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WGC Day 3: Ophthalmologist Shortages and Ocular Blood Flow

If you ever want to understand how international something truly is, then consider how many variations of its name could be found. For example, your correspondent’s name of Andrew is one of the most common in the English-speaking world and has many international variations like Andrei in Russian, Anders in Danish, Andarāwus in Arabic, and Andra in his native Scots. Sometimes a name may be broadly the same, regardless of country or language, and sometimes a term undergoes more localization.

Of course when it comes to medical terminology, a lot of terms stay the same regardless of where you find yourself, and glaucoma generally speaking follows this trend. Glaukoom, the Afrikaans term for the disease, is one of the greater deviations from the norm, and there’s also galukooma in Somali, glawkoma in Maltese and glakom in Turkish. At the more localized end of the scale, you should remember zelený zákal in Czech (a language your correspondent is currently learning and his teacher assured him that this was correct) and in Vietnamese, bệnh tăng nhãn áp (Editor’s Note: You better have got that right!).

One Ophthalmologist for 239,130 Citizens

The point is, glaucoma is truly international, and Day 3 of the World Glaucoma e-Congress (WGC 2021) continued to emphasize the global nature of both the disease and the community that exists to treat it. The first part of the day began with several symposiums covering glaucoma and ophthalmology societies in various parts of the world, including Malaysia, Pakistan and Vietnam. This has been one of the standout characteristics of the Beyond Borders theme as we’ve learned a great deal about clinical practices in regions that often don’t get as much coverage as others.

WGC Day 3: Ophthalmologist Shortages and Ocular Blood Flow
They might bowl more softly if they knew about the ophthalmologist shortage.

A good example of this phenomenon is in Sri Lanka, the pearl-shaped island of the Indian Ocean that has faced its fair share of troubles with providing adequate access to medical treatment for its citizens. Glaucoma Interest Group of the College of Ophthalmologists of Sri Lanka — Breakthroughs to Combat Dilemmas in Glaucoma Care in Sri Lanka was one of the aforementioned country-focused symposiums that started the day’s proceedings and provided a fascinating insight for its viewers. This applies to ophthalmology broadly, as well as glaucoma (as you might expect).

A particularly noteworthy speaker was Dr. Dilruwani Aryasingha, a consultant ophthalmologist at the Golden Key Eye and ENT Hospital (Colombo, Sri Lanka), who highlighted the shocking challenges that Sri Lankan ophthalmologists face when providing access to care. There are only 92 consulting ophthalmologists like herself, serving nearly 22 million people — and these clinicians are heavily concentrated in major urban areas, meaning those people living in rural or isolated areas often face significant barriers to treatment. Given that among those aged 40 and over, 1.7% are blind and 2.1% are affected by glaucoma, Sri Lankan ophthalmology could perhaps benefit from the international community’s assistance.

Sometimes Things in Life are Complicated

If you went into Day 3 looking for information about the specifics of glaucoma, like rare cases and best practice advice, then you wouldn’t have been disappointed either. Prevention and Management of Complications following Trabeculectomy, held during the middle segment of the conference, covered a wide array of topics relating not just to the titular condition, but also to wider aspects of glaucoma treatment when things go wrong. The session started with a particularly noteworthy speaker, Dr. Shamira Perera, an associate professor at the Singapore National Eye Centre, who spoke about his experience with conjunctival leakage.

Dr. Perera stated that clinicians should be vigilant for the inappropriate usage of instruments like toothed forceps as this can result in conjunctival leakage and that this can also occur due to poor visualization. He recommends using a cross-stitch technique with 10-0 nylon when treating the condition, and that close inspection and careful handling of tissue should be applied to minimize the extension of the hole. He also spoke about limbus leakage, recommending a management process of limbal mattress sutures and that the limbus must be watertight post-surgery.

Also speaking during the same symposium was Dr. J. Garcia Feijoo, the chairman of the ophthalmology department at the Hospital Clínico San Carlos (Madrid, Spain). Dr. Feijoo spoke about his treatment of hypotony, stating that the key to avoiding this significant buildup of intraocular pressure (IOP) was to consider the degree of a patient’s myopia, especially if they were young, as well as to consider flap dissection surgery. He also emphasized that aggressive treatment is not always required and that a clinician should make an assessment based on the patient’s specific needs.

We’re Sanguine About the Next Symposium

WGC Day 3: Ophthalmologist Shortages and Ocular Blood Flow

Now as you can imagine, IOP tends to come up fairly often during a conference on glaucoma but this of course is related to high blood pressure in individuals. IOP is often called ocular hypertension after all, so a symposium that covered the specifics of blood pressure was a welcome addition to Day 3. Blood Pressure, Flow and More… certainly bucked the trend of Beyond Borders by having a shorter name, and it provided an interesting window into a different perspective on ophthalmological treatment.

During this symposium, Dr. Jaewen Choi, the director of Glaucoma Service at the Central Seoul Eye Center (South Korea) reported on his research into optical coherence tomography angiography (OCTA) for ocular blood flow. He stated that in moderate to advanced glaucoma cases, OCTA provides a better structure-function relationship. However, he also cautioned that the technique offers limited diagnostic accuracy and that it can be difficult to attain reliable images.

We have many more articles providing in-depth coverage of WGC 2021 Day 3, so make sure to check them out to keep track of all that’s cool and critical in glaucoma. The final day of the conference is approaching, which of course makes us sad, but there’s still another day full of content to consume, don’t miss our reporting! In the meantime, why don’t you tell us on social media or by email about what the word for glaucoma is in your language? Till tomorrow…

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