What do people with glaucoma know about their condition? A comparative cross-sectional incidence and prevalence survey

Knowledge of Glaucoma Among New Patients to a Tertiary Eye Care Center in China

PRCIS

Patients with glaucoma who had previously been evaluated by eye care professionals at lower-level facilities possessed limited awareness and knowledge about their condition upon presentation to a tertiary-care ophthalmic hospital, highlighting the need for improved patient education throughout the healthcare system.

PURPOSE

To investigate the depth of knowledge about glaucoma among patients who were referred to a tertiary eye hospital for their first visit.

MATERIAL AND METHODS

An internally designed questionnaire (scored 0-15) assessing patients' knowledge about glaucoma was administered at a glaucoma outpatient service. Patients were divided into normal, high-risk, and glaucoma groups based on comprehensive eye evaluation. Scores were analyzed by regression models. The relationship between glaucoma awareness and the stage of disease at presentation was explored.

RESULTS

One hundred thirty patients were enrolled and divided into 3 groups. The group with definitive diagnosis of glaucoma had the most prior medical visits but scored the lowest, with the primary source of information being previous healthcare providers. The high-risk group possessed more knowledge about glaucoma than the other groups and tended to acquire knowledge from the media and sought tertiary care earlier. Significant differences were observed between the glaucoma and the high-risk groups in all aspects of glaucoma knowledge ( P < 0.05). In addition, the average scores of all participants who had visited lower-level facilities were low. Education, economic status, presence of risk factors for glaucoma positively correlated with awareness and knowledge, whereas age had an inverse relationship (all P < 0.05). Ophthalmic visit frequency had no impact ( P > 0.05). Doctors were the primary source of information for all groups, but social media users were better informed.

CONCLUSIONS

Patients at tertiary eye care centers lack glaucoma knowledge, despite experience with eye care providers previously. Implementing health education at all levels is crucial in preventing glaucoma-related visual impairment.

A Previsit Intervention's Influence on Glaucoma Topics Discussed between Black Patients and Providers

PURPOSE

The objectives of this study were to conduct a randomized controlled trial testing the effectiveness of a previsit glaucoma video/question prompt list intervention, and to examine the impact on how often providers educate Black patients about glaucoma and glaucoma medication topics during visits.

DESIGN

A randomized controlled trial of a glaucoma question prompt list/video intervention.

PARTICIPANTS

Black patients with a diagnosis of glaucoma who are taking 1 or more glaucoma medications and report being nonadherent.

METHODS

One hundred eighty-nine Black patients with glaucoma were enrolled and assigned to either a usual care or an intervention group where they watched a video emphasizing the importance of asking questions and received a glaucoma question prompt list to complete before clinic visits. Visits were audio-taped and patients were interviewed after visits.

MAIN OUTCOME MEASURES

Whether the provider educates about different glaucoma and glaucoma medication topics.

RESULTS

Patients in the intervention group were significantly more likely to ask providers 1 or more questions about glaucoma and its treatment. Providers were significantly more likely to educate intervention patients about their diagnosis (P = 0.001), intraocular pressure (P = 0.03), the likelihood of the need for long-term therapy (P = 0.001), and the physical changes associated with glaucoma (P = 0.001) than usual-care patients. Providers were also significantly more likely to educate intervention patients about the purpose of their medications (P = 0.03) and side effects (P = 0.001) than usual-care patients. Providers only educated 29% of patients about adherence (33% of intervention group patients and 25% of usual-care patients). Few providers educated patients about barriers and fears/concerns in using glaucoma medications, the cost of medications and insurance coverage, how to administer eye drops, and nasolacrimal occlusion.

CONCLUSIONS

The intervention significantly increased provider education about many glaucoma and glaucoma medication topics.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The Effectiveness of a Nurse-led Glaucoma Education on Patient Knowledge and Compliance Motivation Levels: A 1-year Prospective Case Series

Purpose

To evaluate the impact of a nurse-led glaucoma education program on patient knowledge and compliance levels in an Asian population.

Materials and Methods

A 1-year prospective case series involving 69 adult glaucoma patients. Each patient attended a standardized nurse-led glaucoma education session. A questionnaire was administered by a single nurse-clinician and analyzed at three time points (preeducation for baseline, immediately posteducation, and at the 1-year follow-up) to evaluate for associations with patient knowledge and compliance motivation levels.

Results

A total of 64 patients were included in the final analysis. Patients with higher educational qualifications or who were employed had better baseline knowledge of glaucoma. Younger patients had higher baseline compliance motivation levels. Immediately posteducation, both median patient knowledge score and compliance motivation levels had a statistically significant increase. Patients on more glaucoma eye drops had greater immediate improvement in confidence in eye drop application. Patients with more positive Humphrey visual field mean deviation values had a greater immediate improvement in confidence in their understanding of glaucoma. A total of 34 patients were readministered the questionnaire at the 1-year time point. Median score for patient knowledge was highest at this point. Employed patients demonstrated better patient knowledge at baseline and at 1-year time point compared to unemployed patients. Unemployed patients experienced a significant improvement in scores from baseline to immediately posteducation, but improvement from immediately posteducation to the 1-year time point was insignificant was insignificant.

Conclusion

Our study has examined the effectiveness of a nurse-led glaucoma education program in an Asian population, demonstrating improvement in both patient knowledge and compliance motivation levels up to 1 year after intervention.

How to cite this article

Sng JJ, Ang BCH, Soo Hoo WC, et al. The Effectiveness of a Nurse-led Glaucoma Education on Patient Knowledge and Compliance Motivation Levels: A 1-year Prospective Case Series. J Curr Glaucoma Pract 2023;17(3):149-156.

Glaucoma Knowledge and Disease Severity in a Veteran Population: The Medication Adherence in Glaucoma to Improve Care (MAGIC) Study

PURPOSE

To assess the relationship between glaucoma knowledge and disease severity.

DESIGN

Substudy of a randomized controlled trial at a single Veterans Affairs (VA) eye clinic.

PARTICIPANTS

Veterans with medically treated open-angle glaucoma who self-reported poor medication adherence.

METHODS

Participants completed a glaucoma knowledge assessment using the 10-question National Eye Health Education Program (NEHEP) Eye-Q Test on glaucoma knowledge. Disease severity was determined using visual field criteria. Multiple linear regression was used to assess the association of NEHEP Eye-Q score and disease severity, adjusting for age, number of glaucoma medications, race, sex, and VA Care Assessment Needs (CAN) score.

MAIN OUTCOME MEASURES

In this cross-sectional, preintervention analysis, the main outcome was glaucoma knowledge as measured by the NEHEP Eye-Q Test.

RESULTS

Among the 200 study participants, glaucoma severity was mild in 53 (27%), moderate in 56 (28%), severe in 74 (37%), and indeterminant in 17 (9%). The NEHEP Eye-Q scores were low across all severity levels. Scored out of 10, the mean (standard deviation) NEHEP Eye-Q scores were 6.06 (1.57) for mild, 6.21 (1.47) for moderate, 6.28 (1.82) for severe, and 5.88 (1.93) for indeterminate stage. There was no evidence of a significant association between NEHEP scores and disease severity categories (P = 0.78). A regression model did not identify a significant estimated association between NEHEP Eye-Q scores and disease severity after adjusting for age, CAN risk score, number of glaucoma medications, race, and sex.

CONCLUSIONS

There was no difference in level of glaucoma knowledge based on disease severity. Education-based interventions may benefit patients across all glaucoma stages.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Randomized Control Trial of the Impact of Patient Decision Aid Developed for Chinese Primary Open-Angle Glaucoma Patients

INTRODUCTION

Patient decision aid (PDA) is a tool to prompt shared decision-making. The aim of this study was to evaluate the impact of a PDA on Chinese primary open-angle glaucoma patients.

METHODS

All subjects were randomized into control and PDA group. The questionnaires, including 1) glaucoma knowledge; 2) 8-item Morisky medication adherence scale (MMAS-8); 3) 10-item glaucoma medication adherence self-efficacy scale (GMASES-10); and 4) 16-item decision conflict scale (DCS), were evaluated at baseline, 3- and 6-month follow-up.

RESULTS

Totally, 156 subjects participated in this study, including 77 in the control group and 79 in the PDA group. Compared to the control group, PDA group showed around 1 point more improvement in disease knowledge at both 3 and 6 months (both p < 0.05), 2.5 (95% CI: [1.0, 4.1]) and 1.9 (95% CI: [0.2, 3.7]) points more improvement in GMASES-10 at 3 and 6 months, respectively, and reduction in DCS by 8.8 (95% CI: [4.6, 12.9]) points more at 3 months and 13.5 (95% CI: [8.9, 18.0]) points more at 6 months. No difference was detected in MMAS-8.

CONCLUSION

PDA led to improvement in disease knowledge and self-confidence in medication adherence and reduced decision conflict compared to control group for at least 6 months.

Predictors of glaucoma knowledge and its risk factors among Jordanian patients with primary open angle glaucoma at a tertiary teaching hospital: A cross-sectional survey

PURPOSE OF STUDY

To assess and compare glaucoma knowledge between Jordanian patients with glaucoma and non-glaucoma ophthalmic patients.

METHODS

A cross-sectional survey was developed after an extensive literature search to investigate glaucoma-related knowledge among participants with glaucoma visiting the Jordan University Hospital clinics from October 2021 to February 2022. Responses were compared to a sample of ophthalmic participants with eye conditions other than glaucoma visiting the ophthalmology clinics at the same time frame.

RESULTS

A total of 256 participants filled out the survey, of which 53.1% were diagnosed with glaucoma while 46.9% had ophthalmic conditions other than glaucoma. Our sample of participants is characterized by a mean age of 52.2 ± 17.8 years and a male-to-female ratio of 1.04:1. Overall, participants with glaucoma were more aware of their disease than participants with other ophthalmic conditions. Compared to their ophthalmic non-glaucoma counterparts, those diagnosed with glaucoma face significantly more daily life difficulties due to their ophthalmic disease (p <0.001). Results of the independent sample t-test demonstrate that participants with glaucoma have significantly higher knowledge scores (p <0.001) and were able to recognize more glaucoma symptoms than their non-glaucoma counterparts (p = 0.002). Similarly, those with a positive family history of glaucoma displayed higher knowledge (p = 0.005). Multivariate linear regression demonstrates that family history of glaucoma, higher symptom recognition score, reliance on ophthalmologists, and the internet for glaucoma-related information are positive predictors of higher knowledge scores.

CONCLUSION

We have demonstrated that both glaucoma and non-glaucoma ophthalmic patients display average levels of glaucoma knowledge. Raising awareness through various interventions may improve the lifestyles of patients with glaucoma and alleviate the economic burden associated with treating the disease.

Applying the Health Belief Model to predict preference for surgical intervention versus medical therapy among patients with open-angle glaucoma

Objective

To determine the factors influencing patient preference of surgical intervention versus medical therapy for open-angle glaucoma based on the Health Belief Model.

Methods and analysis

The study is a cross-sectional study. The study was conducted on 309 patients having open-angle glaucoma attending glaucoma clinic at Alexandria Ophthalmology Hospital, Alexandria, Egypt. The patients were subjected to an interview questionnaire comprising demographic data, patient knowledge and beliefs about glaucoma, glaucoma medications and treatment options, and patient preference of treatment modality, based on the Health Belief Model.

Results

About half of the patients (46%) were found to prefer surgical intervention. Patients were less knowledgeable about glaucoma, in general, but knowledge scores of patients preferring surgical intervention were significantly higher than those preferring medical therapy (Percentage Mean Score, PMS: 42.46%–37.37%, respectively). Male and female patients using more medications were significantly more likely to prefer surgical intervention (p=0.015 and p=0.003, respectively). Patients having preference for surgical intervention reported higher scores for perceived susceptibility and severity of long-term medical therapy (PMS=72.61% vs 54.62%–68.62% versus 52.83%, respectively), higher scores for perceived benefits of surgical intervention (PMS=92.90% vs 43.96%, respectively) and higher scores for self-efficacy (PMS=97.18% vs 50.37%, respectively). Meanwhile, they obtained lower scores for perceived barriers to surgical intervention (PMS=53.43% vs 86.07%, respectively).

Conclusions

Male gender, increased number of used eye-drops and more knowledge about glaucoma were significantly associated with patient preference for surgical intervention. Perceived benefits and barriers and self-efficacy were the significant predictors for patient surgical interference preference.

The Vision Detroit Project: Integrated Screening and Community Eye-Health Education Interventions Improve Eyecare Awareness

PURPOSE

Poor eye-health knowledge and health literacy are pervasive, contributing to worse outcomes. This study aims to examine short- and long-term eye-health knowledge retention following eye-health education interventions in adults.

METHODS

Vision Detroit was an outreach vision screening program that integrated a 5-Point Teaching Intervention (5PTI), at a Southwest Community Center (SW-CC) from 2015-2017. The 5PTI consists of eye-health learning points developed to verbally educate patients. During vision screenings, eye-health knowledge tests were administered before and after 5PTI (Test 1 and Test 2, respectively). In 2016, Community Eye-Health Education Interventions (CHEI) were initiated at the SW-CC. During CHEI, bilingual healthcare students taught voluntary SW-CC members the 5PTI learning points, regardless of participant interest to attend future screenings. CHEI sessions occurred on separate dates prior to vision screening events. Test 1 and Test 2 scores were compared for all participants. Test 1 scores were compared for those who underwent CHEI prior to vision screening (CHEI positive) versus those who did not (CHEI negative).

RESULTS

Two-hundred-seventeen adult patients met inclusion criteria, with 75.8% women, 82.6% Hispanic, mean age 50.4 ± 16.2 years, 74.6% had high school or less education, and 49.2% had health insurance. Test 1 to Test 2 scores improved after 5PTI (71.2 ± 26.4% vs. 97.2 ± 9.9%, p < .00001). Forty-eight participants attended CHEI and subsequent vision screening. Test 1 scores were higher among those CHEI positive versus CHEI negative (81.1 ± 2.1% vs. 68.3 ± 3.4%, p = .0027).

CONCLUSION

Simple eye-health education interventions, delivered during vision screenings and via community-based education, can improve eye-health knowledge.

Knowledge of glaucoma and associated factors among primary glaucoma patients in Kunming, China

Background

To investigate the level of knowledge, attitude, and practices about glaucoma and associated factors among primary glaucoma patients in Kunming, China.

Methods

A hospital-based study was conducted on 93 patients from the First Affiliated Hospital of Kunming Medical University. Interviewer-administered questionnaires were used to collect data after written informed consent. Data were analyzed by SPSS 19.0. Univariate and multivariate logistic regression models were used to identify factors. A Chi-square test was used to analyze the association between knowledge of glaucoma and medication compliance, Mann–Whitney U test was performed to assess the relationship between knowledge of glaucoma and quality of life in patients with glaucoma. P-value < 0.05 was considered statistically significant.

Results

Among 93 patients, 55 (59.14%) were aware of glaucoma, 48 (51.61%) had good knowledge of glaucoma, while 45 (48.39%) had poor knowledge. Younger age and duration of glaucoma were associated positively with knowledge of glaucoma. 87 (93.54%) patients got knowledge of their disease from doctors. 79.17% of respondents could use all the anti-glaucoma medications on time, out of which 54.17% had good knowledge of glaucoma while 25.00% had poor knowledge of glaucoma. 30.56% of respondents used to stop anti-glaucoma medications on their own out of which only 9.72% had good knowledge of glaucoma while 20.83% had poor knowledge of glaucoma. Patients with good knowledge of glaucoma had lower scores on the Glaucoma Quality of Life-15 questionnaire. Thus, the compliance to anti-glaucoma medications and glaucoma-related quality of life were better in patients with good knowledge.

Conclusions

The level of knowledge of glaucoma among patients in Kunming is relatively low. Improving knowledge with suitable content for patients through effective multiple means such as the mass media rather than relying only on ophthalmologists may be a veritable first step in combating blindness from glaucoma and enhancing patients' quality of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02322-0.

Health Literacy, Medication Adherence, and Quality of Life in Patients With Uveitis

Purpose: To evaluate health literacy, medication adherence, and quality of life (QOL) in uveitis patients.Methods: Cross-sectional quality improvement study using questionnaires of health literacy (Short Assessment of Health Literacy), adherence (Beliefs about Medicine Questionnaire), and QOL (12-item Short Form Health Survey).Results: Sixty patients were surveyed: 57% women, 80% identified as Black, and 42% with schooling beyond high school. Forty-three percent of the patients had poor health literacy, with lower scores among those with less schooling (p < .01). Necessity scores were higher for multiple providers (p = .02). Necessity (p = .03) and Concerns (p < .01) scores were higher for patients seeing a rheumatologist. Patients had lower physical (p < .01) and mental QOL (p < .01) than the general US population.Conclusions: Uveitis patients reported many barriers to care. Despite strong perceptions of treatment necessity, there were significant concerns, especially among patients seeing a rheumatologist. We recommend multidisciplinary care, individualized education, and counseling regarding medication safety and the necessity to improve adherence.

Use of Telepresence Robots in Glaucoma Patient Education

PRCIS

Telepresence robots (TR) present the versatility to effectively provide remote educational sessions for patients affected by glaucoma to improve disease knowledge. Given COVID-19's effect on clinical practice, TR can maintain social distancing when educating patients.

PURPOSE

TR are devices that allow remote users to have a mobile presence anywhere. We compared the effect of an education session given by an in-person educator versus a TR on glaucoma knowledge and identified factors that impact patient education.

METHODS

Eighty-five glaucoma patients were split into control, human, and TR groups. We measured glaucoma knowledge scores (KS) using the National Eye Institute's Eye-Q Test. Human and TR groups had the education session with a human or TR followed by the questionnaire. The control group was administered the questionnaire without an education session. Treatment regimen recall (RR) >90% was considered a success. We used linear regression and binary logistic regression to determine variables that affect KS and RR, respectively.

RESULTS

Mean age was 58.3±2.8 years. 49% were female. Mean KS were 5.8±0.7 in the control group (n=31), 7.9±0.5 in the TR group (n=26), and 8.4±0.5 in the human group (n=28). Control participants had a lower mean KS than the human or TR groups (P<0.001). Having the education session (2.5, P<0.001), education greater than high school (0.8, P=0.016), and diabetes (-0.7, P=0.037) affected KS. Having diabetes (odds ratio=0.14, P=0.014) negatively affected RR. Having the education session may affect RR (odds ratio=5.47, P=0.07), warranting additional studies.

CONCLUSIONS

Education sessions with a human and TR improved patients' glaucoma KS. TRs may serve as an alternative to in-person education sessions and allow educators to safely and effectively educate patients remotely to adhere to COVID-19 social distancing guidelines.

Knowledge of Thyroid Eye Disease in Graves' Disease Patients With and Without Orbitopathy

BACKGROUND

Thyroid eye disease (TED) develops in around 25% of those with Graves' disease (GD). Patients with TED may present late to ophthalmologists, when debilitating orbital inflammatory changes have already occurred. The reasons for this are multifactorial, but poor knowledge of TED in GD patients may be contributory. This study aimed to assess the knowledge of TED in those with established TED, GD without orbitopathy, and control subjects.

METHODS

A validated, anonymized questionnaire, with 20 knowledge-based questions, was prospectively completed by 100 GD patients, 100 TED patients, and 100 age- and sex-matched controls (with no history of thyroid disease or TED) in two tertiary referral thyroid and orbital diseases clinics. Demographic data and details of highest educational level, disease duration, and follow-up were gained. Residence postcode was used to determine Index of Multiple Deprivation (2015) quintile. Knowledge score was established for each of the study groups of interest. Statistical analysis was undertaken with Kruskal-Wallis test, chi-square test, and multivariable logistic regression.

RESULTS

There was no significant difference in median knowledge scores (out of 20) between GD (13.71, range 9-18) and TED (14.25, range 9-18) patients. However, both groups had significantly higher scores than controls (11.53, range 4-16; p < 0.001). Multivariable analysis determined no particular independent factor associated with lower knowledge score. There were a number of important areas in which patient knowledge of TED was poor. While almost all (99% TED, 89% GD) knew that TED involved orbital tissue inflammation, a large proportion (60% TED, 50% GD) were unaware that TED may develop in the absence of hyperthyroidism or did not know that cigarette smoking is associated with more severe TED (21%TED, 33% GD).

CONCLUSIONS

TED patients had equivalent levels of TED knowledge compared to GD patients without orbitopathy. While subjects in both disease groups had greater knowledge than controls, each had significant misconceptions regarding aspects of TED diagnosis, management, and treatment. These findings should guide the future provision of patient information for TED, with educational materials being targeted to address existing gaps in knowledge.

Knowledge, attitudes and self-care practices of patients with glaucoma in uThungulu in KwaZulu-Natal

Background: Glaucoma remains one of the leading causes of blindness in South Africa. Early detection, effective treatment and strict compliance with treatment are instrumental to prevent further damage to the optic nerve and thus preserve vision.Aim: The purpose of this study was to assess the knowledge, attitude and self-care practices of patients with glaucoma in KwaZulu-Natal.Setting: The study was conducted in the ophthalmology outpatient department of a public hospital and a private ophthalmology practice in the uThungulu district.Methods: This was an observational, analytic, cross-sectional study. Structured questionnaires assessing knowledge, attitudes and self-care practices were administered to patients presenting for follow-up glaucoma management.Results: The median age of the 384 patients in this study was 60 (interquartile range [IQR] 48.5–69.5) and 59 years (IQR 49.0–66.5) for males and females, respectively (p > 0.05). Two hundred and thirty-eight (62.0%) patients had good knowledge of glaucoma. Age, gender and duration of glaucoma diagnosis were significantly associated with good knowledge of glaucoma. Three hundred and forty-four (89.6%) patients reported having good self-care practices. Patients over the age of 65 years were significantly less likely to have good self-care practices compared to patients aged 26–45 years (odds ratio [OR]: 0.2, confidence interval [CI]: 0.1–0.6, p = 0.01). Good knowledge of glaucoma was significantly associated with good self-care practices of glaucoma (p < 0.001).Conclusion: Elderly patients do not have sufficient knowledge of glaucoma and have poor self-care glaucoma practices. It is important to involve family members of these patients in the education and counselling of glaucoma to facilitate improved disease management.

Areas and factors associated with patients' dissatisfaction with glaucoma care

OBJECTIVE

The aim of this study was to evaluate patients' dissatisfaction with overall and specific aspects of a tertiary glaucoma service and to determine their independent factors, including intraocular pressure (IOP) and visual acuity (VA).

METHODS

Patients, aged ≥21 years, from a specialist glaucoma service in a tertiary eye hospital in Singapore for at least 6 months, were recruited for this cross-sectional study between March and June 2014. All consenting patients completed a 7-area glaucoma-specific satisfaction questionnaire and one item related to satisfaction with overall glaucoma care. We determined the top three areas of dissatisfaction and overall dissatisfaction with the glaucoma service. We also explored the independent factors associated with overall and specific areas of patients' dissatisfaction with their glaucoma care, including VA and IOP by using logistic regression models.

RESULTS

Of the 518 patients recruited, 438 (84.6%) patients completed the study. Patients' dissatisfaction with the overall glaucoma service was 7.5%. The three areas of glaucoma service with the highest dissatisfaction rates were as follows: 1) explanation of test results (24.8%); 2) explanation of glaucoma complications (23.7%); and 3) advice on managing glaucoma (23.5%). Patients who were dissatisfied with the overall service had a worse mean VA compared with satisfied patients (logarithm of the minimum angle of resolution =0.41±0.43 vs 0.27±0.49, p=0.005), whereas mean IOP remained well-controlled in both the groups (13.55±2.46 mmHg vs 14.82±2.86 mmHg, p=0.014). In adjusted models, factors associated with overall dissatisfaction with glaucoma care included a pre-university education and above (odds ratio [OR] =8.06, 95% CI =1.57-41.27) and lower IOP (OR =0.83, 95% CI =0.71-0.98).

CONCLUSION

Although less than one tenth of glaucoma patients were dissatisfied with the overall glaucoma service, one in four patients were dissatisfied with three specific aspects of care. A lower IOP, ironically, and education level were associated with overall dissatisfaction. Improving patients' understanding of glaucoma test results, glaucoma complications, and disease management may increase patient satisfaction levels.

Validation of a glaucoma knowledge assessment in glaucoma patients

Summary

To develop metrics to identify knowledge deficits and barriers to learning in glaucoma patients, this study seeks to validate a glaucoma knowledge assessment to use in the evaluation of knowledge in glaucoma patients.

Purpose

Glaucoma treatment adherence appears to improve when patients demonstrate a greater knowledge of the disease and its treatment. This study seeks to validate a glaucoma knowledge assessment in a glaucoma patient population to assist in patient educational assessments and interventions.

Patients and methods

The National Eye Health Education Program’s (NEHEP) glaucoma knowledge assessment has previously been suggested as a useful measure to assess glaucoma patient’s knowledge. This questionnaire was administered in glaucoma patients along with a more comprehensive 49-question examination. Demographic data and health literacy were assessed. Statistical analyses were performed to assess the validity of the assessments.

Results

A total of 12 glaucoma patients completed the knowledge assessments. The mean ± standard deviation age of the patients was 69±14 years, and the duration of glaucoma was 14±13 years. The participants’ mean score on the NEHEP assessment was 7.3±0.8 (of 10, 73% correct) vs 29.3±7.3 (of 49, 60% correct) on the comprehensive assessment. The value of coefficient α was 0.592 for NEHEP and 0.872 for the cumulative assessment. The P-value (proportion of examinees answering correctly) ranged from 0 to 1 for individual questions. Item point–biserial correlation values for each question ranged from −0.402 to 0.813.

Discussion

The NEHEP quiz may be a good starting point for the development of a reliable knowledge assessment tool to measure and monitor glaucoma knowledge, due to its concise nature and reasonable level of difficulty. This study suggests that questions included in the currently available questionnaires vary widely in difficulty and ability to differentiate knowledge level, which may ultimately compromise reliability and utility of existing examinations. Further examination of individual questions and teaching points included in the current assessments may help to construct increasingly reliable and useful knowledge assessments in the future.

Intraocular Pressure Characteristics of Exfoliative Glaucoma and Exfoliation Syndrome as Determined With the Water Drinking Test

PURPOSE

To investigate the intraocular pressure (IOP) characteristics of patients with exfoliation glaucoma (XFG) and exfoliation syndrome (XFS) during the water drinking test (WDT).

METHODS

This was a prospective observational study undertaken at an academic setting. Consecutive patients with XFG whose office IOP levels were <21 mm Hg, normotensive XFS patients, and control subjects underwent WDT, which involved ingestion of 1 L of water within 5 minutes. The IOP was measured before and 4 times after water ingestion at 15-minute intervals. Maximum IOP (IOPmax), mean IOP (IOPmean), IOP increase (IOPΔ) from baseline IOP to IOPmax, and percentage of IOP fluctuation (IOPfluct) during the WDT were compared across groups. One-way analysis of variance (ANOVA) test or the Kruskal-Wallis test was used for comparisons.

RESULTS

The age, gender ratios, visual acuity level, central corneal thickness, and office IOP levels were similar between the 3 groups. As compared with patients with XFS and controls, XFG patients revealed significantly higher values for all IOP measurements at 15 minutes intervals as well as IOPmax (25.1±4.0 mm Hg, 18.7±2.8 mm Hg, 18.6±2.5mm Hg; P<0.001), IOPmean (22.6±3.3mm Hg, 17.2±2.6 mm Hg, 17.2±2.4 mm Hg; P<0.001), IOPΔ (9.2±3.4 mm Hg, 4.4±2.1 mm Hg, 3.7±1.5 mm Hg; P<0.001), and IOPfluct (60.1±24.0%, 33.4±20.0%, 25.7±11.3%; P<0.001).

CONCLUSIONS

Medically treated XFG patients, but not XFS subjects, reveal significant IOP elevations during WDT indicative of impaired trabecular outflow facility.

Glaucoma, "the silent thief of sight": patients' perspectives and health seeking behaviour in Bauchi, northern Nigeria

BACKGROUND

In Nigeria, glaucoma has a high prevalence and is the second cause of blindness among adults after cataract. People with glaucoma frequently present very late with advanced disease, and acceptance of and adherence to treatment is low. The purpose of the study was to explore how patients' understand and respond to glaucoma in order develop an intervention to improve adherence to treatment.

METHOD

Hospital based qualitative study. Six focus group discussions were held with patients with advanced disease and who had either undergone glaucoma surgery, were receiving medical treatment, or had neither surgery nor medical treatment. Two traditional healers who treat eye conditions were interviewed. Audio files were transcribed, translated into English and recurring themes coded and categorized as the impact of vision loss, and understandings of the disease and its management.

RESULTS

Visual loss impacted significantly on the lives of people with glaucoma in many ways. Many heard the term "glaucoma" for the first time during the study. Local terms to describe the symptoms included Hawan jinin ido ("hypertension of the eye"). Patients sought treatment in pharmacies, or with traditional healers who had different interpretations of glaucoma and its treatment to biomedical understandings. Cost and forgetfulness were the main reasons for low adherence to treatment while fear was a reason for not accepting surgery. Lack of money and negative staff attitudes were reasons for low follow up.

CONCLUSION

Halting the progression of glaucoma is possible with treatment but the condition will remain a "silent thief of sight" in West Africa unless awareness, uptake of services and adherence to treatment improve. Understanding how glaucoma is locally conceptualised, lived with and responded to by patients is essential to aid the design of interventions to prevent glaucoma blindness in Africa. Findings have been used to adapt a motivational interviewing intervention, which is being evaluated in a clinical trial.

Finding the best glaucoma questionnaire: a qualitative and quantitative evaluation of glaucoma knowledge assessments

Objective

The goal of the study was to determine which glaucoma quiz provides the best information about patient glaucoma knowledge to clinicians in clinical practice settings.

Methods

Four glaucoma quizzes were identified from the literature and national eye education programs and were qualitatively analyzed to categorize questions by topic. Quizzes were assessed by 64 glaucoma specialists using an online survey, with descriptive statistics. Comments about the quizzes were analyzed qualitatively using themes and representative quotations.

Results

Quizzes covered content that was important for glaucoma diagnosis and management. The National Eye Health Education Program (NEHEP) and Prevent Blindness America quizzes covered primarily diagnosis, screening, and risk factors, and the quizzes from the literature primarily covered causes of glaucoma, vision loss, eye drops, and systemic disease. Overall, the NEHEP quiz was ranked best for clinical practice, ranked first by 38%. Ranked second overall, the Gray quiz was ranked first by 34% and last by 34%.

Conclusion

The NEHEP quiz was rated most useful for assessing baseline general glaucoma knowledge for a busy clinical practice. The Gray quiz appears to be more useful as part of a comprehensive education program, perhaps in combination with an ophthalmic educator.

Level of knowledge about glaucoma in Vienna

BACKGROUND

Glaucoma is a chronic and serious disease calling for consistent lifelong therapy. The patient's compliance requires that he/she be well informed about the disease. The purpose of the present study was to determine the level of knowledge about glaucoma, and compare young patients with older ones as well as glaucoma patients with nonglaucoma ones.

METHODS

A total of 1110 questionnaires were distributed to patients and their relatives at the outpatient eye clinic of Hietzing Hospital (Vienna), of which 1041 were returned. The questionnaire comprised 18 questions. Patients were divided into two groups: group 1 consisted of those aged 18-60 years, while group 2 consisted of those older than 61 years.

RESULTS

In total, 941 questionnaires were evaluated; 72.8% of the respondents were older than 60 years, and one-half of the respondents had glaucoma (51%). The majority of patients had "moderate knowledge" of the disease (41.87%), followed by "poor knowledge" (32.52%). Glaucoma patients had considerably better knowledge of the disease (p < 0.01) than did nonglaucoma patients. Younger patients were significantly better informed than older ones (p < 0.01). Nonglaucoma patients with a positive diagnosis of glaucoma among their circle of friends or family were significantly better informed (p < 0.01) than those without such persons in their circle of friends.

CONCLUSION

Persons with glaucoma are much better informed about the disease than nonglaucoma patients, but the general level of knowledge is very low. Notably, younger patients were better informed than older ones. The present study, comprising a large number of patients, revealed poor knowledge of glaucoma among patients with the disease and especially among nonglaucoma patients in Vienna.

A proposed methodology for the assessment of glaucoma awareness in Greece: introduction of the EIT-8G scale

PURPOSE

To develop a reliable and practical questionnaire for glaucoma awareness and evaluate the impact of potential determinants.

METHODS

Patients with primary open-angle, pigmentary, and exfoliation glaucoma, as well as healthy controls, were recruited. The instrument included questions about demographic characteristics, as well as 8 questions assessing the participant's familiarity with glaucoma. Rasch analysis was used for the validation of the questionnaire. The effect of demographics as potential determinants of awareness was examined with a multivariate logistic regression analysis. Bonferroni-corrected statistical significance was tested with the Mann-Whitney U test or one-way analysis of variance. Association between demographics and questionnaire scores was examined with Spearman correlation.

RESULTS

As indicated by power analysis, responses from 175 patients (mean age 65.5 years) and 314 controls (mean age 43.3 years) were analyzed. Rasch analysis indicated no multidimensionality and good item-person targeting. Mean ± SD awareness scores for the glaucoma and control groups were 4.43 ± 2.10 and 4.20 ± 2.11, respectively (p=0.207). Sex and residence were not predictors of disease awareness, whereas educational level was only a determinant in the control group (p<0.001). Income was a predictor only for patients (r=0.357, p<0.001), whereas family history was predictive for both groups (p<0.001). Logistic regression analysis revealed that only family history was associated with increased awareness (Chi(2)=4.61, p=0.03, odds ratio 1.98).

CONCLUSIONS

This study introduces a practical and valid instrument for the assessment of glaucoma awareness.

Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: an exploratory randomised controlled trial

PURPOSE

To evaluate the impact of individualised patient care, as an adjunct to standard care, on adherence to ocular hypotensive therapy.

METHODS

A two-arm, single-masked exploratory randomised controlled trial recruited patients newly prescribed ocular hypotensive therapy. The intervention involved an individual assessment of health-care needs and beliefs and a 1-year follow-up period according to need. The primary outcome was refill adherence, measured by collating prescription and dispensing data for 12 months. Secondary outcomes included self-reported adherence, glaucoma knowledge, beliefs about illness and medicines, quality of care, intraocular pressure (IOP) fluctuation, and changes in clinical management assessed at 12 months. The strength of the intervention was measured following withdrawal by reviewing clinical outcomes for a further 12 months.

RESULTS

In all, 127 patients were recruited (91% response rate). Intervention-arm patients collected significantly more prescriptions than control-arm patients. Self-report adherence was significantly better in the intervention-arm for patients who forgot drops and those who intentionally missed drops. The intervention group demonstrated significantly more glaucoma knowledge, expressed a significantly stronger belief in the necessity of eye drops and believed that they had more personal control over managing their condition. Control-arm patients had more IOP fluctuation and changes in clinical management. However, this finding only reached significance at 24 months.

CONCLUSION

Modelling patient care according to health-care needs and beliefs about illness and medicines can have a significant impact on improving adherence to therapy for this patient group, with the potential benefit of improving clinical outcomes.

Preliminary survey of educational support for patients prescribed ocular hypotensive therapy

PURPOSE

to establish the impact of educational support on patients' knowledge of glaucoma and adherence, in preparation for an intervention study.

METHODS

structured observation encapsulated the educational support provided during clinical consultations and patient interviews captured the depth of glaucoma knowledge, problems associated with glaucoma therapy, and adherence issues.

RESULTS

one hundred and thirty-eight patients completed the study. Education was didactic in nature, limited for many patients and inconsistent across clinics. Patients showed generally poor knowledge of glaucoma with a median score of 6 (range 0-16). A significant association was found between educational support and knowledge for newly prescribed patients (Kendall's tau=0.30, P=0.003), but no association was found for follow-up patients (Kendall's tau=0.11, P=0.174). Only five (6%) patients admitted to a doctor that they did not adhere to their drop regimen, yet 75 (94%) reported at interview that they missed drops.

CONCLUSIONS

although important, knowledge alone may not sufficiently improve adherence: a patient-centred approach based on ongoing support according to need may provide a more effective solution for this patient group.

Medical management of primary open-angle glaucoma: Best practices associated with enhanced patient compliance and persistency

Primary open angle glaucoma is a chronic optic neuropathy often requiring lifelong treatment. Patient compliance, adherence and persistence with therapy play a vital role in improved outcomes by reducing morbidity and the economic consequences that are associated with disease progression. A literature review including searches of The Cochrane Library, MEDLINE, PubMed, conference proceedings, and bibliographies of identified articles reveals the enormous public health burden in various populations due to the impact of glaucoma associated visual impairment on the overall quality of life eg, fear of blindness, inability to work in certain occupations, driving restrictions, motor vehicle accidents, falls, and general health status. Providing specific definitions for the frequently misunderstood terms "compliance, persistence and adherence" with reference to medication use is central not only for monitoring patients' drug dosing histories and clinical outcomes but also for subsequent research. In this review article, a summary of the advantages/disadvantages including cost-effectiveness of various medical approaches to glaucoma treatment, techniques employed for measuring patient compliance and actual patient preferences for therapy are outlined. We conclude by identifying the key barriers to ongoing treatment and suggest some best practices to enhance compliance and persistence.