Abstract
ABSTRACTAimSub-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 designInstitution Review Board approved the 5-year chart review.Materials and methodsConsecutive glaucomatous adults underwent SLT (Lumenis Selecta) on one or both eyes applying 360° treatment of 120 to 140 closely spaced burns (400 urn 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.ResultsAmong 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.ConclusionSelective laser trabeculoplasty was effective in producing clinically significant IOP reduction among South African adults with or without prior medical or surgical anti-glaucoma 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 articleGoosen E, Coleman K, Visser L, Sponsel WE. Racial Differences in Selective Laser Trabeculoplasty Efficacy. J Curr Glaucoma Pract 2017;11(1):22-27.
Highlights
About 285 million people are visually impaired worldwide: 39 million are blind and 246 million have compromising visual impairment.[1]
Mean intraocuar pressure (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
Summary
About 285 million people are visually impaired worldwide: 39 million are blind and 246 million have compromising visual impairment (low vision).[1] Preventable causes account for as nearly 80% of the total global visual impairment burden. About 90% of the world’s visually impaired people live in developing countries.[1,2,3,4,5,6] Approximately, 60 million people have glaucomatous optic neuropathy, and an estimated 8.4 million people are blind as a result of glaucoma. By 2020, these figures are expected to increase to 80 million and 11.2 million respectively. Glaucoma is the world’s second leading cause of blindness, and the highest prevalence of open-angle glaucoma occurs in individuals of African ancestry.[7,8,9,10]
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