The Capacity of Eye Care Services for Patients with Glaucoma in Botswana

Factors limiting glaucoma care among glaucoma patients in Nigeria: A scoping review

Glaucoma currently accounts for 11% of irreversible visual loss worldwide. Due to many factors, patients do not access the glaucoma care pathway and present late with poor vision, while many are undiagnosed or untreated. These factors may be personal-level dispositions or Institutional-level dispositions, limiting the awareness, diagnosis, and treatment of glaucoma or adherence to medications or follow-up clinic visits. This scoping review followed the JBI methodology for scoping reviews and was pre-registered on the open science platform (https://osf.io/wqx57/?view_only=727eb6c803764509a2809e5d0794e214). The PUBMED, EMBASE, WEB OF SCIENCE, AJOL, and GOOGLE SCHOLAR databases were systematically searched for studies published in English between 1990 and June 2023. Data were extracted and analysed along a conceptualised framework of factors limiting access to glaucoma care in Nigeria. Of the 336 records retrieved, 13 studies were included in this scoping review. These included one (1) mixed method (quantitative/qualitative) study, three qualitative studies, and nine quantitative studies spanning 2008-2022 covering eight states and 2,643 sampled respondents. Nine studies reported personal-level dispositions limiting glaucoma care, including low levels of education, unemployment, gender, living distance from the hospital, cost of care, and faith/religion. Four reported institutional-level dispositions, including the lack of proper equipment and expertise to diagnose or manage glaucoma. The factors limiting Glaucoma care in Nigeria are varied and may act alone or combined with other elements to determine the awareness or knowledge of glaucoma, uptake of glaucoma surgery, medication adherence, or clinic follow-up. While most of these factors limiting glaucoma care in Nigeria may be amenable to policy, a bottom-up approach is needed to improve the community's awareness and uptake of glaucoma services. A shift from the over-dependence and reliance on tertiary hospitals, which are often far away from the people who need them, is required to bridge the information and service gap currently being witnessed.

Ophthalmology training in sub-Saharan Africa: a scoping review

Sub-Saharan Africa is home to 12% of the global population, and 4.3 million are blind and over 15 million are visually impaired. There are only 2.5 ophthalmologists per million people in SSA. Training of ophthalmologists is critical. We designed a systematic literature review protocol, searched MEDLINE Ovid and Embase OVID on 1 August 2019 and limited these searches to the year 2000 onwards. We also searched Google Scholar and websites of ophthalmic institutions for additional information. We include a total of 49 references in this review and used a narrative approach to synthesise the results. There are 56 training institutions for ophthalmologists in eleven Anglophone, eleven Francophone, and two Lusophone SSA countries. The median duration of ophthalmology training programmes was 4 years. Most curricula have been regionally standardised. National, regional and international collaborations are a key feature to ophthalmology training in more than half of ophthalmology training programmes. There is a drive, although perhaps not always evidence-based, for sub-specialisation in the region. Available published scientific data on ophthalmic medical and surgical training in SSA is sparse, especially for Francophone and Lusophone countries. However, through a broad scoping review strategy it has been possible to obtain a valuable and detailed view of ophthalmology training in SSA. Training of ophthalmologists is a complex and multi-faceted task. There are challenges in appropriate selection, capacity, and funding of available training institutions. Numerous learning outcomes demand curriculum, time, faculty, support, and appropriate assessment. There are opportunities provided by modern training approaches. Partnership is key.

Glaucoma Features in an East African Population: A 6-Year Cohort Study of Older Adults in Nakuru, Kenya

PURPOSE

Glaucoma is a leading cause of blindness in people of African descent. Minimal data is available from African population-based cohort studies. The primary aims of this study were to describe the normative distribution of glaucoma features to enable glaucoma classification and to assess risk factors for those with glaucoma at follow-up among people aged 50 years and above in Kenya.

MATERIALS AND METHODS

Random cluster sampling with probability proportionate to size was used to select a representative cross-sectional sample of adults aged 50 years and above in 2007 to 2008 in Nakuru District, Kenya. A 6-year follow-up was undertaken in 2013 to 2014. Comprehensive ophthalmic examination included visual acuity, digital retinal photography, visual fields, intraocular pressure, optical coherence tomography, and independent grading of optic nerve images. We report glaucoma features, prevalence and predictors for glaucoma based on the International Society for Geographical & Epidemiological Ophthalmology (ISGEO) criteria. Measures were estimated using a Poisson regression model and including inverse-probability weighting for loss to follow-up.

RESULTS

At baseline, 4414 participants aged 50 years and above underwent examination. Anterior chamber optical coherence tomography findings: mean anterior chamber angle of 36.6 degrees, mean central corneal thickness of 508.1 μm and a mean anterior chamber depth of 2.67 mm. A total of 2171 participants were examined at follow-up. The vertical cup to disc ratio distribution was 0.7 and 0.8 at the 97.5th and 99.5th percentiles, respectively. A total of 88 (4.3%, 95% confidence interval, 3.5%-5.9%) of participants at follow-up had glaucoma consistent with ISGEO criteria. A relative afferent pupillary defect and raised intraocular pressure were associated with the diagnosis.

CONCLUSIONS

Glaucoma is a public health challenge in low-resource settings. Research into testing and treatment modalities in Africa is needed.

Ophthalmologists' practice patterns and challenges in achieving optimal management for glaucoma in Nigeria: results from a nationwide survey

PURPOSE OF THE STUDY

Glaucoma, a chronic non-communicable disease, and leading cause of irreversible blindness worldwide is a public health problem in Nigeria, with a prevalence of 5.02% in people aged ≥40 years. The purpose of this nationwide survey was to assess Nigerian ophthalmologists' practice patterns and their constraints in managing glaucoma.

STUDY DESIGN

Ophthalmologists were sent a semistructured questionnaire on how they manage glaucoma, their training in glaucoma care, where they practice, their access to equipment for diagnosis and treatment, whether they use protocols and the challenges they face in managing patients with glaucoma.

RESULTS

153/250 ophthalmologists in 80 centres completed questionnaires. Although 79% felt their training was excellent or good, 46% needed more training in glaucoma diagnosis and surgery. All had ophthalmoscopes, 93% had access to applanation tonometers, 81% to visual field analysers and 29% to laser machines (in 19 centres). 3 ophthalmologists had only ophthalmoscopes and schiøtz tonometers. For 85%, a glaucomatous optic disc was the most important feature that would prompt glaucoma work-up. Only 56% routinely performed gonioscopy and 61% used slit-lamp stereoscopic biomicroscopy for disc assessment. Trabeculectomy (with/without antimetabolites) was the only glaucoma surgery performed with one mention of canaloplasty. Poor compliance with medical treatment (78%) and low acceptance of surgery (71%) were their greatest challenges.

CONCLUSIONS

This study indicates that a systems-oriented approach is required to enhance ophthalmologist's capability for glaucoma care. Strategies to improve glaucoma management include strengthening poorly equipped centres including provision of lasers and training, and improving patients' awareness and education on glaucoma.