Strategy for decentralised prevention of angle closure glaucoma in Greenland.

Abstract

In 1962 a blindness survey showed glaucomas to be responsible for 64% of all blindness in Greenland. In 1968 primary angle closure glaucoma was found to be the major glaucoma problem. Population studies using gonioscopy, optical anterior chamber depth, corneal thickness, diameter- and curvature measurements as well as ultrasound biometry were gradually performed. Prevalence was estimated at 5.1% in women and 1.6% in men aged 40+. Main findings were eye traits associated with increased risk of angle closure glaucoma: shallow anterior chamber depth and small corneal diameters. A high heritability (70%) was found. Surgical iridectomies and later YAG-laser iridotomies were introduced as routine procedures by travelling consultants and at the referral centre Rigshospitalet in Copenhagen. Eventually, in 1993-96 a surgical eye clinic was established in the capital Nuuk, also introducing phakoemulsification cataract surgery. Blindness due to glaucomas had fallen to about 9% of the registrations in Greenland per 1999. In 1999 an outreach model had to be established again, including consultants covering the 16 districts in 45 weeks and surgical teams of 2 surgeons 3 x 3 weeks per year. In 2002 the coverage was reduced to 31 weeks and only two surgical tours.--The possible consequences for glaucoma blindness will be discussed.