MORGANTOWN, W.Va. – Anthony Realini, M.D., M.P.H., a glaucoma specialist in the West Virginia University Eye Institute, has received a $1.5 million grant from the National Eye Institute to conduct a five-year study aimed at finding better ways to address the problem of glaucoma on the Caribbean islands of Dominica and St. Lucia.
“Glaucoma is now the leading cause of blindness in the African-derived developing world,” Dr. Realini said. “In many countries, the disease burden is substantial and represents a significant public health challenge.”
Health professionals from the Eye Institute have been helping the people of St. Lucia for a number of years. But Dr. Realini’s project raises the engagement to a whole new level, one that has implications not only for the Caribbean but all areas where glaucoma is a serious problem.
St. Lucia is an independent nation just 238 square miles in size (about the same size as Wirt County, W.Va.). Of its population of 174,000, more than 9 out of 10 people have African origins.
Realini’s study focuses on the use of a laser treatment, rather than medication, as the front-line defense against progress of the disease.
“Selective laser trabeculoplasty (SLT) is fast, safe, and minimally invasive, and it requires minimal care after treatment. Once the equipment and expertise are on-site, the cost of providing treatment to individual patients is small,” he said.
People in the first stages of glaucoma experience no symptoms. As glaucoma progresses, increased pressure from the fluids within the eye begin to damage the optic nerve. Typically, damage to the periphery of the visual field is a late manifestation of the disease. In most patients, both eyes will be affected.
An eye exam can detect increased pressure within the eye, identifying possible glaucoma at an early stage.
“One problem in a place like St. Lucia,” Realini said, “is that without the availability of treatment, there’s not much incentive to screen the public for the disease.”
The WVU Eye Institute is currently pioneering new approaches to glaucoma screening in West Virginia, and Realini hopes that the strategies found to work in West Virginia can be successfully translated to the Caribbean.
If Realini’s use of SLT proves successful in St. Lucia, that small nation may actually leapfrog the U.S. in using a new protocol for glaucoma treatment.
“The current standard of care in the U.S. is to use medication eye drops first. That pattern may be changing, and our St. Lucia work will help answer questions about the viability of starting with SLT,” he said.
With SLT, the laser is used to unclog the drain of the eye that permits fluid to exit the eye, thus reducing pressure within the eye. SLT is not a permanent solution, and the St. Lucia research will address several questions, including:
- What is the long-term efficacy of SLT in this population?
- Is repeat SLT effective once the benefits of initial SLT wane after one to three years?
- Can the results obtained on St. Lucia be generalized to other developing nations populated by people of African descent? To address this question, Realini’s project will be duplicated on the Caribbean island of Dominica.
“Our work has the potential to bend the glaucoma-related blindness curve in the African-derived developing world,” Realini said.
Of course, the area with the greatest population of people of African descent is Africa itself.
“We have started to network with researchers in Africa to get a better global picture of glaucoma, the human and social costs it imposes, and the success of different screening and treatment processes,” Realini said.
India, he added, is another medically underserved country with a huge glaucoma burden.
“Our long-term goal is to create a pan-Caribbean laser glaucoma program that may serve as a model for other overburdened regions,” Realini said. “It’s not unrealistic to hope that this project’s output could ultimately reduce the risk of glaucoma-related visual dysfunction in hundreds of thousands of individuals throughout the developing world.”