The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Issue 6, November/December 2018 Review Article

The Rationale for Selective Laser Trabeculoplasty in Africa

Realini, Tony; Olawoye, Olusola; Kizor-Akaraiwe, Nkiru; Manji, Selina; Sit, Arthur



Author Information


From the *West Virginia University Eye Institute, Morgantown, WV; †Department of Ophthalmology, College of Medicine, University of Ibadan, Nigeria; ‡Enugu State University Teaching Hospital, Enugu, Nigeria; §Global Health Program, McMaster University, Hamilton, Ontario, Canada; and ¶Mayo Clinic, Rochester, MN.


Reprints: Tony Realini, West Virginia University Eye Institute, Morgantown, WV. 
E-mail: realinia@wvumedicine.org.



Abstract


Glaucoma is the leading cause of irreversible blindness in Africa. The condition is treatable but not curable. There are numerous obstacles to glaucoma care in Africa, including availability, accessibility and affordability of treatments, as well as medication nonadherence among patients. Medical therapy is costly relative to the average income in Africa and it requires daily self-dosing by patients. Surgery is of limited availability in many regions in Africa, and a high proportion of patients refuse surgery because it is expensive. Selective laser trabeculoplasty (SLT) proves to be a favorable alternative to medical or surgical care, as it is highly effective and safe in people of African descent, more cost-effective than medical therapy, quick and easy to perform, and portable. The procedure also requires no postoperative care, thus obviates the issue of nonadherence. In uncontrolled studies, SLT has a high response rate and it lowers intraocular pressure by 30% to 40%, which exceeds the goal in international guidelines for initial therapies. The African Glaucoma Consortium (AGC), a member-driven stakeholder collective, has been formed in part to develop the infrastructure for continent-wide improvements in glaucoma care. It embraces SLT as a potential key tool in their development plans. The mission of AGC includes improving clinical care by educating existing and new health care professionals to expand the provider network, by conducting trials to identify optimal care strategies for glaucoma in Africa, and by facilitating the development of an integrated network of Centers of Excellence to bring SLT and other crucial glaucoma therapies to communities throughout Africa.




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