Cutting Edge Glaucoma - Issue 2

CHILDHOOD GLAUCOMA SURGERY IN DEVELOPING COUNTRIES • 21  interventions with a combination of different surgical techniques may be needed to manage these complex glaucomas. The responsibility of the surgeon does not stop with surgery and good surgical control of IOP. Visual rehabilitation is as important in the management of the disease as is IOP control. Visual rehabilitation involves correction of refractive errors, correction of opacities in the media (e.g., corneal scarring and cataract), and amblyopia therapy (when necessary). Amblyopia must also be aggressively managed to give these children the best chance for good vision in both eyes. These measures should be undertaken as early as possible. One of the major concerns in the developing countries, despite improvement with early rec- ognition and appropriate treatment, is the problem of poor follow-up. The emphasis on child- hood glaucoma as a serious chronic disease with need for lifelong follow-up is needed. Creating awareness is the first step to tackling this problem and patient support groups play an important role in helping this cause. Furthermore, to provide appropriate care as well as to follow these chil- dren, pediatric glaucoma specialists must be appropriately trained and their skill and knowledge updated periodically. It must be recognized that in some eyes the prognosis for long-term vision is poor regard- less of the technical skill and heroic efforts of patients, caregivers, and physicians. Preservation of even limited amounts of vision in these children can improve their ability to function as adults. However, children with glaucoma resulting in moderate to severe visual loss require the com- bined resources of a team that extends well beyond the patient-caregiver-physician triad, includ- ing those who can provide counselling and help with training, education, integration into the schools, and later into society. These needs are great in all societies but perhaps greatest in devel- oping countries. References 1. Rahi JS, Gilbert CE. Epidemiology and the worldwide impact of visual impairment in children. In: Lambert SR, Lyons CJ, editors. Taylor and Hoyt’s pediatric ophthalmology and strabismus. 5th ed. Philadelphia: Elsevier; 2016. p. 7–16. 2. World Health Organization/International Agency for the Prevention of Blindness. Global initiative for the elimination of avoidable blindness. Geneva: WHO; 1998. 3. World Health Organization. Preventing blindness in children: report of a WHO/IAPB scientific meeting, Hyderabad, India, 13–17 April 1999, WHO/PBL/00.77. 4. Beck AD. Primary congenital glaucoma in the developing world. Ophthalmology. 2011;118(2):229–30. 5. Hoguet A, Grajewski A, Hodapp E, Chang TC. A retrospective survey of childhood glaucoma prevalence according to Childhood Glaucoma Research Network classification. Indian J Ophthalmol. 2016;64(2):118–23. 6. Papadopoulos M, Cable N, Rahji J, Khaw PT. The British infantile and childhood glaucoma (BIG) eye study. Invest Ophthalmol Vis Sci. 2007;48:4100–6. 7. Gencik A, Gencikova A, Ferak V. Population genetical aspects of primary congenital glaucoma. I. Incidence, prevalence, gene frequency, and age of onset. Hum Genet. 1982;61(3):193–7. 8. Gencik A. Epidemiology and genetics of primary congenital glaucoma in Slovakia. Description of a form of primary congenital glaucoma in gypsies with autosomal-recessive inheritance and complete penetrance. Dev Ophthalmol. 1989;16:76–115. 9. Bejjani BA, Lewis RA, Tomey KF, Anderson KL, Dueker DK, Jabak M, et al . Mutations in CYP1B1, the gene for cytochrome P4501B1, are the predominant cause of primary congenital glaucoma in Saudi Arabia. Am J Hum Genet. 1998;62(2):325–33. 10. Dandona L, Williams JD, Williams BC, Rao GN. Population-based assessment of childhood blindness in southern India. Arch Ophthalmol. 1998;116(4):545–6.