Is Minimally Invasive Glaucoma Surgery a Viable Option in Africa?
Main Article Content
Abstract
Glaucoma is a public health challenge in Africa. Many of the affected individuals are not aware and the patients present with advanced disease. The management of glaucoma is also challenging due to a myriad of factors such as poverty, poor drug compliance and limited treatment options.
The major surgical option in Africa is trabeculectomy which is usually reserved for advanced disease. Minimally Invasive Glaucoma Surgery (MIGS) has been found to be efficacious in the management of mild-to-moderate primary open glaucoma and ocular hypertension with minimal complications.
Minimally Invasive Glaucoma procedures are usually expensive and cannot be affordable by average African patients. Low-cost procedures such bent needle goniectomy, Sinskey hook goniotomy and GATT with 5/0 prolene suture have been found to be comparably efficacious like their original expensive counterparts.
Using these low-cost methods and the some the original MIGS procedures for those who can afford will enhance the management of glaucoma in Africa and reduce the reliance on medical therapy. Collaborative partnerships with Industry stakeholders will help in reducing the cost of the devices for MIGS and promote their widespread use in Africa.
Keywords:
Glaucoma, Minimally Invasive Glaucoma Surgery, viable, Africa
Article Details
How to Cite
ADUNOLA, Ogunro; GODSWILL, Nathaniel.
Is Minimally Invasive Glaucoma Surgery a Viable Option in Africa?.
Medical Research Archives, [S.l.], v. 13, n. 5, june 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6565>. Date accessed: 21 june 2025.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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14. Sugihara, K., Fukuda, H., Omura, T. et al. Reasons for choice of glaucoma surgery in eyes not treated with anti-glaucoma medications. BMC Ophthalmol 22, 145 (2022). https://doi.org/10.1186/s12886-022-02369-z
15. Kaštelan, Snježana, et al. "How ocular surface disease impacts the glaucoma treatment outcome." BioMed research international 2013.1 (2013): 696328.
16. Lacey, J., H. Cate, and D. C. Broadway. "Barriers to adherence with glaucoma medications: a qualitative research study." Eye 23.4 (2009): 924-932.
17. Traverso CE, Walt JG, Kelly SP, Hommer AH, Bron AM, Denis P, Nordmann JP, Renard JP, Bayer A, Grehn F, Pfeiffer N, Cedrone C, Gandolfi S, Orzalesi N, Nucci C, Rossetti L, Azuara-Blanco A, Bagnis A, Hitchings R, Salmon JF, Bricola G, Buchholz PM, Kotak SV, Katz LM, Siegartel LR, Doyle JJ. Direct costs of glaucoma and severity of the disease: a multinational long term study of resource utilisation in Europe. Br J Ophthalmol. 2005 Oct;89(10):1245-9. doi: 10.1136/bjo.2005.067355. PMID: 16170109; PMCID: PMC1772870.
18. Lee PP, Kelly SP, Mills RP, Traverso CE, Walt JG, Doyle JJ, Katz LM, Siegartel LR; Costs of Glaucoma Study Group. Glaucoma in the United States and europe: predicting costs and surgical rates based upon stage of disease. J Glaucoma. 2007 Aug;16(5):471-8. doi: 10.1097/IJG.0b013e31805 75202. PMID: 17700290.
19. Adio AO, Onua AA. Economic burden of glaucoma in Rivers State,;1; Nigeria. Clin Ophthalmol 2012;6:2023–31. [DOI] [PMC free article] [PubMed] [Google Scholar]
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21. Cantor, Louis B., et al. "Economic evaluation of medication, laser trabeculoplasty and filtering surgeries in treating patients with glaucoma in the US." Current medical research and opinion 24.10 (2008): 2905-2918.
22. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393(10180):1505–16.
23. Andrew NH, Akkach S, Casson RJ. A review of aqueous outflow resistance and its relevance to micro-invasive glaucoma surgery. Surv Ophthalmol. 2020;65:18–31.
24. Pradeep MD, PhD. The Association Between Intraocular Pressure and Visual Field Worsening in Treated Glaucoma Patients. Journal of Glaucoma 30(9):p 759-768, September 2021. Doi:10.1097/ IJG.0000000000001906
25. Weinreb RN, Papadopoulos, M. Consensus on Childhood glaucoma. Amsterdam: Kugel publications, 2013.
26. Alsheikheh A, Klink J, Klink T, Steffen H, Grehn F. Long-term results of surgery in childhood glaucoma. Graefes Arch Clin Exp Ophthalmol. 2007 Feb;245(2):195-203. doi: 10.1007/s00417-006-0415-2. PMID: 16983524.
27. Knight G, Du Bruyn M, Kruse C, Pons J. Surgical outcomes of 5/0 polypropylene gonioscopy-assisted transluminal trabeculotomy (GATT) for primary management of open-angle glaucoma in Eswatini. South African Ophthalmology Journal. 2023;18(4):14-19.
28. Girkin CA, Rhodes L, McGwin G, Marchase N, Cogen MS. Goniotomy versus circumferential trabeculotomy with an illuminated microcatheter in congenital glaucoma. J AAPOS. 2012 Oct;16(5):424-7. doi:
29. Grover DS, Godfrey DG, Smith O, Feuer WJ, Montes de Oca I, Fellman RL. Gonioscopy-assisted transluminal trabeculotomy, ab-interno trabeculotomy: technique report and preliminary results. Ophthalmology. 2014;121(4):855- 861
30. Laroche D, Oseni J, Nkrumah G, Ng C. Clear Lensectomy with Hydrus stent in Black and Afro-Latino patients: a 1-year retrospective study. J Ophthalmol. 2022;2022:8011745.
31. Nathaniel Godswill I and Ogunro A Short Term Outcome of Goniotomy with Kahook Dual Blade in the Management of Primary Open Angle Glaucoma-A Retrospective Interventional Case Series: J Ophthalmol Clin Res, 2019 . vol 3 issue 3
32. Ogunro A, Nathaniel G. One year outcome of goniotomy with Kahook Dual Blade in Primary Open Angle Glaucoma patients. Lat Am J Ophthalmol. 2024;7:9. Doi:10. 25259/LAJO_26_2023
33. Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016;388 (10052):1389–97.
34. Laroche D, Okaka Y, Ng C. A novel low cost efective technique in using a 23 gauge straight cystotome to perform goniotomy: making micro-invasive glaucoma surgery (MIGS) accessible to the Africans and the Diaspora. J Natl Med Assoc. 2019;111(2):193–7.
35. WHO African Region Health Expenditure Atlas 2023
36. Masaki Tanito Microhook ab-interno trabeculotomy, A novel minimally invasive glaucoma surgery. Clini Ophthalmol. 2018; 12: 43-48
37. Rowson AC, Hark L, Wang H, et al. Minimally invasive glaucoma surgery: safety of individual devices. J Clin Med. 2022;11(22):6833.
2. Quigley, H. A., & B Roman, J. (1997). "The number of people with glaucoma worldwide in 2010 and 2020." Archives of Ophthalmology, 115(12), 1000-1005.
3. Tham, Y. C., Li, X., Wong, T. Y., et al. (2014). "Global prevalence of glaucoma and projections of glaucoma burden through 2040." Ophthalmology, 121(11), 2081-2090.
4. Kyari F, Entekume G, Rabiu M, et al. 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; 15:176.
5. Ntim-Amponsah CT. Visual loss in urban and rural chronic glaucoma patients in Ghana. Trop Doct. 2002;32:102−104.
6. Bastawrous A, Mathenge W, Buchan J, et al. Glaucoma features in an East African Population: a 6-year cohort study of older adults in Nakuru, Kenya. J Glaucoma. 2018;27:455−463.
7. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014 May 14;311(18):1901-11. doi: 10.1001/jama.2014.3192. PMID: 24825645; PMCID: PMC4523637.
8. Coleman, Anne L., and Stefano Miglior. "Risk factors for glaucoma onset and progression." Survey of ophthalmology 53.6 (2008): S3-S10.
9. Doucette, Lance P., et al. "The interactions of genes, age, and environment in glaucoma pathogenesis." Survey of ophthalmology 60.4 (2015): 310-326.
10. Worley, Anthea, and Karen Grimmer-Somers. "Risk factors for glaucoma: what do they really mean?" Australian journal of primary health 17.3 (2011): 233-239.
11. Williams AM, Huang W, Muir KW, et al. Identifying risk factors for blindness from primary open-angle glaucoma by race: a case-control study. Clin Ophthalmol. 2018;12:377−383.
12. Pleet A, Sulewski M, Salowe RJ, et al. Risk factors associated with progression to blindness from primary open-angle glaucoma in an African- American Population. Ophthalmic Epidemiol. 2016;23:248−256.
13. Faiq M, Sharma R, Dada R, Mohanty K, Saluja D, Dada T. Genetic, Biochemical and Clinical Insights into Primary Congenital Glaucoma. J Current Glau Prac 2013;7(2):66-84.
14. Sugihara, K., Fukuda, H., Omura, T. et al. Reasons for choice of glaucoma surgery in eyes not treated with anti-glaucoma medications. BMC Ophthalmol 22, 145 (2022). https://doi.org/10.1186/s12886-022-02369-z
15. Kaštelan, Snježana, et al. "How ocular surface disease impacts the glaucoma treatment outcome." BioMed research international 2013.1 (2013): 696328.
16. Lacey, J., H. Cate, and D. C. Broadway. "Barriers to adherence with glaucoma medications: a qualitative research study." Eye 23.4 (2009): 924-932.
17. Traverso CE, Walt JG, Kelly SP, Hommer AH, Bron AM, Denis P, Nordmann JP, Renard JP, Bayer A, Grehn F, Pfeiffer N, Cedrone C, Gandolfi S, Orzalesi N, Nucci C, Rossetti L, Azuara-Blanco A, Bagnis A, Hitchings R, Salmon JF, Bricola G, Buchholz PM, Kotak SV, Katz LM, Siegartel LR, Doyle JJ. Direct costs of glaucoma and severity of the disease: a multinational long term study of resource utilisation in Europe. Br J Ophthalmol. 2005 Oct;89(10):1245-9. doi: 10.1136/bjo.2005.067355. PMID: 16170109; PMCID: PMC1772870.
18. Lee PP, Kelly SP, Mills RP, Traverso CE, Walt JG, Doyle JJ, Katz LM, Siegartel LR; Costs of Glaucoma Study Group. Glaucoma in the United States and europe: predicting costs and surgical rates based upon stage of disease. J Glaucoma. 2007 Aug;16(5):471-8. doi: 10.1097/IJG.0b013e31805 75202. PMID: 17700290.
19. Adio AO, Onua AA. Economic burden of glaucoma in Rivers State,;1; Nigeria. Clin Ophthalmol 2012;6:2023–31. [DOI] [PMC free article] [PubMed] [Google Scholar]
20. Xu, Ke, et al. "Protecting households from catastrophic health spending." Health affairs 26.4 (2007): 972-983
21. Cantor, Louis B., et al. "Economic evaluation of medication, laser trabeculoplasty and filtering surgeries in treating patients with glaucoma in the US." Current medical research and opinion 24.10 (2008): 2905-2918.
22. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393(10180):1505–16.
23. Andrew NH, Akkach S, Casson RJ. A review of aqueous outflow resistance and its relevance to micro-invasive glaucoma surgery. Surv Ophthalmol. 2020;65:18–31.
24. Pradeep MD, PhD. The Association Between Intraocular Pressure and Visual Field Worsening in Treated Glaucoma Patients. Journal of Glaucoma 30(9):p 759-768, September 2021. Doi:10.1097/ IJG.0000000000001906
25. Weinreb RN, Papadopoulos, M. Consensus on Childhood glaucoma. Amsterdam: Kugel publications, 2013.
26. Alsheikheh A, Klink J, Klink T, Steffen H, Grehn F. Long-term results of surgery in childhood glaucoma. Graefes Arch Clin Exp Ophthalmol. 2007 Feb;245(2):195-203. doi: 10.1007/s00417-006-0415-2. PMID: 16983524.
27. Knight G, Du Bruyn M, Kruse C, Pons J. Surgical outcomes of 5/0 polypropylene gonioscopy-assisted transluminal trabeculotomy (GATT) for primary management of open-angle glaucoma in Eswatini. South African Ophthalmology Journal. 2023;18(4):14-19.
28. Girkin CA, Rhodes L, McGwin G, Marchase N, Cogen MS. Goniotomy versus circumferential trabeculotomy with an illuminated microcatheter in congenital glaucoma. J AAPOS. 2012 Oct;16(5):424-7. doi:
29. Grover DS, Godfrey DG, Smith O, Feuer WJ, Montes de Oca I, Fellman RL. Gonioscopy-assisted transluminal trabeculotomy, ab-interno trabeculotomy: technique report and preliminary results. Ophthalmology. 2014;121(4):855- 861
30. Laroche D, Oseni J, Nkrumah G, Ng C. Clear Lensectomy with Hydrus stent in Black and Afro-Latino patients: a 1-year retrospective study. J Ophthalmol. 2022;2022:8011745.
31. Nathaniel Godswill I and Ogunro A Short Term Outcome of Goniotomy with Kahook Dual Blade in the Management of Primary Open Angle Glaucoma-A Retrospective Interventional Case Series: J Ophthalmol Clin Res, 2019 . vol 3 issue 3
32. Ogunro A, Nathaniel G. One year outcome of goniotomy with Kahook Dual Blade in Primary Open Angle Glaucoma patients. Lat Am J Ophthalmol. 2024;7:9. Doi:10. 25259/LAJO_26_2023
33. Azuara-Blanco A, Burr J, Ramsay C, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016;388 (10052):1389–97.
34. Laroche D, Okaka Y, Ng C. A novel low cost efective technique in using a 23 gauge straight cystotome to perform goniotomy: making micro-invasive glaucoma surgery (MIGS) accessible to the Africans and the Diaspora. J Natl Med Assoc. 2019;111(2):193–7.
35. WHO African Region Health Expenditure Atlas 2023
36. Masaki Tanito Microhook ab-interno trabeculotomy, A novel minimally invasive glaucoma surgery. Clini Ophthalmol. 2018; 12: 43-48
37. Rowson AC, Hark L, Wang H, et al. Minimally invasive glaucoma surgery: safety of individual devices. J Clin Med. 2022;11(22):6833.