Gaps in Glaucoma Diagnosis and Management in Low-Resource Settings: Evidence, Challenges, and Practical Solutions for West Africa

Abstract

Glaucoma remains a leading cause of irreversible blindness in West Africa, where prevalence among adults aged ≥40 years far exceed global norms. Despite the availability of effective medical and surgical interventions, late presentation and advanced disease at diagnosis persist, driven by systemic, socioeconomic, and cultural barriers. This review synthesizes evidence on epidemiological burden, risk factors, diagnostic capacity, and care pathway challenges in low-resource settings. Key findings include aggressive disease phenotypes, thin corneal profiles, and high familial risk, compounded by deficits in diagnostic infrastructure, particularly gonioscopy, and workforce shortages. Barriers span awareness, access, adherence, and follow-up, with cost and health literacy as dominant constraints. Practical solutions emphasize community-based screening, task-shifting to optometrists, integration of glaucoma care into primary health systems, cost-containment strategies for medications, and telemedicine for remote monitoring. Implementation science approaches and policy reforms, including insurance coverage and workforce upskilling, are critical to reducing glaucoma-related blindness. Addressing these gaps through coordinated, context-specific interventions offers a pathway to preserve vision and improve quality of life across West Africa.