The socioeconomic impact among Egyptian glaucoma patients

The outcomes of a low-cost, non-valved glaucoma drainage device using mitomycin-C: 1-year results

PURPOSE

To evaluate the indications, outcomes, and complications of the usage of Aurolab Aqueous Drainage Implant (AADI) using mitomycin-C.

METHODS

A retrospective case series of patients who underwent AADI placement using mitomycin-C between April 2018 and June 2020 at Ain Shams University Hospitals, Cairo, Egypt. The data was extracted from the records of the patients with a minimum of 1 year of follow-up. Complete success was defined as IOP ≥ 5 mmHg and ≤ 21 mmHg or reduction of IOP by ≥ 20% from baseline without antiglaucoma medications (AGMs). Qualified success was defined as reaching the same IOP range with the aid of AGM.

RESULTS

A total of 50 eyes of 48 patients were included. Neovascular glaucoma represented the commonest indication (13 patients, 26%). The mean preoperative IOP was 34.0 ± 7.1 mmHg, with a median number of AGM of 3 (mean ± SD = 2.84 ± 1), while the mean IOP after 12 months was 14.3 ± 4 with a median number of AGM of 0. (mean ± SD = 0.52 ± 0.89) (p < 0.001). Complete success was achieved in 33 patients (66%). Qualified success was achieved in 14 patients (28%). Thirteen eyes (26%) had variable postoperative complications; none of them required explantation of the device or affected the visual acuity (except one patient).

CONCLUSION

AADI with using mitomycin-C and ripcord during the surgery is an effective and relatively safe method of control of IOP in refractory and advanced cases of glaucoma, with an overall success rate of 94%.

Cost effectiveness analysis associated to the treatment of primary open-angle glaucoma according to disease severity

Introduction/Objective. POAG treatment should be individually tailored to the disease severity and type, effectiveness and secondary side effects of the medications used. This research aimed to assess the direct medical costs and the cost effectiveness associated with pharmacotherapy in visually impaired people with primary open-angle glaucoma according to disease severity. Methods. This scientific study is designed as an observational cross-sectional study with a quantitative analytical approach and was conducted in the period from July 2020 to June 2021 on the territory of North Macedonia. The study included 157 patients with binocular POAG in the early, moderate and advanced clinical stage, up to the age of 67, with changes in visual acuity and work ability. During the assessment of the effects of pharmacotherapy were analyzed the types, mutual correlations and effectiveness of the most commonly prescribed antiglaucomatous medications and the cost benefit from their administration. Direct medical costs are calculated according to disease severity in the last 12 months using real-time data of public interest. Results. The beta blockers due to their affordable price and availability are the dominant option with high-cost benefit for primary treatment of POAG. Antiglaucoma medications and diagnostic procedures are major components of direct medical treatment costs. Conclusion. Pharmacotherapy is the dominant alternative compared to other types of treatment because it is safer and is associated with greater effictiveness and lower direct medical costs.

Accuracy of perceived glaucoma risk by patients in a clinical setting

Objective

To determine whether patients attending the ophthalmology department underestimate their glaucoma risks.

Method

We conducted a cross-sectional survey with a final study population of 1203 individuals from two medical centers in Taiwan during January 1–June 30, 2019. The “High concern” group was defined as the set of patients who rated themselves as having low risk but who had been rated by physicians as having medium or high risk of developing glaucoma over the next year.

Results

Approximately 12% of the respondents belonged to the “High concern” group. For those with education at the college level or higher, the interaction term was estimated to be 0.294 (95% CI = 0.136–0.634). Marginal effect calculations revealed significant sex-based differences in the effect of knowledge at specific age intervals.

Conclusions

A considerable proportion of patients attending the ophthalmology department underestimate their glaucoma risks. Misjudgment of glaucoma risks can lead to delays in seeking of medical attention. Glaucoma education should be designed according to each patient’s education level and sex, as its effect is not consistent across different education and sex clusters.

Patients’ adherence to topical antiglaucoma medications in a tertiary care hospital

Objectives

Adherence to glaucoma medications is a central factor to control intraocular pressure and manage glaucoma effectively. This study aims to assess the level of adherence of glaucoma patients to ocular hypotensive agents and determine factors contributing to non-adherence in the Aseer region.

Methods

This was a single-centre, prospective cross-sectional study carried out in Aseer Hospital, Saudi Arabia. Data were collected through a customized questionnaire adapted from the Morisky, Green and Levine Medication Adherence Questionnaire (MGLS).

Key findings

Of the 102 glaucoma patients, 63 (61.8%) were non-adherent to their glaucoma medications. About 48 (76.2%) of them reported that they have no background information about glaucoma. Older participants (37, 58.7%; &gt;50 years) showed a low adherence level compared with the younger individuals. Contributing factors to non-adherence include forgetting the dose time (32, 50.8%), illiteracy (31, 49.2%; P = 0.313), economic problems (26, 41.3%; P = 0.286) and lack of information about prescribed medications (15, 23.8%; P = 0.188).

Conclusions

No significant relationship was found between medication adherence and patient’s demographic data or their background knowledge about glaucoma. Despite the need for improving the glaucoma patient’s knowledge of their disease and the importance of medication adherence, an additional strategy as alerts by smartwatches should be encouraged to improve the adherence level.

So let me find my way, whatever it will cost me, rather than leaving myself in darkness: experiences of glaucoma in Nigeria

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.

Analysis of Factors Affecting Patients' Compliance to Topical Antiglaucoma Medications in Egypt as a Developing Country Model

Purpose. To study factors affecting patients' compliance to antiglaucoma medications in Egypt where there are unique factors as a developing country. Patients and Methods. A cross-sectional descriptive study on 440 Egyptian patients with open angle glaucoma (OAG) recruited for over two years. The patients were thoroughly interviewed about their age, education level, duration of glaucoma, difficulty in instilling the drops, medication regimens, a family history of glaucoma, knowledge of the disease, and the presence of medical insurance. Results. 236 (53.6%) were noncompliant compared to 204 (46.4%) who were compliant. Females had a tendency for higher compliance (p=0.061). Patient age above 50 years and low level of education and negative family history of glaucoma were factors significantly associated with poor compliance (p < 0.0001). Polytherapy and lack of medical insurance could be contributing factors. Conclusion. Egyptian patients have a high rate of noncompliance compared to the average in literature. Great effort is needed in educating patients about the importance of medications and the risk and the prognosis of this disease. Economic factors must also be taken into consideration in developing countries with large number of poor patients. We recommend simplifying drug regimens, incorporating electronic dose monitors, and creating reminders for follow-up visits of glaucoma patients.

Blindness and Visual Impairment among Egyptian Glaucoma Patients

Purpose. Glaucoma is the second commonest cause of blindness worldwide. Visual fields and intraocular pressures are optimum outcomes to be assessed in developed countries. Visual acuity as an outcome is the key player when assessing blindness in developing countries. The aim of this study is to assess visual impairment and blindness in glaucoma patients and to identify the bulk they represent in comparison to nonglaucoma patients in the same practice setting. Methods. Patients attending outpatient clinics of Cairo University Hospitals were enrolled in this cross-sectional study. Clinical data collected for these patients included their demographic data, best obtained visual acuity, and whether or not they have had an established diagnosis of glaucoma. Results were compared at 95% confidence intervals. Results. 988 eyes of 494 patients were included for this study. Their mean visual acuity was 6/24 (±3 Snellen lines). Legal blindness was found in 5% and 4% of glaucoma and nonglaucoma groups, respectively. There were high odds for finding eyes with total blindness due to glaucoma. That was statistically significant (P < 0.05). Conclusions. A large proportion of glaucoma patients suffered from blindness in at least one eye. Interventional strategies are recommended regarding visual disability among Egyptian glaucoma patients.

Prevalence and determinants of glaucoma in citizens of qatar aged 40 years or older: a community-based survey

Background:

We present the prevalence and determinants of glaucoma among subjects 40 years of age and older in Qatar.

Materials and Methods:

This community-based survey was held in 2009 at 49 randomly selected clusters. Demographic details and history of glaucoma was collected by the nurses. Ophthalmologists evaluated the optic disc and retina using a digital camera housed in a mobile van. Visual field was tested with an automated perimeter, the intraocular pressure with an applanation tonometer and the angle of the anterior chamber by gonioscopy. A panel of glaucoma experts diagnosed subjects with glaucoma.

Results:

This survey enrolled 3,149 (97.3%) participants. The age- and sex-adjusted prevalence of glaucoma in the population aged 40 years and older was 1.73% (95% confidence intervals [CI] 1.69-1.77). Accordingly, 5,641 individuals in this age group in Qatar would have glaucoma. Chronological age of 60 years and older (Odds ratio [OR] 11.1) and the presence of myopia (OR 1.78) were predictors of glaucoma. Open-angle glaucoma was diagnosed in 44 (65.7%) individuals with glaucoma. In nine (13.4%) and 15 (20.9%) subjects, angle closure glaucoma and other (post-traumatic, pseudoexfoliation) glaucoma were present. Bilateral blindness (vision <3/60) and severe visual impairment (<6/60) were found in four (6%) and three (4.5%) subjects with glaucoma, respectively. Glaucoma was treated in 36 (54%) subjects.

Conclusions:

The prevalence of glaucoma among citizens of Qatar aged 40 years and older was 1.71%. Glaucoma was associated with the age of 60 years and older and the presence of myopia.