Aim: Sub-Saharan Africa has a population of 1 billion, with one ophthalmologist per million people. Basic ophthalmic support services are virtually absent for all but a few urban populations. Minimally invasive laser treatment may help. This study reports our initial experience using selective laser trabeculoplasty (SLT) in a mixed-racial population of adult glaucoma patients in Durban, South Africa.
Study design: Institution Review Board approved the 5-year chart review.
Materials and methods: Consecutive glaucomatous adults underwent SLT (Lumenis Selecta) on one or both eyes applying 360° treatment of 120 to 140 closely spaced burns (400 μm spot size for 3 ns; range 1.1—1.4 mJ). Significance of change in intraocuar pressure (IOP) from baseline at 1, 3, 6, and 12 months was assessed by two-tailed paired t-test.
Results: Among 148 eyes of 84 patients (60 African, 21 Indian, 3 Caucasian), 69 had already undergone glaucoma therapy, and 15 untreated (de novo). Among all eyes, mean IOP was reduced by >32% with mean IOP < 15 mm Hg from baseline at all four study intervals (p < 0.0001). A 20% reduction in IOP was sustained at 12 months in 90% of African eyes but in only 50% of Indian eyes.
Conclusion: Selective laser trabeculoplasty was effective in producing clinically significant IOP reduction among South African adults with or without prior medical or surgical antiglaucoma therapy. Socioeconomically comparable individuals of Indian ancestry showed good therapeutic responses, but significantly less efficacious than those observed among Black subjects. Programs to provide first-line SLT management of glaucoma in Africa, where 90% of patients are unable to sustain prescribed medical therapy, appear to be a very appropriate option.
How to cite this article: Goosen E, Coleman K, Visser L, Sponsel WE. Racial Differences in Selective Laser Trabeculo-plasty Efficacy. J Curr Glaucoma Pract 2017;11(1):22-27.
Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012 May;96(5):614-618.
WHO Library Cataloguing-in-Publication Data. WHO Action Plan for the prevention of avoidable blindness and visual impairment 2009-2013 [Internet]. Available from: http://www.who.int/blindness/ACTION_PLAN_WHA62- 1-English.pdf
WHO Regional Office for Africa. Accelerating the elimination of avoidable blindness: a strategy for the WHO African region report of the regional director. WHO IRIS [Internet]. 2007. Available from: http://apps.who.int/iris/handle/10665/92257
Global Data on Visual Impairments 2010 (WHO). WHO 2010 [Internet]. Available from: http://www.who.int/blindness/GLOBALDATAFINALforweb.pdf
Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006 Mar;90(3):262-267.
The International Agency for the Prevention of Blindness. WHO Facts. Blindness and visual impairment: global facts [Internet]. Available from: http://www.iapb.org/vision-2020/global-facts.
Ramchandani M. Glaucoma in the developing world. Br J Ophthalmol 2006 Nov;333(7575):932.
Cook C, Foster P. Epidemiology of glaucoma: what's new? Can J Ophthalmol 2012 Jun;47(3):223-226.
Rotchford AP, Johnson GJ. Glaucoma in Zulus: a populationbased cross-sectional survey in a rural district in South Africa. Arch Ophthalmol 2002 Apr;120(4):471-478.
Budenz DL, Barton K, Whiteside-de Vos J, Schiffman J, Bandi J, Nolan W, Herndon L, Kim H, Hay-Smith G, Tielsch JM; Tema Eye Survey Study Group. Prevalence of glaucoma in an urban West African population: the Tema Eye Survey. JAMA Ophthalmol 2013 May;131(5):651-658.
Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary openangle glaucoma. The Baltimore Eye Survey. JAMA 1991 Jul;266(3):369-374.
Racette L, Wilson MR, Zangwill LM, Weinreb RN, Sample PA. Primary open-angle glaucoma in blacks: a review. Surv Ophthalmol 2003 May-Jun;48(3):295-313.
Egbert PR. Glaucoma in West Africa: a neglected problem. Br J Ophthalmol 2002 Feb;86(2):131-132.
Mukherji A. Durban largest “Indian” city outside India. The Times of India, 2011 Jun 23.
Migdal C, Gregory W, Hitchings R. Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma. Ophthalmology 1994 Oct;101(10):1651-1656.
The Glaucoma Laser Trial (GLT) and glaucoma laser trial follow-up study: 7. Results. Glaucoma Laser Trial Research Group. Am J Ophthalmol 1995 Dec:120(6):718-731.
Realini T. Selective laser trabeculoplasty for the management of open-angle glaucoma in St. Lucia. JAMA Ophthalmol 2013 Mar;131(3):321-327.
Mason RP, Kosoko O, Wilson MR, Martone JF, Cowan CL Jr, Gear JC, Ross-Degnan D. National survey of the prevalence and risk factors of glaucoma in St. Lucia, West Indies. Part I. Prevalence findings. Ophthalmology 1989 Sep;96(9):1363-1368.
Kyari F, Entekume G, Rabiu M, Spry P, Wormald R, Nolan W, Murthy GV, Gilbert CE; Nigeria National Blindness and Visual Impairment Study Group. A Population-based survey of the prevalence and types of glaucoma in Nigeria: results from the Nigeria National Blindness and Visual Impairment Survey. BMC Ophthalmol 2015 Dec 12; 15:176.