Uniting for a glaucoma-free world – but who is still being left behind?

Dr Nombuso Mathe

It is a moment that repeats itself in clinics across the African continent. A patient in their 40s or 50s, sometimes younger, arrives because their vision is “not quite right” or has suddenly deteriorated in one eye. The examination tells a devastating story: irreversible damage to the optic nerve.

The diagnosis is glaucoma.

As a glaucoma specialist, the hardest part of the conversation is explaining that the vision already lost cannot be restored. Patients are often shocked and distressed, struggling to understand how their sight could deteriorate so severely without warning. This is the quiet cruelty of glaucoma. Unlike cataracts, where vision loss can often be reversed with surgery, glaucoma causes permanent loss of visual function.

Each year, World Glaucoma Week reminds us of this reality. The 2026 theme, “Uniting for a Glaucoma-Free World,” calls on clinicians, researchers, health systems and communities to work together to prevent avoidable blindness. Yet while this vision is inspiring, it also forces us to confront an uncomfortable truth: the path to a glaucoma-free world is not the same everywhere.

Glaucoma is the leading cause of irreversible blindness worldwide, and its burden continues to grow. The World Glaucoma Association estimates that 1 in 200 people aged 40 live with glaucoma, rising dramatically to 1 in 8 by the age of 80. As populations age, the number of people affected globally is expected to exceed 110 million by 2040.

One of the greatest challenges is that glaucoma is often asymptomatic in its early stages. Vision changes usually become noticeable only when the disease is already advanced. For this reason, glaucoma has long been described as the “silent thief of sight.”

Early detection through routine eye examinations can dramatically slow or prevent vision loss. Treatments such as eye drops, laser procedures and surgery aim to lower intraocular pressure and protect the optic nerve. In high-income countries, where routine eye examinations and specialised care are widely available, many patients are diagnosed before significant vision loss occurs.

In much of Africa, however, the story is very different.

Sub-Saharan Africa carries one of the highest burdens of glaucoma in the world. People of African ancestry are not only more likely to develop glaucoma, but they also tend to develop it at a younger age and experience more aggressive disease progression. Despite this well-recognised risk, many patients are still diagnosed only when the disease is already advanced.

Across clinics in the region, including within our own environment, it is not unusual for a newly diagnosed patient to already have severe vision loss or blindness in one eye at their first presentation.

Several factors drive this disparity.

Awareness remains limited. Many people simply do not know that glaucoma exists, or that it is the leading cause of irreversible blindness. Without symptoms in the early stages, patients rarely seek care until significant damage has already occurred.

Opportunities for screening are also scarce. Routine eye examinations are not part of standard healthcare for most people in low- and middle-income settings, yet they are common in wealthier countries. Screening for conditions such as glaucoma and diabetic retinopathy has not been widely integrated into public health or primary healthcare programmes, despite visual impairment being among the most frequently reported disabilities in South Africa.

The shortage of trained ophthalmologists and glaucoma specialists across the continent further compounds the problem. In some countries, only a handful of specialists serve millions of people. Patients may travel long distances, face long waiting times, or never reach specialised care at all.

Even when glaucoma is diagnosed, treatment is not always straightforward. Many patients rely on long-term eye-drop therapy, requiring daily use and regular follow-up. Not all medications are readily accessible across Africa, and many remain expensive, with costs often borne directly by patients. South Africans are comparatively fortunate in this regard, although disparities remain between the public and private healthcare sectors.

Surgical treatment can be highly effective, particularly for the aggressive forms of glaucoma often seen in Africa. However, many surgical devices developed in wealthier countries are unaffordable in our settings. Surgical procedures also require specialised training, equipment and infrastructure, which are frequently limited.

Accessing specialist care can also be economically and socially burdensome. Patients who are already visually impaired may struggle with transport costs, lost work time and caregiving responsibilities. As a result, loss to follow-up after surgery remains common.

Adherence to treatment presents another challenge. Eye drops must be used daily for life, even when patients feel no symptoms. Many discontinue treatment because they expect medication to restore vision that has already been lost. When treatment requires out-of-pocket payment, individuals facing financial pressures may be forced to choose between medication and basic household needs.

These realities highlight a broader truth: glaucoma is not only a medical condition. It is also a health-systems challenge and a pressing issue of global health equity.

Despite these challenges, the field of glaucoma research is advancing rapidly and offers much-needed hope. New diagnostic technologies allow earlier detection of optic nerve damage, improving the ability to identify disease before vision loss occurs. Artificial intelligence and decision-support tools are also beginning to assist in screening, particularly through automated analysis of retinal images. These developments may allow screening responsibilities to be shared across a wider group of healthcare professionals involved in eye care.

Treatment innovations are also emerging. Researchers are exploring sustained-release drug delivery systems, including implants capable of delivering medication over months rather than requiring daily eye drops.

Minimally invasive glaucoma surgeries (MIGS) are expanding the surgical options available to clinicians. Within our ophthalmology unit, research is underway to evaluate lower-cost MIGS approaches in our patient population and whether these options could be scaled as more accessible global surgical interventions.

There is also growing interest in strategies to better preserve the optic nerve in glaucoma. Early studies exploring the role of exercise and certain supplements show promise. Stem cell research aimed at repairing optic nerve damage and potentially restoring vision remains an area of intense interest, as it could profoundly change the outlook for patients living with irreversible sight loss.

Yet the impact of these innovations will depend on whether they become accessible beyond well-resourced healthcare systems. Technology alone cannot close the gap in glaucoma care. That requires deliberate investment in health systems, workforce training and policy.

For those of us working in ophthalmology, glaucoma also raises difficult ethical questions. How do we respond to a disease that is detectable and treatable, yet continues to cause blindness on such a large scale? What responsibility do healthcare systems have to ensure that those at greatest risk are not the least likely to receive care?

As clinicians and educators, our role extends beyond treating disease. We are also responsible for shaping the values and priorities of the next generation of ophthalmologists. Preventing glaucoma blindness requires not only clinical expertise, but also systems thinking and moral commitment.

One of the most important goals of World Glaucoma Week is to increase public awareness. When people understand that glaucoma exists, who is at risk, and that it can cause irreversible blindness, they are more likely to seek eye examinations. Families recognise that glaucoma often runs in families, prompting relatives to be screened, as they are up to 10 times more likely to be affected. Communities begin to see eye health as part of overall well-being. The responsibility then lies in ensuring that healthcare systems are capable of responding when patients seek care.

The theme of this year’s campaign, “Uniting for a Glaucoma-Free World,” reminds us that preventing glaucoma blindness cannot rest with specialists alone. It requires collaboration between health systems, governments, researchers, educators and communities.

Because the tragedy of glaucoma is not simply that it causes blindness.

The tragedy is that so much of that blindness could have been prevented.

The fight against glaucoma is not only about saving sight, but also about upholding dignity, equity and the fundamental right to health.

*Dr Nombuso Mathe is an Ophthalmologist, Bioethicist, and the current Academic HOD of Ophthalmology at the University of KwaZulu-Natal in Durban, South Africa. She is an adult and paediatric glaucoma specialist trained at Moorfields Eye Hospital, London. She is the Vice President of the South African Glaucoma Society, the President of Women in Ophthalmology South Africa and is a Visiting Professor to Wenzhou Medical University and Eye Hospital in Wenzhou, China. Dr Mathe serves on a number of provincial and national committees, as well as the Global Advisory Council for Women Leaders in Eye Health, and is Volunteer Faculty for Orbis International. Her passions and research interests are in clinical governance in eye care, surgical training, and the management of Paediatric and adult Glaucoma patients.

** The views expressed do not necessarily reflect the views of IOL, Independent Media or The African.