We are exploring optimal ways to share public messaging, including trialling outreach via community health workers; this appears to be working well in India but less so in Nigeria, where glaucoma messages become ‘lost’ amongst the better-understood eye health conditions such as refractive error.
We have begun to see an increase in people attending screenings where public health messaging has been successful and supported deeper understanding of the condition, screening and treatment options.
A practical example of educational messaging in action is our glaucoma identification and treatment process flow chart designed for clinicians. This step-by-step model helps eye health professionals navigate the path to tackle this complex condition and helps them describe the process to patients: from screening, to what happens next if they are diagnosed with glaucoma, to the treatment plan.
After the flow chart’s successful use within the Keep Sight programme, it was published in the Toolkit for Glaucoma Management in Africa and well received by eye health professionals for its helpful and digestible guidance.
There is a significant lack of skilled workers available to screen people in the community, and in Nigeria there was no operational glaucoma unit. The capacities of the ophthalmic team in managing glaucoma are being expanded using a mix of training methods provided by a glaucoma specialist and developed in consultation with the practitioners to meet their specific development needs.
The training packages are being assembled into a package of continuing medical education at the West African College of Surgeons and administered on a need and request basis. This provides a good example of how the learning and experience of this project will contribute to improved glaucoma management and understanding in the health system at large.
Adopting new technology
Technological innovations such as low-cost portable retina imaging devices, highly accurate portable tools to measure intraocular pressure, and artificial intelligence-assisted screening tools have played a key role in the success of the Keep Sight initiative to date. Technology speeds up screening and makes services more efficient as well as enabling us to see more people.
Without technology-assisted targeted screening, upskilling ophthalmic service providers, improved standards of practice and improved communication, Keep Sight would not have been able to screen over 23,000 people in the Ganjam district, India, and over 2,400 people in Abuja, Nigeria, from October 2019 through to March 2021.
India had existing glaucoma services through another partner and we are building on that good work. For example, we are improving the use of technology to identify patients with glaucoma, considering artificial intelligence for initial screening and training community health workers to use the technology. Preliminary data show that this is helping increase the number of people attending screenings and being diagnosed with glaucoma, which will in turn help reduce the number of people going blind from the condition in the long run.