Glaucoma admissions and surgery in public sector tertiary care hospitals in pakistan: results of a national study

PURPOSE: To assess the annual number of glaucoma operations and admissions in the public sector tertiary care hospitals in Pakistan. METHODS: Eye departments in all 18 public tertiary care centers in the country were requested to provide data on the number of glaucoma operations and admissions during 1998. Of these, 13 hospitals agreed to participate. Eye departments' log books or patients' records were used to collect data retrospectively on the total number of eye admissions, the total number of glaucoma admissions, the type of glaucoma, and the total number and type of glaucoma operations. RESULTS: Glaucoma accounted for 8.1% (1,942/23,931) of all eye admissions. Open-angle glaucoma was responsible for 37.6% or 731 glaucoma admissions followed by secondary glaucoma (35.0%) and angle-closure glaucoma (18.2%). During 1998, 1,407 glaucoma-related operations were performed in the selected hospitals. The mean (+/-SD) and the median number of operations performed were 108.2 (+/-59.6) and 112 (range: 17-206), respectively. Trabeculectomies accounted for 1,043 (74.1 %) of all procedures. Their number ranged from 16 to 170 (median: 84) in the selected hospitals. CONCLUSIONS: We believe that the annual number of glaucoma operations performed in the public tertiary care hospitals in Pakistan is far less than required. In-depth research is therefore needed to explain if this is because of gaps in service provision or a genuine shift to medical management of glaucoma on an outpatient basis.     

Glaucoma as a cause of poor vision in severe retinopathy of prematurity

Despite surgical reattachment of the retina in infants with severe retinopathy of prematurity (ROP), visual acuity may decline. We performed gonioscopy and applanation tonometry on 26 eyes of 17 infants with severe ROP who were randomly selected and followed prospectively for 2 years. Of these 26 eyes, one eye of one patient had only peripheral retinocryopexy for threshold stage III disease and had an attached retina before enrollment into the study. Sixteen infants subsequently underwent vitrectomy, scleral buckle, or both. Retinal reattachment of the posterior pole was present in at least one eye each of 10 of the 17 infants. Glaucoma was diagnosed in 5 of the 10 patients; all 5 showed a decrease in visual acuity of greater than 1 octave. Of the 5 infants without glaucoma, 3 showed visual improvement, and 2 remained the same. Although we studied a small number of cases, our results suggest that glaucoma may be a cause of visual decline in infants with severe ROP. A decline in visual acuity in infants with severe ROP and surgical retinal reattachment may warn us of glaucoma, as this diagnosis is difficult to make in these small infants.     

Glaucoma care in West Africa

The authors draw on the peer review literature and 8 years of personal experience to provide an overview of the prevalence and management of glaucoma in West Africa.     

慢性病自我管理模式指导纸质视力表标准化自我视力监测的研究

目的:探讨慢性病自我管理模式指导纸质视力表应用于近视青少年进行标准化自我视力监测的有效性。方法:近视青少年74例随机分为试验组和对照组。试验组依据慢性病自我管理模式进行纸质视力表标准化自我视力监测及门诊定期随访。对照组常规用眼卫生教育和门诊随访。比较试验组和对照组屈光度进展情况。结果:试验前,试验组和对照组之间平均屈光度无显著性差异(P>0.05)。试验结束时,试验组和对照组之间平均屈光度存在显著性差异(P<0.05),对照组平均屈光度进展大于试验组,差别有显著性(P<0.05)。结论:慢性病自我管理模式指导纸质视力标准化自我视力监测可以控制青少年近视屈光度的进展。     

Glare measurement as a predictor of outdoor vision among cataract patients

Eighty-four cataractous eyes of 52 consecutive patients and 81 normal eyes of 48 subjects were evaluated with a commercially availability glare tester. Tests results were compared to visual acuity determinations in the refracting lane for ability to predict vision outdoors under daylight conditions. Among cataract patients, predictability of the two methods of measurement was not significantly different when subjects faced away from the sun. Glare scores were significantly better predictors (nearly twice as predictive) of outdoor visual acuity among cataract subjects facing the sun. These results demonstrate that measurement of sensitivity to glare is an important clinical procedure for evaluating functional visual disability in cataract patients under glare-producing conditions.     

The Collaborative Initial Glaucoma Treatment Study: study design, methods, and baseline characteristics of enrolled patients

OBJECTIVE: The Collaborative Initial Glaucoma Treatment Study (CIGTS) is a randomized, controlled clinical trial designed to determine whether patients with newly diagnosed open-angle glaucoma (primary, pigmentary, or pseudoexfoliative) are better treated by initial treatment with medications or by immediate filtration surgery. DESIGN: Randomized, controlled clinical trial. PARTICIPANTS: A total of 607 patients with open-angle glaucoma were enrolled. INTERVENTION: Patients randomized to initial medications (n=307) received a stepped regimen of medications to lower intraocular pressure. Those randomized to initial surgery (n=300) underwent trabeculectomy to lower intraocular pressure. MAIN OUTCOME MEASURES: Progression in visual field loss constitutes the study's primary outcome variable. Secondary outcomes include health-related quality of life, visual acuity, and intraocular pressure. RESULTS: Randomized assignment resulted in a balanced distribution between treatment groups for most demographic and clinical measures assessed at enrollment. More males than females were enrolled (55% were males), and a substantial percentage (38.1 %) of enrollees were blacks. Most enrollees (90.6%) were diagnosed with primary open-angle glaucoma; the remainder had either pseudoexfoliative (4.8%) or pigmentary (4.6%) forms of open-angle glaucoma. CONCLUSIONS: Follow-up of this well-characterized group of patients should provide well-rounded guidance, based on both traditional ophthalmic measures and patients' perspectives on their health-related quality of life, on how best to initially treat open-angle glaucoma.     

Canadian ophthalmologists and low vision: a national survey

It is estimated that by the year 2000 there will be a 36% increase in the number of people over 65 years of age compared with the number in 1977. Since visual impairment in developed countries is largely age related, the number of people who require low-vision services is rapidly increasing. A questionnaire survey was carried out to assess the extent of provision of low-vision services by ophthalmologists in Canada; 119 physicians (13%) responded. The results show that few ophthalmologists provide low-vision care. This situation warrants immediate attention.     

Glaucoma monitoring in patients with a 'pseudophakic cataract'

PURPOSE: To assess potential problems in monitoring glaucoma status in pseudophakic patients in whom the intraocular lens (IOL) has undergone varying degrees of opacification. METHODS: Data was collected by retrospective review of the notes of such patients, who had received a hydrophilic acrylic IOL, SC-60B-0UV, after primary cataract extraction by phacoemulsification. At first, among these, patients with glaucoma were identified and notes were reviewed to identify problems with patients in whom the IOL had undergone varying degrees of opacification. RESULTS: A total of 32 eyes with glaucoma were identified to have received the SC-60B-0UV IOL. Of these, 13 IOLs (40.6%) had undergone varying degrees of opacification. Eyes with the opacified IOLs showed decreased visual acuity (2.5 lines of Snellen acuity on average). For these eyes, visual field performance (as determined on automated field analyzers) and optic disc assessments were adversely affected giving a false impression of advanced glaucomatous field loss. CONCLUSION: In our experience, glaucoma monitoring is made comparatively more difficult in pseudophakic patients with cloudy IOLs. Problems are encountered during assessment of the glaucomatous optic disc due to poor view of the optic disc. On standard static automated visual fields, these opacified IOLs produce artefactual visual field defects making monitoring glaucoma and subsequent management more difficult.     

Glaucoma screening in the health care setting

Glaucoma surveys are an important means of detecting early cases of glaucoma. Traditionally, most such surveys have been conducted in the community, while the health care setting has been underutilized as a screening location. We reviewed studies on surveys conducted in community and health care settings, using tonometry and ophthalmoscopy, and presented data from a study we carried out in the outpatient department of a hospital. Results of our review indicate that over 11 times as many people were screened in the community studies as in the health care studies, but the latter had the higher percentage of referrals. Data from the literature review, as well as from our own study, suggest that the high number of referrals is related to the characteristics of the population available for screening in a health care facility. In such a population there is a higher percentage of individuals at risk for development of glaucoma. Risk factors for the disease include age, sex (males more at risk than females), race, (blacks more at risk than whites), family history of glaucoma, and presence of diabetes and vascular diseases. It was also found that ophthalmoscopy is an effective, but underutilized, method of screening. We recommend an increase in use of health care facilities as sites of glaucoma screening surveys. We also suggest that physicians employ ophthalmoscopy to screen for glaucoma as part of the routine funduscopic examination.     

Glaucoma among Saudi Arabian population: a scoping review

Despite its high risk of leading to permanent visual dysfunction, glaucoma remains underdiagnosed in primary care settings. About 11% of glaucoma patients in Saudi Arabia end up with bilateral blindness. This scoping review investigates and presents results on the glaucoma profile, including its prevalence, knowledge, attitude, and practice of Saudi Arabians towards the disease. An online search using four databases through online software (www.rayyan.ai) was performed to extract the relevant articles. Out of 76 records, 21 articles were eligible for the analysis. All included studies were published between the years 2014 and 2022. Most studies were in Riyadh city, followed by Jeddah. All participants (n=11 388) were adults >18 years old, and male participants were generally higher than females. The findings showed poor knowledge of glaucoma among the general population, while the knowledge among glaucoma patients was acceptable. The attitude was positive, while the compliance and practice were fair. More educational programs about glaucoma, its risk to the eyes, and the overall quality of life are highly recommended.     

Comprehensive vision care: a model.

This paper suggests a model for the practice of vision care in which the optometrist and ophthalmologist are each used to maximum advantage. It is demonstrated how the present antagonism between the two fields can be removed with a resultant enhancement of the practice of both optometry and ophthalmology. The natural outcome of the new relationship will be better vision care for the public.