Tackling glaucoma in Lebanon

Glaucoma is the leading cause of irreversible vision loss worldwide, affecting an estimated 80 to 100 million people. Unfortunately, these numbers are expected to rise in the next decades because of increased life expectancy.

Glaucoma is often referred to as the “silent thief of sight” and can affect one or both eyes. There are no symptoms during the early stages, as the central vision stays normal. .

As the disease gets worse, peripheral vision begins to fail, meaning that objects straight ahead remain clear but those on the sides may not be seen. With time, as glaucoma progresses if left untreated, it will eventually also affect the central vision causing permanent vision loss or blindness. At that stage, glaucoma can significantly affect the patients’ quality of life and impair their daily routine activities such as reading, walking, and driving. It has also been associated with a significant increase in the rates of injurious falls and fractures.

Raising Awareness

Unfortunately, undiagnosed glaucoma is a pressing issue: more than half of the adults affected by are unaware that they have the condition. This proportion is probably much higher in developing countries where access to health care is often problematic. An analysis of the global distribution of visual impairment by the World Health Organization shows a disproportionately large prevalence in low-income developing countries, where almost 90 per cent of vision impairment and blindness occur.

Raising awareness about the disease is key because it emphasizes the importance of periodic eye exams, which are the most efficient means of diagnosing the disease at an early stage, thus starting treatment before significant vision impairment occurs.

World Glaucoma Week (WGW) is a global joint initiative between the World Glaucoma Association (WGA) and the World Glaucoma Patient Network (WGPN), in order to raise awareness on glaucoma.

The glaucoma department at the Beirut Eye and ENT Specialist Hospital takes part in this global campaign.   We have worked on the first mass glaucoma screening and awareness campaigns in Lebanon in 2018 and 2019. We organized these events during WGW in collaboration with the WGA, managing to screen more than 2000 individuals.

Visually attractive booths were set up at two separate malls and free Glaucoma screenings were offered. The staff distributed information leaflets and Glaucoma Simulation Goggles were utilized to help visitors realize the potential effects of the condition.

The twist to our campaign was our ability to leverage digital media (e.g., social media, online influencers) to generate a buzz around the topic, invite patients to the stands, and as a result, help us access a portion of the population that we could not have reached otherwise. The communication strategy managed to put glaucoma on both the news and social media maps in Lebanon.

This campaign received the first prize for the ESCRS Practice Management and Development Innovation Award competition at the 2018 ESCRS meeting in Vienna.

Challenging Times

There’s no doubt that the last two years were extremely challenging in Lebanon. A combination of high COVID-19 rates, a struggling economy and renewed political turmoil worsened a major crisis which began after a popular uprising in October 2019.

First of all, the COVID-19 pandemic dramatically changed the way we follow-up and manage glaucoma patients. Lebanon had its share of lockdowns during which the healthcare sector efforts were focused on fighting the pandemic while insuring the minimal level of urgent activity in other medical specialties. Routine visits were delayed and most of our elderly glaucoma patients were too afraid to leave their homes to get their medications or visit the clinic. All countries including Lebanon faced a shortage of personal protective equipment in the early months of the pandemic. Healthcare workers, including ophthalmologists, were at high risk while doing their duties.

Secondly, the unprecedented economic and monetary crisis that our country is facing resulted in a massive hyperinflation. According to the World Bank, the social impact (which is already grim) could become catastrophic: half the population is falling below the poverty line and unemployment is rising rapidly. Many patients are losing their jobs and cannot afford their medications anymore. The cost of glaucoma surgery is rising exponentially, as most of the hospital supplies are imported and the national currency has lost nearly 80% of its value to the US dollar. To make things worse, in August 2020, one of the largest non-nuclear explosions ever recorded hit the Beirut port and destroyed almost half of the country’s capital. The death toll has exceeded 200 and more than 6,500 people were injured.

Let’s not forget that glaucoma patients have a chronic disease and are therefore at a higher risk of anxiety and depression. There’s no doubt that they are severely affected by the magnitude of this crisis and unfortunately many of them are now being lost to follow up. We can also think that the rates of undiagnosed cases are skyrocketing because people are delaying any “unnecessary” visits to their doctors.

Looking ahead

The good news is that every crisis challenges our ability to adapt and innovate. We transformed our practice to adapt to the pandemic, focusing on social distancing and other protective measures.  A leaner approach to glaucoma care is definitely emerging with a focus on reducing the financial burden of glaucoma management.

It’s my hope today that we’re seeing a light at the end of the tunnel. The vaccination campaign has started in Lebanon and the COVID-19 pandemic will hopefully decline. The Lebanese crisis will eventually lead to the long-awaited political reforms that will open the door to a better future. In that perspective, the 2021 slogan of the WGW is on point: The world is bright, save your sight!

Doctor Ziad Khoueir is the Associate Director of the Glaucoma Department at the Beirut Eye & ENT Specialist Hospital and Clinical Instructor and Lecturer at the Saint-Joseph University Faculty of Medicine. He’s a research collaborator at the Mayo Clinic Ophthalmology Department in Jacksonville, Florida. He is a member of the associate advisory board of the World Glaucoma Association and of  the International Society of Glaucoma Surgery.