Glaucoma Management Therapies and Clinical Outcomes in an African Population: A Review of Prospective Studies

TL;DR

This paper reviews glaucoma treatments and outcomes in Africa, highlighting surgical and laser interventions, and challenges like limited access and expertise.

Contribution

The paper provides a synthesis of prospective studies on glaucoma management in Africa, emphasizing regional treatment efficacy and barriers.

Findings

Trabeculectomy with anti-metabolites achieves ~80% success rates in African populations.

Laser interventions like selective laser trabeculoplasty show moderate to high efficacy in reducing intraocular pressure.

Pharmacological treatment evidence is scarce and hindered by high non-adherence rates.

Abstract

Glaucoma is a leading cause of irreversible blindness in Africa, with disease burden exacerbated by limited access to eye care, shortages of trained ophthalmologists, and socioeconomic disparities. This review synthesizes prospective and interventional studies evaluating glaucoma management modalities and associated clinical outcomes in an African population. Trabeculectomy remains the predominant surgical intervention, achieving success rates of approximately 80%, with enhanced outcomes when augmented with anti-metabolites such as mitomycin-C or 5-fluorouracil. Laser-based interventions, including selective laser trabeculoplasty and transscleral cyclophotocoagulation, demonstrate moderate to high efficacy in reducing intraocular pressure, while nonpenetrating surgeries such as deep sclerectomy, viscocanalostomy, and canaloplasty provide substantial pressure reduction with fewer complications. Pediatric interventions, notably goniotomy, show efficacy in lowering intraocular pressure, although region-specific evidence remains limited. Evidence on pharmacological intervention remains scarce, fragmented, with high rates of non-adherence frequently reported, highlighting the need for rigorously-designed outcome-oriented studies to inform clinical practice. Adoption of newer surgical and laser techniques is constrained by cost, limited equipment, and insufficient subspeciality expertise. Improving glaucoma outcomes in Africa will require strategic expansion of access to effective treatments, strengthen local surgical capacity, and prioritize evidence-based research. Collectively, these efforts will provide a more robust framework to optimize glaucoma management and reduce the burden of irreversible blindness across the continent.