Category: Glaucoma

Glaucoma in Uganda are estimated at 3.6% of blindness cases. But in busy clinics, early detection of glaucoma may be challenging. Seva is pleased to support this project with Dr. Shamiim Namwaswe, expected to start in May, 2025. We welcome your questions or guidance from your past experiences as we begin this work.

Lira Regional Referral Hospital  

Lira Regional Referral Hospital provides eye care in the northern hilly regions of Uganda where patients have few eye care options.  Currently, there is no visual field testing for glaucoma at Lira and a review of the last quarter (Oct-Dec, 2024) shows 64 patients were diagnosed.  Of those, 36 are on treatment and 11 were referred to another clinic.

Patients with glaucoma typically present with some peripheral vision loss and optic nerve damage or optic disc lesions are observed during examination.  It is best practice at Lira to evaluate intraocular pressure for every patient but there can be erroneous readings if the contact isn’t properly placed.  

If the standard exam reveals that glaucoma is suspected, patients are referred for additional testing approximately 340 km away since a Humphrey visual field analyzer isn’t available locally.  The visual field test costs approximately 100K Ugandan shillings and may take 2 days for patients to travel, wait to register, complete the testing and return home.  The cost and inconvenience could result in patients not getting the treatment they need to preserve their sight.  

Expanding the glaucoma service at Lira is straightforward given the technology advancements toward visual field testing on any device, like a laptop.  This service would allow immediate evaluation of visual field at Lira, resulting in faster diagnosis and earlier initiation of therapy.  

 Patients typically present with they are noticing changes in their peripheral vision that are causing challenges in their daily lives.  

The hospital is a reasonable journey away for many patients and bus routes are generally available, though the journeys can be long (5 hours for some remote patients) and crowded.  

When patients arrive, they are greeted and sent to a central point for initial counseling and screening.  Patients with visual issues are sent to the eye department where they are:

• Screened for visual acuity
• Assigned a number
• Sent to a clinical room for an eye exam.  Here, the Clinical Officer will examine the patient and if they see a risk for glaucoma, they will call Dr. Shamiim.  She will perform the more advanced eye testing and confirm suspected glaucoma.  
• For patients with suspected glaucoma, they will be guided to the laptop with Eyeonic for visual field testing.
  • Younger patients will likely be able to test independently given the visual and audible cues from the software.
  • Older patients may not speak English well or be less comfortable with the technology so Clinical Officers or Counselors will help to guide them through the process.  
• After glaucoma is confirmed, counseling is critical to explain the condition, what medication is available, what will happen if the patient does not adhere to their treatment plan, and how to use the medications properly.  It is critical to explain that the lost vision will not return – we are preventing continued visual loss.  Setting proper expectations and noting that repeated testing is available when patients return for refills or if they see continued worsening is critical.

Medical treatment is started first. Eye drops are available at Lira or locally and tablets are available for cases that are more severe.  Patients are asked to follow up 1 month after receiving eye drops since the eye pressure is expected to drop after 3 weeks or use.  If the first medication fails (i.e. pressure remains high), they will try another medication.  After the 3rd failed medical attempt, surgery at the government hospital is advised.  In some cases, patients may refuse medical help or present with very severe cases where surgery is recommended earlier.  

 Juniors, or Clinical Officers, perform the initial eye exams and call Dr. Shamiim when necessary.  These professionals are younger in general – and a majority embrace change.  Most of them would be happy to have additional tools, and may know the team at Eyeonic, adding a level of trust.  They would like not having to refer patients to other centers since patients can easily take the test at Lira.  

It is important to have a complete, easy training process since they are eager to learn.  This process will cover glaucoma reminders as well as details on how to use Eyeonic.

There are other critical stakeholders for the new testing introduction.  The Ministry of Health has  District Health Officers who should be made aware, in addition to the Lira hospital, health centers that refer patients to Lira, and the Lira eye care team.  These activities – expected to take less than a day and ideally added to existing meetings or gatherings – will help to drive demand. 

1. MOH – district health officer (may need multiple meetings for these district officers).
2. General hospital staff
3. Lira Referral eye care team
4. Training for regional team
5. Back up training for regional teams

Features	Eyeonic	Radius XR
Hardware needed	Any computer, tablet or phone with stable internet	Virtual reality headset, software and analytics
Patient experience	comfortable with audio and visual cues	Custom library of tools
Staff training	Minimal	Included
Telemed-enabled	Online reports	Cloud data manager
Service	Africa personnel	USA-based
Warranty	Subscription-based	Not published

In addition, EyeSimplify offers a web-based portal. Zeiss offers an online visual field test but it is not recommended to replace doctor evaluation.

How do you approach visual field testing and glaucoma awareness? Do you have advice as Dr. Shamiim begins her study? We’d love for you to comment below and let us know what you think!