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Obasuyi OC, Yeye-Agba OO, Ofuadarho OJ. Factors limiting glaucoma care among glaucoma patients in Nigeria: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002488. [PMID: 38277402 PMCID: PMC10817109 DOI: 10.1371/journal.pgph.0002488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/19/2023] [Indexed: 01/28/2024]
Abstract
Glaucoma currently accounts for 11% of irreversible visual loss worldwide. Due to many factors, patients do not access the glaucoma care pathway and present late with poor vision, while many are undiagnosed or untreated. These factors may be personal-level dispositions or Institutional-level dispositions, limiting the awareness, diagnosis, and treatment of glaucoma or adherence to medications or follow-up clinic visits. This scoping review followed the JBI methodology for scoping reviews and was pre-registered on the open science platform (https://osf.io/wqx57/?view_only=727eb6c803764509a2809e5d0794e214). The PUBMED, EMBASE, WEB OF SCIENCE, AJOL, and GOOGLE SCHOLAR databases were systematically searched for studies published in English between 1990 and June 2023. Data were extracted and analysed along a conceptualised framework of factors limiting access to glaucoma care in Nigeria. Of the 336 records retrieved, 13 studies were included in this scoping review. These included one (1) mixed method (quantitative/qualitative) study, three qualitative studies, and nine quantitative studies spanning 2008-2022 covering eight states and 2,643 sampled respondents. Nine studies reported personal-level dispositions limiting glaucoma care, including low levels of education, unemployment, gender, living distance from the hospital, cost of care, and faith/religion. Four reported institutional-level dispositions, including the lack of proper equipment and expertise to diagnose or manage glaucoma. The factors limiting Glaucoma care in Nigeria are varied and may act alone or combined with other elements to determine the awareness or knowledge of glaucoma, uptake of glaucoma surgery, medication adherence, or clinic follow-up. While most of these factors limiting glaucoma care in Nigeria may be amenable to policy, a bottom-up approach is needed to improve the community's awareness and uptake of glaucoma services. A shift from the over-dependence and reliance on tertiary hospitals, which are often far away from the people who need them, is required to bridge the information and service gap currently being witnessed.
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Olawoye O, Washaya J, Gessesse GW, Balo K, Agre J, Macheka B, Kizor-Akaraiwe N, Pons J, Sarimiye T, Ashaye A, Garba F, Chitedze R, Ibanga A, Mahdi A, Ogunro A, Budengeri P, Ajibode HA, Tamrat L, Onakoya A, Okeke S, Giorgis AT, Okosa CC, Fowobaje K, Cook S, Lawrence S, Chan VF, Azuara-Blanco A, Congdon N, Realini T. Glaucoma Treatment Patterns in Sub-Saharan Africa. J Glaucoma 2023; 32:815-819. [PMID: 37523638 DOI: 10.1097/ijg.0000000000002273] [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: 04/07/2023] [Accepted: 06/02/2023] [Indexed: 08/02/2023]
Abstract
PRCIS Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma. Laser therapy was underutilized where they were available. Physicians were more likely to recommend surgery in severe glaucoma, laser therapy in mild glaucoma, while recommendation of medical therapy did not depend on glaucoma severity. PURPOSE To characterize treatment patterns for newly diagnosed glaucoma in sub-Saharan Africa (SSA). METHODS This was a multicenter cross-sectional study of adults newly diagnosed with glaucoma at 27 eye care centers in 10 African countries. In addition to demographic and clinical data, physician treatment recommendations (medication, laser, surgery, or no treatment) were recorded. Statistical analyses were performed using STATA version 14.0. RESULTS Data from 1201 patients were analyzed. Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma (69.4%), with laser (13.2%), surgery (14.9%), and no treatment (2.5%) recommended to the remaining patients. All sites had medical therapy available and most (25/27, 92.6%) could provide surgical treatment; only 16/27 (59.3%) sites offered laser, and at these sites, 30.8% of eyes were recommended to undergo primary laser procedures. As glaucoma severity increased, the laser was recommended less, surgery more, and medications unchanged. Patient acceptance of medical therapy was 99.1%, laser 88.3%, and surgery 69.3%. CONCLUSIONS Medical therapy for first-line glaucoma management is preferred by most physicians in SSA (69%). Laser therapy may be underutilized at centers where it is available. These findings underscore the need for comparative studies of glaucoma treatments in SSA to inform the development of evidence-based treatment guidelines and of programs to reduce glaucoma blindness in SSA. Strategic approaches to glaucoma therapy in SSA must address the question of whether medical therapy is the most optimal first-line approach in this setting.
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Affiliation(s)
- Olusola Olawoye
- Department of Ophthalmology, College of Medicine, University of Ibadan, Nigeria
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, United Kingdom
| | | | - Girum W Gessesse
- Department of Ophthalmology, St Pauls Millenium Hospital, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Komi Balo
- Department of Ophthalmology, Sylvanus Olympio University Hospital, Lome Togo
| | - Jeremie Agre
- Department of Ophthalmology, The Eye Cliinic Bujumbura Burundi, West Africa
| | - Boniface Macheka
- Department of Ophthalmology, Sekuru Kaguvi Hospital, Harare, Zimbabwe
| | - Nkiru Kizor-Akaraiwe
- Department of Ophthalmology, College of Medicine, Enugu State University of Technology, Enugu, Nigeria
- The Eye Specialists Hospital (TESH), Enugu, Nigeria
| | - Jonathan Pons
- Department of Ophthalmology, Good Shepherd Hospital, Siteki, Eswatini
| | - Tarela Sarimiye
- Department of Ophthalmology, College of Medicine, University of Ibadan, Nigeria
| | - Adeyinka Ashaye
- Department of Ophthalmology, College of Medicine, University of Ibadan, Nigeria
| | - Farouk Garba
- Department of Ophthalmology, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | | | - Affiong Ibanga
- Department of Ophthalmology, College of Medical Sciences, University of Nigeria Ituku-Ozalla Campus Enugu Nigeria
| | - Abdull Mahdi
- Department of Ophthalmology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Patrick Budengeri
- Department of Ophthalmology, Clinique de l'Oeil de Bujumbura, Burundi (Ophthalmology centre Siloam Abidjan)
| | | | - Lemlem Tamrat
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Adeola Onakoya
- Department of Ophthalmology, Lagos University Teaching Hospital Idi Araba, Lagos, Nigeria
| | - Suhanyah Okeke
- Enugu State University of Science and Technology, Esut Parklane, Enugu, Nigeria
| | - Abeba T Giorgis
- Department of Ophthalmology, SM, CHS, Addis Ababa University of Michigan School Michigan United States
| | - Chimdi Chuka Okosa
- Department of Ophthalmology, College of Medicine, University of Nigeria, Ituku-Ozalla campus
| | - Kayode Fowobaje
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | | | - Scott Lawrence
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Ving Fai Chan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, United Kingdom
| | - Augusto Azuara-Blanco
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, United Kingdom
| | - Nathan Congdon
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, United Kingdom
- Orbis International, New York, NY
| | - Tony Realini
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, WV
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Hou CH, Shih SF, Pu C. Adherence of those With Self-Reported Glaucoma in the United States to Eye Examination Visits. J Glaucoma 2023; 32:885-890. [PMID: 36971614 DOI: 10.1097/ijg.0000000000002213] [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: 08/01/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023]
Abstract
PRCIS The adherence of American patients with self-reported glaucoma to the follow-up recommendations is extremely low. Estimated adherence rate is lower than that obtained by previous studies that did not use a US nationally representative sample. PURPOSE To evaluate adherence to ophthalmic outpatient follow-up visits and vision examinations in the American population aged 40 years or above. METHODS The percentage of American patients aged≥40 years who adhered to glaucoma treatment guidelines was estimated using 2015-2019 Medical Expenditure Panel Survey (MEPS) data. Adherence was defined according to the International Council of Ophthalmology guidelines. We also compared individuals with and without self-reported glaucoma who have made at least one ophthalmic outpatient visit and at least 1 vision examination visit within a year. Differences in means and percentages were estimated to account for the covariance due to the complex sampling design. RESULTS Approximately 4.4 million people aged or above 40 years had self-reported glaucoma in 2019 (3.21%). The rate of prevalence significantly differed with race, with Black people having the highest prevalence in all studied years. Only 7.1% (95% CI: 0.049-0.102) and 2.67% (95% CI: 0.0137-0.0519) of this population underwent at least 1 ophthalmic outpatient examination or 1 vision examination per year. Older age, never married status, higher education, eye conditions, and diabetes were significantly associated with a higher probability of ophthalmic health care use. CONCLUSIONS Adherence to follow-up among patients with self-reported glaucoma in this population-level study was lower than that in previously reported American, non-nationally representative studies. Barriers to adherence at the population level should be assessed to inform the design of future policy or program interventions.
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Affiliation(s)
- Chiun-Ho Hou
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, China
| | - Shu-Fang Shih
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University
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Realini T, Shillingford-Ricketts H, Burt D, Balasubramani GK. Long-Term Outcomes of Selective Laser Trabeculoplasty for Open-Angle Glaucoma in the Caribbean. Am J Ophthalmol 2021; 232:83-89. [PMID: 34153267 DOI: 10.1016/j.ajo.2021.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/05/2021] [Accepted: 06/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To characterize long-term clinical outcomes of monotherapy selective laser trabeculoplasty (SLT) in Afro-Caribbean patients with open-angle glaucoma (OAG). DESIGN This was a post hoc analysis of nearly 8 years (median, 3.2; interquartile range, 2.1-7.1) of pooled data from the West Indies Glaucoma Laser Study and its preliminary study. METHODS Setting: Three eye care practices in Saint Lucia and Dominica. PARTICIPANTS Afro-Caribbean adults with mild-moderate OAG treated with ≤2 medications (61 in preliminary study, 72 in West Indies Glaucoma Laser Study). INTERVENTION Participants underwent medication washout, baseline intraocular pressure (IOP) determination, and bilateral 360-degree SLT. Participants were followed for up to 94 months. Repeat SLT was performed according to prespecified criteria. MAIN OUTCOME MEASURES The primary outcome was mean IOP reduction from baseline. The secondary outcome was medication-free survival with SLT repeated as needed. RESULTS The pooled data set included 265 eyes of 133 Afro-Caribbean participants. The mean (standard deviation) baseline IOP was 21.2 (3.4) and 21.2 (3.9) mmHg in right and left eyes, respectively. Over 8 years, the mean IOP ranged from 12.8 to 15.7 mm Hg and from 13.1 to 15.8 mm Hg, respectively (P < .0001 for every comparison with baseline). The median medication-free survival time for initial SLT was 85.4 months in both eyes. The 94-month medication-free survival of SLT repeated as needed was 71.2% and 71.7%, respectively. CONCLUSIONS Monotherapy SLT, repeated as needed, safely provides significant IOP reductions in most Afro-Caribbean adults with primary OAG through nearly 8 years of follow-up and has significant potential to delay or prevent glaucoma-related vision loss in black patients in low-resource regions.
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Olawoye O, Azuara-Blanco A, Chan VF, Piyasena P, Crealey GE, O'Neill C, Congdon N. A Review to Populate A Proposed Cost-Effectiveness Analysis of Glaucoma Screening in Sub-Saharan Africa. Ophthalmic Epidemiol 2021; 29:328-338. [PMID: 34372742 DOI: 10.1080/09286586.2021.1939887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To populate a proposed cost-effectiveness analysis of glaucoma screening in Sub-Saharan Africa (SSA).A complete search was conducted on PubMed, Medline and African Journals Online (AJOL) to obtain relevant published articles, which were included in this review. All relevant articles on prevalence of glaucoma in SSA and among other African-derived populations, severity of glaucoma, cost of diagnosis and management, clinical effectiveness of glaucoma screening and treatment and the different glaucoma screening strategies in SSA were reviewed.Population screening interventions for glaucoma may be considered as follows: standalone screening for glaucoma, screening for glaucoma during cataract outreach, and screening incorporated with diabetic retinopathy image review using tele-ophthalmology. Our review suggests that cost of glaucoma treatment is relatively low with cost of medical treatment ranging from USD 273 to USD 480 per year/patient and surgical treatment cost of USD 283 per patient as with other developing countries. Compliance with medication is moderate to good in about 50% of glaucoma patients. Prevalence of glaucoma is much higher in SSA and almost 50% of glaucoma patients are blind in at least one eye at presentation in clinics (without outreach screening). Our review suggests a moderate sensitivity and specificity in identifying glaucoma with basic equipment (direct ophthalmoscope, contact tonometer and frequency doubling technology) during outreach screening although about a third or fewer take up glaucoma services in clinics.Our review provides the necessary information to conduct a cost-effective analysis of glaucoma screening in SSA using the decision Markov model.
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Affiliation(s)
- Olusola Olawoye
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,School of Optometry, College of Health Sciences, University of Kwa-Zulu Natal (Ving Fai Chan)
| | - Augusto Azuara-Blanco
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Ving Fai Chan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,College of Health Sciences, University of Kwa-Zulu Natal, South Africa
| | - Prabhath Piyasena
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Grainne E Crealey
- J.E. Cairns School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Nathan Congdon
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Eni EN, Nolan W, Eval B, Buchan JC. What Glaucoma Surgical Rate could Serve as a Target for West Africa? A Systematic Review. J Curr Glaucoma Pract 2021; 15:19-27. [PMID: 34393452 PMCID: PMC8322596 DOI: 10.5005/jp-journals-10078-1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
AIM AND OBJECTIVE This study aimed to use the available evidence to model a glaucoma surgical rate (GSR), which could serve as a target for West Africa. MATERIALS AND METHODS A comprehensive literature search was performed in Medline, Embase, Global Health, and CINAHL, and studies published between January 1, 2000, and June 19, 2020, were retrieved. Study selection, quality appraisal, and data extraction were performed and the results of individual studies aggregated and presented using a narrative synthesis. Using these data, we aimed to construct a target GSR per million population per year that is sufficient to offer trabeculectomy to most patients with glaucoma who are diagnosed, and for whom other treatment options are either ineffective or inappropriate. The findings were then used to develop a trabeculectomy target for West Africa. RESULTS Initial searches returned 633 references, of which 33 unique studies were eligible for inclusion. The glaucoma prevalence population-based surveys identified, reported a wide range of prevalence of primary open-angle glaucoma (POAG) ranging from 1.0 to 8.4%. The studies on glaucoma medications reported intraocular pressure (IOP)-lowering effects ranging from 12.8% (beta-blockers) to 63.7% (Timolol-Latanoprost combinations). The adherence rate to antiglaucoma medications spanned from 10.3 to 82.3%. Regarding selective laser trabeculoplasty (SLT), only two studies were found. All the studies on trabeculectomy showed a significant reduction in IOPs at different follow-up periods with many reporting the absence of vision-threatening complications. From these available data, a GSR of 50 trabeculectomies was suggested for countries in West Africa. CONCLUSION This trabeculectomy target metric is expected to minimize POAG blindness in the West African subregion. CLINICAL SIGNIFICANCE The proposed GSR will enable eye care workers involved in glaucoma care in West Africa to assess their efforts compared with the proposed target. The gap will signal the potential for improvement. HOW TO CITE THIS ARTICLE Eni EN, Nolan W, Eval B, et al. What Glaucoma Surgical Rate could Serve as a Target for West Africa? A Systematic Review. J Curr Glaucoma Pract 2021;15(1):19-27.
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Affiliation(s)
- Egbula N Eni
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Winifred Nolan
- Department of Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, UK
| | - Bassey Eval
- Department of Eye Care Programme, Cross River State Ministry of Health, Nigeria
| | - John C Buchan
- Department of Ophthalmology, The Leeds Teaching Hospitals NHS Trust, UK
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