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Sarfo JO, Mordi P, Aggrey EK, Quaicoe ASP, Attafuah PYA. Glaucoma prevalence and treatment in sub-Saharan Africa's elderly population: a scoping review. BMC Geriatr 2025; 25:255. [PMID: 40240955 PMCID: PMC12004714 DOI: 10.1186/s12877-025-05901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 04/01/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Glaucoma is one of the leading causes of visual impairment and blindness globally, mainly affecting older adults. Disproportionately affecting people of African descent, its high prevalence, combined with the region's limited healthcare infrastructure and access to eye care services, make it a major public health challenge deserving attention in sub-Saharan Africa. OBJECTIVE This paper aims to synthesise current literature on glaucoma prevalence and management options among older adults in sub-Saharan Africa. MATERIALS AND METHODS A systematic search was conducted using databases including PubMed, Scopus, Medline, and Google Scholar. Following inclusion criteria and study objectives, five published articles from 2013 to 2022 were included in this scoping review. RESULTS We found that, generally, across various studies reviewed, the prevalence of glaucoma among adults aged 60 and above was high. Glaucoma prevalence increases with age. Current management options were pharmacotherapy, surgery and laser, with pharmacotherapy most often the first line. Although initially cheaper, the other options are practical and cost-effective over time. CONCLUSION This scoping review adds to evidence that with the growing population, glaucoma continues to be a public health issue since glaucoma has a high prevalence among older adults, particularly in SSA. With most of the sub-Saharan population's high prevalence and low-income levels, ideal management must include early screening and detection and reliable and long-term treatment options that are not particularly dependent on patient compliance and adherence. Evidence-based policies are needed to reduce the prevalence of glaucoma-related visual impairment for older adults across sub-Saharan Africa.
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Affiliation(s)
- Jacob Owusu Sarfo
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Centre for Behaviour and Wellness Advocacy, Koforidua, Ghana
| | - Prince Mordi
- Centre for Behaviour and Wellness Advocacy, Koforidua, Ghana
- Department of Optometry & Vision Science, University of Cape Coast, Cape Coast, Ghana
| | - Esi Kyirba Aggrey
- Centre for Behaviour and Wellness Advocacy, Koforidua, Ghana
- Department of Optometry & Vision Science, University of Cape Coast, Cape Coast, Ghana
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Almulhim A, Almulhim A. Age, Sex, and Clinical Characteristics of Juvenile Open-Angle Glaucoma Patients in a Saudi Tertiary Hospital: A Retrospective Study of Surgical and Non-Surgical Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1591. [PMID: 39459379 PMCID: PMC11509360 DOI: 10.3390/medicina60101591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 09/17/2024] [Accepted: 09/26/2024] [Indexed: 10/28/2024]
Abstract
Background/Objectives: Juvenile Open Angle Glaucoma (JOAG) is a condition that presents peculiar issues because it starts at a very early age and, in the end, causes substantial vision loss. This study aimed to analyze the age and gender distribution and treatment outcomes in JOAG patients. Methods: We carried out a retrospective study at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, from 2015 to 2022. We extracted data from the medical records. Visual acuity data were converted to the logarithm of the minimum angle resolution (LogMAR) for standardized analysis. The CARL ZEISS Humphrey 745i Field Analyzer/HFA II-i Visual Field Analyzer was used to perform visual field examinations under the 24-2 program SITA standard. Results: The study involved 45 JOAG patients (87 affected eyes) with a mean age of 26.91 years. Myopia was the prevailing trait (93%), and a family history of glaucoma was found in 51.1% of cases. Most of the patients presented with severe visual field defects in both eyes (right-57.1%, left-44.4%). Regarding visual acuity, we found that the majority of affected categories belonged to either mild or moderate in both eyes. Initial and final Intraocular pressure (IOP) measurements together showed a significant reduction (p < 0.001) and clearly demonstrated the need for IOP control. Surgical and non-surgical treatments significantly reduced IOP, with no gender or eye differences Conclusions: This research offers important data concerning JOAG demographics (age and gender), clinical picture, and treatment results. Though early-onset presents challenges, multidimensional therapeutic methods have great potential to get JOAG under control and maintain visual function. Additional research is needed to study the genetic causes of JOAG and assess the long-term treatment outcomes.
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Affiliation(s)
- Amar Almulhim
- Department of Ophthalmology, Al Jabr Eye and ENT Hospital, Ministry of Health, Al-Asha 36422, Saudi Arabia;
| | - Abdulmohsen Almulhim
- Department of Ophthalmology, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
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Liu CK, Ali O, Murdoch I, Simon J. Proportion of Angle Closure Glaucoma in Tamale, Ghana. J Glaucoma 2024; 33:709-714. [PMID: 38551403 DOI: 10.1097/ijg.0000000000002383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/29/2024] [Indexed: 08/30/2024]
Abstract
PRCIS In the largest clinic-based study to date, our review of 588 patients presenting with glaucoma in Northern Ghana revealed 36% of these had primary angle closure glaucoma (PACG). OBJECTIVE Glaucoma is the second leading cause of blindness worldwide. In Africa, glaucoma is an established public health problem, and PACG is not commonly discussed. Recognizing it is important because of its negative impact on visual morbidity, and also because its treatment is different from primary open angle glaucoma. In response to the observation of many PACG cases at the Northern Community Eye Hospital in Tamale, Ghana, we investigated the proportion of those attending with a first diagnosis of glaucoma who had PACG. PATIENTS AND METHODS Using the electronic records, we identified 976 patients who attended with a first diagnosis of glaucoma between January 2021 and October 2022. Of these, 588 met the inclusion criterion of a clear glaucoma subtype diagnosis. RESULTS Of these 316 (53.7%) had primary open angle glaucoma, 210 (35.7%) PACG, and 62 (10.5%) secondary glaucoma. Thus, over a third of presenting glaucomas had PACG. CONCLUSION This study highlights that PACG is present in about a third of patients presenting to our clinic in North Ghana. Our study demonstrates the importance of a clear diagnostic pathway including gonioscopy in the assessment of glaucoma patients and the consideration of wider training on angle closure glaucoma diagnosis and management.
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Affiliation(s)
- Catherine K Liu
- Wills Eye Hospital Center for Academic Global Ophthalmology, Thomas Jefferson University, Philadelphia, PA
| | - Omair Ali
- Wills Eye Hospital Center for Academic Global Ophthalmology, Thomas Jefferson University, Philadelphia, PA
| | - Ian Murdoch
- Moorfields Eye Hospital, Department of Glaucoma, London, UK
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Eze UA, Obasuyi OC, Salihu DV, Bature M, Yeye-Agba OO, Kanmodi KK. Prevalence and Causes of Blindness and Visual Impairment Among Nigerian Children: A Systematic Review. Clin Ophthalmol 2024; 18:289-301. [PMID: 38317794 PMCID: PMC10840545 DOI: 10.2147/opth.s440744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
Background Low/middle-income countries have the highest burden of blindeness and visual impairment, which directly affects the children and indirectly affects their community. Furthermore, the number of blind years suffered by children with low vision or blindness creates a self-perpetuating ripple effect on their development, health and the socio-economic development of their communities. This systematic review aims to interrogate the existing evidence on the prevalence and causes of blindness and visual impairment in Nigerian children to provide evidence to drive health policy. Methods This was a systematic review without meta-analysis (SwiM) using a narrative synthesis of the evidence reported using the PRISMA guidelines. All primary cross-sectional studies (in English) reporting the prevalence and causes of visual impairment among Nigerian children under 20 years old between 2003 and 2022 were included in this review. PUBMED, AJOL, BASE and ProQuest databases were searched for eligible studies between 6 June and 15 July 2023. The quality of the included studies was assessed using the AXIS tool. Results were extracted and summarised using descriptive statistics. Visual impairment and blindness using the presenting visual acuity in the better eye were reported using the WHO classification. Results Seventeen studies, involving 16,924 children from 13 states across five geo-political zones in Nigeria, were included in the final analysis of this review. The prevalence of visual impairment was 3.9%, 2.7% and 0.3% for mild, moderate and severe visual impairments, respectively, due to ametropia, cataracts, glaucoma, etc. The prevalence of blindness was 0.2% due to cataracts, corneal scars and optic atrophy. Conclusion Blindness and visual impairment is still a significant clinical and public health burden among Nigerian children. Hence, there is still a need for clinicians, especially opthalmologists, public health specialists, policy-makers, and other relevant stakeholders to intensify efforts towards the prevention and control of this burden.
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Affiliation(s)
- Ugochukwu Anthony Eze
- Department of Ophthalmology, Federal Medical Centre, Asaba, Nigeria
- School of Sciences, Health Sciences Technology Engineering University of Suffolk-Unicaf, Ipswich, UK
| | | | | | - Mustapha Bature
- Department of Ophthalmology, Usmanu Danfodiyo University, Sokoto, Nigeria
- University Teaching Hospital, Sokoto, Nigeria
| | | | - Kehinde Kazeem Kanmodi
- School of Dentistry, University of Rwanda, Kigali, Rwanda
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
- Cephas Health Research Initiative Inc, Ibadan, Nigeria
- School of Life Sciences, Teesside University, Middleborough, UK
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Seth PK, Senthil S, Das AV, Garudadri C. Prevalence of glaucoma types, clinical profile and disease severity at presentation: Tertiary Institute based cross-sectional study from South India. Indian J Ophthalmol 2023; 71:3305-3312. [PMID: 37787226 PMCID: PMC10683705 DOI: 10.4103/ijo.ijo_3305_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/19/2023] [Accepted: 06/07/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose To describe the clinical profile and relative prevalence of subtypes of glaucoma presenting to a tertiary care center in India. Methods This cross-sectional hospital-based study included 6,120 new patients (>16 years) presenting between January 2016 and December 2017. The data were collected using an electronic medical record system. Results A total of 11,016 eyes of 6,120 new patients were diagnosed with glaucoma. Sixty-one percent were male and 79% had a bilateral affliction. Primary glaucoma was present in 4,352 (71.1%) and secondary glaucoma in 1,063 (17.4%) subjects. Glaucoma was primary open-angle (POAG) in 4,015 (36.4%) eyes and primary angle closure disease (PACD) in 3,806 (34.5%) eyes. Commonest among secondary glaucoma was post-cataract surgery glaucoma (3.1%), neovascular glaucoma (2.4%), pseudoexfoliation glaucoma (PXG) (2.1%), and steroid-induced glaucoma (SIG) (1.4%). Patients with primary glaucoma were older than secondary (56.6 ± 0.2 vs 54.1 ± 0.4; P < 0.0001). Mean IOP was higher in secondary glaucoma compared to primary (26.9 ± 0.3 vs 18.9 ± 0.1; P < 0.0001). Secondary glaucoma had greater mean CDR compared to primary glaucoma (0.77 ± 0.007 vs 0.70 ± 0.003; P < 0.0001). The prevalence of blindness (visual acuity <20/200) was 16.2% of eyes. Mean deviation (MD) 20db or worse was noted in 39.5% of eyes at presentation including 47.8% of PACG, 37.3% of POAG, 51% of JOAG, 58% of PXG, and 45% of SIG, suggesting disease severity. Conclusion At the presentation to a tertiary care center, 40% of all eyes with glaucoma had advanced disease with MD worse than - 20D. PACG and JOAG had the worse disease among primary; among secondary, PXG and SIG had the worse disease at presentation.
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Affiliation(s)
- Praveen Kumar Seth
- Department of Glaucoma, VST Centre for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sirisha Senthil
- Department of Glaucoma, VST Centre for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anthony Vipin Das
- Department of EyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Chandrasekar Garudadri
- Department of Glaucoma, VST Centre for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Ezinne NE, Kwarteng MA, Ekemiri KK, Iroanachi VI, Tagoh S, Ogbonna G, Mashige KP. Clinical Profile of Primary Open-angle Glaucoma Patients at an Eye Center in Nigeria. J Curr Glaucoma Pract 2023; 17:113-117. [PMID: 37920378 PMCID: PMC10618605 DOI: 10.5005/jp-journals-10078-1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/15/2023] [Indexed: 11/04/2023] Open
Abstract
Aim Globally, one of the leading causes of preventable blindness is primary open-angle glaucoma (POAG). The study assessed the clinical presentations of POAG patients attending an eye center in Abuja, Nigeria. Materials and methods Records of 188 eyes, collected from 94 patients diagnosed with POAG for a period of 1 year at the eye center, were reviewed. Clinical records, including age, gender, visual acuity (VA), central cornea thickness (CCT), intraocular pressure (IOP), cup-to-disk ratios, and retinal nerve fiber layer (RNFL) thickness of the participants, were extracted and analyzed. Results The majority of the participants were males (56.4%) and adults (57.4%), most of whom had normal VA (>70% in each eye). Our analysis revealed normal average estimates of RNFL thickness, IOP, and CCT among the participants. Females had thicker RNFL compared to males (p = 0.02). Although CCT decreased with age (r = -0.28, p = 0.005), there was no such link between IOP and CCT (r = 0.09, p = 0.38). Conclusion Central cornea thickness (CCT), RNFL thickness, and IOP in isolation should not be used as early indicators for POAG; rather, a combination of these and other indices is recommended. Early detection through active screening and treatment in the community for at-risk groups is highly advised. How to cite this article Ezinne NE, Kwarteng MA, Ekemiri KK, et al. Clinical Profile of Primary Open-angle Glaucoma Patients at an Eye Center in Nigeria. J Curr Glaucoma Pract 2023;17(3):113-117.
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Affiliation(s)
- Ngozika E Ezinne
- Optometry Unit, Department of Clinical Surgical Sciences, University of the West Indies, Saint Augustine Campus, Trinidad and Tobago
| | - Michael A Kwarteng
- Department of Optometry, Bindura University of Science Education, Zimbabwe
| | - Kingsley K Ekemiri
- Optometry Unit, Department of Clinical Surgical Sciences, University of the West Indies, Saint Augustine Campus, Trinidad and Tobago
| | | | - Selassie Tagoh
- Department of Optometry, Bindura University of Science Education, Zimbabwe; School of Optometry and Vision Science, University of Auckland, Aotearoa, New Zealand
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Liu Q, Liu C, Cheng W, Feng X, Li H, Yang X, Dong Y. Clinical analysis of secondary glaucoma in Central China. Sci Rep 2023; 13:8439. [PMID: 37231009 DOI: 10.1038/s41598-023-34872-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
To describe the epidemiology, clinical and social characteristics, management, and outcomes of patients with secondary glaucoma in Central China, a total of 1,129 cases (1,158 eyes) among 710 males (62.89%) and 419 females (37.11%) were analyzed. The mean age was 53.75 ± 17.11 years. The New Rural Cooperative Medical System (NCMS) played the most important role in reimbursement (60.32%) for secondary glaucoma-related medical expenses. The predominant occupation was "farmer" (53.41%). Neovascularization and trauma were the leading causes of secondary glaucoma. Cases of trauma-induced glaucoma decreased substantially during the coronavirus disease 2019 (COVID-19) pandemic. An education level of senior high school or above was uncommon. Ahmed glaucoma valve implantation was the most commonly performed surgery. At the final follow-up, the overall intraocular pressure (IOP) in patients with vascular disease- and trauma-related secondary glaucoma was 19.53 ± 10.20 mmHg, 20.26 ± 11.75 mmHg, and 16.90 ± 6.72 mmHg, while the mean visual acuity (VA) was 0.33 ± 0.32, 0.34 ± 0.36, and 0.43 ± 0.36. In 814 (70.29%) eyes, the VA was < 0.01. Effective preventive measures for at-risk populations, increased NCMS coverage and the promotion of higher education are necessary. These findings will help ophthalmologists detect secondary glaucoma early and manage it in a timely manner.
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Affiliation(s)
- Qian Liu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China.
| | - Changgeng Liu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Wenjun Cheng
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Xiaomei Feng
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Haijun Li
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Xiaoyuan Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Yangzeng Dong
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou University People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
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Visual Impairment and Blindness among Patients at Nigeria Army Eye Centre, Bonny Cantonment Lagos, Nigeria. Healthcare (Basel) 2022; 10:healthcare10112312. [PMID: 36421637 PMCID: PMC9690283 DOI: 10.3390/healthcare10112312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/05/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Visual impairment (VI) is a public health problem that can affect an individual’s social wellbeing. The study aims to determine the distribution and causes of vision impairment (VI) and blindness among patients at Nigerian Army Eye Centre Lagos, Nigeria. Method: An institutional cross-sectional study was conducted, and a systematic random sampling technique was used to enrol study participants from their medical records. Information about their demography, presenting visual acuity (VA), best corrected visual acuity and cause of VI and blindness, were retrieved. Result: A total of five hundred (500) medical records of patients aged from 4 to 96 years, with a mean age of 54.07 ± 21.43 years, were considered for the study. Among the participants, more than half were males (51.2%) and ≥60 years (53.0%). A large (47.2%) proportion of the patients had moderate VI at the time of presentation, followed by blindness (22.0%). The major cause of blindness was cataract, while glaucoma and refractive error were the major causes of VI. Blindness and VI were significantly associated with the type of VI before and after the provision of intervention (p < 0.05) across different age groups (children, youths, adults, elderly) with an adjusted p < 0.003 after an intervention. Conclusions: Cataracts, glaucoma and uncorrected refractive error (URE) were the major causes of VI and blindness in Lagos State. VI was more prevalent in males than females; however, there was no significant difference between the two proportions. The prevalence of VI among age groups was more significant for those 60 years and above. Early screening for the detection and management of cataract, URE and glaucoma is highly advised to reduce the burden of VI.
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