Implementation of new EGS guideline in Ukraine – progressive changes in glaucoma care

Abstract

Background. Statistical data showed the progressive increase of all glaucoma cases in Ukraine by 10-12% every 5 years with the same level of increase of advanced glaucoma is still resist. We predict the increase of glaucoma morbidity in 2021 by more than 10%. The appearance of Ukrainian version of 5th editions of «Terminology and diagnostic of Glaucoma» (2020) opened wider information window in the diagnosis, monitoring and treatment of glaucoma for ophthalmologists and for glaucoma patients. The 5th edition of «Terminology and Diagnostic of Glaucoma» is the result of teamwork of a large group of international glaucoma experts from different countries including Ukraine and Russia within the last 5 years. This document contains great world experience in glaucoma care with 3 degrees of levels in evidence and recommendations: weak, moderate and strong. So, it is very important and helpful for everybody who works in this field. Very important that in 5-th edition of «Terminology…» the definition of POAG included «… the increased IOP as one of risk factors among others: “POAG is a chronic, progressive, potentially blinding, irreversible eye disease causing optic nerve rim and retinal nerve fiber layer with related visual field defects. Angle appearance is normal, and major risk factors include the level of IOP and older age.” In the 4th edition of the "Terminology and Guidelines for Glaucoma", the role of increased IOP as a risk factor for glaucoma was only presumptive [1,2]. In Ukraine the increased level IOP has always been considered as one of the main factors in the development and progression of glaucoma and the one of the main points for control. Negative statistics on the incidence of glaucoma has attracted universal attention to the problems of glaucoma in the medical and public spheres of our life. Ukrainian Glaucoma Society holds an active position in the implementation of modern European standards on the diagnosis and treatment of glaucoma according to the EGS Guidelines (2020). The aim. To provide careful statistics and analysis which are very important in improving the system of medical care of glaucoma patients with glaucoma. Results. Analysis of the changes in the number of surgical interventions and the use of drug therapy of glaucoma in Ukraine (2016-2020) demonstrated the stable level of the number of surgeries during the last 3 years (2018-2020) and increase in the activity of the drug therapy by 17.2% during the last year. The study of antiglaucoma drugs market in Ukraine (2020) revealed the positive trend in prescribing of different groups of drugs according the latest recommendations: three groups of drugs (PGAs, CAIs, CAIs + BB) accounted for 70% of all the volume of glaucoma therapy. The structure of the glaucoma surgery in Ukraine (2020) showed that only 17% of surgical interventions were performed in private clinics. Conclusions. In summary, according to the modern approach in prevention of blindness in glaucoma patients, we suggest that glaucoma care in our country has to be based on well-known and very important principles, like these: - Routine screening to identify individuals with increased IOP - Program of education for young ophthalmologists on the base of the latest data on the diagnosis and treatment of POAG: Glaucoma Plus Annual International Educational project of Ukrainian Glaucoma Society and Kyiv Medical University "Glaucoma plus". - Public programs on prevention of blindness due to glaucoma - School for glaucoma patients - Implementation of the national protocol on the base of latest European recommendations.