Prevalence of glaucoma in rural India

PLOS ONE, 2013

Purpose: To assess the prevalence of glaucoma in rural Central India. Methods: The population-based Central India Eye and Medical Study is a population-based study performed in a rural region of Central India. The study included 4711 subjects (aged 30+ years). A detailed ophthalmic and medical examination was performed. Glaucoma was defined by glaucomatous optic disc morphology, and in a second step, by the criteria of the International Society of Geographical and Epidemiological Ophthalmology (ISGEO).

Ophthalmology, 2003

To determine the prevalence of glaucoma and risk factors for primary open-angle glaucoma in a rural population of southern India. Design: A population-based cross-sectional study. Participants: A total of 5150 subjects aged 40 years and older from 50 clusters representative of three southern districts of Tamil Nadu in southern India. Methods: All participants had a comprehensive eye examination at the base hospital, including visual acuity using logarithm of the minimum angle of resolution illiterate E charts and refraction, slit-lamp biomicroscopy, gonioscopy, applanation tonometry, dilated fundus examinations, and automated central 24-2 full-threshold perimetry. Main Outcome Measures: Definite primary open-angle glaucoma (POAG) was defined as angles open on gonioscopy and glaucomatous optic disc changes with matching visual field defects, whereas ocular hypertension was defined as intraocular pressure (IOP) greater than 21 mmHg without glaucomatous optic disc damage and visual field defects in the presence of an open angle. Manifest primary angle-closure glaucoma (PACG) was defined as glaucomatous optic disc damage or glaucomatous visual field defects with the anterior chamber angle partly or totally closed, appositional angle closure or synechiae in the angle, and absence of signs of secondary angle closure. Secondary glaucoma was defined as glaucomatous optic nerve damage and/or visual field abnormalities suggestive of glaucoma with ocular disorders that contribute to a secondary elevation in IOP. Results: The prevalence (95% confidence interval) of any glaucoma was 2.6% (2.2, 3.0), of POAG it was 1.7% (1.3, 2.1), and if PACG it was 0.5% (0.3, 0.7), and secondary glaucoma excluding pseudoexfoliation was 0.3% (0.2,0.5). On multivariate analysis, increasing age, male gender, myopia greater than 1 diopter, and pseudoexfoliation were significantly associated with POAG. After best correction, 18 persons (20.9%) with POAG were blind in either eye because of glaucoma, including 6 who were bilaterally blind and an additional 12 persons with unilateral blindness because of glaucomatous optic neuropathy in that eye. Of those identified with POAG, 93.0% had not been previously diagnosed with POAG. Conclusions: The prevalence of glaucoma in this population is not lower than that reported for white populations elsewhere. A large proportion of those with POAG had not been previously diagnosed. One fifth of those with POAG had blindness in one or both eyes from glaucoma. Early detection of glaucoma in this population will reduce the burden of blindness in India.

Innovative Publication, 2017

Introduction: Primary Open Angle Glaucoma causes damage to the fibers of optic nerve which results in permanent visual loss. There may not be any symptoms; this is dangerous because patient may become blind silently. Glaucoma caused by angle closure mechanism causes symptoms and patient seeks medical attendance early. Aims and Objectives: To study clinical types and Factors associated with the Glaucoma patients. Methodology: This was cross-sectional study of the patients reporting to ophthalmology outpatient department or admitted in the ophthalmology wards having symptoms suggestive of Glaucoma, at tertiary health care center during the year 2016. The patients underwent detailed elucidation of history and examination. All essential investigations were undertaken. Attention was also paid to monitor treatment response and follow up. As per above criteria total 64 patients were included into the study. Result: Majority of the Glaucoma patients were from older age group. As age increases the problem of Glaucoma was more prevalent. It was more frequent in Males. More patients had Open angle Glaucoma than close angle or narrow angle. The most common associated factors with Glaucoma patients were Diabetes followed by Systemic Hypertension; Phacomorphic; post Iridocyclitis; Steroid induced Glaucoma; Traumatic Glaucoma. Conclusion: The problem of Glaucoma was more common in Older age and in males. The most common associated factors with Glaucoma patients were Diabetes followed by Systemic Hypertension; Phacomorphic; post Iridocyclitis; Steroid induced Glaucoma; Traumatic Glaucoma. So these factors should be considered during diagnosis and management of Glaucoma patients.

British Journal of Ophthalmology, 2005

To determine (i) the prevalence of glaucoma in people aged >50 years, (ii) the proportions of different types of glaucoma, (iii) the distributions of intraocular pressure and vertical cup disc ratio. Method: Population based prevalence survey in rural West Bengal. People aged >50 years in randomly selected villages in 24 Parganas South district. The main outcome measures were diagnosis of glaucoma, based on criteria described by the International Society for Geographic and Epidemiological Ophthalmology. Results: 1594 people aged >50 years were enumerated in nine villages; 1324 (83.1%) were surveyed and 1269 people adequately examined. 42 definite cases of glaucoma were identified, with prevalence increasing from 2.7% (95% CI 1.7 to 3.7) in people aged 50-59 years to 6.5% (95% CI 0.0 to 14.1) in those aged >80 years. The age standardised estimate for the prevalence of all glaucoma in people aged >50 years was 3.4%. Only three cases of primary angle closure glaucoma (PACG) were identified, giving a crude ratio of primary open angle glaucoma (POAG) to PACG of more than 10:1. Three people with glaucoma were blind in one eye but none was blind in both eyes. Conclusion: Compared to other surveys of glaucoma in India, the age standardised prevalence observed was less than in Hyderabad, but similar to Tamil Nadu and Dhaka. The ratio of POAG to PACG was much higher than found previously, suggesting that PACG may be less prevalent in Bengalis than in Indian populations living in south India. The authors conclude that ophthalmic services in West Bengal should focus on detecting POAG. Since there is still no satisfactory method of screening for POAG, there is no alternative to case detection (opportunistic screening) in eye clinics.

Ophthalmology, 2008

To estimate the prevalence and risk factors of primary open-angle glaucoma (POAG) in an urban population and compare the same with that of our published rural population data in southern India. Design: Population-based cross-sectional study. Participants: Four thousand eight hundred subjects 40 years or older were selected using a multistage random cluster sampling procedure in Chennai city. Intervention: Three thousand eight hundred fifty (80.2%) subjects underwent a complete ophthalmic examination, including applanation tonometry, gonioscopy, pachymetry, optic disc photography, and automated perimetry. Main Outcome Measures: Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology Classification. Results: The distribution of intraocular pressure (IOP) and vertical cup-to-disc ratio (VCDR) was obtained from the right eye of the 2532 subjects with normal suprathreshold visual fields. Mean IOP was 16.17 Ϯ3.74 mmHg (97.5th and 99.5th percentiles, 24 mmHg and 30 mmHg). The mean VCDR was 0.43Ϯ0.17 (97.5th and 99.5th percentiles, 0.7 and 0.8). One hundred thirty-five (64 men, 71 women) subjects had POAG (3.51%; 95% confidence interval [CI], 3.04-4.0). Primary open-angle glaucoma subjects (58.4Ϯ11.3 years) were older (PϽ0.0001) than the study population (54.8Ϯ10.6 years). One hundred twenty-seven (94%) subjects were diagnosed to have POAG for the first time. Two subjects (1.5%) were bilaterally blind, and 3 (3.3%) were unilaterally blind due to POAG. The urban population prevalence was more than that of the rural population (1.62%; 95% CI, 1.4%-1.8%; PϽ0.0001). In both populations, increasing IOP (per millimeter of mercury) and older age were associated with the disease. There was no association with gender, myopia, systemic hypertension, diabetes, or central corneal thickness. Conclusions: The prevalence of POAG in a Ն40-year-old south Indian urban population was 3.51%, higher than that of the rural population. The prevalence increased with age, and Ͼ90% were not aware of the disease.

Ophthalmology, 2008

Objective: To estimate the prevalence and risk factors of primary open-angle glaucoma (POAG) in an urban population and compare the same with that of our published rural population data in southern India.

Indian Journal of Ophthalmology, 2008

Purpose: A community-based survey was conducted in Rajnandangaon district of Chhatt isgarh state of central India in 2001 to assess the prevalence of glaucoma in the age group of ≥35 years.

Indian Journal of Ophthalmology, 2011

Despite new medical and surgical strategies to control intraocular pressure (IOP), blindness caused by glaucoma continues to increase, and glaucoma remains the second or the third most common cause of blindness in the world. [9,10] As glaucoma is a disease with few symptoms in initials stages, late presentation is common and, when visual field loss threatens central vision, is an important risk factor for blindness. [11,12] While there have been few studies demonstrating the association of late presentation of glaucoma with social factors from the UK, [13,14] there has been none from India where glaucoma is a significant cause of blindness. [7] Lack of awareness about glaucoma also contributes to its late presentation. In the Barbados Eye Study (BES), about half of the total number of persons with prevalent primary open angle glaucoma (POAG, 51%) were unaware of their diagnosis. [15] Some communities in developed countries like the UK too had lack of awareness. [16] The Andhra Pradesh Eye Disease Study (APEDS) showed that awareness of glaucoma was very limited in the rural areas of southern India. [17] To our knowledge no such study has been conducted in Maharashtra in western India. We undertook a case-control study to determine the association between social factors, awareness, and late presentation of glaucoma in a tertiary eye care center in Maharashtra, West India. Materials and Methods A hospital-based case-control study was conducted involving patients diagnosed with primary glaucoma for the first time at visit to a tertiary eye care center in Pune, Maharashtra, India. Newly diagnosed patients with primary glaucoma were selected. A complete ophthalmic examination was performed including best corrected visual acuity (BCVA), IOP measurement by applanation tonometer and fundus examination for the cup:disc ratio (C:D ratio), gonioscopy by Goldman's three-mirror goniolens, and visual field test by the Humphrey automated perimeter (30-2 glaucoma threshold). The Hodapp-Parrish-Anderson visual field grading scale was used for the field defects. Glaucoma was diagnosed if the C:D ratio was >0.5 or if there was a difference of >0.2 between the two eyes with corresponding field defects. POAG and primary angle closure glaucoma (PACG) were differentiated by gonioscopy. Patients were classified as early and late presenters using the following criteria: early presenters (controls) had visual field with no absolute scotoma within 20° of fixation or C:D ratio >0.5 and <0.8 or a difference of >0.2 between the two eyes. Late presenters (cases) had no perception of light or severe visual field loss affecting an area within 20° of fixation or a C:D ratio >0.8. Patients with secondary glaucoma, congenital and

Investigative Ophthalmology & Visual Science, 2005

PURPOSE. To determine the prevalence of primary open-angle glaucoma (POAG) and the associated risk factors in a rural population in southern India. METHODS. Subjects aged 40 years or more (n ϭ 3934) underwent a complete ophthalmic examination. Glaucoma was diagnosed according to the International Society of Geographical and Epidemiologic Ophthalmology classification. RESULTS. Complete data were available for 3924 subjects (response rate, 81.75%). In eyes with normal suprathreshold visual fields, the mean intraocular pressure was 14.29 Ϯ 3.32 mm Hg (97.5th and 99.5th percentiles, 21 and 25 mm Hg, respectively). The mean vertical cup-to-disc ratio was 0.39 Ϯ 0.17 (97.5th and 99.5th percentiles, 0.7 and 0.8, respectively). Sixtyfour subjects had definite POAG (1.62%, 9.5% CI 1.42-1.82); 30 were men and 34 were women. Subjects with POAG (59.85 Ϯ 10.43 years) were older (P Ͻ 0.001) than the study population (53.78 Ϯ 10.71 years). In only one (1.5%) person was POAG diagnosed before the study. Two (3.12%) subjects were blind due to POAG; 21 (32.81%) subjects had a presenting IOP Ͼ21 mm Hg, and 43 (67.19%) had an IOP Ͻ21 mm Hg. The mean central corneal thickness in subjects with POAG (502.82 Ϯ 35.29 m) was not different from that of the normal study population (505.93 Ϯ 31.11 m). No association was found with diabetes mellitus, systemic hypertension, gender, and myopia. Increasing IOP (per mm Hg) was associated with the disease (OR 1.12; 95% CI, 1.08-1.16). The odds for POAG increased with advancing age after adjustment for gender. CONCLUSIONS. The prevalence of POAG in this population was 1.62%. The prevalence increased with age, and 98.5% were not aware of the disease.

Indian Journal of Ophthalmology, 2014

Background: Studies done on the prevalence of glaucoma have reported a high proportion of undiagnosed patients. Late diagnosis is related to increased risk of glaucoma associated with visual disability. Lack of awareness and non-availability of appropriate screening procedures are among the major reasons for non-diagnosis or late diagnosis of glaucoma. The present study has been undertaken to evaluate the level of awareness about glaucoma among the North Indian rural population. Materials and Methods: A group-administered, questionnaire-based survey, involving 5000 rural residents (aged 20 and above) was conducted through random sampling. The questionnaire was structured to evaluate the level of awareness and knowledge about glaucoma and the effect of gender, education status, and glaucoma diagnosis was also studied. The source of awareness about glaucoma was also questioned. Results: Of the 5000 individuals enrolled for the survey, responses from 4927 (98.5%; 95% Confidence Interval (CI): 98.2-98.9) participants, including 3104 males (63%; 95% CI: 61.7-64.3) and 1823 females (37%; 95% CI: 35.7-38.3) were evaluated. A total of 409 (~8.3%; 95% CI: 7.6-9.14) respondents were aware about glaucoma and only 93 (1.89%; 95% CI: 1.55-2.31) were qualified as having knowledge about glaucoma as per the set questionnaire. Education was the only variable significantly correlated (P value < 0.001) with the awareness and knowledge of glaucoma out of the parameters included in this study. Close acquaintance with a glaucoma patient was the most common source of information. Conclusions: There is a lack of awareness about glaucoma among the rural residents of North India. The study findings stress the need to spread awareness about glaucoma for prevention of glaucoma-related blindness.