Glaucoma Treatment in a War Zone

Four years after Russia’s full-scale invasion of Ukraine, the conflict there continues to make headlines. Hundreds of thousands of people have been killed and millions more displaced, and the world has seen it all unfold in real time.

Ever since the first Russian troops crossed the border, ophthalmologists from across Europe and elsewhere have done their utmost to support their Ukrainian colleagues and have learned much in return. Experience in treating ocular trauma has been particularly valuable—especially insights from glaucoma specialists who have kept working despite the war.

“We all understand that our main task is to save the vision of our patients, to save their vision at the early stages if they have glaucoma. We must use effective drops and laser treatment, regularly monitor them, and move to invasive surgery if required,” said Volodymyr Melnyk MD, PhD.

“We need compliance for that, for good feedback from the patient. Do we have a problem with that in Ukraine? Yes. Has the war made this situation worse? Unfortunately, yes.”

Fewer patients are visiting their doctors

Early diagnosis is always the key in glaucoma treatment. While ophthalmologists can identify it, the patient must be willing and able to visit the clinic in the first place, which they might not do if they do not have symptoms.

Unfortunately, fewer patients in Ukraine are getting to their doctor’s clinic, either due to conflict conditions or to prioritising other matters over their health. Dr Melnyk carried out studies on patients undergoing late-stage glaucoma surgery in 2020–2022 and 2022–2024 to understand the delays in receiving treatment.

Between 2020 and 2022, 32% of patients polled were not aware of glaucoma, which increased to 42% in the second study. Also, those patients who couldn’t receive earlier-stage treatment due to logistical or equipment constraints rose from 28% to 32% in the same period.

Dr Melnyk also commissioned a study into patient behaviour, surveying 1,200 ophthalmologists across Ukraine. They reported the number of patients arriving late was 75%, 84% of patients attend their appointments irregularly, and 63% of patients do not follow their doctors’ recommendations properly.

“Many of these patients live in temporarily occupied areas or places in active war zones,” Dr Melnyk said. “This means there’s no ophthalmic care, no examinations, and no regular eye drops.”

Delays cost patients their sight

These problems can be exemplified in case studies, like that of a patient born in 1956 who had advanced, operated, non-compensated glaucoma and pseudophakia. This individual was scheduled to undergo a trabeculectomy procedure, but after the war began in 2022 the procedure became impossible, and they could only be seen halfway through 2024.

By this time, the diagnosis had worsened to terminal glaucoma, with 46 mmHg of intraocular pressure (IOP) in one eye. Dr Melnyk and his team were finally able to perform a trabeculectomy and reduce the IOP to 16 mmHg, but unfortunately, the patient’s sight could not be saved.

“This is just one example of the situations we face in our country. The other problem is that we don’t have access to techniques like microinvasive glaucoma surgery (MIGS) and others because we don’t have distribution,” Dr Melnyk said.

“In Ukraine, we also don’t have access to legal distribution of valves, including Ahmed valves. However, we do have friends like the ESCRS who buy valves for us, which can be applied in treating injured soldiers.”

Unity creates lasting power

The effect of Ahmed valves on serious cases was demonstrated by another case study, this time involving a wounded soldier. Vision in the right eye was recorded at 2/100 with an IOP of 32 mmHg while the left measured 8/100 and 44 mmHg. The patient was implanted with an Ahmed valve to reduce this pressure.

The result was a significant reduction in IOP in both eyes, falling to 16 mmHg in the right eye and 19 mmHg in the left. While this result was made possible thanks to the Ahmed valve, Dr Melnyk relies on implanting a tube with small holes when circumstances dictate, which he reports to be nearly as effective in reducing IOP.

Much of Ukrainian ophthalmology is now forced to improvise like this due to wartime disruption, such as legal issues affecting distribution, among other factors. This uncertainty, Dr Melnyk explained, makes the support of organisations such as the ESCRS crucial in securing the best outcomes for patients in Ukraine.

“We need to focus on people at risk of glaucoma, and we also need to focus on developing portable diagnostic machines based on AI. It’s also important to use different types and methods of glaucoma surgery,” Dr Melnyk said.

“We need to create new glaucoma surgical techniques that could make surgery easier, less expensive, and less likely to be affected by distribution issues. Cooperation and collaboration; together we are powerful.”

Dr Melnyk presented at the 2025 Society of Ukrainian Ophthalmic Surgeons Congress in Kyiv.

Volodymyr Melnyk MD, PhD is the Head of the Society of Ukrainian Ophthalmic Surgeons.suo.org.ua@gmail.com