Medicine has more than its share of awareness months, and they serve an important role in patient education. When you're in the forest though, it's easy to miss a tree. Even though I spend my days in ophthalmology, somehow January slipped by and I didn't notice a single reminder that it was Glaucoma Awareness month. No matter. Except that the lack of awareness about the consequences of undiagnosed glaucoma in the developed world may be one of medicine's saddest failures.

Reminders of that lack of awareness are plentiful, though, and pay little heed to any designated month. Last year, a national survey revealed that, despite glaucoma's fivefold increased incidence among blacks compared to whites, one in five blacks does not have a regular eye doctor and one in four had not had an eye exam in the previous two years.

Even among those fortunate (?) enough to have been diagnosed, the complexity of current drug regimens and the pitiful compliance is well-detailed. A recent British survey found that even among patients with diagnosed glaucoma, just one in four had a reasonable understanding of their condition.  This month, a Canadian study details the increased risk for motor vehicle and other accidents among people with glaucoma. The number of Americans with open-angle glaucoma is projected to increase by 50 percent by the end of the next decade.

It would be nice to report that ophthalmology is mounting an appropriate response to a building public health crisis, but that appears not to be the case. Dr. Steve Gedde and his colleagues report in January's Journal of Glaucoma that while other subspecialties are attracting increased applicants for fellowship training, glaucoma fellowships are down. The reasons are understandable. And unacceptable.

It would be nice to report that pharmaceutical R&D is mounting an appropriate response, but that appears not to be the case either. As our feature on future glaucoma drugs shows, the operative word, as it always seems to be in glaucoma, is future. The reasons are understandable. And unacceptable.

One thing at a time. This started out to be about awareness, and that's as good a place as any. If we can afford to spend $138,000 a minute on the war in Iraq, if we can afford to spend $2.3 million dollars for 30 seconds of air time on a football game, we can afford to educate our own countrymen about how to keep from going blind from glaucoma.