Noncompliance with medical treatment among glaucoma patients in Oman--a cross-sectional descriptive study

PURPOSE: Glaucoma is a priority eye disease in Oman. In order to revise the existing policies for eye care, a study was conducted to review the noncompliance rates among glaucoma patients. METHODS: Using the random method, we selected 105 glaucoma patients from among those visiting glaucoma clinics during 2003. They were interviewed by trained health professionals. A closed-ended questionnaire with 42 questions was used to note their responses. The questions dealt with their personal characteristics along with the patients' glaucoma treatment and their knowledge of and attitudes towards different components of noncompliance with medical treatment. The field staffs also observed the 'practice' of instilling placebo eyedrops. The responses were analyzed to grade the compliance, knowledge, attitude and practice of each patient. RESULTS: Excellent compliance was found in 26 patients. Discontinuation of medication in the past was reported by 87 patients. Missing instillation of eyedrops and irregular visits to the ophthalmologist were noted in 10 and 14 patients, respectively. Adequate knowledge about glaucoma and its complications was negatively associated with noncompliance [RR 2.05 (95% CI 1.07-3.93)]. CONCLUSIONS: The high rates of noncompliance among glaucoma patients in Oman demand a systematic programmed approach. Longitudinal studies are needed to confirm the causal association between noncompliance and Knowledge, Attitude and Practice. Health education, communication while dispensing medication, reducing the frequency of medication and using devices for the easy administration of eyedrops could further improve compliance.     

Glaucoma management in Sweden – results from a nationwide survey

Purpose: To report the results from a nationwide survey on glaucoma management in Sweden, performed as a part of an Open Angle Glaucoma project conducted by the Swedish Council on Health Technology Assessment 2004–2008. Methods: In 2005, a survey was distributed to all providers of glaucoma care in Sweden: public eye departments, public outpatient departments and private practices. The questionnaire included questions on number of examined patients, types of examinations during one defined week, internal organization and access to diagnostic equipment. The questionnaire was endorsed by the Swedish Ophthalmological Society. Reminders were sent out to nonresponders. Results: Response rate was high; 97% (33/34) of eye departments, 85% (39/46) of outpatient departments and 55% (69/125) of private practices. Out of 29 282 visits in ophthalmic care during the study week, 7737 (26%) were related to glaucoma. Diagnostic equipment was generally available; all public eye facilities and 92% of private practices had at least one computerized perimeter, while equipment for fundus photography/imaging was available at 100% of eye departments, 82% of outpatient departments and 62% of private practices. The number of visual field tests and fundus images was rather low. Survey results indicate that patients on the average underwent bilateral field testing every 2nd year and fundus imaging every 8th year. Conclusion: Glaucoma care generated about a quarter of all patient visits in Swedish ophthalmic care. Access to diagnostic facilities was good. To meet modern standards of glaucoma care, glaucoma damage must be measured and followed more closely than at the time of the survey.     

The Capacity of Eye Care Services for Patients with Glaucoma in Botswana

ABSTRACT

Purpose: To evaluate current delivery of glaucoma care in Botswana; in particular, the service infrastructure available and glaucoma-related workload.

Methods: A multi-center cross-sectional study was undertaken comprising government eye care institutions and ophthalmic personnel across Botswana. Data on human resources, equipment types and numbers, diagnostic criteria routinely used, treatments routinely provided, and new and repeat glaucoma consultations were obtained through quantitative and qualitative surveys.

Results: In 27 government eye care institutions there were two general ophthalmologists, neither of whom had a subspecialty interest in glaucoma, 64 ophthalmic nurses, two optometrists, one low vision therapist, one refractionist, and two equipment technicians. Only 8.5% of available ophthalmic human resources were taken up with provision of glaucoma care. About 1/3 of hospitals did not have tonometers, most primary hospitals lacked slit lamp biomicroscopes and most hospitals lacked sensitive diagnostic equipment. A diagnosis of glaucoma was made by either an ophthalmic nurse or an ophthalmologist, but only 10% of institutions could meet recommendations for follow-up assessment. Topical glaucoma medications were prescribed by almost all hospital clinics, usually by ophthalmic nurses. Drug choices were largely determined by local availability. Glaucoma surgery accounted for 0.8% of total eye operations. Glaucoma patients took up 8.5% of total clinic visits. The total number of glaucoma visits was highest in the two hospitals with ophthalmologists. New glaucoma cases took up 10.3% of total glaucoma visits.

Conclusion: This study highlights the challenges faced in caring for glaucoma patients in Botswana; in particular, lack of professional human resources, equipment and availability of effective treatments.     

The prevalence and determinants of glaucoma among 40 years and older Saudi residents in the Riyadh Governorate (except the Capital) – A community based survey

PurposeTo evaluate the prevalence of glaucoma and its determinants among adult Saudi Residents aged 40 years and older in the Riyadh Governorate (except the Capital).MethodsA cluster-based sample of randomly selected citizens from six primary health center catchment areas were examined between 2014 and 2015. Data were collected on their glaucoma management. Assessment included measurement of intraocular pressure, optic nerve head evaluation and gonioscopy. Glaucoma suspects were referred for visual field testing.ResultA total of 940 citizens were examined and 124 had glaucoma. The prevalence of glaucoma was 5.6% [95% Confidence interval (CI): 5.43–5.75] with an estimated 3758 cases of glaucoma in study area. Males had a significantly higher prevalence (7.62%) than females (3.48%). Glaucoma was not significantly associated to diabetes [Odds ratio (OR) = 1.1; (95% CI: 0.8–1.7); P = 0.5]. The variation in the prevalence of glaucoma by age group was not significant (P = 0.2). Open angle of anterior chamber was in 78% of glaucoma cases. The coverage of glaucoma management was 27.8%. Among known glaucoma patients were 69% were treatment-complaint. Of 124 glaucoma patients, 29 (23.5%) were aware of their diagnosis. Mild and moderate visual impairment was in 67% and 8 (6.5%) glaucoma patients while one (0.8%) patient was bilateral blind.ConclusionThe prevalence of glaucoma was high. Identified determinants should be noted and accordingly a public health approach for early detection and adequate management is recommended.     

Temba glaucoma study: a population-based cross-sectional survey in urban South Africa

OBJECTIVE: To determine the prevalence and features of glaucoma in an urban South African black population. DESIGN: Random sampling cross-sectional population survey. PARTICIPANTS: Black residents of Temba, North West Province, South Africa, age > or =40 years. MAIN OUTCOME MEASURES: Automated visual field testing and detailed, standardized slit-lamp examination were attempted on all subjects. Glaucoma was diagnosed by use of the scheme proposed by the Working Group for Defining Glaucoma of the International Society of Geographical and Epidemiologic Ophthalmology on the basis of evidence of end-organ damage. RESULTS: Of 1120 subjects, 839 (74.9%) were examined. The age- and gender-adjusted prevalence of glaucoma of all types was 5.3% (95% confidence interval [CI], 3.9%-7.1%). Primary open-angle glaucoma (POAG) was the most common glaucoma diagnosis, with an adjusted prevalence of 2.9% (95% CI, 1.9%-4.3%). Secondary glaucoma occurred with an adjusted prevalence of 2.0% (95% CI, 1.2%-3.3%). Exfoliative glaucoma was responsible for 16% of all glaucoma cases. The prevalence of primary angle-closure glaucoma was 0.5% (95% CI, 0.13%-1.2%). Of all subjects with glaucoma, 58% were blind in at least one eye. The prevalence of all types of glaucoma increased with age. Of subjects with POAG, 87% had not been previously diagnosed. CONCLUSIONS: The prevalence of glaucoma in this South African population was higher than that found in white populations, and most cases were undiagnosed and untreated. Glaucoma is a major cause of blindness in this population.     

Factors associated with use of glaucoma medications in a population of older people: The Blue Mountains Eye Study.

PURPOSE: To examine factors associated with use of glaucoma medications in a population of older people. METHODS: The Blue Mountains Eye Study examined 3654 people aged 49-97 years. Participants completed an interviewer-administered questionnaire which included information on current medication use. Open-angle glaucoma (OAG) was diagnosed if matching glaucomatous visual field defects and optic disc cupping were present. Ocular hypertension (OH) was diagnosed in subjects without glaucomatous disc and field changes who had an intraocular pressure (IOP) of > or = 22 mmHg in either eye or who had lower IOP levels but reported treatment with glaucoma medication. RESULTS: Use of glaucoma medication was reported by 3.3% of persons in this population (119/3644), including 44% of OAG and 28% of OH cases. Among newly diagnosed OAG and OH cases, 30% had never visited an ophthalmologist. Factors associated with a previous diagnosis of OAG or OH in a multivariate model included use of one or more general medications (OR 7.5; 95% CI 2.5-22.9), a history of other eye disease (OR 3.4; 95% CI 1.9-6.2) and first-degree family history of glaucoma (OR 3.6; 95% CI 1.8-7.2). CONCLUSIONS: Glaucoma screening may need to target individuals with OAG risk factors who are less likely to visit a general practitioner or ophthalmologist.     

成都市767例干部体检眼科疾病构成分析

目的:了解四川省成都市干部的眼部患病情况。方法:对2012年在四川大学华西医院体检的成都市高干人群,总计767例进行眼科初步体检,包括常规视力、裂隙灯、眼压及直接眼底镜检查。结果:有565例(73.7%)体检者患有眼病。其中检出白内障379例(49.4%),屈光不正209例(27.2%),黄斑病变28例(3.7%),青光眼10例(1.3%),视网膜病变7例(0.9%),翼状胬肉5例(0.7%)。本次体检新发现患眼病的有白内障52例,青光眼1例,翼状胬肉5例。结论:四川省成都市干部眼病检出率73.7%,主要是白内障、屈光不正、黄斑病变。通过体检新发现眼病58例,常规体检有助于早发现疾病,及时转诊到专科就诊。     

Glaukome bei prim?ren Irisver?nderungen

Iris malformations are often associated with malformations of the entire eye and systemic diseases. Malformations of the anterior chamber angle can lead to juvenile glaucoma. Axenfeld-Rieger syndromes have autosomal dominant transmission and are associated with juvenile glaucoma in 50?C60% of patients. Besides eye anomalies craniofacial malformations are also typical. The etiology of iridocorneal endothelial (ICE) syndrome is unclear but atypical endothelial cells lead to malformations of the entire anterior eye segment of the eye and glaucoma. Aniridia is a bilateral, congenital malformation which manifests sporadically and transmission is usually autosomal dominant. Glaucoma, malformations of the entire eye and systemic malformations are associated with aniridia. Conservative and microsurgical treatment of glaucoma of these syndromes need the cooperation of different medical subspecialties and are often ineffective.     

Coverage of cataract surgery per person and per eye: review of a community-based blindness survey in Oman

BACKGROUND AND OBJECTIVE: The data from a national survey of blindness and common eye diseases in Oman in 1996 were reviewed. The objective was to compare the calculation of cataract surgery services coverage on a per eye and per person basis. The advantages and limitations of both methods of program management are evaluated. METHODS AND MATERIALS: The information on cataract status, visual status and past history/evidence of cataract surgery was collected for 11,415 Omani subjects. The coverage of existing cataract services was calculated per eye and per person. The rates by gender, age groups, regional groups and type of cataract were also compared. RESULTS: The cataract surgery services could address more than 60% of the reported persons with blinding cataract (vision less than 3/60) and more than half of the eyes with blinding cataract. The services could cover more than one-fourth of the persons with cataract (with any grade of vision defect) and less than one-fourth of the eyes with cataract. If the coverage of cataract services for blinding cataract is calculated using persons as the denominator, it is nearly 10% higher than that calculated using eyes as the denominator. CONCLUSIONS: The two methods of calculating the coverage of cataract services give different results and both are useful for monitoring ophthalmic services. A national program should implement a system for reporting the visual and cataract status of the fellow eye so that coverage rates could be calculated by person and by eye and the impact of the cataract services in relation to time, place, gender and resources could be reviewed.     

Glaucoma with primary iris malformations. Axenfeld-Rieger syndromes, ICE syndromes (essential iris atrophy, Chandler's syndrome, Cogan-Reese syndrome), aniridia

Iris malformations are often associated with malformations of the entire eye and systemic diseases. Malformations of the anterior chamber angle can lead to juvenile glaucoma. Axenfeld-Rieger syndromes have autosomal dominant transmission and are associated with juvenile glaucoma in 50-60% of patients. Besides eye anomalies craniofacial malformations are also typical. The etiology of iridocorneal endothelial (ICE) syndrome is unclear but atypical endothelial cells lead to malformations of the entire anterior eye segment of the eye and glaucoma. Aniridia is a bilateral, congenital malformation which manifests sporadically and transmission is usually autosomal dominant. Glaucoma, malformations of the entire eye and systemic malformations are associated with aniridia. Conservative and microsurgical treatment of glaucoma of these syndromes need the cooperation of different medical subspecialties and are often ineffective.     

冬季广州市眼科门诊病人眼病构成情况调查

目的了解冬季广州市眼科门诊病人当中各种眼病构成的情况。方法对广东省人民医院2004年11月至2005年1月共13811例眼科门诊病人按照疾病分类进行统计学分析。结果男5940例,43.04%;女7871例,56.96%。其中眼睑疾病545例(3.95%)结膜疾病4235例(30.66%),角膜疾病844例(6.11%),青光眼501例(3.63%),白内障1309例(9.48%),视网膜疾病1155例(8.36%),屈光不正2807例(20.32%),健康检查650例(4.71%),其他疾病包括葡萄膜炎、眼眶疾病、泪器疾病、眼外伤、术后复诊等等共计1765例(12.79%)。性别对疾病构成的影响:眼睑疾病、角膜疾病和白内障等在男女之间差异无显著性,青光眼、视网膜疾病和屈光不正等疾病在男性中较为多见,而结膜疾病和健康检查的病人女性病人明显增多,统计学分析差异有显著性。结论在眼科门诊病人当中,结膜炎和屈光不正是最常见和占主要构成的疾病,占眼科门诊的一半以上,其次是白内障、视网膜疾病和角膜疾病,但各病种比例差别不大。女性患者似乎较男性病人更加注重眼病的防治。     

Glaucoma in developing countries

Objective: To describe the background and strategy required for the prevention of blindness from glaucoma in developing countries. Materials and Methods: Extrapolation of existing data and experience in eye care delivery and teaching models in an unequally developed country (India) are used to make recommendations. Results: Parameters like population attributable risk percentage indicate that glaucoma is a public health problem but lack of simple diagnostic techniques and therapeutic interventions are barriers to any effective plan. Case detection rather than population-based screening is the recommended strategy for detection. Population awareness of the disease is low and most patients attending eye clinics do not receive a routine comprehensive eye examination that is required to detect glaucoma (and other potentially blinding eye diseases). Such a routine is not taught or practiced by the majority of training institutions either. Angle closure can be detected clinically and relatively simple interventions (including well performed cataract surgery) can prevent blindness from this condition. The strategy for open angle glaucoma should focus on those with established functional loss. Outcomes of this proposed strategy are not yet available. Conclusions: Glaucoma cannot be managed in isolation. The objective should be to detect and manage all potential causes of blindness and prevention of blindness from glaucoma should be integrated into existing programs. The original pyramidal model of eye care delivery incorporates this principle and provides an initial starting point. The routine of comprehensive eye examination in every clinic and its teaching (and use) in residency programs is mandatory for the detection and management of potentially preventable blinding pathology from any cause, including glaucoma. Programs for detection of glaucoma should not be initiated unless adequate facilities for diagnosis and surgical intervention are in place and their monitoring requires reporting of functional outcomes rather than number of operations performed.     

Awareness of eye diseases and risk factors: identifying needs for health education and promotion in Canada

BACKGROUND: Little is known about the level of general public knowledge in Canada regarding the risk factors, prevention, and treatment of major blinding eye diseases. METHODS: The study was a cross-sectional survey using self-administered questionnaires of patients presenting to 33 family practitioners' offices in British Columbia. We asked patients' opinions on the "value" of preventing blindness; the possibility of preventing cataract, glaucoma, and macular degeneration; the possibility of treating these conditions; and their knowledge of risk factors. RESULTS: A total of 882 adults completed the questionnaires. Preventing vision loss was reported as one of 2 top health priorities in 28% of the questionnaires, more commonly by those with higher education and non-European ancestry. Overall, 69.2% reported familiarity with cataract as a cause of vision loss, 41.2% with glaucoma, and 20.2% with macular degeneration. Of these, 97.5% recognized the possibility of treatment for cataract, 91.5% for glaucoma, and 77.0% for macular degeneration, yet few respondents knew risk factors (amenable to intervention) for specific eye diseases. Men and younger respondents were more likely to report not knowing risk factors. Chinese-Canadians were least familiar with the association between smoking and cataract. Family history, probably the most important factor to help diagnose glaucoma, was recognized by only 23% of respondents. INTERPRETATION: Although loss of vision was reported as a major medical concern, there is little understanding of the risk factors for different eye diseases. The association of non-European ancestry and low educational attainment with poor knowledge of eye diseases suggests that innovative education programmes in primary and secondary schools and in non-English languages are needed to improve knowledge, attitudes, and practices.     

Determinants of glaucoma awareness in a general eye clinic

PURPOSE: Heightened public awareness about glaucoma may increase the chance of identifying undetected cases. To ascertain determinants of glaucoma awareness, we surveyed a population visiting a general eye clinic. DESIGN: Cross-sectional study. PARTICIPANTS: 1197 general eye clinic patients and their companions. METHODS: We designed and administered a questionnaire about glaucoma to general eye clinic patients and their companions. We created multivariate logistic regression models to ascertain the effect of demographic and clinical features on the likelihood of being unaware of glaucoma. MAIN OUTCOME MEASURES: Adjusted odds ratio (OR) with 95% confidence intervals of survey attributes associated with self-perceived unfamiliarity with glaucoma. RESULTS: Glaucoma awareness overall (72%) approached that found in the subgroup self-reporting a diagnosis of glaucoma (80%). Survey attributes associated with an increased likelihood of being unaware of glaucoma were African American race (OR = 1.69 [1.28-2.20], Hispanic ethnicity (OR = 2.13 [1.46-3.02]), and less than a college education (OR = 1.67 [1.37-2.05]). Age was also a determinant of glaucoma awareness (for ages 50-64 years, OR = 0.60 [0.44-0.80] and for ages 65-79 years, OR = 0.56 [0.41-0.75] compared with ages less than 35 years). A self-report of glaucoma was not a determinant of glaucoma awareness (OR = 0.63 [0.33-1.17]), although there was a trend toward enhanced glaucoma awareness in this subgroup. Finally, respondents with a history of employment in the health field (OR = 0.63 [0.49-0.82]) myopia (OR = 0.68 [0.56-0.82]), glaucoma in a first-degree relative (OR = 0.68 [0.53-0.87]), and respondents who reported having a dilated eye examination (OR = 0.53 [0.42-0.66]) were less likely to be unaware of glaucoma than those who did not have these attributes. CONCLUSIONS: Although glaucoma awareness in this population was high, Hispanics, African Americans, and those with less than a college education were more likely to be unfamiliar with the disease. Interestingly, a self-report of having glaucoma was not a statistically significant determinant of glaucoma awareness.     

The European glaucoma prevention study design and baseline description of the participants

OBJECTIVES: The European Glaucoma Prevention Study seeks to evaluate the efficacy of reducing intraocular pressure (IOP), with dorzolamide to prevent or delay patients affected by ocular hypertension from developing primary open-angle glaucoma. DESIGN: Randomized, double-blinded, controlled clinical trial. PARTICIPANTS: Patients (age > or =30 years) were enrolled from 18 European centers. The patients fulfilled a series of inclusion criteria including the measurements of IOP (22-29 mmHg), two normal and reliable visual fields (VFs) (on the basis of mean defect and corrected pattern standard deviation/corrected loss of variance of standard 30/II Humphrey or Octopus perimetry), and normal optic disc as determined by the Optic Disc Reading Center (vertical and horizontal cup-to-disc ratios; asymmetry between the two eyes < or =0.4). INTERVENTION: Patients were randomized to the treatment with dorzolamide or a placebo. MAIN OUTCOME MEASURES: End points are VF and/or optic disc changes. A VF change during the follow-up must be confirmed by two further positive tests. Optic disc change is defined by the agreement of two out of three independent observers evaluating optic disc stereo-slides. RESULTS: One thousand seventy-seven subjects were randomized between January 1, 1997 and May 31, 1999. The mean age was 57.03 +/- 10.3 years; 54.41% were women and 99.9% were Caucasian. Mean IOP was 23.6 +/- 1.6 mmHg in both eyes. Mean visual acuity was 0.97 +/- 0.11 in both eyes; mean refraction was 0.23 +/- 1.76 diopters in the right eye and 0.18 +/- 1.79 diopters in the left eye. Previous use of medication for ocular hypertension was reported by 38.4% of the patients, systemic hypertension by 28.1%, cardiovascular diseases by 12.9%, and diabetes mellitus by 4.7%. The qualifying VFs were normal and reliable according to protocol criteria. CONCLUSIONS: The mean IOP of the patients enrolled in the European Glaucoma Prevention Study is consistent with the estimated mean IOP (within the range of 22-29 mmHg) found in a large sample of the European population. The European Glaucoma Prevention Study should be able to better address the clinical question of whether pharmacological reduction of IOP (by means of dorzolamide) in ocular hypertension patients at moderate risk for developing primary open-angle glaucoma effectively lowers the incidence of primary open-angle glaucoma.     

Presentation of glaucoma in an urban tertiary care hospital in South America: legal blindness and prevalence

Purpose: To determine disease severity in glaucoma patients who presented to a tertiary care service for the first time and to determine the prevalence of different types of glaucoma. Methods: Retrospective analysis of data of patients referred to the Glaucoma Service at the Santa Casa de Misericórdia de São Paulo, Brazil in 2007. A complete chart review from 448 patients was done; data regarding age, gender, ethnicity, family history, duration of the disease, previous treatment, best corrected visual acuity, cup-to-disc ratio, intraocular pressure, diagnosis and treatment were collected. Glaucoma was diagnosed by the presence of typical optic disk abnormalities, disregarding IOP values. Results: 52.3% of patients presented visual acuity less than or equal to 20/200 and 67.7% presented cup-to-disc ratio between 0.8 and 1.0 in the worse-seeing eye; 13.4% of patients were considered legally blind. Primary open angle glaucoma was the most prevalent form of glaucoma (54.2%, 95% CI: 48.5–59.5) and chronic angle closure glaucoma was the second most frequent (11.5%, 95% CI: 8.25–15.5). Conclusion: A considerable rate of patients (almost 60% in the better-seeing eye and 70% in the worse-seeing eye) presented with advanced glaucoma. Strategies that create conditions for early diagnosis are deemed necessary to reduce glaucoma-related blindness in the Brazilian population.     

普通眼科门诊青光眼认知度的调查

目的提高公众对青光眼的认知度及青光眼患者的检出率。方法采用问卷随机抽样调查646例普通眼科门诊就诊者。所有数据用χ^2检验和多因素logistic回归分析处理数据。结果66.6%的受访者表示对青光眼不了解,其中51.61%为已确诊的青光眼患者。青光眼的认知与性别、服用糖皮质激素史、高血压、糖尿病以及近视均无相关性（P〉0.05）,与年龄、教育程度、具有卫生部门工作经历、定期眼科检查、曾经接受散瞳检查、具有青光眼家族史等显著相关。心血管患者及服用降血压药物的受访者对青光眼的认知度高于其他人群。结论青光眼认知度问卷调查为青光眼患者的宣教和知识普及提供了目标人群,使早期防治有所提示。近视患者、糖皮质激素服用者、高龄人群、低教育程度者、糖尿病及高血压患者、无定期眼科保健者以及部分对青光眼缺乏认识的青光眼患者,是今后加强宣教的目标人群。     

The problem of glaucoma in Africa--progress report from Cameroon

BACKGROUND: Glaucoma is one of the most common causes of blindness in the world. This aspect is well known for the developed countries, however in Africa blindness mainly occurs due to cataract, trachoma and onchocercosis. Glaucoma is not mentioned enough. Patients present with severe findings after a long-lasting history of disease. PATIENTS AND METHODS: In our project experienced surgeons and young medical doctors have been practising regularly in Cameroon since 2001. By means of support from the "Komitee zur Verhütung von Blindheit" and medical industries we keep in contact with a local ophthalmologist. During the consultation of hundreds of patients we have often seen highly advanced glaucoma cases. RESULTS: The medical therapy of glaucoma and also the surgical procedures are limited -- modern antiglaucomatosa are not available. We achieved sufficient regulation of intraocular pressure after trabeculectomy with or without cataract surgery in many cases. The success rate was decreased by severe scar reactions especially in young black people. In advanced glaucoma cases and oculus ultimus we also used the old techniques of iridencleisis. There was a good postoperative regulation of eye pressure, but sometimes we saw a giant filtering bleb after this iris-mutilating procedure. CONCLUSIONS: Glaucoma is a very complex problem, also in Cameroon. Although the diagnostic possibilities are limited, the therapeutic spectrum is differentiated. The introduction of a robust laser for cyclophotocoagulation would be a useful alternative.     

Australian and New Zealand Registry of Advanced Glaucoma: methodology and recruitment

Background: Glaucoma is a sight‐threatening disease affecting 3% of the population over the age of 50. Glaucoma is treatable, and severe vision loss can usually be prevented if diagnosis is made at an early stage. Genetic factors play a major role in the pathogenesis of the condition, and therefore, genetic testing to identify asymptomatic at‐risk individuals is a promising strategy to reduce the prevalence of glaucoma blindness. Furthermore, unravelling genetic risk factors for glaucoma would also allow a better understanding of the pathogenesis of the condition and the development of new treatments. Design: The Australian and New Zealand Registry of Advanced Glaucoma is a prospective study that aims to develop a large cohort of glaucoma cases with severe visual field loss to identify novel genetic risk factors for glaucoma blindness. Methods: Clinical information and blood are collected from participants after referral by eye practitioners. Samples are collected across Australia and New Zealand using postage kits. Participants: Our registry has recruited just over 2000 participants with advanced glaucoma, as well as secondary and developmental glaucomas. Results: A positive family history of glaucoma is present in more than half of the advanced glaucoma cases and the age at diagnosis is significantly younger for participants with affected relatives, which reinforces the involvement of genetic factors in glaucoma. Conclusions: With the collection of glaucoma cases recruited so far, our registry aims to identify novel glaucoma genetic risk factors to establish risk profiling of the population and protocols for genetic testing.     

Magnitude and causes of unilateral absolute blindness in a region of Oman: a hospital-based study

PURPOSE: To report the magnitude and causes of unilateral absolute blindness (no light perception) and barriers faced by persons with unilateral blindness in the South Batinah region of Oman. METHODS: Between January and June 2002, 12,000 patients were evaluated for visual acuity, ocular pressure, anterior ocular biomicroscopic examination, and posterior segment indirect ophthalmoscopy examination by ophthalmologists at Al Rustaq hospital in Oman. Patients having no perception of light in at least one eye were included in the cohort. A closed-ended questionnaire was used to collect data on the personal profile, history of blindness, barriers perceived as the cause of blindness, and participants' attitude towards eye care and quality of life following visual disability. RESULTS: In the 12,000 patients studied, absolute unilateral blindness (no perception of light) was present in 122 persons, a rate of 1.0% in our series. The onset of blindness was gradual in 78 (63.9%) persons and 64 (54.9%) persons had unilateral blindness for more than 10 years. The main causes of blindness e phthisis/absent/disorganized blind eye, which was present in 64 (52.5%) persons; glaucoma, seen in 49 (40.2%) participants; and corneal opacity, seen in 8 (6.5%) persons. Eighty 4.8%) persons had <3/60 vision in the fellow eye. Thirty (24.6%) persons had cataract and 19 (15.6%) persons glaucoma in the fellow eye. Forty-eight (39.3%) persons had undergone cataract surgeries while 2 (1.6%) persons were operated for glaucoma in the fellow eye. Lack of access to ophthalmic services and use of traditional medicines during the onset of blindness were reported by nearly half of the cohort. The attitude towards blindness was negative in two thirds of subjects. CONCLUSIONS: Cataract and glaucoma were important determinants of visual impairment in the fellow eyes of this cohort. These patients are at higher risk of developing bilateral impairment and need special care to prevent/treat visual disabilities in the fellow eyes. Using appropriate services, one can attempt attitudinal changes, rehabilitate them, and create a positive attitude towards life.