Ophthalmologist Annette Giangiacomo On Glaucoma, Eye Health, And Orbis' Flying Eye Hospital - Exclusive Interview

Dr. Annette Giangiacomo is one of the many ophthalmologists around the world on a mission to prevent vision loss. As a glaucoma specialist, she helps adults and children treat and manage the disease so they can keep their vision for the rest of their lives. When necessary, Giangiacomo uses sophisticated surgical and laser interventions to ensure that her patients' eyes stay as healthy as possible.

Because glaucoma can develop without any noticeable symptoms, it often goes undetected until it's too late, leading to irreversible damage and sometimes blindness. However, if it's diagnosed early, glaucoma is easily managed. In addition to direct patient care, Giangiacomo provides education on how to catch glaucoma early. 

In an exclusive interview with Health Digest, Giangiacomo discussed the importance of regular eye appointments, the everyday things you can do to keep your eyes healthy, and the work she does with the non-profit Orbis International to bring affordable eye care to the world. 

What are the most common treatments for glaucoma?

Eye examinations are critical for early detection and intervention. Earlier and more frequent exams are recommended for those at higher risk for developing glaucoma. There are no treatments that can cure glaucoma, but there are treatments that can reduce the chance of damage to the eye and secondary sight loss. We often start by prescribing eye drops to reduce the pressure in the eye — these drops must be used on a regular basis. In addition, it is important that follow-up evaluations with the eye care provider are completed to evaluate the eye pressure, side vision, and other parameters. Laser treatment is another approach that can be utilized to control eye pressure.

What kind of surgical treatments do you use to treat glaucoma?

If eye drops and laser surgery are ineffective, surgery may be suggested. There are traditional and novel approaches to surgery for glaucoma. Trabeculectomy is a traditional approach that involves creating a drainage system for the eye to allow fluid to drain more easily. Alternatively, a glaucoma drainage device can be implanted. In infants, an operation to open up the traditional drainage system can be very successful.

What promising new treatments for glaucoma are being developed?

There are many novel surgical approaches to treating glaucoma that have become available over the last several years, and many are in the pipeline as well. There are surgeries that can be combined with cataract surgery, such as iStent and Hydrus, that have been shown to lower eye pressure. There are standalone options as well, including, among others, Xen implant and OMNI surgical device. These surgeries aim to improve eye pressure by either bypassing the obstruction in the drainage system of the eye or opening this drainage system.

How has the pandemic impacted people's eye health?

The pandemic has impacted patients' access to routine vision care. Many clinics were limited in the care they could offer by local ordinances and shutdowns early in the pandemic, and even as reopenings occurred, people were afraid of infection. But untreated eye diseases, like glaucoma, can result in blindness in afflicted patients. So it's critical that people return to getting their routine eye exams, or begin a habit of doing so if they weren't already. Preventative measures like social distancing and masks have been essential to making patients feel safer and reducing transmission risk when seeking necessary care.

What's the impact of missing regular appointments with your ophthalmologist?

The American Academy of Ophthalmology recommends a few eye exams for adults between the ages of 20-40 years without any known problems or complaints. Under certain conditions, an examination is recommended sooner, such as a family history of eye disease or a personal history of diabetes or eye injury.

Many people think an eye exam is only for getting a pair of glasses, but it's about so much more. It's about catching eye conditions early before they lead to vision loss. It's about taking care of your eyes so that you don't miss any of life's important moments. An eye exam could show early signs of cataracts, glaucoma, macular degeneration, or diabetic retinopathy — all preventable, treatable, or manageable conditions if caught early enough.

Having access to quality eye care transforms lives. Out of the 1 billion people living with avoidable vision loss, 33 million people are blind and a further 227 million have moderate to severe visual impairment that's completely avoidable.

Can you tell us a little bit about your work with Orbis?

I became a volunteer faculty member — volunteer medical expert — with eye care non-profit Orbis International in 2016, and since then, I have been training eye care teams in low and middle-income countries so they can save and restore vision in their communities, ensuring no one has to face a life of avoidable blindness. I have traveled with Orbis to several countries — including Cameroon, China, Ghana, and Jamaica — where I've taught medical and surgical techniques for treating glaucoma to eye care professionals in local hospitals and at Orbis' Flying Eye Hospital.

It's been really memorable for me to build connections with other health professionals and patients globally in this field. For example, my most recent trip was to Jamaica, and I've remained in touch with the local doctor we worked with there to talk about patient cases and situations she encounters. Even 16 years into my career, I know how important it is to have someone in your field to be able to reach out to, and I'm proud to see how our work at Orbis has resulted in a community of supportive peers and innovative practices. The relationships we create between the volunteer faculty like myself and local clinicians are special and empower us to provide a higher quality of care to all of our patients.

How is Orbis providing care in countries where people have trouble accessing eye care?

9 out of 10 people with vision loss live in low- and middle-income countries where eye care is often impossible or difficult to access. For the past 40 years, Orbis has been working in areas with the greatest need to end avoidable blindness by leveraging a deep network of partners, supporters, staff, and volunteer faculty to help local communities build the skills and resources necessary to fight blindness on their own.

There are three main ways that Orbis carries out its mission. The first is through long-term country programs in Africa, Asia, Latin America, and the Caribbean, training local eye care teams, building robust eye care systems, and influencing national policies to prioritize eye care. 

The second, Orbis' telemedicine platform, Cybersight, was launched in the earliest days of the internet and now allows Orbis to train more people in more places than ever before. With it, we can put quality training programs in the hands of any eye care professional with an internet connection and a smartphone, which are common and affordable in low- and middle-income countries.

Finally, there is the Flying Eye Hospital, a fully accredited teaching hospital on board an MD-10 aircraft. Packed with the latest medical equipment, the Flying Eye Hospital brings training from top medical experts to local teams so they can build the skills to fight blindness. Orbis also began offering virtual Flying Eye Hospital training projects during the pandemic.

Visit the Orbis website to make a sight-saving donation to support the children and adult patients that Orbis volunteers, including Dr. Annette, provide care to across the globe.

This interview was edited for clarity.