Knowledge about cataract, glaucoma, and age related macular degeneration in the Hong Kong Chinese population

Impact of COVID-19 pandemic on ocular disease: KNHANES 2015-2021

The aim of this study was to evaluate the impact of COVID-19 on ocular diseases and changes in risk factors before and after the COVID-19 pandemic. This study was conducted using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2015-2021, a national cross-sectional health examination and survey. Associations between ocular diseases and risk factors were determined using the chi-squared test and logistic regression analysis. Bivariable adjusted logistic regression analysis was performed to examine the odds ratio (OR) and 95% confidence interval (CI) to evaluate of the impact of COVID-19 on ocular diseases. Individuals were divided into two age groups (< 60 and ≥ 60 years). A total of 50,158 people were diagnosed, of whom 7270 were diagnosed with cataract, 921 with glaucoma, and 439 with age-related macular degeneration (AMD). Risk factors for cataract were COVID-19 pandemic (OR 1.161), hypertension (OR 1.608), diabetes (OR 1.573), dyslipidemia (OR 1.167), stroke (OR 1.272), and depression (OR 1.567). Risk factors for AMD were COVID-19 pandemic (OR 1.600), dyslipidemia (OR 1.610), and depression (OR 1.466). Risk factors for glaucoma were hypertension (OR 1.234), dyslipidemia (OR 1.529), diabetes (OR 1.323), and depression (OR 1.830). The COVID-19 pandemic was a risk factor for cataracts and AMD, but not for glaucoma. Cataracts and AMD may be more influenced by the acquired health conditions or the environment.

Barriers and Potential Solutions to Glaucoma Screening in the Developing World: A Review

PURPOSE

Glaucoma is a leading public health concern globally and its detection and management are way more complex and challenging in the developing world. This review article discusses barriers to glaucoma screening in developing countries from the perspective of different key stakeholders and proposes solutions.

METHODS/RESULTS

A literature search was carried out in the electronic catalogs of PubMed, Medline, and Cochrane database of systematic reviews to find studies that focused on barriers and enablers to glaucoma screening. The authors' interpretations were tabulated as descriptive and qualitative data and presented concisely from the point of view of key stakeholders such as the patients and their relatives, care providers, and system/governing bodies. Key barriers to glaucoma care identified are lack of awareness, poor accessibility to ophthalmic centers, inadequately trained human resources, unsatisfactory infrastructure, and nonavailability of financially viable screening programs. Educating care providers, as well as the public, providing care closer to where people live, and developing cost-effective screening strategies are needed to ensure proper identification of glaucoma patients in developing countries.

CONCLUSIONS

The logistics of glaucoma detection and management are complex. Hence, glaucoma detection programs should be implemented only when facilities for glaucoma management are in place. Understanding the importance of glaucoma screening and its future implications, addressing the various roadblocks, empowering and efficiently implementing the existing strategies, and incorporating novel ones using Artificial Intelligence (AI) and deep learning (DL) will help in establishing a robust glaucoma screening program in developing countries.

Glaucoma awareness, anxiety and its impact on patients undergoing visual field testing and optical coherence tomography

PURPOSE

To assess the effect of Glaucoma awareness, knowledge, and anxiety on patients under visual field analysis by Humphrey's visual field analyzer (HFA) and optical coherence tomography(OCT).

METHODS

This prospective comparative cohort study included glaucoma patients undergoing HFA (Group A)(n = 150) and OCT(Group B) (n = 150). Each group consisted of 75 newly diagnosed patients and 75 patients who were on follow-up. Participants completed State trait anxiety inventory form Y2(STAI) before and after the test to assess pre-test and intra-test anxiety. Another validated and structured questionnaire was used to assess patient awareness and knowledge of glaucoma. Anxiety scores were used to make correlations and comparisons between the two groups and also against visual field reliability indices. The impact of awareness on anxiety scores and its correlation with reliability indices were also determined.

RESULTS

Overall pretest and intratest anxiety scores in patients undergoing HFA were 52.39(9.5) and 52.45(8.6)and OCT 53.04(8.0) and 53.83(8.2) respectively.Pretest anxiety was less in follow-up patients of both groups(Group A-51.04,Group B-52.72).There was no statistically significant difference between the groups(pretest p = 0.52,Intratest p = 0.15). Anxiety score was found to be significantly high in female participants(54.07,p = 0.01)and those without awareness(p < 0.001). Patients with education of graduation and above in group B had significantly lower anxiety scores(p = 0.007).

CONCLUSION

Anxiety levels induced by both diagnostic modalities HFA and OCT appear to be similar and it does not affect the reliability indices.Anxiety score was higher in female participants and participants lacking disease awareness.

Knowledge about age-related eye diseases in the general population in Germany

BACKGROUND

With a rising prevalence of age-related eye diseases, prevention and early diagnosis of these conditions are key goals of public eye health. Disease-related knowledge in the general public supports these goals but there is little data available. Thus, we have assessed knowledge of cataract, glaucoma, age-related macular degeneration (AMD) and diabetic eye disease in the German adult general population in a cross-sectional study and identified target groups for health education interventions.

METHODS

Knowledge assessment content was identified based on a literature review, expert input, and a list of items was generated after a qualitative selection process. The resulting 16-item instrument (4 items per condition) was administered to 1,008 participants from a survey panel, demographically representative of the adult German population. Test properties were evaluated based on a Rasch model and multiple correspondence analysis (MCA). Binary-logistic regression analysis was performed to investigate associations with age, sex, education level, employment status, marital status, income, reported health status, visual difficulties, and recent general practitioner (GP) and ophthalmologist consultations.

RESULTS

Replies were correct for a median of 9 out of 16 (range 2 - 16) items, which differed between conditions (p < 0.0001). Most responses were correct for cataract items (median: 3 / 4) and least were correct for AMD items (median: 2 / 4). 27%, 9%, 1% and 19% of respondents replied correctly to all cataract, glaucoma, AMD and diabetic eye disease-related items, respectively. Rasch analysis suggested an adequate targeting of items and in MCA, no evidence of multidimensionality was present. Older age, being retired, decreased general health and recent GP or ophthalmology consultations were significantly associated with more knowledge about common eye conditions (p ≤ 0.005). GP or ophthalmology consultations remained significant in a multivariable model (p ≤ 0.011).

CONCLUSIONS

Knowledge gaps regarding eye health are considerable in the German general population and should therefore be addressed in educational interventions targeting the public. Special attention when designing such campaigns needs to be paid to infrequent users of the healthcare system. Knowledge of AMD seems to be poorer compared to other eye conditions.

A systematic literature review for evaluation of knowledge, attitude, and self-care practice regarding common eye diseases in the healthy general population

Background and purpose

Increasing people's knowledge and then changing their attitude and practice with the aim of taking care of their eye health are very important. Considering the importance of the mentioned topic, the main goal of this study was to evaluate the knowledge, attitude, and practice about eye diseases in the general population of the world in the form of a systematic literature review.

Materials and Methods

This study was a systematic literature review study, and to do it, a systematic search was conducted in internationally available databases including Web of Science, ScienceDirect, Scopus, PubMed, and Google Scholar in the time range of 1998 to 2023. Finally, considering the inclusion and exclusion criteria of the study, the results of 18 articles were extracted.

Results

The findings showed that in general, people's level of knowledge about glaucoma was lower compared to other eye diseases, and the level of knowledge of men and women about eye diseases was different. In addition, the results showed that there was significant relationship between age and knowledge of various eye diseases. The results of all evaluated studies showed that people with higher education have more knowledge about eye diseases.

Conclusion

Based on this, it can be concluded that as glaucoma is one of the most important causes of blindness worldwide, it is necessary to plan to increase the level of public knowledge to recognize the symptoms and complications of this disease. In addition to that, it is necessary to increase people's advertisement by ophthalmology centers and eye specialists about the use of glasses and also to encourage people to visit the eye physician regularly.

Advanced Visualization Engineering for Vision Disorders: A Clinically Focused Guide to Current Technology and Future Applications

Head-mounted visualization technology, often in the form of virtual, augmented, and mixed reality (VAMR), has revolutionized how visual disorders may be approached clinically. In this manuscript, we review the available literature on VAMR for visual disorders and provide a clinically oriented guide to how VAMR technology has been deployed for visual impairments. The chief areas of clinical investigation with VAMR are divided include (1) vision assessment, (2) vision simulation, and (3) vision rehabilitation. We discuss in-depth the current literature of these areas in VAMR and upcoming/future applications to combat the detrimental impact of visual impairment worldwide.

Awareness and Knowledge of Glaucoma and Its Associated Risk Factors Among Adult Population in the Jazan Region, Saudi Arabia

Introduction Glaucoma can be considered a heterogeneous group of diseases with characteristic progressive optic neuropathy, which causes the development of visual field dysfunctions and irreversible blindness. Glaucoma is the most prevalent cause of irreversible blindness worldwide. Aim This study aimed to assess the awareness and knowledge of glaucoma and its associated risk factors among the adult population in Jazan, Saudi Arabia, in 2022. Methods A community-based cross-sectional study was conducted with 384 participants aged 40 years and above in the Jazan region. A convenience sampling technique was adopted to obtain the target sample size. Data were collected using a self-administered electronic questionnaire on Google Forms. Results A majority (73.1%) of the 387 respondents to the questionnaire were in the age group of 40-50 years, with the average age being 47.43 years. No statistically significant difference was found between different age groups' level of knowledge (p=0.769). In addition, the difference between levels of knowledge based on participants' residence was also statistically insignificant (p=0.387). Of the participants who were not diagnosed with glaucoma, 55% had poor knowledge of glaucoma; however, only 3.10% of the participants diagnosed with glaucoma had poor knowledge of the condition. Consequently, there was a statistically significant difference between participants' levels of knowledge based on their diagnosis of glaucoma (p=0.04). Conclusion The study revealed low knowledge and awareness levels regarding glaucoma among adults aged 40 years and above in the Jazan region.

First Assessment of Awareness and Knowledge of Glaucoma Among Citizens of Addu City, Maldives: A Cross-Sectional Study

Background Glaucoma is a progressive optic neuropathy characterized by visual field loss and potentially irreversible blindness, which poses a significant global health challenge. The Maldives, renowned for its unique geography and vibrant culture, faces unique challenges in healthcare access and delivery due to its scattered islands. Limited access to specialized healthcare services, coupled with cultural and socioeconomic factors, can contribute to disparities in glaucoma awareness and early detection. Understanding glaucoma awareness is paramount due to its potential impact on public health and the healthcare system. The aim of this study is to assess the awareness and knowledge about glaucoma among the citizens of Addu City, Maldives. Methods A cross-sectional study was conducted among 390 residents of Addu City, Maldives. The online survey questionnaire assessed demographic information, knowledge and awareness of glaucoma, and risk factors associated with the disease. Results The majority of participants (66.9%) had never heard of glaucoma. Among those who had heard of glaucoma, only 22.6% knew that it could cause irreversible blindness. Logistic regression analysis and multivariate analysis showed that age, gender, socioeconomic status, and education level were significantly associated with awareness and knowledge of glaucoma (p<0.05). Conclusion Findings suggest a high likelihood of low awareness and knowledge of glaucoma among residents of Addu City, Maldives. The study highlights the urgent need for policymakers, program implementers, and the health sector to conduct awareness programs in the community and provide facilities for annual eye examinations, as well as to organize systematic screening plans for glaucoma across the Maldives.

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.

Factors influencing cataract awareness and treatment attitudes among the middle-aged and older in western China's rural areas

Purpose

This study was conducted to determine the level of knowledge about cataracts and the associated factors among adults aged 50 and above in rural areas of Qingcheng county in Gansu Province of Western China, 2020.

Methods

A large community-based cross-sectional study was conducted among the randomly selected 1,503 adults aged 50 and above from October to December 2020. Data were collected by conducting eye examinations and face-to-face interviews. Multivariate binary logistic regression and multivariate linear regression were used to identify associated factors of knowledge about cataracts. Odds Ratio (OR), Coefficient (C), and 95% Confidence Interval (CI) were reported to declare the statistical associations between knowledge about cataracts and the independent variables.

Results

Of the 1,503 study participants, 1,078 (71.7%) had good knowledge about cataracts. The primary school completed [OR = 1.43 (95% CI 1.08-1.90), P = 0.012], Secondary school & above [OR = 2.69 (95% CI 1.86-3.89), P <0.001], Examine for cataract [OR = 1.82 (95%CI 1.27-2.62), P = 0.001] were positively significantly associated with knowledge about cataracts. Whereas eye examinations [OR = 0.73(95% CI 0.55-0.96), P = 0.022] were negatively associated with knowledge about cataracts. Multivariate linear regression analyses showed a significant negative correlation between age and knowledge of cataract treatment options. Living with at least one child was positively correlated with knowledge of the therapeutic effects of cataracts. And monthly household income was significantly positively correlated with knowledge of the therapeutic effects of cataracts, treatment options, and the surgical reimbursement ratio for cataracts.

Conclusions

More than one-third of the participants still had poor knowledge about cataracts. The respondents with at least primary education and above, with previous examinations, and with examination for cataracts had significant associations with good knowledge about cataracts. So, it is recommended that stakeholders in different hierarchies organize health education by considering the education level of the community, focusing on cataract treatment knowledge and the surgical reimbursement ratio to improve cataract surgery rates.

Knowledge of cataracts and eye care utilization among adults aged 50 and above in rural Western China

Background

Cataracts are highly prevalent in rural China, but patient utilization of eye care services is low. Cataract knowledge is regarded as an important factor in eye care utilization. Few studies, however, have been conducted to measure the level of cataract knowledge and its relationship with eye care utilization among older adults in rural China. Hence, we described cataract knowledge and investigated the relationships between cataract knowledge and eye care utilization among adults (≥50 years) in rural Western China.

Methods

A large community-based cross-sectional study was conducted from October to December 2020 among adults aged 50 years and older in 73 rural villages in Qingcheng County, Western China. The participants underwent an eye examination at their village clinic to determine whether they had cataracts. Participants also answered a questionnaire about cataracts, eye care utilization status, and sociodemographic characteristics. The collected data underwent descriptive and multiple logistic regression analyses.

Results

The eye examinations revealed that 45.15% (675/1,495) of participants had cataracts in at least one eye, yet 90.67% (612/675) were left untreated. The average score achieved by participants about cataract knowledge was 4.91 points (total score was eight points). Correct knowledge about cataracts was positively associated with cataract screening and cataract surgery. Elders with better cataract knowledge were 2.21 times more likely to undergo cataract screening (OR, 2.21; 95% CI, 1.54-3.16) and 5.61 times more likely to undergo cataract surgery (OR, 5.61; 95% CI, 2.87-10.98). More than half had three fundamental misconceptions about how cataracts should be treated, how much they should cost, and when they should be treated. Participants who did not have these misconceptions were more likely to receive cataract screening by 1.21-2.02 times and cataract surgery by 1.76-3.48 times.

Conclusion

There are misunderstandings about cataract treatment methods, treatment costs and timing in the sample areas. A better understanding of cataracts was significantly positively associated with cataract screening and cataract surgery. Health education on cataracts and regular eye examinations are needed to improve eye care utilization in rural China.

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.

Assessment of the Levels of Knowledge Regarding Cataract and Glaucoma in Saudi Arabia and Measurement of the Ability to Differentiate Between the Two

Objectives

To assess the general public’s level of knowledge on glaucoma and cataract and measure their ability to differentiate between the two.

Materials and methods

This was an analytic, cross-sectional study. We used a self-explanatory questionnaire to obtain information regarding the level of knowledge of glaucoma and cataract and measured the ability of the public to differentiate between the two in Saudi Arabia. The obtained results were manually entered into an Excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 26.

Results

The levels of knowledge on glaucoma and cataract and those of education were significantly associated (chi-square: P < 0.001). There was a significant association between having an eye condition and the ability to correctly define glaucoma and cataract (chi-square: P = 0.002). Concerning the definition of glaucoma, 48.4% of the participants who had a previous eye disorder answered correctly, whereas 40.1% of the participants who had no previous eye disorder answered correctly. In addition, 20.9% of the participants with a previous eye disease and 17.6% of the participants without any previous eye disease defined glaucoma incorrectly as cataract. A total of 71.4% of the participants with a previous eye disease, compared with 49.6% of the participants without any previous eye disease, correctly defined cataract. In addition, only 7.3% of the participants with a history of eye disease answered the definition of cataract as that of glaucoma (glaucoma: chi-square, P = 0.002; cataract: chi-square, P < 0.001).

Conclusion

This study is in line with other studies measuring the knowledge of the two diseases, with glaucoma being less known than cataract. While many of the participants were able to define glaucoma and cataract, they had many difficulties identifying how they present and which symptom belonged to cataract and glaucoma. Glaucoma and cataract were confused by a number of participants especially in the case of glaucoma as more defined it as cataract rather than the opposite.

Survey of AREDS2 Formula Intake in Korean Patients with Age-related Macular Degeneration

Purpose: To investigate the use of second AREDS2 formula in patients with intermediate or advanced age-related macular degeneration.Methods: A prospective survey was conducted between December 2019 and July 2020. The questionnaire consisted of 24 questions on demographics, disease perception, and formula intake.Results: The survey included 100 patients (males, 56%; age [>60 years], 89%). We found that 66%, 84%, and 93% of patients had a good understanding of their disease, had stopped smoking, and were aware of the need for antioxidant supplements; 58% of patients were aware of the supplement they were prescribed, and 63.8% (37% of total) were using the AREDS2 formula. Only 8% of patients had knowledge regarding the supplement ingredients, and 91% consumed the supplement daily. Patients with long disease duration used supplements less frequently (p < 0.05). Older patients and those with a low education level had a limited perception of the disease (p < 0.05).Conclusions: In this prospective survey, some patients consumed supplements other than the AREDS2 formula. Further studies are required to determine ways to increase the use of the AREDS2 formula.

Cost-utility analysis of trabecular micro-bypass stents (TBS) in patients with mild-to-moderate open-angle Glaucoma in Italy

BACKGROUND

Glaucoma is a disease characterized by progressive damage of the optic nerve. Several therapeutic options are available to lower intraocular pressure (IOP). In primary open-angle glaucoma (POAG) patients with inadequate IOP control (or controlled with multiple medical therapies or for whom medical therapy is contraindicated), the implantation of micro-invasive glaucoma surgery devices (MIGS) and concomitant cataract surgery has proved to be more effective in reducing intraocular pressure (IOP), as compared to cataract surgery alone. The objective of this study was to assess the cost-effectiveness of iStent inject® device with concurrent cataract surgery vs. cataract surgery alone, in patients with mild-to-moderate POAG, adopting the Italian National Health Service (NHS) perspective.

METHODS

Simulation of outcomes and costs was undertaken using a Markov model with 4 health states and one-month cycles, that is used to simulate the prognosis of these patients. Efficacy data were obtained from the randomized clinical trial (RCT). A lifetime horizon was adopted in the analysis. A discount rate of 3.5% was applied to both costs and effects. The Italian National Healthcare Service (NHS) perspective was considered, therefore only healthcare direct costs (acquisition of main interventions and subsequent procedures; medications; monitoring and follow-up; adverse events). Model robustness was tested through sensitivity analyses.

RESULTS

Results of the base-case analysis showed that the total lifetime costs were higher in the iStent inject® + concurrent cataract surgery, compared with the cataract surgery alone group (€8368.51 vs. €7134.71 respectively). iStent inject® + concurrent cataract surgery was cost-effective vs. cataract surgery alone, with an incremental cost-effectiveness ratio of €13,037.01 per quality-adjusted life year (QALY) gained. Both one-way deterministic and probabilistic sensitivity analyses confirmed robustness of base-case results. The cost-effectiveness accessibility curve (CEAC) showed that iStent inject® + cataract surgery would have a 98% probability of being cost-effective, compared to cataract surgery alone, when the willingness to pay (WTP) is equal to €50,000 per QALY gained.

CONCLUSIONS

The results of the cost-utility analysis confirm that iStent inject® + cataract surgery is a cost-effective option for the treatment of patients affected by mild-to-moderate POAG, compared with cataract surgery alone, when evaluated from the Italian NHS perspective.

Mobile health intervention for promotion of eye health literacy

PURPOSE

Improving eye health awareness in the underserved population is a universal eye health priority. The ubiquity of cell phones and internet usage provides new and innovative opportunities for health promotion. This study evaluated the effect of mobile health intervention (text message link) to promote eye health literacy (EHL) of priority ocular morbidities.

METHODS

This study was an intervention evaluation and employed a two-armed pre-test post-test approach. Baseline assessment on EHL was performed on 424 university students. Participants were categorised into intervention and control groups, using the 1:1 allocation ratio. The intervention and control group received a text message alone and text message with a link, respectively. EHL was assessed via a self-administered questionnaire. The primary outcome measures were changes in EHL scores between baseline and one month post-intervention. Descriptive analysis was performed to assess the cost-effectiveness of the intervention.

RESULTS

With low attrition and a response rate of 95.6%, 409 responses were eligible for analysis. The mean age of the participants (49.4% males and 50.6% of females) was 19.9±1.68 years. Baseline EHL scores were low, and there was no correlation with a demographic profile (all p<0.05, CI 95%). The demographic characteristics were similar between the two groups (for all, P <0.05, CI 95%) at baseline. The EHL scores improved in both groups between the pre-and post-test assessment; however, improvements were statistically significant only in the control group. The one-month post-intervention EHL scores were also higher in the intervention group compared to the control (p≤0.001, CI 95% for all). The total cost incurred for the intervention used was 11.5 USD.

CONCLUSION

Text message link demonstrated effectiveness for improving the EHL scores; the low baseline EHL scores substantially improved with intervention. The text message link intervention is a cost-effective method and could be considered in advocating for eye health in developing countries, particularly during global emergencies.

Epidemiological factors associated with health knowledge of three common eye diseases: A community-based pilot survey in Hong Kong

Objectives

To assess the proportions of respondents in the general community having heard or awareness, and their knowledge level, of three common eye diseases: age-related macular degeneration, cataract, and glaucoma. We also attempted to assess for risk factors that may be associated with any variations, which will help identify the areas of inadequate knowledge and demographics of potential audiences for focused health education.

Methods

We conducted a community-based pilot survey for the residents from a southern suburb of Hong Kong in early 2016, by inviting all aged 50 or above to complete a standardized questionnaire in the local community hall.

Results

Most of the 222 respondents have heard, or awareness, of cataract (92.79% or 81.98%, respectively), followed by glaucoma (86.94% or 52.70%, respectively), and age-related macular degeneration (51.35% or 29.28%, respectively). The results of Cronbach's alpha (α > 0.7) and Spearman's correlation coefficient (p < 0.01) suggested that the internal consistency, convergent and discriminant validities of the questionnaire were acceptable for the study population. Compared to a previous Hong Kong survey in 2002, the proportions of having heard of the three eye diseases were greater, but the overall knowledge remained limited. From a maximum knowledge score of 29, the median scores for age-related macular degeneration, cataract, and glaucoma were 9, 13, and 14, respectively. Except for the treatment of cataract, the knowledge level in most areas was low. Sociodemographic factors and medical history, rather than behavioral factors, were more likely to be associated with having a higher knowledge level. Subjects with family or friends with a history of glaucoma or age-related macular degeneration were more aware and knowledgeable, but not for subjects who were current and past smokers or alcohol drinkers. For age-related macular degeneration, gender modified the effect between age and knowledge level, while age was a confounder of having medical history, and having heard or awareness, of the disease.

Conclusion

Despite a larger proportion of the community having heard or awareness since 15 years ago, much effort remains for improving health knowledge of these three eye diseases in Hong Kong. We recommend targeting respondents with higher lifestyle risks, such as current and past smokers or alcohol drinkers, as a focused audience, and utilizing family members, relatives, or friends as another way of distributing health information.

Seeing other perspectives: evaluating the use of virtual and augmented reality to simulate visual impairments (OpenVisSim)

Simulations of visual impairment are used to educate and inform the public. However, evidence regarding their accuracy remains lacking. Here we evaluated the effectiveness of modern digital technologies to simulate the everyday difficulties caused by glaucoma. 23 normally sighted adults performed two everyday tasks that glaucoma patients often report difficulties with: a visual search task in which participants attempted to locate a mobile phone in virtual domestic environments (virtual reality (VR)), and a visual mobility task in which participants navigated a physical, room-scale environment, while impairments were overlaid using augmented reality (AR). On some trials, a gaze-contingent simulated scotoma-generated using perimetric data from a real patient with advanced glaucoma-was presented in either the superior or inferior hemifield. The main outcome measure was task completion time. Eye and head movements were also tracked and used to assess individual differences in looking behaviors. The results showed that the simulated impairments substantially impaired performance in both the VR (visual search) and AR (visual mobility) tasks (both P < 0.001). Furthermore, and in line with previous patient data: impairments were greatest when the simulated Visual Field Loss (VFL) was inferior versus superior (P < 0.001), participants made more eye and head movements in the inferior VFL condition (P < 0.001), and participants rated the inferior VFL condition as more difficult (P < 0.001). Notably, the difference in performance between the inferior and superior conditions was almost as great as the difference between a superior VFL and no impairment at all (VR: 71%; AR: 70%). We conclude that modern digital simulators are able to replicate and objectively quantify some of the key everyday difficulties associated with visual impairments. Advantages, limitations, and possible applications of current technologies are discussed. Instructions are also given for how to freely obtain the software described (OpenVisSim).

Feeling the pressure: a cross-sectional study exploring feasibility of a healthcare Pop-Up for intraocular pressure measurements in shopping centres in England

OBJECTIVES

To test the hypothesis that a shopping centre Pop-Up health check combining an intraocular pressure (IOP) check with a general health check (blood pressure (BP)) is more readily accepted by the general public than an IOP check only. We investigate public awareness of IOP compared with BP and the feasibility of measuring IOP in large numbers in a Pop-Up.

DESIGN

A cross-sectional study using a tailor-made healthcare Pop-Up.

SETTING

The 'Feeling the Pressure' Pop-Up was sited in eight regionally-different shopping centres in England.

PARTICIPANTS

Adult members of the public in shopping centres.

METHODS

On one day we measured IOP only and on another measured BP and IOP. IOP was measured by Icare IC100 tonometer (Helsinki, Finland). Potential participants were asked about their awareness of IOP and BP and when they last visited their optometrist.

RESULTS

More people attended the combined BP + IOP days (461; 60%; 95% CI 56% to 64%) than IOP-only days (307; 40%, 95% CI 37% to 43%) over 16 days of testing. We recorded IOP in 652 participants (median (IQR) age and IOP of 54 (42 to 68) years and 13 (11 to 15) mm Hg, respectively). Fewer people reported awareness about IOP (19%, 95% CI 16% to 23%) compared with BP (71%, 95% CI 66% to 75%). Of 768 participants, 60 (8%) reported no previous optometric eye examination and 185 (24%) reported >2 years since their most recent examination.

CONCLUSIONS

Measuring IOP in large numbers of the public via a shopping centre Pop-Up is feasible. Public engagement was greater when a BP check was offered alongside an IOP check, suggesting unfamiliar health checks can be promoted by aligning them with a more familiar check. Our findings hint at strategies for public health schemes that engage the public with their eye health.

Factors Associated with Knowledge, Attitude and Practices of Common Eye Diseases in General Population: A Multicenter Cross-Sectional Study from Pakistan

High prevalence of blindness coupled with low public awareness of eye diseases is a severe problem in Pakistan. The objective of this study was to evaluate the awareness, attitude and practices related to common ocular problems and eye care use among general population of Punjab, Pakistan. Data were collected cross-sectionally, using random selection of participants from five districts of Punjab, Pakistan. A pre-tested questionnaire was used to collect the data from January to March 2017. The ordinal data were converted to interval--based data by Rasch analysis, which is termed as "knowledge score" and ranges from -3 to +3. Descriptive statistics, linear regression, binary logistic regression and chi square analysis were performed to evaluate the data. Of the 2073 people contacted, 96.4% (2019) responded the interviewer. The mean (SD) age was 39.9 (11.4) years, majority were males (64.8%) and only 3.1% were illiterate. The majority (68.1%) of respondents were aware that blindness can be prevented and are least aware of age-related macular degradation (31.4%). Multivariate analysis to knowledge scores demonstrated that male gender (β = 0.53 95%CI = 0.39, 0.66, p < 0.001), higher education (β = 0.31 95%CI = 0.25, 0.37, p < 0.001) were significantly associated with knowledge score. Eighty-two percent of our respondents had a positive attitude towards health-seeking behavior and those who had adequate income on most of occasions were 1.82 (AOR = 1.82 95%CI = 1.26, 2.62 p = 0.001) times more prone towards health-seeking behavior than those who had insufficient income. Out of all respondents, 21.5% had an eye examination at least once a year and this frequency was significantly higher in lower age, females, high education and high Socio Economic Status level (p < 0.05). Among the general population of Pakistan, awareness about prevention of blindness and refractive error was optimum, while awareness of blindness causing eye conditions, like age-related macular degradation was low. Intensive improvements in the health literacy and public interventions-specifically in old age people, males and respondents with lower education-are urgently needed.

Knowledge about cataract and associated factors among adults in Gondar town, northwest Ethiopia

Purpose

The aim of this study was to assess knowledge regarding cataract and associated factors among adults in Gondar town Northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted on 836 adults age ≥18years, using multi-stage systematic random sampling technique, in Gondar town Northwest Ethiopia from April 15-May 7, 2017. Data were collected using pre-tested structured questionnaires through face to face interview. The collected data was entered to Epi info version 7 and analyzed using SPSS version 20. Binary logistic regression was used to identify associated factors. Those variables with p-value <0.05 and confidence interval ≠ 1 in multivariable logistic regression were considered as statistically significant factors for knowledge regarding cataract.

Result

Among 845 eligible adults, 98.9% (836) of them were fully participated. The median age of participants was 28 years with an interquartile range of 17 years. Of the total participants, 67.2% (562) of them had awareness about cataract [95% CI, 63.8–70.2]. Among 562 participants, 61.7% of them had good knowledge about cataract [95% CI, 57.5–66.00]. It was also found that higher level of education [AOR = 2.86, 95%CI: 1.37–5.96], higher family monthly income [AOR = 1.92, 95%CI: 1.03–3.57], having previous eye examination [AOR = 1.53, 95% CI: 1.02–2.31] and positive family history of cataract [AOR = 1.76, 95%CI: 1.03–3.01] were positively associated with good knowledge.

Conclusion

Significant portion of the participants had good knowledge about cataract, which was positively associated with higher level of education, higher family monthly income, presence of previous eye examination and positive family history of cataract. However, significant knowledge gap regarding the risk factors and prevention strategies was recognized. Hence, it might be logical to pay special attention in prospering knowledge on how to prevent the occurrence of the disease.

Barriers for Cataract Treatment among Elderly in Sri Lanka

Cataract is still the leading cause of blindness. Many government institutes and voluntary organizations in Sri Lanka are providing free treatment services to patients with cataract. Still people are not patronizing the available free services; thus they have to live with impaired vision or blindness. This paper describes the barriers for cataract treatment among the population over 60 years of age. Out of 470 elders, 379 were found to have some kind of cataract. This study demonstrated lack of awareness and knowledge, socioeconomic factors, and misconceptions as the main barriers for cataract treatment which has led to a lower cataract surgery rate irrespective of the high cataract prevalence reported. Findings of this study highlight the importance of cataract as a common health problem in elderly and need for removal of the barriers for its treatment which should be given due prominence in the formulation of public health policy in Sri Lanka at the earliest.

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.

Glaucoma awareness Indian military personnel: a tri-service study

INTRODUCTION

In India, glaucoma is the third most common cause of blindness, reflecting both its asymptomatic presentation and a lack of knowledge in the general population. No previous published data of glaucoma awareness among the Indian Armed forces personnel exists, who constitute a unique group consisting of people drawn from all parts of the country and society.

METHODS

Bilingual questionnaires were distributed to 496 serving Army, Navy and Air Force personnel serving in units local to the Zonal military hospital in North India. Having heard of the term glaucoma resulted in the subject being 'glaucoma aware', while 'knowledge of glaucoma' required at least three out of six questions to be answered correctly.

RESULTS

110/496 (22%) participants were found to be glaucoma aware, while knowledge of glaucoma was found in 60/496 (12%) participants.

CONCLUSIONS

This study demonstrates that glaucoma awareness and knowledge is high compared with rural or urban Indian populations. This is likely reflects the frequent health camps conducted by the armed forces and periodic medical examinations. However, these figures are still low compared with developed countries and likely reflects differences in education standards, socioeconomic status and differing influences of the media.

Development and pilot-testing of patient decision aid for use among Chinese patients with primary open-angle glaucoma

Background

A patient decision aid (PDA) is a tool for shared decision making (SDM), which emphasises patient empowerment. It is useful in chronic diseases and when there are multiple, no best single treatment option. Although SDM is prevalent in Western countries, its use is limited in Chinese societies, where the adoption of a paternalistic approach is strong. Here, we report the development, acceptance and pilot test results of a PDA targeted at Chinese patients with primary open-angle glaucoma (POAG).

Methods

We developed a PDA designed for use in Chinese patients with POAG. Recruited subjects were given our PDA. Baseline evaluation included decision conflict scale (DCS), validated glaucoma adherence questionnaires and glaucoma knowledge questionnaire. Subjects were briefed through the PDA and instructed to read it that day. Three to four weeks later, follow-up questionnaire as described above were conducted with the addition of acceptance questionnaires.

Results

Data from 65 subjects were available. The PDA was well received among subjects. DCS improved from 48.9±20.4 at baseline to 34.3±20.3 during follow-up, with P<0.01. Validated medication adherence questionnaires and knowledge showed improvement from baseline, which was statistically significant.

Conclusions

The use of PDA among Chinese subjects with POAG demonstrated positive reception and acceptance. Evaluation of its initial effects shows improvement in DCS, medication adherence and glaucoma knowledge. The implementation of SDM and PDA among Chinese subjects with POAG is encouraged. Future studies with randomised design and later evaluation time points can further reveal the impacts of PDA among Chinese subjects with POAG.

Investigation of time to first presentation and extrahospital factors in the treatment of neovascular age-related macular degeneration: a retrospective cross-sectional study

OBJECTIVES

To assess the time from symptom onset to treatment for neovascular age-related macular degeneration (nvAMD) and to measure the awareness of AMD in Southeast Scotland.

DESIGN

Retrospective cross-sectional study.

SETTING

Secondary care, Southeast of Scotland.

METHODS

Patients treated with intravitreal therapy (IVT) for nvAMD in Southeast Scotland between 2013 and 2015 were identified using a treatment register. Notes were retrospectively reviewed. We measured time from: (A) symptom onset to first presentation at primary care, (B) referral to ophthalmic clinic appointment and (C) ophthalmic clinic appointment to first IVT treatment. To investigate AMD awareness, we performed a cluster random sample survey of patients visiting non-AMD ophthalmic clinics using a previously validated 12-item questionnaire.

RESULTS

195 patients (mean age 78 years) were included in the study. The mean delays between the different stages-A, B and C-were 54.2 (95% CI ±13), 28.2 (95% CI ±4.0) and 31.5 (95% CI ±3.6) days, respectively. There was an additional mean delay of 7.5 (95% CI ±1.6) days when patients were indirectly referred by optometrists via general practitioners (P<0.05). 140 patients (mean age 78) participated in the awareness survey; 62.1% reported being 'aware' of AMD but only 37.3% described AMD symptoms correctly.

CONCLUSIONS

There was a significant delay at every step of the nvAMD care pathway. The causes for this were multifactorial and included delays in first presentation to a healthcare provider, referral from primary care and initiation of secondary care treatment. Our data are likely to underestimate prehospital delays as a large number of cases are likely to have undefined symptoms and onset. We also identified suboptimal awareness of AMD which could account for a substantial delay in presentation from symptom onset. These findings highlight the need to address AMD awareness and the need for urgent treatment to prevent avoidable vision loss resulting from nvAMD.

Awareness and eye health-seeking practices for cataract among urban slum population of Delhi: The North India eye disease awareness study

Purpose:

The objective of the study was to assess the awareness and health-seeking practices related to cataract in urban slums of Delhi.

Methods:

This study design was a population-based cross-sectional study. Participants aged 18–60 years were recruited from randomly selected five slums of South Delhi. They were interviewed using a semi-structured interview schedule on awareness and eye health-seeking practices related to cataract. The practices were recorded if the respondents themselves or any other member of the family was diagnosed with cataract in previous 2 years.

Results:

A total of 1552 respondents participated in the study, of which, 89.9% had heard of cataract but only (42%) were aware of any symptom of cataract. The common symptoms of cataract reported by the participants were white opacity in eyes (25.9%) and loss of vision (20.6%). Surgery as a treatment of cataract was known to only 559 (40.1%) participants. Awareness about surgery as treatment of cataract was significantly higher among people aged 45–60 years (adjusted odds ratio = 2.89, 95% confidence interval = 2.11–3.97) and in educated people (adjusted OR = 3.69 95% CI = 2.37–5.73). Out of 84 respondents who had been diagnosed with cataract, the health-seeking practices were observed by 70 (83.3%) participants. Among them, 51 (72.9%) had undergone surgery and another 19 (27.1%) had been advised to wait for surgery. Most of the operated patients 48 (94.1%) attended the postoperative follow-up.

Conclusion:

The study findings suggest the majority of participants have heard of cataract, but there is low awareness of its symptoms and treatment, and good eye health-seeking practices observed for cataract in urban slum population. Gaps in awareness observed can be filled up by implementing proper eye health education programs.

Public awareness of common eye diseases in Jordan

BACKGROUND

Cataract, glaucoma, diabetic retinopathy and dry eye disease are common with high prevalence in Jordan. This study aims to assess the awareness of these ocular diseases among Jordanian population.

METHOD

A self-designed questionnaire was developed in Arabic and used to interview people in different provinces of Jordan. Socio-demographic data e.g. age, gender and level of education was reported. Public awareness of four ocular diseases; cataract, glaucoma, diabetic retinopathy (DR) and dry eye disease (DED) was assessed. Questions about familiarity with the diseases, familiarity with their risk factors and participants' source of knowledge were asked. Moreover, awareness of the effect of these disease on the eye whether they are blinding, preventable, treatable and/or the vision is back to normal following treatment was also assessed.

RESULTS

A total of 802 participants (232 males and 570 females) completed the questionnaire. The average age (± standard deviation) of the study participants was 28 ± 11.6 (range 18 to 80 years old). Awareness of cataract, glaucoma, DR and DED was reported by 31%, 38%, 37% and 52% of the study population, respectively. Family/relatives/friends and mass media appeared to be the most common sources of knowledge. Age and level of education of the participants were significantly associated with the level of disease awareness.

CONCLUSION

This work shows that the level of awareness of the four ocular diseases among Jordanians is good and compares with many reports in the developed and developing countries. Familiarity and knowledge about ocular diseases is essential as it would increase the chance of the subject being tested and thus diagnosed early enough if any problem occurred. Better understanding of the disease would encourage subjects to seek medical care sooner which in turn would prevent visual impairment. Therefore, awareness campaigns should be made to target unaware population.

Awareness of Glaucoma and Eye Health Services Among Faith-based Communities in Kumasi, Ghana

PURPOSE

To determine awareness of glaucoma, "hinta anifraye" and available eye health services among urban communities in Kumasi, Ghana. "Hinta anifraye" is a recently developed term for glaucoma in the local Twi language.

MATERIALS AND METHODS

Convenience sampling was used to survey the communities of 4 churches and 2 mosques in Kumasi, recruiting participants as they arrived to attend religious services. Ten interviewers collected data by quantitative, interviewer-administered questionnaires. An awareness grading system was devised to categorize participant knowledge from level 0 to 4.

RESULTS

Of a total 484 respondents, 269 (56%; 95% confidence interval, 52%-60%) had heard of glaucoma, and 284 (60%; 95% confidence interval, 56%-64%) had heard of either glaucoma or hinta anifraye. Only 142 (29%) had disease-specific knowledge of symptoms or causes. TV and radio were the main reported sources of information. Education, religious community, English language, male sex, and older age were all found to be significant indicators of awareness, with education shown to be a key confounding factor. Overall 436 (90%) mentioned either a hospital or doctor as a place they knew they could seek help for an eye problem.

CONCLUSIONS

Awareness of glaucoma is higher than previously suggested from similar studies, but still very low from a global perspective. The findings suggest that media is a useful tool in disseminating health messages. Awareness of professional care was found to be remarkably high. Eye health promotion is recommended to raise awareness of glaucoma among this population.

Awareness of Age-related Macular Degeneration and Its Risk Factors among Beijing Residents in China

BACKGROUND

Age-related macular degeneration (AMD) is a major cause of irreversible blindness, and awareness of this disease is important in the prevention of blindness. However, lack of public awareness of AMD was shown in previous studies, and there was no report of AMD awareness in the Mainland of China. Therefore, the aim of our study was to assess the awareness of AMD and its risk factors among Beijing residents in China.

METHODS

A cross-sectional, computer-assisted, telephone investigation was conducted to measure the awareness of AMD among Beijing residents. All the contacts of potential respondents were randomly generated by computer. Only those above 18 years of age and willing to participate in the study were included. The questionnaire for the study was modified from the AMD Alliance International Global Report. Pearson's Chi-square test and binary logistic regression analysis were used to identify the factors that affected the knowledge of AMD.

RESULTS

Among 385 Beijing residents who agreed to participate, the awareness of AMD was 6.8%, far below than that of cataract and glaucoma. Participants who were above 30 years of age (odds ratio [OR] 6.17, confidence interval [CI] 1.44-26.57), with experience of health-related work (OR 8.11, CI 3.25-20.27), and whose relatives/friends or themselves suffering from AMD (OR 32.18, CI 11.29-91.68) had better AMD awareness. Among those familiar with AMD, only 35% of them identified smoking as a risk factor, and only 23.1% of the residents believed that smoking could lead to blindness.

CONCLUSIONS

The sample of Chinese population had limited knowledge of AMD. Educational programs need to be carried out to raise public awareness of AMD.

Knowledge and awareness of ocular allergy among undergraduate students of public universities in Ghana

BACKGROUND

Ocular allergy is a growing public health problem that greatly impacts the day-to-day life of sufferers and their families. Other aspects of their activities of daily living such as schooling, professional, and social life are affected hence an increased awareness and knowledge of ocular allergies, their detection and treatment is paramount. This study was to assess the level of knowledge and awareness of ocular allergy among undergraduate students of public universities in Ghana.

METHODS

A descriptive cross sectional survey was conducted among 1000 students from three selected public universities in Ghana. Each respondent completed a questionnaire that had questions concerning awareness and knowledge of ocular allergy.

RESULTS

Out of the 1000 students, 347 (34.7 %) were aware of ocular allergy. Of these 347 students, the level of knowledge of ocular allergy was generally low. Majority of the students had their source of information about ocular allergy from the media and the internet. There was statistical significant association among awareness of ocular allergy, sources of information and programme of study (p < 0.001).

CONCLUSION

Level of awareness among university students is generally low. Students' programmes of study influenced their knowledge of ocular allergy. Public health measures are recommended to help educate students on the prevention and control of ocular allergy as well as the complications associated with this condition.

Eye Care Quality and Accessibility Improvement in the Community (EQUALITY): impact of an eye health education program on patient knowledge about glaucoma and attitudes about eye care

Purpose

To assess the impact of the education program of the Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) telemedicine program on at-risk patients’ knowledge about glaucoma and attitudes about eye care as well as to assess patient satisfaction with EQUALITY.

Patients and methods

New or existing patients presenting for a comprehensive eye exam (CEE) at one of two retail-based primary eye clinics were enrolled based on ≥1 of the following at-risk criteria for glaucoma: African Americans ≥40 years of age, Whites ≥50 years of age, diabetes, family history of glaucoma, and/or preexisting diagnosis of glaucoma. A total of 651 patients were enrolled. A questionnaire was administered prior to the patients’ CEE and prior to the patients receiving any of the evidence-based eye health education program; a follow-up questionnaire was administered 2–4 weeks later by phone. Baseline and follow-up patient responses regarding knowledge about glaucoma and attitudes about eye care were compared using McNemar’s test. Logistic regression models were used to assess the association of patient-level characteristics with improvement in knowledge and attitudes. Overall patient satisfaction was summarized.

Results

At follow-up, all patient responses in the knowledge and attitude domains significantly improved from baseline (P≤0.01 for all questions). Those who were unemployed (odds ratio =0.63, 95% confidence interval =0.42–0.95, P=0.026) or had lower education (odds ratio =0.55, 95% confidence interval =0.29–1.02, P=0.058) were less likely to improve their knowledge after adjusting for age, sex, race, and prior glaucoma diagnosis. This association was attenuated after further adjustment for other patient-level characteristics. Ninety-eight percent (n=501) of patients reported being likely to have a CEE within the next 2 years, whereas 63% (n=326) had a CEE in the previous 2 years. Patient satisfaction with EQUALITY was high (99%).

Conclusion

Improved knowledge about glaucoma and a high intent to pursue eye care may lead to improved detection of early disease, thus lowering the risk of blindness.

Population awareness of diabetic eye disease and age related macular degeneration in Nepal: the Bhaktapur Retina Study

BACKGROUND

Diabetic retinopathy (DR) and age-related macular degeneration (AMD) are among the leading causes of visual impairment and blindness in developing countries. This study aims to explore the awareness of these retinal diseases in Nepal.

METHOD

A population based cross-sectional study conducted among individuals 60 years and older from the Bhaktapur district of Nepal. One thousand consecutive subjects were enrolled and subjected to a structured questionnaire.

RESULT

Subject age ranged from 60 to 93 years with a meanof 69.5 years ± 7.1(S.D.). Males and females comprised 45.1 and 55.9 % of the population, respectively. The majority was illiterate (78.2 %), and agriculture was the predominant occupation (79.8 %). 12.1 % were aware of the effect of diabetes on the eye, and among them, 99 % were aware that diabetes was a blinding disease caused by DR.11.5 % of the subjects were aware of DR, and 10.1 % were aware that subjects with diabetes should undergo periodic eye examinations. Only 7.6 % of subjects were aware of AMD.7.5 and 7.4 % were aware about its aggravation with smoking and sunlight exposure, respectively. Younger age group, males, literates, service holders, best corrected visual acuity >0.3 LogMAR, were each significantly associated with an increase in awareness of diabetic retinopathy. Smokers and those with agricultural occupations were less aware regarding AMD. Those with diabetes,with or without DRwere significantly more aware than those not having the disease.

CONCLUSION

Among the Bhaktapur population, awareness of DR and AMD was only 11.5 and7.6 % respectively. Older age groups, females, illiterates, farmers, and those with poor visual acuity were less aware of these blinding diseases. We recommend community-based eye health education programs targeted at raising awareness of these diseases and preventive measures.

Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up

Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158.

Awareness, knowledge, and practice: a survey of glaucoma in north Indian rural residents

Background:

Studies done on the prevalence of glaucoma have reported a high proportion of undiagnosed patients. Late diagnosis is related to increased risk of glaucoma associated with visual disability. Lack of awareness and non-availability of appropriate screening procedures are among the major reasons for non-diagnosis or late diagnosis of glaucoma. The present study has been undertaken to evaluate the level of awareness about glaucoma among the North Indian rural population.

Materials and Methods:

A group-administered, questionnaire-based survey, involving 5000 rural residents (aged 20 and above) was conducted through random sampling. The questionnaire was structured to evaluate the level of awareness and knowledge about glaucoma and the effect of gender, education status, and glaucoma diagnosis was also studied. The source of awareness about glaucoma was also questioned.

Results:

Of the 5000 individuals enrolled for the survey, responses from 4927 (98.5%; 95% Confidence Interval (CI): 98.2 - 98.9) participants, including 3104 males (63%; 95% CI: 61.7 - 64.3) and 1823 females (37%; 95% CI: 35.7 - 38.3) were evaluated. A total of 409 (~8.3%; 95% CI: 7.6 - 9.14) respondents were aware about glaucoma and only 93 (1.89%; 95% CI: 1.55 - 2.31) were qualified as having knowledge about glaucoma as per the set questionnaire. Education was the only variable significantly correlated (P value < 0.001) with the awareness and knowledge of glaucoma out of the parameters included in this study. Close acquaintance with a glaucoma patient was the most common source of information.

Conclusions:

There is a lack of awareness about glaucoma among the rural residents of North India. The study findings stress the need to spread awareness about glaucoma for prevention of glaucoma-related blindness.

Strategies for improving early detection and diagnosis of neovascular age-related macular degeneration

Treatment of the neovascular form of age-related macular degeneration (AMD) has been revolutionized by the introduction of such agents as ranibizumab, bevacizumab, and aflibercept. As a result, the incidence of legal blindness occurring secondary to AMD has fallen dramatically in recent years in many countries. While these agents have undoubtedly been successful in reducing visual impairment and blindness, patients with neovascular AMD typically lose some vision over time, and often lose the ability to read, drive, or perform other important activities of daily living. Efforts are therefore under way to develop strategies that allow for earlier detection and treatment of this disease. In this review, we begin by providing an overview of the rationale for, and the benefits of, early detection and treatment of neovascular AMD. To achieve this, we begin by providing an overview of the pathophysiology and natural history of choroidal neovascularization, before reviewing the evidence from both clinical trials and “real-world” outcome studies. We continue by highlighting an area that is often overlooked: the importance of patient education and awareness for early AMD detection. We conclude the review by reviewing an array of both established and emerging technologies for early detection of choroidal neovascularization, ranging from Amsler chart testing, to hyperacuity testing, to advanced imaging techniques, such as optical coherence tomography.

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.

Awareness, knowledge and self-care practices toward glaucoma among final year health science university students in Ghana

BACKGROUND

In the absence of adequate services, patients have to rely on the few health professionals that they do come into contact with to advise them on their treatment options. The aim of this study was to determine the level of awareness and knowledge of glaucoma, and the association between these factors and self-care practices among final year health science university students in Ghana.

METHOD

A cross-sectional survey involving the use of a structured questionnaire was conducted among 273 final year students (67 per cent) studying at any one of eight health science programs in three selected public universities in Ghana.

RESULTS

All 273 respondents were aware of glaucoma but only 37.7 per cent had knowledge of it. The majority (65.9 per cent) defined glaucoma as raised intraocular pressure, and confused glaucoma with ocular hypertension. Over half (56.8 per cent) had acquired their knowledge of glaucoma during the course of their training. The media also played a major role in glaucoma awareness; however, it played a limited role in impacting on the knowledge of glaucoma. Only 28.6 per cent of respondents had previously undergone glaucoma screening.

CONCLUSION

Although all respondents were aware of glaucoma, their level of knowledge of glaucoma was low. Self-care practices were also generally poor among the respondents. This information may be useful for glaucoma health education in Ghana.

Knowledge and awareness of age related eye diseases: a population-based survey

PURPOSE

To determine general awareness and knowledge about cataracts, glaucoma and diabetic retinopathy (DR), as common avoidable causes of blindness in an Iranian population.

METHODS

This cross-sectional population-based survey was performed on residents over 45 years of age in Tehran. The sampling frame was the list of all landline phone numbers registered by the Telecommunications Center of Iran, through which systematic random sampling was performed. Data was collected by phone-call interviews and completing a semi-structured questionnaire. Awareness was defined as whether the respondent had ever heard of the disease. Knowledge was assessed by realizing different aspects of each disease.

RESULTS

Of a total of 1,084 eligible people including 574 (52.9%) women and 510 (47.1%) men were included and 957 subjects (response rate, 88.3%) completed the interview. Awareness regarding glaucoma, cataract and DR was 46.6% (95% confidence interval [CI]:43.4 -49.8%), 82.9% (95% CI: 80.5 -85.3%) and 86.2% (95% CI: 84-88.4%). In addition, 19.2% (95% CI: 16.7 -21.7%), 57.3% (95% CI: 54.2-60.4%) and 72% (95% CI: 69.2 -74.8%) of respondents could give at least a basic definition of the mentioned diseases, respectively. Only 22.6% (95% CI: 20-25.2%) and 41.6% (95% CI: 38.5-44.7%) realized glaucoma and DR as a treatable condition; in contrast, 77.2% (95% CI: 74.5-79.9%) categorized cataract as treatable. Only 19% and 7.1% knew that DR and glaucoma may commence without any apparent symptoms.

CONCLUSION

Compared with cataract and DR, most participants had limited information about glaucoma. In addition, few of the respondents were familiar with the initial symptoms of DR and glaucoma.

Intraocular pressure after phacoemulsification in patients with uncontrolled primary open angle glaucoma

RATIONALE (HYPOTHESIS): Although cataract and glaucoma represent an increasingly common situation encountered concomitantly, the management of this association is still debatable. OBJECTIVE (AIM): We aimed to assess intraocular pressure dynamics after phacoemulsification in patients with uncontrolled primary open angle glaucoma (POAG).

METHODS AND RESULTS

The present study was designed as a prospective, non-randomized, cohort study. The study population comprised of 38 patients with medically uncontrolled POAG who underwent cataract surgery by phacoemulsification between 2011 and 2012. Most of the patients (32/38, 84.2%) needed glaucoma surgery after a variable time (mean time between surgeries was 11.6 +/- 4.18 months). Mean preoperative IOP decreased with 2,1 +/- 3,7 mmHg at 6 months (CI 95% 1.96 to 3.56) and with 1,9 +/- 3,9 mmHg at 12 months compared with the baseline IOP. Postoperative IOP was statistically significant lower compared with its preoperative value at 6 months (p=9.11 x 10⁻⁸) and at one year (p=9.2 x 10⁻⁵). The difference between mean IOP at 6 months and 1 year after cataract surgery was not statistically significant (p>0.05). Preoperatively, all the patients received topical antiglaucoma therapy. After phacoemulsification, their number did not change statistically significant, but it showed a slight increase. Average number of topical glaucoma medications used preoperatively was 2.66 + / -0.66, while at 6 months after surgery it was 2.71 + / - 0,75 and at 12 months postoperatively, 2.9 +/- 0.53.

DISCUSSION

IOP decreased statistically significant after phacoemulsification in patients with uncontrolled POAG, but the decrease was not sufficient for optimal glaucoma management; therefore, many patients needed subsequent glaucoma surgery.

Noncompliance with Ocular Hypertensive Treatment in Patients with Primary Open Angle Glaucoma among the Arab Population in Israel: A Cross-Sectional Descriptive Study

Objective. To evaluate the noncompliance treatment rates among primary open angle glaucoma (POAG) Arab patients in Israel and to verify the associated factors for noncompliance. Patients and Methods. A cross-sectional study took place using a questionnaire. Patients were initially interviewed and requested to answer a questionnaire. The questionnaire was developed based on a pilot test. Items included information about age, gender, number of prescribed drugs, and multiple reasons for noncompliance with drug therapy. Setting. Ophthalmologic HMO clinics, located in 3 Arab cities in the center of Israel. Participants. 400 Arab participants (197 men, 203 women) undergoing routine clinical care were recruited. Results. General rate of noncompliance, for both genders, was found to be 50%. Factors associated with nonadherence included inadequate knowledge (32%), underestimation of the disease severity (25.5%), and denial 15.5%. Compliance rates were unaffected by gender or number of prescribed drugs. Compliance was significantly higher in younger patients (age < 50) and in older patients (age > 80), 63% and 77%, respectively, (P < 0.05). Conclusion(s). Noncompliance was found to be common among an Arab population in Israel, particularly between the ages of 50 and 80. Educational programs, improving patient-physician relationship, and personalizing treatment could provide means for improved adherence.

The prevalence of primary glaucoma in mainland China: a systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of primary glaucoma in mainland China and to quantify its association with age, sex, and region.

METHODS

Population-based studies that reported the prevalence of primary open-angle glaucoma (POAG) or/and primary angle-closure glaucoma (PACG) among adult populations in mainland China were identified through systematic searches. Fourteen articles providing 12 population-based studies were included. The overall pooled prevalence estimates were calculated using a random-effects model. A logistic metaregression was used to model the associations between the odds ratio (OR) and 95% confidence interval of primary glaucoma and age, sex, and region.

RESULTS

The overall pooled prevalence of POAG was 0.7% (95% confidence interval, 0.4-1.2), and PACG was found in 1.4% (1.0%, 1.7%). The OR per decade increase in age was 1.68 (1.12, 2.52) for POAG, and 2.11 (1.72, 2.60) for PACG. The OR of POAG prevalence was 0.65 (0.26, 1.62) between men and women. Chinese women were 1.75 (1.20, 2.56) times more likely than men to have PACG. The OR between western China and east China were 0.37 (0.10, 1.35) for POAG, and 1.06 (0.63, 1.76) for PACG. The OR between urban China and rural China were 3.92 (1.55, 9.92) for POAG, and 1.07 (0.55, 2.10) for PACG.

CONCLUSIONS

The prevalence of PACG was approximately double that of POAG in adult Chinese. The rate of change of PACG prevalence with age increased more rapidly than that of POAG. The prevalence of POAG in urban was higher than that in rural. PACG was more common in women than in men.

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.

Glaucoma among patients enrolled in a national vision care plan

BACKGROUND

Glaucoma is one of the leading causes of impaired vision and blindness in the United States. An understanding of the disease process and its risk factors by patients is essential if its consequences are to be mitigated. Among the known risk factors, family history is one that can help promote awareness for early recognition and treatment among potential patients. This study reports on the responses to a questionnaire by glaucoma patients on their use of vision care, their understanding of their disease, and whether they shared their medical history with other family members.

METHODS

A survey was mailed to members of a national vision care benefits plan who received an eye examination with a diagnosis of glaucoma. Patients were identified by diagnosis through the managed care organization's management information system. A survey instrument was designed to determine family history, use of vision care, medications used, and basic knowledge of glaucoma.

RESULTS

One hundred forty-eight surveys were returned; two thirds were from glaucoma patients and one third from glaucoma suspects. The frequency of eye examinations and the reason for their most recent examination differed between the 2 groups. Most glaucoma patients informed relatives of their condition. As expected, glaucoma patients were better educated than the glaucoma suspect group; however, knowledge of the disease process and its consequences was lacking even among those who were taking glaucoma medication.

CONCLUSIONS

Some glaucoma patients appear to be unaware as to how glaucoma affects their vision. Understanding one's disease can enhance patient compliance and ensure that the patient returns for continued treatment and management. Patients with poor health literacy (especially with a disease with an asymptomatic beginning stage) are at a higher risk for noncompliance.

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.