Screening for Glaucoma in Rural Population: A Hospital Based Study

Journal of Evidence Based Medicine and Healthcare, 2017

BACKGROUND Early detection and management of glaucoma can reduce the visual morbidity. As the population-based screening programs were not cost effective because of low prevalence of glaucoma in general population, this study was aimed at screening by the comprehensive eye checkup at hospital attending patients for any possibility of developing glaucoma in future and if detected to evaluate the extent of damage suffered at initial diagnosis and to provide treatment. MATERIALS AND METHODS A cross-sectional survey conducted on participants aging 40 years or older attending eye department from March 2013 to February 2014. All were subjected to a pre-structured questionnaires. Data on demographics collected besides screening and evaluating each patient for glaucoma by extensive comprehensive eye checkup. The results were analysed. RESULTS 924 patients participated in this study from urban and semi-urban areas having similar ethnicity. The mean age was 52 (range 28-76 yrs.); 146 (15.8%) were labelled as glaucoma suspects. Optic nerve head changes of glaucoma suspects were noted and correlated with visual field defects and intraocular pressure; 28 (3.03%) were detected to have various types of glaucoma. CONCLUSION Comprehensive eye checkup to screen glaucoma in hospital attending patients proved a good measure to detect and manage glaucoma at the earliest as is shown in result of this study; 3.03% were detected with various types of glaucoma, of which 1.62% had POAG. All patients were managed conservatively and surgically as per need. Proper training of optometrists will also be an effective step in early detection, management and preventing this blinding disease.

Healthline, Journal of Indian Association of Preventive and Social Medicine, 2022

Introduction : Glaucoma is the leading cause of irreversible visual loss in world and also in India. Because of the relatively asymptomatic initial phase of the disease, it is often detected by chance and is frequently associated with extensive and irreversible damage at the time of diagnosis. Objectives: To screen for Glaucoma among patients eligible as per inclusion criteria, to classify the glaucoma cases according to clinical presentation and to correlate the occurrence of glaucoma with different variables. Method: The present study was conducted at one of the tertiary care hospitals of Ahmedabad city during celebration of "World Glaucoma Week-2021". Total 1421 patients were offered opportunistic screening after oral informed consent during 6-12 March 2021, who attended the institute. After applying exclusion criteria, 945 were found eligible who underwent a comprehensive ophthalmic examination like visual acuity, intraocular pressure measurement, gonioscopy, optical disc and visual filed examinations were carried out as per standard protocols. Sociodemographic details, any relevant ophthalmic history pertaining to glaucoma and systemic illnesses were also assessed. The data were entered and analyzed in MS excel. Results: The incidence of newly diagnosed cases of glaucoma among opportunistic screened cohort was 36.71% (n=347). Of total newly diagnosed, the presentation as per clinical classification was as follows: Primary open angle glaucoma (POAG)-202 (58.21%), Primary angle closure glaucoma (PACG)-77 (22.19%), Primary angle closure suspect (PACS)-41 (11.82%), Ocular hypertension (OHT)-6 (1.73%), Normal tension glaucoma (NTG)-10 (2.88%), Secondary glaucoma-9 (7.09%) and Congenital glaucoma-2 (0.58%). In yield, 25 (19.68%) were ≤40 years and 36 (28.35%) had positive family history of glaucoma. Conclusion: Presence of stand-alone Diabetes and Hypertension or presence of both accompanying-all three conditions were found to be statistically significant determinant for occurrence of particular variety of Glaucoma. There was highly significant statistical association between cup-disc ratio level at the time of presentation and clinical variety of glaucoma.

Indian Journal of Clinical and Experimental Ophthalmology, 2016

Objective: To study the profile of glaucoma patients in Eastern UP. Method: Prospective cross sectional study includes 193 cases of age group (more than 30 years). Both male and female were included. Results: The total number of 193 cases was studied. Out of these 106 (54.9%) were male and 87 (45.07%) were female with a male female ratio was 1.21. Primary glaucoma was more common than secondary glaucoma. Among primary glaucoma, primary narrow angle glaucoma (44.4%) was more common followed by primary open angle glaucoma (36.2%). Mean age of POAG patients was (54.2±7.2 years), PNAG was (60.1±11.1 years), NTG was of (64.6±11.8 years), ocular hypertension was of (55±7.2 years) and secondary glaucoma was of (53.2±11.2 years). PNAG was more common in females and rest of glaucoma was common in male. Glaucoma, Profile, Visual impairment, Eastern U.P. Conclusion: Glaucoma causes progressive atrophy of the optic disc resulting in typical defects in the visual field. It can lead to total loss of vision if left untreated. The diagnosis glaucoma has to be made only after comprehensive eye examination and not only on one parameter. Regular follow up is must to access progression which is essential for glaucoma. Glaucoma awareness has to be created among peoples, for them to get examined at early stage to rule out presence of glaucoma. If glaucoma is found, appropriate management is provided to prevent visual function impairment or loss.

Background: Rapid Survey by Government of India (2006-07) estimated the prevalence of blindness as 1% and 0.95% in India and Maharashtra respectively. Diabetic retinopathy (DR) is seen in 3.5% of all and 18% of diabetic cases above 40 years of age. Glaucoma is also one of the potentially blinding diseases that affect 11.2 million persons aged 40 years and above in India Objectives: of the project were to build the capacity of General Practitioners (GPs) & Female Health Volunteers (FHVs) for early detection & referral of diabetics cases from the rural area ,to establish an effective referral linkage between trained GPs, FHVs & Pravara hospital for further evaluation and treatment at referral center. Methods: The Project was implemented for three years (2004-2006) in the contiguous villages from four talukas of Ahmednagar district. Screening of general and high risk population for diabetic retinopathy and glaucoma through diagnostic camps & training workshops for General Practitioners (GPs) and Female Health Volunteers (FHVs) were organized. The trained GPs & FHVs from the villages of the project area subsequently referred the cases after preliminary screening at the community level to the Specialized DR and Glaucoma clinic Results: During the project period, 6860 individuals were screened by GP,FHV and the specialists. Out of the screened population, 486 cases (7.08%) were diagnosed and treated for glaucoma. Among 5176 individuals screened for DR, 453 cases (8.75%) were diagnosed and treated. Conclusion: Blindness due to DR and glaucoma can be reduced by organizing screening programmes at village level with the help of trained health volunteers and paramedical workers. Early detection, timely referral to higher centers and specialized treatment can prevent the long term morbidity due to blindness and would improve the quality of life.

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

Journal of Evidence Based Medicine and Healthcare, 2016

BACKGROUND Visual disability is a major public health problem in developing countries. Ocular diseases cause partial or total blindness. Causes can be treatable or non-treatable. Non-treatable causes lead to permanent visual disability. Persons with disabilities are given certificates mentioning percentage of disability after they demand certificates for various benefits. MATERIALS AND METHODS Records of the individuals who had been issued visual disability certificates during the period of 1 st March 2011 to 30 th June 2013 were obtained from Medical Records Office of the hospital and the information was analysed. RESULTS Out of 132 individuals with visual disability certificates, 97 were males and 35 were females. Avoidable causes of visual impairment were found in 43.18% individuals who were with corneal opacity, diabetic retinopathy, glaucoma, traumatic retinal detachment and postoperative retinal detachment. Unavoidable causes were found in 56.82% individuals who were with congenital diseases, optic nerve atrophy, hereditary causes, retinitis pigmentosa and age-related macular degeneration. Maximum numbers of individuals were issued certificates of 40% visual disability and least being 20% visual disability. Maximum number of individuals (48.49%) demanded disability certificates for benefit in jobs. CONCLUSION High number of congenital diseases of eye explains the need of genetic counselling. Gender-based inequality for getting visual disability certificates should be minimised through awareness and education of people. Avoiding trauma to eyes can reduce the visual disability due to corneal scarring and infections in large extent. Early diagnosis and treatment is necessary to prevent blindness from avoidable causes like diabetic retinopathy, glaucoma and retinopathy of prematurity.

Nepalese Journal of Ophthalmology

Glaucoma is a leading cause of blindness worldwide. The diagnosis and management of glaucoma is especially difficult in the developing countries. Lack of cost effective screening strategies, low income, low rates of literacy and inadequate infrastructures and human resources for eye care services are the obstacles for delivering glaucoma service. Majority of people with glaucoma in developing countries usually present at an advanced stage at the time of diagnosis; which negatively affects their quality of life. Further research, proper allocation of resources and collaborative effort by blindness prevention programs will hopefully provide new evidences on cost effective ways to screen and manage glaucoma in the future. This article aims to highlight the burden of glaucoma and ways to address the challenges in developing countries.

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.