Glaucoma management in developing countries: medical, laser, and surgical options for glaucoma management in countries with limited resources.
OBJECTIVE
Most people affected by glaucoma live in developing countries. Recent trials and reports provide sound evidence for management of glaucoma. This review extrapolates relevant articles to the developing world.


RESULTS
The predictive value of gonioscopy for progression of primary angle closure suspects (PACS) to primary angle closure (PAC) is only 22% (95% CI: 9.80-34.2). PACS are not uncommon; laser peripheral iridotomy (LPI) is neither indicated nor feasible for all. Twenty-eight and a half percent of PAC progress to primary angle closure glaucoma; the number needed to treat (NNT) for LPI to prevent progression is only 4. Laser peripheral iridoplasty controls acute angle closure glaucoma (AACG) faster than medical therapy alone. Primary lens extraction has also been suggested as treatment for AACG after control of the acute attack. A 5-year NNT for ocular hypertension (OH) of 20 is too high to allow treatment of all OH. High-risk OH and primary open angle glaucoma (POAG) have an NNT of 5 to 6 and merit treatment. Latanoprost and brimonidine are effective in lowering IOP in Asian eyes with POAG, but primary surgical therapy may be a more viable option. For cataract and coexistent glaucoma requiring filtration, trabeculectomy combined with the Blumenthal technique of cataract surgery may be as effective as trabeculectomy combined with phacoemulsification.


CONCLUSIONS
The principles of glaucoma management should be the same the world over. Considering the paucity of resources and competing opportunity costs, countries with limited resources have to extrapolate available information in a sensible and cost-effective manner.
Thomas
Ravi
R
L.V. Prasad Eye Institute, L.V.Prasad Marg, Banjara Hills, Hyderabad, India. ravithomas@lvpei.org
Sekhar
G Chandra
GC
Kumar
Rajesh S
RS
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003906:Developing Countries; D018463:Filtering Surgery / Q000379:methods*; D005901:Glaucoma / Q000628:therapy*; D006295:Health Resources / Q000191:economics*; D006801:Humans; D032801:Iridectomy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic
D000959:Antihypertensive Agents