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

Public Awareness and Knowledge of Glaucoma and Cataract: A Cross-Sectional Study

Introduction Glaucoma and cataracts are the leading causes of visual impairment worldwide. Public awareness and knowledge of these conditions are crucial for early detection and prevention. This study aimed to assess the knowledge level of the general public in the Qassim region of Saudi Arabia regarding glaucoma and cataracts and to evaluate their ability to differentiate between the two conditions. Method A cross-sectional study was conducted using a validated online electronic questionnaire distributed via social media platforms. The survey collected demographic data, ocular and medical history, and responses assessing knowledge of glaucoma and cataracts. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), including descriptive statistics and chi-squared tests with a significance level of p<0.05. Result A total of 401 participants completed the survey, with 58.4% (n=234) females and 94% (n=377) Saudi nationals. The mean age was 33.36±10.35 years. Most participants (76.6%; n=307) held a bachelor's degree, and 25.2% (n=101) worked in the healthcare field. Only 23.7% (n=95) correctly identified glaucoma as optic nerve damage due to increased eye pressure, while 44.1% (n=177) correctly recognized cataracts as clouding of the lens. The most commonly identified risk factor for glaucoma and cataracts was diabetes (56.4% vs. 53.4%, respectively). Only 23.2% (n=93) correctly associated tunnel vision with glaucoma, while blurry vision, a cataract symptom, was correctly identified by 32.9% (n=132). Higher educational level was significantly associated with better knowledge of cataracts (p=0.002) but not glaucoma (p=0.100). Healthcare professionals had significantly higher knowledge of both conditions (p<0.001). Conclusion This study highlights knowledge gaps and misconceptions regarding glaucoma and cataracts among the public in the Qassim region of Saudi Arabia. While cataract awareness was relatively higher, understanding of glaucoma symptoms and risk factors was insufficient. Educational interventions are needed to improve public awareness and promote early detection and prevention strategies for these vision-threatening conditions.

Multiple medications and quality of life of Nigerians with primary open angle glaucoma

PURPOSE

To determine the impact of multiple medications on the quality of life of primary open angle glaucoma (POAG) patients on medical treatment at Guinness Eye Centre Onitsha, Nigeria.

MATERIALS AND METHODS

Adult patients diagnosed with POAG who were undergoing medical therapy were selected through systematic sampling. They were asked to provide information on socio-demographic background, the number and types of glaucoma medications they were using and any adverse effects encountered while using these medications. The patients' quality of life was assessed by utilizing the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and all patients completed ocular examination. Data analysis was with Statistical Package for Social Sciences (SPSS) version 23.

RESULTS

One hundred and seventy-one patients, aged 40-83 years, mean 59.1 ± 11.1 were studied; there were 79(46.2%) males and 92(53.8%) females. One hundred and nine (63.7%) patients were on multiple medications. Side effects of treatment increased with increasing number of medications. The mean quality of life score in monotherapy group and double therapy group were 89.3 ± 15.8 and 80.2 ± 21.1 respectively; while that in ≥ triple therapy group was 78.9 ± 18.8. This decrease in mean quality of life score with increasing number of medications was statistically significant in bivariate analysis (P < 0.01), however, multiple regression analysis showed that the number of medications did not significantly affect the quality of life scores after adjusting for confounding variables(p = 0.881).

CONCLUSION

Among the patients studied, use of multiple medications, unlike visual acuity (VA) and severity of glaucoma, was not an independent predictor of quality of life.

Knowledge, attitude, and practice (KAP) towards glaucoma among new glaucoma patients and their first-degree relatives: A cross-sectional study in a tertiary eye care centre in Riyadh, Saudi Arabia

PURPOSE

Glaucoma, a disease characterized by optic nerve damage and associated visual field defects, is the main cause of irreversible loss of vision, both globally and locally. Appropriate management of glaucoma involves early diagnosis in addition to early and continuous control of the disease to protect the optic nerve from further damage. This study aimed to assess the knowledge, attitude, and practice (KAP) towards glaucoma among patients making their first visit to the glaucoma clinics, at King Khaled Eye Specialist Hospital in Riyadh, and their first-degree relatives.

METHODS

This cross-sectional study used self-administered questionnaires. Informed consent was obtained prior to questionnaire distribution. The questionnaire included four sections on sociodemographic data, and awareness, and KAP towards glaucoma.

RESULTS

Overall, 120 participants were included in our study: 70 (58.3%) were glaucoma patients and 50 (41.7%) were first-degree relatives. Forty-four (62.9%) participants in the patient group and 39 (78%) in the relative group were men. Thirty-four (48.6%) patients were aged 41-65 years, whereas 41 (82%) relatives were aged 18-40 years. Thirty-six patients (52.2%) and 35 relatives (70%) had heard of the term 'glaucoma'. The correct definition of glaucoma was selected by only 12 participants (17.1%) in the patient group and 4 (8.2%) in the relative group. Living outside the central region of Saudi Arabia and having a negative systemic medical history were associated with poorer knowledge of glaucoma definition (p < 0.05). Although 84.8% of patients believed that compliance with anti-glaucoma medications helps in disease control, only 22.7% reported good compliance. The correct method of instilling eye drops was stated by 43.9% of the patients, and good hospital visit habits were reported by 53.03%. Eighty percent of glaucoma patients strongly recommended that their first-degree relatives be screened for glaucoma.

CONCLUSION

Knowledge about glaucoma is still limited, and awareness programs need to be further activated to spread correct knowledge about the nature of glaucoma, the importance of compliance with treatment, the correct method of instilling eye drops, and the significance of screening at-risk individuals. Patient families should also be involved in educational programs.

Awareness and Knowledge About Glaucoma in the Western Region of Saudi Arabia: A Population-Based Survey

Background Glaucoma is a leading cause of irreversible blindness worldwide. This study aimed to assess the Saudi population's levels of awareness and knowledge regarding glaucoma risk factors, symptoms, treatment, and outcomes. Methods A cross-sectional study was conducted among the Glaucoma Awareness Campaign attendees during the World Glaucoma Week (2015-2016). A structured questionnaire was used, and a knowledge score (0-25) was calculated as the sum of all correct answers. Sociodemographic factors, personal and family history of glaucoma, and the presence of risk factors were investigated and analyzed as factors affecting knowledge. Results The study included 1751 participants, with a mean age of 40.23 (SD ±13.86) years; 51.5% were males, 3.7% had glaucoma and 22.6% had a family history of glaucoma. The overall awareness rate was 65.6%, which was moderately higher among females (71.6%), older participants (≥40 years, 69.7%), and highly educated participants (70.6%). Concerning knowledge, 15.4% had fair to good knowledge (score 15-25). Participants with a personal history of glaucoma had relatively greater knowledge regarding glaucoma-specific questions, such as optic nerve damage (p=0.001) and the requirement of lifetime treatment (p<0.001). Conclusion Awareness and knowledge about glaucoma are limited among the Saudi population, regardless of socioeconomic class or educational status. Knowledge about glaucoma should be further promoted to enable early screening and prevention.

Prevalence and clinical profile of glaucoma patients in rural Nigeria-A hospital based study

PURPOSE

To determine the prevalence and clinical presentation of participants with glaucoma attending a public eye care facility in Nigeria.

METHOD

Hospital based retrospective study of glaucoma participants aged 50 years and above seen over a 5-year period. Descriptive statistics summarized the demographic, clinical characteristics and treatment of the participants and determined the association of variables with gender and age. Prevalence of the glaucoma by type, and their 95% confidence intervals (CI) were also calculated.

RESULT

Of the 5482 case files that were reviewed, 995 (18.15%, 95% Cl 17.15-19.19%) had glaucoma particularly primary open angle glaucoma (11.55%, 95%CI 10.73-12.42%) and were mostly females (564, 56.7%) aged 69 ± 12 years (range, 50-103 years). In contrast to other glaucoma types, the prevalence of primary angle closure glaucoma (3.68, 95%CI 3.22-4.22) increased by 15% over 5 years. The mean intraocular pressure ranged from 15-50 mmHg but higher in females than males (27.8 ± 6.1mmHg versus 26.6 ± 6.0 mmHg, P <0.05) who had comparable VA (0.58 ± 0.4 Log MAR) and cup-disc ratios (P >0.05). On presentation, the glaucoma hemi field test (GHFT) was outside the normal limits in 45.5% and 54.5% of males and females, respectively. The type of visual field defect was associated with glaucoma type (P = 0.047). Arcuate scotoma was most common (35.5%) across glaucoma types, paracentral scotoma more common in Secondary glaucoma while Seidel scotoma was highest in NTG (19.3%). Beta-blocker was the mainstay of management (42.2%) but more likely to be prescribed to males while more females received carbonic anhydrase inhibitors.

CONCLUSIONS

The high prevalence of glaucoma in older people remains a public health problem in Nigeria. The fact that about half of the participants presented with visual field defect suggests there is a need for public health messages to emphasize on early glaucoma screening, detection and management.

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.

Glaucoma Awareness and Knowledge Among Ethiopians in a Tertiary Eye Care Center

INTRODUCTION

Glaucoma outcomes are closely associated with patients' awareness of the disease. However, little is known about glaucoma awareness and knowledge in Addis Ababa, a densely populated and ethnolinguistically diverse capital city in Ethiopia, the second largest country in Africa.

METHODS

We performed a cross-sectional survey in the ophthalmology waiting room at St. Paul's Hospital, a tertiary care center in Addis Ababa. Respondents included patients, patient family members, and non-clinical staff. Participants were asked if they had read or heard about glaucoma to gauge basic awareness of the disease; those with awareness were asked to take a quiz to measure their objective glaucoma knowledge. We performed multivariable regression to identify factors associated with glaucoma awareness, quiz performance, and self-rated ability to use eye drops.

RESULTS

Of 298 respondents, 145 (48.7%) were female, and the average age was 44.9 ± 17.2 years. A majority (167; 56.0%) had primary school or less than primary school education. Only 131 (44.0%) had basic glaucoma awareness. Of these, 95 (72.5%) knew that glaucoma causes permanent vision loss, 103 (78.6%) knew glaucoma is often asymptomatic in early stages, 62 (47.3%) identified elevated intraocular pressure as a glaucoma risk factor, and 124 (94.7%) knew glaucoma was treatable. A majority of this subset (126; 96.2%) said they would be willing to use medicated eye drops, and 130 (99.2%) indicated a willingness to undergo surgery if recommended. Education level was independently associated with glaucoma awareness (p < 0.001) and glaucoma quiz performance (p = 0.03).

CONCLUSION

In a population sample from an ophthalmology waiting room in Addis Ababa, glaucoma awareness was poor and most strongly associated with education level. Educational interventions at public health and provider-patient levels are warranted. Our results suggest high receptiveness to both medical and surgical treatment.

Awareness of Glaucoma and Associated Factors Among Adults in Gish Abay Town, Northwest Ethiopia

PURPOSE

The purpose of this study was to determine the awareness of glaucoma and associated factors among adults living in Gish Abay town, Northwest Ethiopia.

METHODS

A population-based cross-sectional study was conducted on 594 adults who were selected using systematic random sampling from April to May 2018. Data were entered into Epi Info version 7 and were analyzed by SPSS version 23. Binary and multivariable logistic regression was used to determine factors associated with awareness. Variables with P-value < 0.05 were considered statistically significant.

RESULTS

The proportion of awareness of glaucoma was 24.4% [95% CI; 21.0, 28.1]. It was positively associated with educational status, primary education [AOR: 3.15; 1.72, 5.77], secondary education [AOR; 3.11: 1.66, 5.84], college and above [AOR; 6.10; 2.80, 13.27], history of eye examination [AOR: 6.52; 3.46, 12.25], income level >2000 Ethiopian birr [4.65; 2.59, 8.37] and history of chronic diseases [AOR; 2.93: 1.25, 6.85].

CONCLUSION

The status of glaucoma awareness in Gish Abay town can be said to be low as compared to studies. Higher educational status, eye examination, history of chronic diseases and better income level were significantly associated with awareness of glaucoma.

Eye care practices, knowledge, and attitude of glaucoma patients at community eye outreach screening in Nigeria

Background:

Community eye outreach (CEO) screening is an important model which has been widely employed to detect eye conditions such as cataract and glaucoma in high-risk groups. There is a dearth of data on the eye care practices of glaucoma patients identified using this model in South West Nigeria.

Objectives:

The aim of this article is to assess the eye care practices, knowledge, and attitudes of glaucoma patients/suspects identified at CEO screenings in Nigeria.

Design of the Study:

This was a mixed method study with quantitative and qualitative approaches.

Setting in Which the Study Took Place:

The study was carried out at 24 outreach screening centres in communities in Oyo and Osun states.

Materials and Methods:

The quantitative component of this study was a cross-sectional survey of patients with suspected glaucoma identified at routine CEO in South West Nigeria. Surveys were administered by trained personnel and gathered information on knowledge and attitudes towards glaucoma. The qualitative component consisted of structured interviews with providers to assess their knowledge and perspectives of glaucoma patients’ attitudes and behaviours.

Results:

A total of 1881 patients were screened at 24 outreach screenings in South West Nigeria, among which 120 glaucoma cases/suspects were identified. Fifty-six (46.7%) of the glaucoma patients were aware of glaucoma, but only 39 (32.5%) patients could answer at least one knowledge question correctly. Predictors of awareness of glaucoma were minimum of secondary school education [adjusted odds ratio (OR) 8.76; 95% confidence interval (CI) 3.18–24.13] and having had an eye check-up in the past (adjusted OR 5.87; 95% CI 1.92 – 17.92). Patients said cost and ‘not knowing the disease was serious’ were reasons for not following up at the main hospital. Health workers interviewed said that cost and poor knowledge were the main reasons glaucoma patients frequently attended free outreach screening events rather than seeking definitive care.

Conclusion:

Although CEO screenings improve access to eye care, provision of appropriate health education programs and strengthening of the health insurance scheme are needed to improve its impact in glaucoma care.

Characteristics of Patients Receiving Treatment Who Deny A Diagnosis Glaucoma or Elevated Intraocular Pressure in the United States

PURPOSE

The purpose of this study was to determine the proportion of patients in the US population who are receiving long-term intraocular pressure (IOP)-lowering medication, but, deny having a diagnosis of glaucoma or elevated IOP.

MATERIALS AND METHODS

The National Health and Nutrition Examination Survey (NHANES) is a home-based survey of a cross-sectional, representative, stratified sample of the US population every 2 years. Questions on prescription medication use are asked in every survey cycle, and patients were questioned whether they had ever been diagnosed with glaucoma or elevated IOP in the 2005-2006 and 2007-2008 surveys. During these 2 cycles, there were 7081 participants over age 40 of whom 135 endorse at least one year of topical IOP-lowering medication and were included in the final study.

RESULTS

A total of 8.8% of Americans taking IOP-lowering medications for at least one year denied a diagnosis of glaucoma or high eye pressure. Patients taking more medications were more likely to endorse their diagnosis.

CONCLUSIONS

Over 150,000 Americans being treated for glaucoma or ocular hypertension may be unaware or deny a glaucoma diagnosis. Improving this awareness may enhance adherence. Patient awareness of their diagnosis is essential to quality care.

Investigating the level of glaucoma awareness and perception of its risk factors in Anambra State, Nigeria

OBJECTIVES

The purpose of this study was to investigate the level of awareness of glaucoma and perception of its risk factors in Anambra State, and to examine and evaluate the health seeking behaviour of this target population and its relationship with the development glaucoma.

STUDY DESIGN

This is a qualitative study that utilised face-to-face semi-structured interviews to investigate the level of glaucoma awareness in the state.

METHODS

Purposive, non-random sampling technique was used to recruit the participants, and data were collected from 28 participants [aged 21-73 years] using semi-structured interview. The resulting data were analysed using Nvivo 10 software and Interpretative phenomenological analysis framework.

RESULTS

Of the 28 interviewees, 15 (53.6%) live in urban areas, and 13 (46.4%) live in the rural areas; 11 (39.3%) of the participants were male and 17 (60.7%) were females. In this study, people with more education, and people that live in the urban areas tend to have heard about glaucoma compared with people with less education, and who live in the rural areas; although this sample was too small to make substantive claims. Glaucoma was perceived as 'a dangerous eye disease that can cause blindness if not treated early; serious eye problem; an incurable eye problem that can eventually result to blindness, and a dangerous eye problem that can easily render a person blind'. Four a priori themes and ten emergent themes were identified.

CONCLUSIONS

There is low awareness of glaucoma in this population, and this encourages people to indulge in certain risk behaviours that could predispose them to glaucoma. Therefore, providing sustained health promotion programmes and improved eye care services could help this population immensely in the current struggle against glaucoma blindness.

Awareness and knowledge of glaucoma and associated factors among adults: a cross sectional study in Gondar Town, Northwest Ethiopia

Background

Raising public awareness and knowledge about glaucoma is a key for early case identification and prevention of blindness. However, awareness and knowledge about glaucoma is unknown at community level, making provision of interventions difficult. This study was intended to assess the awareness and knowledge of adults about glaucoma and the factors affecting it in Gondar town, Northwest Ethiopia.

Methods

Community based cross - sectional study was conducted on 701 adults 35 and above years in Gondar from April 12–30, 2016. Multistage sampling technique was used to select study participants. Interviewer administered pretested structured questionnaire was used to collect data after verbal informed consent. Data were entered into EpiData version 3.1 and analyzed by Statistical Package for Social Sciences version 20. Bivariate and multivariate logistic regression models and Odds ratio with 95% interval were used to identify factors. P–value <0.05 was considered statistically significant.

Results

Seven hundred one adults age 35 and above years were participated with a response rate of 99.3%. The male to female ratio was 1:1.6 with median age of 48 years with interqurtile range of 20. The proportion of awareness was 35.1% (95% CI: 31.5%, 38.6%). Good knowledge was demonstrated in 49.6% (95%CI: 43.3%, 55%) of glaucoma aware participants. Education (primary [AOR: 3.21; 1.73, 5.95], secondary [AOR: 4.34; 2.30, 8.22]; college and above [AOR: 9.82; 4.27, 22.60]) and having eye examination [AOR: 2.78; 1.86, 4.15] were positively associated with awareness of glaucoma whereas older age (65 –74 years [AOR: 0.31(0.21, 0.76]) was inversely related. Level of Education (primary[AOR:2.83;1.04,7.71],secondary[AOR:3.45;1.33,9.41],college and above [AOR: 4.86;1.82,12,99] and having eye examination [AOR: 2.61;1.53,4.45] were significantly associated with knowledge.

Conclusion

The study has indicated higher level of awareness and knowledge about glaucoma in urban communities than previous studies. It has also identified educational status, eye examination at least once in life are related with better awareness and knowledge. The present awareness and knowledge should be enhanced through public oriented glaucoma education via mass media and incorporating eye check up as a routine in older people.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-017-0542-z) contains supplementary material, which is available to authorized users.

So let me find my way, whatever it will cost me, rather than leaving myself in darkness: experiences of glaucoma in Nigeria

BACKGROUND

Blindness from glaucoma is associated with socio-economic deprivation, presumed to reflect poor access to care and poor adherence to treatment.

OBJECTIVES

To determine why people with glaucoma are presenting late for treatment and to understand access to glaucoma care. Additionally, we sought to identify what patients and the community know, do and think about the condition and why the poor are the most affected with glaucoma blindness.

DESIGN

Study participants were from four communities and two hospitals in Abuja-FCT and Kaduna State, Nigeria. A total of 120 participants were involved, including 8 focus group discussions, 7 in-depth interviews with blind/visually impaired glaucoma patients, 5 rapid direct observation visits with these patients and 13 exit interviews of glaucoma patients in the hospital. The data were analysed using content analysis, interpreting participant experiences in terms of three key steps conceptualised as important in the care pathway: what it takes to know glaucoma, to reach a diagnosis and to access continued care.

RESULTS

This article presents multiple narratives of accessing and maintaining glaucoma care and how people manage and cope with the disease. People may be presenting late due to structural barriers, which include lack of knowledge and awareness about glaucoma and not finding an appropriately equipped health care facility. What keeps glaucoma patients within the care pathway are a good hospital experience; a support structure involving family, counselling and shared patients' experiences; and an informed choice of treatment, as well as agency. The high cost of purchasing care is a major factor for patients dropping out of treatment.

CONCLUSION

The findings suggest the need to address economic and social structural drivers as glaucoma presents another case study to demonstrate that poverty is a strong driver for blindness. There is also a need for clear glaucoma care pathways with early case finding in the community, two-way referral/feedback systems, well-equipped glaucoma care hospitals and better eye health care financing.

Discrepancies in physician-patient agreement in reporting ocular history

OBJECTIVE

The purpose of this study was to investigate the extent of agreement between physicians and patients in reporting ocular history and to determine whether there are any predictive factors for physician-patient consensus.

DESIGN

Retrospective chart review.

PARTICIPANTS

Between June and September 2014, adult patients undergoing cataract surgery were recruited for the study.

METHODS

Before surgery, patient demographics and self-reported ocular history were extracted from a prospectively collected database. Medical charts were retrospectively examined to retrieve physician-reported ocular history.

RESULTS

One hundred and thirty-eight patients participated. Mean cohort logMAR visual acuity was 0.46 ± 0.34 (Snellen equivalent of approximately 20/60) and mean age was 74.1 ± 8.3 years. For glaucoma, Cohen's kappa revealed a moderate-to-good concordance between physicians and patients (κ = 0.604), whereas a poor-to-fair level of agreement existed in reporting maculopathy, such as age-related macular degeneration and macular holes (κ = 0.254). The logistic regression model revealed that preoperative visual acuity (p = 0.223), sex (p = 0.736), age (p = 0.910), and education (p = 0.738) were not significant predictors of physician-patient agreement.

CONCLUSIONS

The accuracy of patient-reported ocular history varies by pathology. Self-reported glaucoma history is consistent between patients and physicians; however, patients under-report the diagnosis of maculopathy. Age, sex, and level of education do not appear to influence patient-reported accuracy of ocular comorbidities.

Microvascular endothelial function and severity of primary open angle glaucoma

PurposeThe role of microvascular endothelial dysfunction on severity of primary open angle glaucoma (POAG) was investigated in this study.Patients and methodsA prospective cohort study was conducted. One hundred and fourteen ethnically Malay patients (114 eyes) with POAG treated at the eye clinic of Hospital University Sains Malaysia between April 2012 and December 2014 were recruited. Patients aged between 40 and 80 years with two consecutive reliable and reproducible Humphrey visual field 24-2 analyses were selected. Patients who were diagnosed with any other type of glaucoma, previous glaucoma-filtering surgery, or other surgeries except uncomplicated cataract and pterygium surgery were excluded. Humphrey visual field analysis 24-2 was used to stratify the severity of glaucoma using Advanced Glaucoma Intervention Study (AGIS) score at the time of recruitment. Microvascular endothelial function was assessed using Laser Doppler fluximetry and iontophoresis. Iontophoresis process with acetylcholine (ACh) and sodium nitroprusside (SNP) was used to measure microvascular endothelium-dependent and -independent vasodilatation, respectively.ResultsBased on the AGIS score, 55 patients showed mild glaucoma, with 29 moderate and 30 severe. There was statistically significant difference in microvascular endothelial function (ACh% and ACh_max) between mild and moderate POAG cases (P=0.023) and between mild and severe POAG cases (P<0.001). There was negative correlation between microvascular endothelial function and severity of POAG (r=-0.457, P<0.001).ConclusionMicrovascular endothelial dysfunction may have a role in influencing the severity of POAG in Malay patients.