International Perspectives

18 glaucoma today July/august 2013 In this edition of Glaucoma Today’s “International Perspectives” column, Scott D. Lawrence, MD, and Donald L. Budenz, MD, MPH, identify issues that differentiate SubSaharan Africa (SSA) from other less developed nations in relation to glaucoma care. This region of Africa has one of the lowest numbers of ophthalmologists per capita globally and has a higher prevalence and severity of glaucoma than other developing countries. Drs. Lawrence and Budenz point out the need for innovative screening strategies and novel therapeutic concepts. An introductory course in a school of public health would ask students the following question: How would you spend $1 million on health care in SSA? Unlike other developing nations, far more eye diseases are competing for each dollar. Most countries in SSA are not only concerned with cataract blindness but must address other diseases such as trachoma and river blindness as well. Add to that the cost of expensive therapies for systemic diseases such as malnutrition, malaria, and AIDS. Taking all of this into account, it is hard to imagine how to balance the million-dollar budget. Self-sufficiency is the cornerstone of long-term success. The development of centers of excellence within SSA, whereby ophthalmologists train others for subspecialty care, is crucial. A matter that will need to be addressed is how and where to develop an initial center of excellence in SSA. I hope you enjoy this edition of “International Perspectives” and that this and the articles that follow broaden your perspective on glaucoma care around the world. —Alan L. Robin, MD, section editor