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Wagner SK, Raja L, Cortina-Borja M, Huemer J, Struyven R, Keane PA, Balaskas K, Sim DA, Thomas PBM, Rahi JS, Solebo AL, Kang S. Determinants of non-attendance at face-to-face and telemedicine ophthalmic consultations. Br J Ophthalmol 2024; 108:625-632. [PMID: 37217292 PMCID: PMC10958256 DOI: 10.1136/bjo-2022-322389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/05/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND/AIMS Evaluation of telemedicine care models has highlighted its potential for exacerbating healthcare inequalities. This study seeks to identify and characterise factors associated with non-attendance across face-to-face and telemedicine outpatient appointments. METHODS A retrospective cohort study at a tertiary-level ophthalmic institution in the UK, between 1 January 2019 and 31 October 2021. Logistic regression modelled non-attendance against sociodemographic, clinical and operational exposure variables for all new patient registrations across five delivery modes: asynchronous, synchronous telephone, synchronous audiovisual and face to face prior to the pandemic and face to face during the pandemic. RESULTS A total of 85 924 patients (median age 55 years, 54.4% female) were newly registered. Non-attendance differed significantly by delivery mode: (9.0% face to face prepandemic, 10.5% face to face during the pandemic, 11.7% asynchronous and 7.8%, synchronous during pandemic). Male sex, greater levels of deprivation, a previously cancelled appointment and not self-reporting ethnicity were strongly associated with non-attendance across all delivery modes. Individuals identifying as black ethnicity had worse attendance in synchronous audiovisual clinics (adjusted OR 4.24, 95% CI 1.59 to 11.28) but not asynchronous. Those not self-reporting their ethnicity were from more deprived backgrounds, had worse broadband access and had significantly higher non-attendance across all modes (all p<0.001). CONCLUSION Persistent non-attendance among underserved populations attending telemedicine appointments highlights the challenge digital transformation faces for reducing healthcare inequalities. Implementation of new programmes should be accompanied by investigation into the differential health outcomes of vulnerable populations.
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Affiliation(s)
- Siegfried K Wagner
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Laxmi Raja
- Digital Clinical Laboratory, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Josef Huemer
- Department of Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Robbert Struyven
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Pearse A Keane
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Konstantinos Balaskas
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Dawn A Sim
- Institute of Ophthalmology, University College London, London, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL, London, UK
| | - Peter B M Thomas
- Institute of Ophthalmology, University College London, London, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL, London, UK
| | - Jugnoo S Rahi
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Ophthamology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Ulverscroft Vision Research Group, University College London, London, UK
| | - Ameenat Lola Solebo
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Ophthamology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Ulverscroft Vision Research Group, University College London, London, UK
| | - Swan Kang
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Adnexal department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Rathore M, Shweikh Y, Kelly SR, Crabb DP. Measures of multiple deprivation and visual field loss in glaucoma clinics in England: lessons from big data. Eye (Lond) 2023; 37:3615-3620. [PMID: 37165010 PMCID: PMC10686257 DOI: 10.1038/s41433-023-02567-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND/OBJECTIVES To examine the association between multiple deprivation with late diagnosis and rapid worsening of glaucoma in patients in English hospital eye services (HES). METHODS 602,439 visual fields (VFs) were extracted from five regionally different glaucoma clinics in England. Mean Deviation (MD) worse than -12 dB was used as a surrogate definition for advanced VF loss at diagnosis in patients with ≥2 reliable VF records. MD loss worse than -1 dB per year was used to define rapid VF progression in patients with ≥6 VFs. Patient data were stratified into deciles of the Index of Multiple Deprivation (IMD) from residential postcodes. RESULTS There was an association between IMD and advanced VF loss at diagnosis in 44,956 patients with 18% (293/1608) and 11% (771/6929) in the most and least deprived IMD decile, respectively. Age-corrected odds ratio (OR) for having advanced VF loss at entry into HES was 1.42 (95% confidence interval [CI] 1.21-1.67) and 0.75 (95% CI: 0.66-0.85) in the most and least deprived IMD decile respectively (reference = fifth decile). In 15,094 patients with follow up data (median [interquartile range] of 6.9 [4.5, 10.0] years), the proportion having rapid VF progression did not differ across the IMD spectrum. CONCLUSION Large-scale VF data from clinics indicates that glaucoma severity at presentation to English HES is associated with levels of multiple deprivation. We found no evidence to suggest likelihood of having rapid VF progression during follow-up is associated with IMD; this hints at equity of glaucoma care and outcomes once patients are in English HES.
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Affiliation(s)
- Mehal Rathore
- Department of Optometry and Visual Sciences, School of Health & Psychological Sciences, City, University of London, London, UK
| | - Yusrah Shweikh
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, West Sussex, UK
| | - Stephen R Kelly
- Department of Optometry and Visual Sciences, School of Health & Psychological Sciences, City, University of London, London, UK
| | - David P Crabb
- Department of Optometry and Visual Sciences, School of Health & Psychological Sciences, City, University of London, London, UK.
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Uche NJ, Okoye O, Kizor-Akaraiwe N, Chuka-Okosa C, Uche EO. Determinants of participation in glaucoma genomic research in South East Nigeria: A cross-sectional analytical study. PLoS One 2023; 18:e0289643. [PMID: 37976286 PMCID: PMC10655997 DOI: 10.1371/journal.pone.0289643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/21/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Genomic research advances the understanding of human health and disease. It also drives both the discovery of salient genetic association(s) as well as targeted screening, diagnostic and therapeutic strategies. Human subject participation is crucial for the success of genomic research. METHODS This is a cross sectional analytical study conducted at two tertiary centers in Enugu Southeast Nigeria. Semi structured questionnaires were administered to eligible consenting participants. Data on their demographics, willingness to participate in genomic research and motivation for participation were obtained. Data was analyzed using Stata version 17 and summarized using median, frequencies and interquartile range(IQR). Associations between covariates were evaluated with Chi square test and multivariable logistic regression. RESULTS Among 228 glaucoma subjects who participated in our study,119(52.2%) were female and 109(47.8%) were male. The median age was 64 years(IQR = 50-76). Although 219 (96.0%) participants expressed willingness to participate in a glaucoma genetic study, only 27(11.9%) of them will be willing to participate if there will not be feedback of results to participants (χ2 = 18.59, P<0.001). No participant expressed willingness to submit ocular tissue samples. Majority (96.2%) of subjects will not participate if the intended research required submission of body samples after death. Desire to know more about glaucoma (63%) was the most common reason for participation. In a multivariable logistic model, subjects between 61-90 years (p = 0.004, OR = 7.2) were 7 times more likely to express willingness to participate in glaucoma genetic research after adjusting for other covariates when compared to subjects aged 41-60 years. Other covariates did not influence participants' willingness. CONCLUSION Glaucoma subjects are more likely to be willing to participate in genetic research, if they would receive feedback of results. Willingness to participate in genetic research is significantly associated with age. LIMITATIONS We did not evaluate the salient options for feedback of results to participants in our study.
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Affiliation(s)
- Nkechinyere J. Uche
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Onochie Okoye
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | | | - Chimdi Chuka-Okosa
- Department of Ophthalmology, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Enoch O. Uche
- Department of Surgery, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
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Nwachukwu NZ, Arinze IC, Onwubiko SN, Maduka-Okafor FC, Aghaji AE, Nkwegu MO, Onwasigwe EN. Distribution of ocular perfusion pressure and its relationship with intraocular pressure in patients with primary open angle glaucoma in Enugu, South East, Nigeria. Niger J Clin Pract 2022; 25:1430-1434. [PMID: 36149201 DOI: 10.4103/njcp.njcp_1813_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Ocular perfusion pressure (OPP) has been suggested as a possible risk factor for the development and progression of primary open angle glaucoma (POAG). Aim To determine the distribution of OPP and its relationship with intraocular pressure (IOP) in Nigerian patients with POAG. Patients and Methods : A descriptive and comparative survey was adopted. A total of 120 subjects, 60 newly diagnosed POAG and 60 non-glaucomatous (NG) subjects, aged 40 years and above, who attended the ophthalmic clinic of University of Nigeria Teaching Hospital Enugu were recruited over a six-month period in 2019. All the subjects had ocular examination, blood pressure and IOP measurements. Statistical package for social sciences software version 25 was used for data analysis. Chi-square test, independent samples t-test, and Mann-Whitney U test were used for comparison while Pearson correlation and simple linear regression were used to ascertain the relationship. A P value of <0.05 was considered significant. Result The mean age of the participants was 57.9 + 11.9 years. The mean OPP was found to be significantly lower in the POAG subjects (Right eye, R = 43.6 ± 12.6, Left eye, L = 41.9 ± 13.3) mmHg compared with the NG group (R = 53.9 ± 10.9, L = 53.7 ± 10.9) mmHg (p < 0.001 for both eyes). A significant inverse relationship was observed between OPP and IOP in POAG subjects (p < 0.001), while there was none in NG subjects. Conclusion OPP was lower in POAG subjects than in NG subjects. The observed relationship suggests that reduced OPP may play a role in the development of POAG.
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Onwubiko SN, Udeh NN, Nkwegu O, Ukwu DO, Nwachukwu NZ. Glaucoma care in Nigeria: Is the current practice poised to tackle this emerging sight-threatening disease? Int Ophthalmol 2019; 39:2385-2390. [PMID: 30710253 DOI: 10.1007/s10792-019-01078-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 01/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the current practice on glaucoma care with the aim of highlighting its poise to tackle this emerging sight-threatening disease in Nigeria. METHODS This was a cross-sectional, descriptive, population-based survey involving 88 ophthalmologists. Information on their demographic characteristics, practice profile, challenges and prospects on glaucoma care was collected using a semi-structured, self-administered questionnaire in August 2016. Data were analysed using SPSS 20. RESULTS The participants are comprised of 46 (52.3%) males and 42 (47.7%) females, with a mean age of 42.2 ± 8.7 SD years. They were 45 (51.1%) consultants, 31 (35.2%) residents and 12 (13.6%) diplomates. Their years of practice were 8.8 ± 6.7 SD years. They worked mainly in government hospitals located at the southern part of Nigeria. The current practice was mainly comprehensive ophthalmology, 63 (71.6%). Only 2 (2.3%) had strict subspecialty practice. Others, 23 (26.1%), had combined practice. Eleven (12.5%) were glaucoma specialists and had combined practice. The majority of the participants, 57 (64.8%), were routinely diagnosed glaucoma properly. Sixty-three (71.6%) participants underwent trabeculectomy, 48 (54.5%) combined cataract surgery with trabeculectomy, 7 (8.0%) drainage implants, 5 (5.7%) laser trabeculoplasty, and 2 (2.3%) minimally invasive glaucoma surgery. Poor patients' acceptance and satisfaction, fear of complications, lengthy post-operative care and cost were the main deterrents to surgeries. Advocacy, public awareness, training of glaucoma specialists, provision of equipment and health insurance were the major recommendations on improving glaucoma care. CONCLUSION Given the meagre number of specialists and lack of strict subspecialty practice, optimal glaucoma care in Nigeria is still far from reality.
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Affiliation(s)
- S N Onwubiko
- Department of Ophthalmology, University of Nigeria Teaching Hospital, PMB 01129, Ituku-Ozalla, Enugu, Nigeria.
| | - N N Udeh
- Department of Ophthalmology, University of Nigeria Teaching Hospital, PMB 01129, Ituku-Ozalla, Enugu, Nigeria
| | - O Nkwegu
- Department of Ophthalmology, University of Nigeria Teaching Hospital, PMB 01129, Ituku-Ozalla, Enugu, Nigeria
| | - D O Ukwu
- Department of Ophthalmology, University of Nigeria Teaching Hospital, PMB 01129, Ituku-Ozalla, Enugu, Nigeria
| | - N Z Nwachukwu
- Department of Ophthalmology, University of Nigeria Teaching Hospital, PMB 01129, Ituku-Ozalla, Enugu, Nigeria
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Song Y, Song Q, Li L, Xu J, Liu X. Effect of ranibizumab on levels of IL-6 and VEGF in peripheral blood and aqueous humor of glaucoma rat model and association of IL-6 and VEGF with optic nerve damage. Exp Ther Med 2018; 16:2506-2510. [PMID: 30210601 PMCID: PMC6122519 DOI: 10.3892/etm.2018.6441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/19/2018] [Indexed: 01/30/2023] Open
Abstract
This study aims to investigate the effect of intravitreal injection of ranibizumab on glaucoma rat model and its effect on optic nerve injury. A total of 125 SD rats were used to establish glaucoma models. Of them, 80 well-established model were selected, 40 of which received intravitreal injections of ranibizumab and were assigned to the observation group. The remaining 40 received no drug and were assigned to the control group. After rats were sacrificed at the time-points, the retina was harvested. Numbers of retinal ganglion cells (RGCs) were counted under a fluorescence microscope. In the meantime, levels of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in peripheral blood and aqueous humor were determined. The levels of IL-6 and VEGF in peripheral blood and aqueous humor decreased gradually over the time of treatment in the observation group (P<0.05). In the control group the levels of IL-6 in peripheral blood and aqueous humor increased gradually over time (P<0.05). At the same time-point, the IL-6 level was higher in the control group than that in the observation group (P<0.05). The VEGF level in the observation group was lower in day 21 than that in day 7 (P<0.05). The VEGF level was higher in the control group than that in the observation group (P<0.05). The number of RGCs in the observation group increased gradually over the time of treatment, and there were significant differences in the number of RGCs between day 7 and 14, as well as day 14 and 21 (P<0.05). The number of RGCs in the control group decreased gradually over time (P<0.05). The levels of IL-6 and VEGF were all negatively correlated with the number of RGCs, and the correlation coefficient r and P-value were −0.743 and 0.012, and −0.675 and 0.022, respectively. Ranibizumab attenuated optic nerve injury by reducing levels of IL-6 and VEGF in peripheral blood and aqueous humor of glaucoma rat model.
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Affiliation(s)
- Yanling Song
- Department of Ophthalmology, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Qiujie Song
- Department of Ophthalmology, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Ling Li
- Department of Ophthalmology, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Jinfeng Xu
- Department of Ophthalmology, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Xingqiang Liu
- Department of Ophthalmology, People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
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Olawoye O, Sarimiye T, Ashaye A, Hwang YH, Han JC, Ahn BH. Surgical outcomes of membrane-tube-type glaucoma shunt device in indigenous West Africans. Clin Ophthalmol 2018; 12:279-286. [PMID: 29440870 PMCID: PMC5799847 DOI: 10.2147/opth.s148325] [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: 11/20/2022] Open
Abstract
Purpose The aim of this study was to report the safety and efficacy of the membrane-tube (MT)-type glaucoma shunt device (Finetube MT) in the management of refractory glaucoma in indigenous West Africans. Methods The Finetube MT was implanted into 25 eyes of 25 West African patients with refractory glaucoma. These patients had inadequate intraocular pressure (IOP) control despite maximum tolerable IOP-lowering medications with or without previous ocular surgeries. IOP, postoperative complications, interventions, visual acuities, and the number of IOP-lowering medications were analyzed preoperatively and postoperatively. Results The mean (standard deviation [SD]) age of the patients was 49.7 (20.9) years. The mean (SD) follow-up duration was 21.0 (10.6) months. Postoperatively, the mean (SD) IOP reduced from a preoperative value of 38.1 (10.3) mmHg to 14.5 (4.6), 16.1 (7.8), and 14.7 (3.0) mmHg at 1, 2, and 3 years postoperatively, respectively, representing 61.9%, 57.7%, and 61.4% reduction from baseline (P<0.01). The mean (SD) number of IOP-lowering medications reduced from 4.1 (1.0) to 0.6 (0.9) at 1 year and 0.9 (1.1) at 2 years after the operation (P<0.01). Using an IOP level between 6 and 21 mmHg and reduced by ≥20% from baseline, the cumulative survival rate (standard error) was 96.0% (3.9%) at 6 months, 89.0% (6.0%) at 18 months, and 81.3% (10.6%) at 3 years after the operation. There was no postoperative ocular hypotony, tube occlusion, or device exposure. Conclusion The Finetube MT may effectively control IOP with minimal risk of postoperative complications in indigenous West Africans.
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Affiliation(s)
- Olusola Olawoye
- Department of Ophthalmology, College of Medicine, University of Ibadan.,Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | - Tarela Sarimiye
- Department of Ophthalmology, College of Medicine, University of Ibadan.,Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | - Adeyinka Ashaye
- Department of Ophthalmology, College of Medicine, University of Ibadan.,Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | - Young Hoon Hwang
- Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Myung-Gok Eye Research Institute
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Byung Heon Ahn
- Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Myung-Gok Eye Research Institute
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Kyari F, Gilbert C, Blanchet K, Wormald R. Improving services for glaucoma care in Nigeria: implications for policy and programmes to achieve universal health coverage. Br J Ophthalmol 2017; 101:543-547. [PMID: 28202479 DOI: 10.1136/bjophthalmol-2016-310040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/17/2017] [Accepted: 01/21/2017] [Indexed: 01/23/2023]
Abstract
Glaucoma in Africa is sometimes referred to as the silent thief of sight. In Nigeria, glaucoma is common, it is serious, ophthalmologists face many constraints in managing it, people do not even know they have it until it is advanced, patients do not understand or comply with treatment after they are diagnosed and the poor are more likely to be glaucoma blind. Available evidence indicates that the health system in Nigeria is failing to meet the needs of patients with glaucoma. Based on evidence, we propose future directions for improving services for glaucoma care in Nigeria, and the implications for policy and programmes to control glaucoma blindness, using a health system-oriented approach. Three complementary strategies are required: (i) strengthening clinical services for glaucoma-by developing models of glaucoma care, improving clinical treatment options, making medicines and equipment available, financing glaucoma care and training eye care workers; (ii) introducing initiatives for earlier detection of glaucoma in the clinic and approaches in the community and (iii) strengthening health system governance. Glaucoma is a complex disease to manage and addressing it as a public health problem is challenging. However, we need to change the paradigm to recognise that glaucoma is a potentially avoidable cause of blindness in Africa.
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Affiliation(s)
- Fatima Kyari
- Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,Baze University, Abuja, Nigeria
| | - Clare Gilbert
- Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Karl Blanchet
- Department of Global Health and Development, Health in Humanitarian Crisis Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Wormald
- Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Ophthalmology, Moorfields Eye Hospital, London, UK
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Kyari F, Chandler CI, Martin M, Gilbert CE. So let me find my way, whatever it will cost me, rather than leaving myself in darkness: experiences of glaucoma in Nigeria. Glob Health Action 2016; 9:31886. [PMID: 27924740 PMCID: PMC5141371 DOI: 10.3402/gha.v9.31886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Blindness from glaucoma is associated with socio-economic deprivation, presumed to reflect poor access to care and poor adherence to treatment. OBJECTIVES To determine why people with glaucoma are presenting late for treatment and to understand access to glaucoma care. Additionally, we sought to identify what patients and the community know, do and think about the condition and why the poor are the most affected with glaucoma blindness. DESIGN Study participants were from four communities and two hospitals in Abuja-FCT and Kaduna State, Nigeria. A total of 120 participants were involved, including 8 focus group discussions, 7 in-depth interviews with blind/visually impaired glaucoma patients, 5 rapid direct observation visits with these patients and 13 exit interviews of glaucoma patients in the hospital. The data were analysed using content analysis, interpreting participant experiences in terms of three key steps conceptualised as important in the care pathway: what it takes to know glaucoma, to reach a diagnosis and to access continued care. RESULTS This article presents multiple narratives of accessing and maintaining glaucoma care and how people manage and cope with the disease. People may be presenting late due to structural barriers, which include lack of knowledge and awareness about glaucoma and not finding an appropriately equipped health care facility. What keeps glaucoma patients within the care pathway are a good hospital experience; a support structure involving family, counselling and shared patients' experiences; and an informed choice of treatment, as well as agency. The high cost of purchasing care is a major factor for patients dropping out of treatment. CONCLUSION The findings suggest the need to address economic and social structural drivers as glaucoma presents another case study to demonstrate that poverty is a strong driver for blindness. There is also a need for clear glaucoma care pathways with early case finding in the community, two-way referral/feedback systems, well-equipped glaucoma care hospitals and better eye health care financing.
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Affiliation(s)
- Fatima Kyari
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria;
| | - Clare I Chandler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martha Martin
- Initiative for Community and Rural Eye Care, Kaduna, Nigeria
| | - Clare E Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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