World Glaucoma Day, 6 March 2008: tackling the glaucoma pandemic

We have all heard many times that ‘Glaucoma is the second most common treatable cause of blindness worldwide’. Glaucoma is a significant public health concern, being the leading cause of irreversible vision loss and consistently ranking among the leading causes of blindness in virtually every nation (Quigley & Broman 2006). This is mainly due to low awareness of the disease and its implications. Indeed, it is estimated that only half of those affected by glaucoma in developed nations are aware that they have the disease (Sommer et al. 1991) while as many as 90% of persons with glaucoma in developing countries are unaware of having it or even having heard of it. Despite our better understanding of risk factors for glaucoma, we have yet to see an improvement in these numbers. Although glaucoma occurs in all age groups, it is more common in older adults; with our ageing population, estimates of glaucoma prevalence are increasing. It has been predicted that by 2020, 79.6 million people worldwide will have glaucoma, 11.2 million of whom will be bilaterally blind, up from the current 4.5 million (Quigley & Broman 2006). Recent years have seen considerable progress in the diagnosis and treatment of glaucoma. Technological advances in optic nerve and retinal nerve fibre layer imaging and visual field testing make it possible to diagnose glaucoma in earlier stages, when treatment can significantly improve the prognosis. Medical treatment is available and effective in controlling glaucoma for most patients (Feiner & Piltz-Seymour 2003), while for those uncontrolled, laser and surgical interventions are often successful. Optic nerve and visual field damage are irreversible. Because damage progresses gradually, often unnoticed by the patient, early detection and treatment are of paramount importance to prevent blindness. For individuals with known risk factors for glaucoma – particularly elevated intraocular pressure, increasing age, African descent, family history of glaucoma, vasospasm, low blood pressure and high myopia – the importance of routine examinations cannot be understated. Also, despite strong evidence that lowering intraocular pressure can delay the onset and progression of glaucoma (AGIS Investigators 2000; Heijl et al. 2002; Kass et al. 2002), reported rates of non-compliance with glaucoma therapy range from 5% to 80% (Olthoff et al. 2005). This high variability results from different definitions of non-compliance and the way in which it is measured. The year 2008 is a pivotal one for glaucoma awareness. To combat the ignorance that leads to so much loss of vision, the World Glaucoma Association (WGA) and the World Glaucoma Patient Association (WGPA) have joined forces to launch a global initiative aimed at raising awareness of glaucoma through an annual World Glaucoma Day. They selected 6 March 2008 for the first observance of the day, as a way to jump-start awareness activities and to enlist the active support of governments, eye care professionals and patient support groups in many nations. Rather than have a single large event held in conjunction with a major conference, the day will consist of the sum total of local, regional and national initiatives and events organized by willing groups and individuals around the world. These activities will include: media campaigns; official recognition (three countries will issue commemorative stamps and a delegation from the American Glaucoma Society will visit the US Congress); public-oriented events (e.g. screenings in public places); and institutional events (open-doors day at eye clinics and universities, with lectures addressed to both professional and lay audiences). All these events, together with supporting material, general information on the disease and useful links, are listed at http://www.wgday.net. The public needs to know that there are means for detecting and treating glaucoma and that sight can be saved. They should be made aware of the insidious nature of glaucoma and the importance of compliance with treatment and follow-up to minimize their risk of visual loss. Persons with glaucoma need to inform family members, so that they too can be screened. Healthcare providers, together with governments, should promote public awareness campaigns encouraging regular eye exams, especially for those with known risk factors. Eye-care professionals should take the lead by writing articles for local newspapers, contacting radio stations or organizing public meetings on glaucoma. Earlier diagnosis and treatment will reduce visual disability, improve patient quality of life and decrease overall cost of treatment. The WGA has set a goal of reducing the undiagnosed rate of glaucoma from 50% to ‘‘No more than 20% by 2020’’. This goal is attainable if all parties work together to increase awareness of glaucoma among both the public and healthcare providers, and if we all ensure that quality eye exams are available worldwide. Each of us can help make this a day to remember. The possibilities abound. Groups and individuals around the world have volunteered to organize events of the types described. Others have come up with original ideas: a national ophthalmology journal will publish a special glaucoma issue; other scientific journals will publish editorials on glaucoma; and a group of volunteers will run in the Geneva annual marathon under the WGD colours. In Latin America, a tongue-in-cheek movie has been produced to remind patients humorously that compliance with therapy is the best way to keep the ‘sneak thief of sight’ at bay. The success of World Glaucoma Day also depends on eye-care professionals participating actively at a national level, and developing local strategies to achieve this goal. Every journey begins with a small step, but it is the cumulative number of steps that will determine how far we will go. As World Glaucoma Day approaches, take that first step: ask yourself ‘what can I do?’ and make this campaign a success. The possibilities are endless and the success of the day will depend not only on the number and attendance of events organized globally, but also on their visibility. So to maximize the impact of this initiative, please take a moment to visit http://www.wgday.net and fill out an event submission form under ‘‘Be Part of It’’ and tell the world how you will contribute to the success of the first ever World Glaucoma Day.

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