Glaucoma is a leading health and social burden in Sub-Saharan Africa (SSA). It affects Africans and those of African ancestry disproportionately compared to other populations globally. The African region has the highest incidence and prevalence of glaucoma and it is disproportionately affected by this irreversible form of blindness. Glaucoma causes an estimated 15% of blindness in SSA compared to 8% globally. Reported prevalence of glaucoma in population based studies within SSA ranges from approximately 5 to 9% over age 40 to as high as 20% in those over age 80. Despite the high prevalence of glaucoma in SSA, resources for treatment are extremely limited. Medical management of glaucoma is impractical and rarely successful in SSA. Lack of available medication, affordability, and non-adherence to prescribed therapy are major impediments to medical management. Trabeculectomy, a surgical treatment for glaucoma, has been recommended as the primary treatment in Africans but is a high cost alternative and suffers from poor acceptance. In one study, only 8% of Nigerian patients would consider surgery citing high cost, fear of surgery, and the fact that vision would not be improved, only stabilized. Laser trabeculoplasty offers many advantages over surgical treatment. It is effective in many patients, requires modest skill levels to perform, has a high safety profile, and can be provided efficiently and at low cost. Studies in SSA, although relatively small in scale, suggest that laser trabeculoplasty is an effective, well tolerated, and accepted treatment alternative in SSA and non-African populations. We propose to conduct a randomized clinical trial (RCT) to compare the efficacy of laser with medical treatment for glaucoma. We will compare two laser technologies, argon (ALT) and selective laser trabeculoplasty (SLT) with standard medical treatment. Study patients will also be enrolled into the GWAS study (Project 1) to look for genetic contributions that may influence treatment response using quantitative trait analysis.
