucoma Australia is having "measurable success" in improving awareness of the need for regular eye checks, supplying information to patients with glaucoma, and raising funds for glaucoma research.

"The Australian Bureau of Statistics, however, shows that for every decade of age, the numbers of Australians [in whom glaucoma is] diagnosed and [who are receiving] treatment for glaucoma has risen over the past 10 years," said Ivan Goldberg, MD, clinical associate professor, University of Sydney, Sydney, Australia and director, Eye Associates, Glaucoma Services, Sydney Eye Hospital. "We feel we are making an impact there, too. There is hope."

The national association in Australia sponsors an annual National Glaucoma Week that highlights the message that the disease is progressive and silent but that effective treatment can halt progression. The late Ray Charles allowed the group to use his name and image for several years to drive home the point that "he needn't have lost his sight, and you needn't either." This past year, the group showed the effects that glaucoma-induced visual disabilities have on safe driving and captured two minutes of television time one evening on three major commercial channels during news broadcasts. "We try to be innovative and imaginative," Dr Goldberg said.

Blindness is unjustifiable
In Greece, Dr Lambrou said he is compelled to try making a difference in the number of glaucoma cases that lead to blindness, a situation he believes is unjustifiable. "[Because] the disease is asymptomatic for a very long time, 50% of patients with glaucoma are unaware of having the disease and are, month by month, year by year, slowly but irreversibly losing their sight capital," he said. He compared the goals of recent efforts with the progress made by cardiovascular health programs, which have influenced people to stop smoking, to exercise, and to eat nutritious foods.

The Greek social structure poses a unique challenge in reaching people. The message must first break into the concentric circles of expanded family, neighbours, and people of the same village or area to make a difference, he said.

Meanwhile, developing countries, particularly those in Africa, have an even greater percentage of people who lack knowledge or treatment. Africans and those with African ancestry are at the highest risk for glaucoma, according to Scott R. Christensen, president and chief executive officer of the Glaucoma Foundation and president of the WGPA. "A number of countries in Africa are still developing and have limited health care in general," he said. "The people at greatest risk are not being seen."

The specialists are not giving up
Despite the challenges ahead, physicians around the world are not giving up. Dr Ritch said that World Glaucoma Day is one more attempt to grab the attention of those who might have the disease. He noted that other efforts have included a week-long glaucoma awareness campaign and January remains Glaucoma Awareness Month in the United States. "The only thing I can think to do is to keep trying to create awareness in people," he said.

As a global specialist in glaucoma, Dr Ritch has treated numerous heads of state, ambassadors and even kings and queens. He wrote to them and asked them to consider issuing postage stamps commemorating the day. A handful of countries are doing so this year, and he hopes more will join the cause next year.

The March 6th date was chosen this year because it coincides with the American Glaucoma Society meeting in Washington, DC, said Christensen. About 80 people have signed up to talk with congressional representatives that day. Christensen said he hopes that the fact that it also is World Glaucoma Day will help reinforce their message. "This [day] is a wonderful idea. We believe it's going to make a huge difference around the world," he said.

On March 6th, Dr Lambrou said, the WGA also will announce two initiatives: "No More than Twenty by Twenty-Twenty," a program aimed at reducing the rate of undiagnosed glaucoma from 50% to 20% by the year 2020, and a "Glaucoma Patient's Bill of Rights,"aimed at educating glaucoma patients about the disease and treatment options available to them. He introduced both ideas and gained support for them at the WGA meeting this past November.

Dr Ritch is not discouraged by the work that remains in alerting people to the importance of glaucoma screening and treatment. "Look how long it took people to get to the moon - about a million years," he said. "You can't worry about these things; you just keep working at it."

How you can help
Here are some ways that ophthalmologists can help:
• Publicize and conduct physical screenings. With proper planning, some 500 people could be screened in a single, day-long event, said Christensen. "It's not easy to do because it's labour-intensive, but it's not difficult to figure out," he said.
• Hold lectures aimed at educating general ophthalmologists about glaucoma.
• Create printed materials about glaucoma to be distributed in hospitals, clinics, and physicians' offices.

For more ideas visit www.wgday.com or www.wgday.net. Once the type of event has been decided, an Intent Form can be completed to help publicize and increase the visibility for the event.

Participating locales
World Glaucoma Day activities are being planned in the locales listed below. The list is changing daily as more events are planned.
Argentina, Australia, Austria, Belgium, Brazil, Bulgaria, Canada, Chile, China, Colombia, Czech Republic, France, Germany, Greece, Hong Kong, Hungary, India, Iran, Italy, Japan, Lithuania, Netherlands, New Zealand, Pakistan, Peru, Philippines, Poland, Singapore, Sweden, Switzerland, Turkey, United Kingdom, United States & Venezuela.