Glaucoma in southwest Nigeria: clinical presentation, family history and perceptions

Determinants of blindness from glaucoma among patients receiving treatment: a retrospective cohort study in Enugu, Nigeria

BACKGROUND

Irreversible blindness is the natural history of untreated glaucoma; however, a significant proportion of those receiving treatment are still blind. This study sought to identify the determinant factors responsible for blindness from glaucoma among those receiving treatment.

METHOD

This retrospective cohort study collected data via chart review of glaucoma patients (N = 231) who attended eye clinics at a large government-owned or a privately owned health facility in Enugu, Nigeria, between October and December 2023. Visual acuity was used to determine whether the eyes met the criteria for blindness. The sociodemographic and clinical characteristics of glaucoma patients who were blind (105) and patients without blindness (126) were compared. Data analysis was performed via the statistical package for social sciences (SPSS) version 26. Binary logistic regression was used to identify determinants of blindness.

RESULTS

The records of a total of 231 glaucoma patients were reviewed. One hundred and five (45.5%) patients were blind in at least one eye. The mean age was 61.1 ± 13.9 years (patients without blindness) and 63.6 ± 10.6 years (blind patients). Those living in urban areas (AOR = 0.49, 95%CI = 0.24-0.99), those with no visual impairment at presentation (AOR = 0.005, 95% CI = 0.000-0.055, p < 0.0001), those with mild to moderate visual impairment (AOR = 0.125, 95% CI = 0.06-0.277, p < 0.0001), and those with presenting IOP < 22 mmHg (AOR = 0.23, 95% CI = 0.09-0.546, p = 0.001) were significantly associated with a lower risk of blindness from glaucoma. However, being non-hypertensive was associated with a higher risk of blindness from glaucoma (AOR = 2.20, 95% CI = 1.16-4.18, p = 0.043).

CONCLUSION

Among patients receiving treatments for glaucoma, living in non-urban areas, presenting with severe visual impairments, presenting with IOP > 22 mmHg, and being non-hypertensive increased the risk of blindness. Improving access to glaucoma care in non-urban areas, increasing awareness creation on screening for early detection and patient counseling may be profitable steps towards reducing vision loss from glaucoma.

Determinants of late presentation of glaucoma in Hong Kong

BACKGROUND

Glaucoma is the commonest cause of irreversible blindness worldwide. As it is typically asymptomatic until advanced, the risk of blindness from late presentation is higher than other eye diseases. This study aims to investigate the risk factors for late presentation of primary glaucoma patients.

METHODS

We undertook a hospital-based case-control study of a random sample of glaucoma patients from a hospital in Hong Kong. Structured questionnaires and existing information from the electronic patient record were used, and the odds of presenting late were analysed by logistic regression.

RESULTS

Of 210 recruited participants, 83 (39.5%) presented with advanced glaucoma unilaterally or bilaterally. The mean age of participants was 61.1 ± 11.9 years, with 110 males (52.4%). Univariate analysis revealed that male sex and primary angle-closure glaucoma (PACG) have 3.06 (CI95:1.71-5.48; P < 0.001) and 2.47 (CI95:1.11-5.49; P = 0.03) times higher odds of late presentation, respectively. Multivariate analysis revealed late presenters were 3.54 (CI95:1.35-9.35; P = 0.01) times more likely to have PACG than primary open-angle glaucoma (POAG). Patients with elevated baseline intraocular pressure (IOP) also had 1.06 times higher odds of presenting with advanced glaucoma (CI95:1.02-1.11; P = 0.002). Linear regression revealed that PACG patients present with 7.12 mmHg higher IOP than POAG patients (CI95:4.23-10.0; P < 0.001).

CONCLUSION

In conclusion, a high proportion of glaucoma patients present late in Hong Kong, with gender and type of glaucoma being significant determinants. Our study shows that PACG presents with higher IOP and, along with male gender, are more likely to have advanced disease than POAG.

Comparison of Structural, Functional, Tonometric, and Visual Acuity Testing for Glaucoma: A Prospective Diagnostic Accuracy Study

PURPOSE

To determine the diagnostic accuracy of potential screening tests for moderate to advanced glaucoma.

DESIGN

Prospective diagnostic test accuracy study.

PARTICIPANTS

The study enrolled a consecutive series of patients aged ≥50 years who presented to a glaucoma clinic in South India without ever having received automated visual field testing.

METHODS

All participants underwent 8 index tests: OCT of the peripapillary retinal nerve fiber layer, optic disc photography, Moorfield's Motion Displacement Test (MDT), frequency doubling technique perimetry, noncontact tonometry, pneumatonometry, presenting visual acuity, and best-corrected visual acuity. Participants also underwent stereoscopic photographs and Humphrey visual fields, which were used by 2 ophthalmologists to arrive at the reference standard diagnosis of moderate to advanced glaucoma.

MAIN OUTCOME MEASURES

Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio.

RESULTS

A total of 217 people were enrolled; 321 eyes from 180 participants had all tests performed. Of these, 127 eyes (40%) were classified as having moderate to advanced glaucoma. Among the 8 tests, OCT best optimized sensitivity (84%, 95% confidence interval [CI], 76-90) and specificity (75%, 95% CI, 68-81). Moorfield's Motion Displacement Test was the best perimetric test, with a sensitivity of 91% (95% CI, 85-96) and specificity of 53% (95% CI, 44-61). Pressure and vision tests were not sensitive (e.g., sensitivity of 16%, 95% CI, 9-23 for noncontact tonometry and 23%, 95% CI, 15-31 for best-corrected visual acuity). Moorfield's Motion Displacement Test identified 16 of 127 eyes (13%) with glaucoma that were not captured by OCT, but also had false-positive results in 65 of 194 eyes (34%) without glaucoma that OCT correctly classified as negative.

CONCLUSIONS

OCT had moderate sensitivity and fair specificity for diagnosing moderate to advanced glaucoma and should be prioritized during an initial assessment for glaucoma.

The Effect of Direct Health Education on the Uptake of Screening by First Degree Relatives of Glaucoma Patients in Nigeria

PRCIS

First degree relatives (FDRs) of glaucoma patients are more likely to present for screening when they are directly contacted and educated by health workers on the phone compared with when they are only invited by their relative with glaucoma.

OBJECTIVE

The aim was to determine the effect of direct health education by phone calls on the uptake of glaucoma screening among FDRs of primary open angle glaucoma patients as a glaucoma blindness control strategy in an asymptomatic high-risk African population.

METHODS

This was a randomized clinical trial in which 102 primary open angle glaucoma patients (probands) were randomized into control and intervention groups. Both proband groups were educated about glaucoma and requested by the investigator to invite their adult FDR to attend a screening clinic within 1 month. In addition, the FDRs in the intervention group were directly contacted, educated, and invited for examination by phone calls. A total of 560 FDRs were enumerated by the probands. The main outcome measure was proportion of FDR that presented for screening.

RESULTS

A total of 218 (38.9%) FDRs took up glaucoma screening services. Eighty-nine (30.1%) of the 296 FDRs in the control group and 129 (48.9%) of the 264 FDRs in the intervention group presented for examination. After multivariate analysis, FDRs in the phone call group were 2.506 times [95% confidence interval (CI): 1.695-3.706] more likely to present than FDRs in the no phone call group. Young FDRs were more likely to present [odds ratio (OR)=3.593; 95% CI: 1.613-8.007] than the elderly FDRs, while FDRs living within 200 km of the hospital were also more likely to present (OR=5.200; 95% CI: 2.860-9.456) than those living far (>200 km) away. Probands with moderate to severe visual impairment were significantly more likely (OR=3.073; 95% CI: 1.845-4.352) to have their FDRs present than probands with mild or no visual impairment.

CONCLUSION

Direct contact and health education of FDRs through phone calls had a significant positive effect on the uptake of glaucoma screening by FDRs. We recommend direct contact and education of the FDRs of glaucoma patients.

Prevalence and risk factors of glaucoma in an adult population from Shahroud, Iran

Purpose

To determine the prevalence of glaucoma and its risk factors in a 40- to 64-year-old Iranian population.

Methods

In this cross-sectional study, 6311 individuals between the ages of 40–64 years old in Shahroud, a northeastern city in Iran, were selected through multistage cluster sampling. All participants underwent eye exams, optometry, and imaging. They had stereoscopic optic disc photography, visual field evaluation, and their intraocular pressure (IOP) was measured by ophthalmologists before pupil dilation. Glaucoma was defined by the standardized criteria, offered by the International Society for Geographical and Epidemiological Ophthalmology (ISGEO).

Results

Of the 5190 people who participated in the study (82.2%), data from 4637 people were used in the analysis. The prevalence of glaucoma was 1.92% [95% confidence intervals (CI): 1.53–2.31]; 1.4% (95% CI: 0.96–1.84) in women and 2.62% (95% CI: 1.95–3.28) in men. Glaucoma prevalence was 0.9% in the 40–44 years age group, and significantly increased to 3.55% in the 60–64 years age group. In the multiple logistic regression model, age [odds ratio (OR) = 1.08, 95% CI: 1.05–1.12], IOP (OR = 1.04, 95% CI: 1.01–1.06), axial length (OR = 1.34, 95% CI: 1.1–1.63), corneal radius of curvature (OR = 2.76, 95% CI: 1.26–6.06), and corneal diameter (OR = 0.63, 95% CI: 0.46–0.87) showed significant statistical association with glaucoma.

Conclusions

The prevalence of glaucoma was considerably high at older ages. Major risk factors confirmed by this study included older age and high IOP. Certain ocular biometric components such as the axial length and the corneal radius of curvature must be noted as important glaucoma risk factors at younger ages.

Awareness and knowledge about glaucoma and proportion of people with glaucoma in an urban outreach programme in Southeast Nigeria

Aim

The aim of this study was to determine the level of awareness and knowledge of glaucoma and the proportion of people with glaucoma among participants of a 1-day urban eye outreach programme.

Methods

The study was a cross-sectional survey. Data, collected by means of a structured questionnaire, included participants' demographic details, and awareness, knowledge and ocular status as regards glaucoma. Publicity for the outreach was created through the mass media (radio stations and television), churches, handbills, posters and different hospital staff. Data analysis was by Statistical Package for Social SciencesV.20.0. Associations between participants' demographic and other details were tested using Pearson's χ² test, and a p value of <0.05 was considered significant.

Results

Four hundred and seventy-eight (93.2%) of the 513 people in attendance were eligible and consented to participate. Awareness, knowledge and proportion of people with glaucoma in the study population were 65.5%, 36.8% and 14.5%, respectively. Awareness was significantly associated with attainment of some formal education, awareness of a positive family history, and having had an eye check prior to the outreach. The mass media was the most common information source. Good knowledge level was significantly associated with higher educational attainment and occupation, whereas proportion of people with glaucoma was significantly associated with increasing age.

Conclusion

Improving awareness with suitable content for the target population through effective means such as the mass media may be a veritable first step in combating blindness from glaucoma.

Ophthalmologists' practice patterns and challenges in achieving optimal management for glaucoma in Nigeria: results from a nationwide survey

PURPOSE OF THE STUDY

Glaucoma, a chronic non-communicable disease, and leading cause of irreversible blindness worldwide is a public health problem in Nigeria, with a prevalence of 5.02% in people aged ≥40 years. The purpose of this nationwide survey was to assess Nigerian ophthalmologists' practice patterns and their constraints in managing glaucoma.

STUDY DESIGN

Ophthalmologists were sent a semistructured questionnaire on how they manage glaucoma, their training in glaucoma care, where they practice, their access to equipment for diagnosis and treatment, whether they use protocols and the challenges they face in managing patients with glaucoma.

RESULTS

153/250 ophthalmologists in 80 centres completed questionnaires. Although 79% felt their training was excellent or good, 46% needed more training in glaucoma diagnosis and surgery. All had ophthalmoscopes, 93% had access to applanation tonometers, 81% to visual field analysers and 29% to laser machines (in 19 centres). 3 ophthalmologists had only ophthalmoscopes and schiøtz tonometers. For 85%, a glaucomatous optic disc was the most important feature that would prompt glaucoma work-up. Only 56% routinely performed gonioscopy and 61% used slit-lamp stereoscopic biomicroscopy for disc assessment. Trabeculectomy (with/without antimetabolites) was the only glaucoma surgery performed with one mention of canaloplasty. Poor compliance with medical treatment (78%) and low acceptance of surgery (71%) were their greatest challenges.

CONCLUSIONS

This study indicates that a systems-oriented approach is required to enhance ophthalmologist's capability for glaucoma care. Strategies to improve glaucoma management include strengthening poorly equipped centres including provision of lasers and training, and improving patients' awareness and education on glaucoma.

The awareness, perceptions and experiences of primary open angle glaucoma patients in Lagos Nigeria

The awareness, perceptions and experiences of Nigerian Primary Open Angle Glaucoma (POAG) patients were assessed using a hospital based cross-sectional study design. One hundred and twenty POAG patients attending a glaucoma clinic in Lagos Nigeria were recruited consecutively. They underwent face-to-face interviews with trained interviewers using a semi-structured questionnaire and an interview guide consisting of open-ended questions. A comprehensive ocular examination which included static automated perimetry, gonioscopy, stereoscopic optic nerve head assessment and contrast sensitivity was carried out for all participants. Twenty per cent (n = 24) of the respondents did not know they were being managed for a disease called Glaucoma. Age, gender, religion, ethnicity, marital status and occupation did not significantly affect the awareness of glaucoma diagnosis (p > 0.05). Positive family history of glaucoma, educational status and duration of disease were the most significant factors associated with awareness of glaucoma diagnosis (p < 0.05). POAG patients in Nigeria lack the depth of perception that can equip them to educate and motivate their family members to screen for glaucoma. There is an urgent need to develop continuous eye health education programmes to improve their perception and outlook; thereby increasing the uptake of glaucoma screening by first degree relatives of glaucoma patients.