Need for skilled glaucoma surgeons a worldwide issue

Key Takeaways

  • Over the past decade, the treatment of glaucoma has been evolving worldwide from medical therapy toward procedures. 
  • Therefore, there is a worldwide need for more glaucoma surgeons.

The 2024 global population is a little over 8 billion, half of which reside in emerging countries with less well-developed economies and health care systems. The incidence of glaucoma is similar in both advanced and emerging countries, approximately 3.5 per 1,000 population.  But patients with glaucoma in an emerging country have a 50% chance of blindness in their lifetime vs. about 10% in advanced countries, making glaucoma one of the leading causes of global blindness after uncorrected prescriptions for glasses and untreated cataract.

Over the past decade, the treatment of glaucoma has been evolving worldwide from medical therapy toward procedures. This transition has been catalyzed by advances in laser treatment, the development of minimally invasive/microinvasive glaucoma surgery (MIGS), and the positive impact of cataract surgery on both narrow- and open-angle glaucoma. Even in wealthier countries where topical medications (eye drops) are readily available, surgeons and their patients are frequently choosing a procedure over medical therapy. Reasons for this transition include cornea damage due to eye drop preservatives, and the improved benefit-risk ratio of laser surgery and MIGS versus the classic trabeculectomy and tube shunt surgery. Well-done laser surgery and MIGS provide most patients with better pressure control and a lower chance of suffering progressive optic nerve damage and visual field loss. 

The primary challenges worldwide are diagnosing glaucoma at an early stage and providing access to a skilled eye care professional. In the U.S., there is one ophthalmologist per 18,000 population and one optometrist per 7,500 population. Vision screening is common in advanced countries, and access to an eye care professional is available to most. Even so, as many as 50% of early glaucoma patients remain without diagnosis and treatment.  In emerging countries, the situation is far more challenging, with only one ophthalmologist per 100,000 population to, in the worst case, one ophthalmologist per 1 million population. In the emerging country environment, volunteers and eye care extenders are needed for diagnosis, and once a patient is diagnosed, a surgical procedure is the therapy of choice. Fortunately, laser therapy, MIGS and even cataract removal with placement of an artificial lens have enhanced the benefit-risk ratio for glaucoma surgery worldwide. 

The need for more skilled glaucoma surgeons exists even in advanced countries and is extraordinary in emerging countries. Unfortunately, the training of a skilled glaucoma surgeon is expensive and time consuming. Ophthalmic servant leaders and volunteers do what they can, but the unmet need is large and growing.

Source: Richard L. Lindstrom, MD, Healio Ocular Surgery News, March 7, 2024; see source article