Determinants of glaucoma awareness and knowledge in urban Chennai

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.

The relationship between multiple deprivation and severity of glaucoma at diagnosis

BACKGROUND

Socioeconomic deprivation is associated with higher odds of chronic diseases, with many individuals living with more than one illness. This study aimed to examine the relationship between deprivation and severity of glaucoma at diagnosis, an important risk factor for glaucoma blindness.

METHODS

A retrospective study of 472 consecutive patients referred by community optometrists to the glaucoma clinic at a university hospital was performed. Glaucoma severity was determined by standard automated perimetry mean deviation (MD) in the worse eye. The Scottish Index of Multiple Deprivation (SIMD) was determined for each patient as a measure of deprivation based on postcode. Regression analyses were performed to determine the relationship between visual field MD and SIMD.

RESULTS

There was a significant relationship between higher levels of deprivation (lower SIMD) and worse severity of glaucoma at diagnosis. 32 of 472 patients (6.8%) had a MD of ≤-6 dB and 11 (2.3%) ≤-12 dB in their better eye. MD in the worse eye was 0.04 dB (95% CI 0.014 to 0.062 dB, P = 0.002) worse for each 100-point decrease in SIMD, with lower SIMD indicating a higher level of deprivation. A higher proportion of patients living in most deprived areas had a MD ≤ -6 dB or ≤ -12 dB at presentation compared to those living in the least deprived areas (14.3% versus 6.8% for ≤ -6 dB and 4.8% versus 0.8% for ≤ -12 dB).

CONCLUSIONS

Higher levels of deprivation were associated with worse glaucoma severity at presentation. The reasons for poorer outcomes in those from more deprived communities need further study so that inequalities can be addressed and the frequency of patients presenting with advanced glaucoma reduced.

Awareness and Knowledge About Glaucoma in the Western Region of Saudi Arabia: A Population-Based Survey

Background Glaucoma is a leading cause of irreversible blindness worldwide. This study aimed to assess the Saudi population's levels of awareness and knowledge regarding glaucoma risk factors, symptoms, treatment, and outcomes. Methods A cross-sectional study was conducted among the Glaucoma Awareness Campaign attendees during the World Glaucoma Week (2015-2016). A structured questionnaire was used, and a knowledge score (0-25) was calculated as the sum of all correct answers. Sociodemographic factors, personal and family history of glaucoma, and the presence of risk factors were investigated and analyzed as factors affecting knowledge. Results The study included 1751 participants, with a mean age of 40.23 (SD ±13.86) years; 51.5% were males, 3.7% had glaucoma and 22.6% had a family history of glaucoma. The overall awareness rate was 65.6%, which was moderately higher among females (71.6%), older participants (≥40 years, 69.7%), and highly educated participants (70.6%). Concerning knowledge, 15.4% had fair to good knowledge (score 15-25). Participants with a personal history of glaucoma had relatively greater knowledge regarding glaucoma-specific questions, such as optic nerve damage (p=0.001) and the requirement of lifetime treatment (p<0.001). Conclusion Awareness and knowledge about glaucoma are limited among the Saudi population, regardless of socioeconomic class or educational status. Knowledge about glaucoma should be further promoted to enable early screening and prevention.

Knowledge and Awareness of Glaucoma Among People Living in Taif City in the Western Region of Saudi Arabia

Background Glaucoma represents a significant global health challenge, characterized by progressive and irreversible optic nerve damage, visual field impairment, and potential blindness. Limited awareness can lead to delayed diagnosis and increased healthcare burden. This research explored glaucoma awareness in Taif City, Saudi Arabia. It delved into the influence of demographics, socioeconomic factors, and cultural beliefs on awareness. The study aimed to inform tailored awareness campaigns and policy decision-makers about regional awareness, ultimately contributing to effective healthcare initiatives in the region. Methodology A cross-sectional study was conducted in Taif City including adults (>18 years) using a community-based approach. Data were collected using an electronic questionnaire. Results This study included 1,000 participants. Most participants were males, aged 18-29 years, with 51.1% (n = 511) having at least a bachelor's education. The media (n = 341, 34.1%) and relatives/friends (n = 336, 33.6%) were common sources of glaucoma information. Among all participants, 58.5% (n = 585) had heard of glaucoma, and many were uncertain about glaucoma's definition and normal eye pressure values. About 63.1% (n = 631) believed in a cure, and 43.1% thought vision loss could be restored. Gender, education, and family history significantly influenced awareness. Closed-angle glaucoma (n = 297, 29.7%) and open-angle glaucoma (n = 231, 23.1%) were recognized types, with surgery (n = 371, 37.1%) and laser treatment (n = 274, 27.4%) perceived as potential cures. Conclusions This study revealed glaucoma awareness among adults in Taif City. Gender, education, and family history played significant roles in shaping awareness levels. There is a need for targeted educational efforts to improve knowledge about glaucoma in the community.

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.

Awareness of Common Eye Diseases and Their Risk Factors-A Nationwide Cross-Sectional Survey among Adults in Poland

Public knowledge and awareness of eye diseases may influence individuals' behaviors toward the use of eye care services and prevention methods. The objective of this study was to assess the awareness of common eye diseases and their risk factors among adults in Poland as well as to identify factors associated with knowledge of eye diseases. This nationwide cross-sectional web-based survey was carried out in December 2022 on a representative sample of 1076 adults in Poland. Most of the respondents had heard of cataracts (83.6%), glaucoma (80.7%), conjunctivitis (74.3%), and hordeolum (73.8%). Awareness of dry eye syndrome was declared by 50% of respondents, and 40% were aware of retinal detachment. Among the respondents, 32.3% had heard of AMD, and 16.4% had heard of diabetic retinopathy. A lack of awareness of glaucoma was declared by 38.1% of respondents, and 54.3% declared a lack of awareness of risk factors for AMD. Gender, age, and the presence of chronic diseases were the most important factors (p < 0.05) associated with awareness of common eye diseases and risk factors for glaucoma and AMD. This study demonstrated a low level of awareness of common eye diseases among adults in Poland. Personalized communication on eye diseases is needed.

Glaucoma awareness in Family Health Centers

This study aims to evaluate the glaucoma knowledge and awareness in individuals who visit to two Family Health Centers in a district of Istanbul. Patients and Method: This descriptive study, using a three-part questionnaire consisting of 20 questions, was carried out on individuals who applied to two Family Health Centers in a district of Istanbul between May and June 2019. Data from 260 were collected through face to face interviews. Results: A total of 44 (16.9%) participants had heard the word glaucoma before, while 179 (68.8%) said that glaucoma was treatable, 78 (30%) knew about asymptomatic course glaucoma. In addition, 47(18.1%) believed that eyes with glaucoma could not be operated, 152 (58.5%) thought that blindness resulting from glaucoma was reversible. Interestingly, 167(68.7%) participants thought that routine ophthalmologic visits should be done at least once a year, whereas 222 (86.9%) consulted an ophthalmologist less than 10 times in their lifetime. Conclusion: There was no statistically significant difference between individuals with family members that have glaucoma and those that do not, when asked about glaucoma being asymptomatic, the preventability of blindness and whether or not they have heard of glaucoma before. The study findings stress the need to spread awareness about glaucoma for prevention of glaucoma related blindness.

Vision-Related Quality of Life and Associated Factors Among an Adult Population with Glaucoma Attending a Comprehensive Specialized Hospital, Northwest Ethiopia

Background

Glaucoma is a group of ocular conditions that leads to irreversible blindness. It can affect the vision-related quality of life in many ways. In Ethiopia, limited information is available on how and to what extent the vision-related quality of life of the glaucoma population has been affected.

Objective

This study attempted to assess the vision-related quality of life and associated factors among an adult population with glaucoma attending Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia.

Methods

The cross-sectional study was conducted on the adult population with glaucoma attending Felege Hiwot Comprehensive Specialized Hospital. Systematic random sampling was employed to select 319 study participants. Descriptive and summary statistics were calculated. Simple and multiple linear regressions were performed to determine factors associated with vision-related quality of life. A p-value of <0.05 in multivariable regression was considered statistically significant at a 95% confidence level.

Results

The mean glaucoma quality of life-15 score in this study was 47.85 ± 15.41. Below primary education, primary education, visual acuity of the better eye, visual acuity of the worse eye, and severe glaucoma were significantly associated with the glaucoma quality of life-15 score.

Conclusion and Recommendation

The study observed poorer vision-related quality of life in the glaucoma population than previously reported in Ethiopia and around the globe. The vision-related quality of life was significantly associated with educational status, visual acuity of the better and worse eye, and stage of glaucoma in the better eye. Educating the glaucoma population on the nature of the disease, advice on early presentation, and better-coping strategies for the condition are warranted.

Enhanced glaucomatous damage accompanied by glial response in a new multifactorial mouse model

Introduction

Glaucoma is a complex, multifactorial neurodegenerative disease, which can lead to blindness if left untreated. It seems that, among others, immune processes, elevated intraocular pressure (IOP), or a combination of these factors are responsible for glaucomatous damage. Here, we combined two glaucoma models to examine if a combination of risk factors (IOP and immune response) results in a more severe damage of retinal ganglion cells (RGCs) and the optic nerves as well as an additional glia activation.

Methods

Six-week-old wildtype (WT+ONA) and βB1-Connective Tissue Growth Factor (CTGF) mice (CTGF+ONA) were immunized with 1 mg ONA (optic nerve antigen). A WT and a CTGF control group (CTGF) received sodium chloride instead. IOP was measured before and every two weeks after immunization. After six weeks, electroretinogram (ERG) measurements were performed. Then, retinae and optic nerves were processed for (immuno-) histology. Further, mRNA levels of corresponding genes in optic nerve and retina were analyzed via RT-qPCR.

Results

Six weeks after immunization, the IOP in CTGF and CTGF+ONA mice was increased. The optic nerve of CTGF+ONA animals displayed the most severe cell inflammation, demyelination, and macroglia activation. Fewer numbers of oligodendrocytes were only observed in WT+ONA optic nerves, while more apoptotic cells triggered by the extrinsic pathway could be revealed in all three glaucoma groups. The number of microglia/macrophages was not altered within the optic nerves of all groups. The loss of neuronal cells, especially RGCs was most pronounced in CTGF+ONA retinae in the central part and this was accompanied by an enhanced activation of microglia/macrophages. Also, Müller cell activation could be noted in CTGF and CTGF+ONA retinae.

Discussion

In this new model, an additive degeneration could be noted in optic nerves as well as in the number of RGCs. These results suggest a potential additive role of high IOP and immune factors in glaucoma development, which will aid for understanding this multifactorial disease more precisely in the future.

Awareness and knowledge of glaucoma among visitors of main public hospitals in Damascus, Syria: a cross-sectional study

BACKGROUND

The main way to prevent blindness from Glaucoma is by early detection and diagnosis; and to do so the awareness must be raised among people where Glaucoma is defined as an acquired chronic optic neuropathy characterized by optic disk cupping and visual field loss. Lack of knowledge about this disease is one of the most important reasons that made it develop to advanced stages. Based on that, we conducted scientific research to assess peoples' awareness and knowledge about Glaucoma. After reviewing the literature, it was found that this study is the first in Syria.

METHODS

We conducted a cross-sectional study in May 2022. The study included participants, who are above 20 years old, from visitors of Al-Mouwasat University Hospital in Damascus, Syria. During one week, Data was gathered according to the questionnaire, which was presented through face-to-face interviews with participants. We have allocated one point (1) to each question. Three levels of knowledge were adopted, namely; weak level from (0) to (3), average level from (4) to (7) and good level from (8) to (11). Associations between participants' demographic and other details were tested using Chi-square test and other tests, and a p-value of < 0.05 was considered significant.

RESULTS

A total of 500 participants were interviewed. For awareness of Glaucoma, 33.6% of the participants (n = 168) had heard of Glaucoma, and 66.4% hadn't (n = 332). Mean test results for the knowledge of Glaucoma was 1.62 out of 11, and only 8% of participants (n = 40) had a good knowledge of Glaucoma. Education Level, governorate, and department of hospital that the patient came for significantly affected the knowledge of Glaucoma. Moreover, hospital, Ophthalmologists' Clinics, and health staff (M = 5.45) were the better Resource for information than family, relatives, and friends (M = 3.16). Finally, social media and the Internet group had the lowest mean test results (M = 1.23). These test results were significant, with a p-value < 0.001.

CONCLUSION

The percentage of knowledge and awareness was significantly low. Organized community awareness methods must disseminate more ability to increase the general public's understanding to avoid injury and late diagnosis of Glaucoma.

Awareness and Knowledge of Glaucoma among Health Workers in Butajira General Hospital, South Ethiopia

Background

Raising awareness and knowledge of glaucoma is a key means of enhancing people alertness, increasing regular eye screening practice, and the chance of identifying undetected cases. Health professionals other than ophthalmologists are often the first point of contact when patients seek medical advice. However, little is known about the awareness and knowledge of glaucoma among health care professionals in Ethiopia. The objective of this study was to determine general awareness and knowledge of glaucoma among health workers in Butajira General Hospital.

Methods

Hospital-based cross-sectional study was conducted at Butajira Hospital in September and October 2021 among health care providers. All health workers except those on leave and the staff in the department of Ophthalmology were included in the study. The awareness and knowledge were assessed using a self-administered questionnaire. Descriptive statistics was computed to describe the study variable, and logistic regression was conducted to see associations between dependent and independent variables. Significant associations were declared at p-values <0.05.

Result

This study showed that 184 (91.1%) had an awareness of glaucoma among the study participants, whereas 8.9% had never heard about glaucoma. Of those who were aware, only 42% have good knowledge. Professionals who had a history of eye examinations and family history of glaucoma were about 3.0 times more likely to have good knowledge.

Conclusions

Fifty-eight percent of clinical professionals from Butajira Hospital had no awareness at all or had poor knowledge about glaucoma. Being a physician, history of eye examinations, and having a family history of glaucoma were factors related to glaucoma knowledge.

Factors associated with adherence to treatment in patients with open angle glaucoma in Sierra Leone, West Africa: patient demographics and questionnaire

BACKGROUND

Glaucoma is a significant cause of blindness worldwide. It is more common, presents earlier and is more aggressive in those of African descent. Non-adherence and poor knowledge of glaucoma is a significant barrier to treatment and has been associated with low health literacy. We aim to establish the factors contributing to late presentation, treatment non-adherence and disease progression in glaucoma patients in Sierra Leone. This will help better understand the challenges eye services face, highlight fields requiring development in patient-clinician interaction and identify areas or specific vulnerable patient groups in which resources should be focused.

METHODS

Prospective, consecutive recruitment of 120 patients with POAG attending the Lowell and Ruth Gess Eye Hospital and the Connaught Government Teaching Hospital, Freetown, Sierra Leone between February and April 2020. Data were collected from 3 sources: (1) review of clinical notes since first attendance, (2) semi-structured interviews and (3) assessment of study participant's drop instillation technique using a structured checklist. Descriptive statistics was performed for demographic data and other relevant data points. Logistic regression was used for analysis of target variables.

RESULTS

The average age was 62 years with more males (52.6%). Agricultural workers and informal street traders represented 13.2% of participants' occupation. 25.8% of participants had no formal school, and 47.4% had either a degree or a diploma. This is out of proportion with the general population and may represent a hidden demographic of glaucoma patients. Drop instillation technique was successful in 52% of study participants. Notable responses to the questionnaire were 30% of patients did not know the name of their eye condition and 22% had no knowledge of glaucoma.

CONCLUSION

Investment in a wide-ranging and robust screening programme and public health campaigns targeting these vulnerable groups and high-risk individuals, for example with a positive family history, alongside improved patient education and staff training is required to improve glaucoma care. Support from government, international organisations and the private sector is required to reduce the economic burden of blindness in Sierra Leone.

Patient-centred care in ophthalmology: current practices, effectiveness and challenges

PURPOSE

To summarise different patient-centred care approaches that can be used in ophthalmology and review their effectiveness.

METHODS

An Entrez Pubmed search on publications concerning different patient-centred care was performed on September 7, 2021. Articles on animal research, non-English language and review articles were excluded after manually screening by two authors.

RESULTS

A total of 16 articles were reviewed after curation by the authors for relevance. Patient-centred care has advantages in improving disease knowledge, enhancing doctor-patient communications and improving mental well-being of patients. Various methods including intensive patient education, patient-centred communication techniques during consultations, personal disease records, education programme for caregivers, on-site ocular care for residential care home resident and shared medical appointments can be used to enhance patient-centred care.

CONCLUSIONS

Current strategies in patient-centred care in ophthalmology were found to be useful. However, they have not been widely practised and more studies would be required generate an evidence-based recommendation for future use.

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.

Gessesse G. Knowledge and practice towards glaucoma among glaucoma patients at University of Gondar Tertiary Eye Care and Training Center

Background

For better treatment outcome, exploring the knowledge of glaucoma and practices among glaucomatous patients is much more important.

Objective

The aimed of this study was to determine the knowledge and self-care practice and their associated factors towards glaucoma and its medications among glaucoma patients.

Methods

Cross section design study was conducted between May and July, 2017. The data was collected from glaucoma patients. Descriptive statistics was done to summarize socio demography data and associated factors with good knowledge and good practice were determined using binary logistic regression. Statistically significant variables were generated by considering p-value < 0.05.

Results

A total of 360 glaucoma patients were participated in this survey. The median age of the participant was 65 years. About 177 (49.25%) (95%CI: 43.9, 54.4) had good knowledge and a total of 197 or 54.7% (95%CI: 49.4, 59.7) had good practice about glaucoma and its medical treatments. The factors such as residence, marital status, educational status and stages of glaucoma of study participants were independently associated with having good knowledge. With respect to practice, educational status, duration of glaucoma, laterality and frequency of follow up were significantly associated with practice status of study participants.

Conclusion

In this study among glaucoma patients in a tertiary hospital, only half of patients have good knowledge about the disease and good practice pattern. Those with urban residence, higher education status and advanced stage of glaucoma were more likely to have good knowledge.

Proteomic Analysis of Retinal Tissue in an S100B Autoimmune Glaucoma Model

Glaucoma is a neurodegenerative disease that leads to damage of retinal ganglion cells and the optic nerve. Patients display altered antibody profiles and increased antibody titer, e.g., against S100B. To identify the meaning of these antibodies, animals were immunized with S100B. Retinal ganglion cell loss, optic nerve degeneration, and increased glial cell activity were noted. Here, we aimed to gain more insights into the pathophysiology from a proteomic point of view. Hence, rats were immunized with S100B, while controls received sodium chloride. After 7 and 14 days, retinae were analyzed through mass spectrometry and immunohistology. Using data-independent acquisition-based mass spectrometry, we identified more than 1700 proteins on a high confidence level for both study groups, respectively. Of these 1700, 43 proteins were significantly altered in retinae after 7 days and 67 proteins revealed significant alterations at 14 days. For example, α2-macroglobulin was found significantly increased not only by mass spectrometry analysis, but also with immunohistological staining in S100B retinae at 7 and 14 days. All in all, the identified proteins are often associated with the immune system, such as heat shock protein 60. Once more, these data underline the important role of immunological factors in glaucoma pathogenesis.

Epidemiological Surveillance of Eye Disease and People Awareness in the Abruzzo Region, Italy

Background and Objectives: Vision impairments and related blindness are major public health problems. The prevalence of eye disease and barriers to optimal care markedly vary among different geographic areas. In the Abruzzo region (central Italy), an epidemiological surveillance on the state of ocular health in the population aged over 50 years was performed in 2019. Materials and Methods: Participants were sampled to be representative of the region’s inhabitants. Data were collected through a telephone interview and an eye examination. Prevalence of cataract, glaucoma, retinopathy, and maculopathy was assessed. The Cohen’s kappa (k) was used to measure the agreement between the presence of eye disease and awareness of the disease by the participants. Results: Overall, 983 people with a mean age of 66.0 ± 9.5 years were included in the study. The prevalence of cataracts, glaucoma, maculopathy, and retinopathy was 52.6%, 5.3%, 5.6%, and 29.1%, respectively. Among the total of the affected people, those aware of their condition were 21.8% (k = 0.12, slight agreement) for cataract, 65.4% (k = 0.78, substantial agreement) for glaucoma, 7.1% (k = 0.10, slight agreement) for maculopathy, and 0% for retinopathy (k = −0.004, agreement lower than that expected by chance). Refractive defects were corrected in the vast majority of participants. Conclusion: In the Abruzzo region, about two thirds of citizens aged 50 years or over suffer from cataract, glaucoma, retinopathy, or maculopathy, which are recognized as leading causes of blindness. Many people with eye disease do not know they have it. These data can be used by clinicians and policymakers to undertake clinical, political, and social actions.

An exploratory study of compliance to anti-glaucoma medications among literate primary glaucoma patients at an urban tertiary eye care center in South India

Purpose:

To understand the factors that explain compliance to anti-glaucoma medication (AGM) in terms of application,purchase, stocking and compliance behaviour.

Methods:

This was a cross-sectional study conducted in the outpatient department of an urban tertiary eye care center in South India. Interviews were completed with consenting, consecutive, literate primary glaucoma patients. The components of the questionnaire included duration, application, purchase, stocking and caregiver's role. Self-reported compliance in medication taking was tested for association with rest of the components by Chi-square test and discriminant analysis.

Results:

A total of 101 patients, aged 34–87 years, were interviewed. Majority (64.4%) were on AGM for more than two years. Early purchase was reported among 44.3% and stocking among 41.2%. Cost was high for income among 28.7%. Majority (91.1%) of them were not aware of side-effects. Fear of blindness was the major factor (68.1%) encouraging regular usage. Half (50.5%) of the patients though, still reported missing medication in the past month. Major reasons cited were relative priority (45.1%) and forgetfulness (35.3%). Self-reported compliance was not different by demographic variables or with responses to questions regarding duration (P = 0.070), application (0.825), time of purchase (0.272), stocking (0.598), and cost perception (0.415).

Conclusion:

Self-reporting of AGM compliance behaviour did not reflect with responses regarding application, purchase, stocking behaviour or cost perception. Awareness and knowledge of the above factors, with an aim of improving compliance by regulating counselling for even literate patients using AGM is called for.

The Global Extent of Undetected Glaucoma in Adults: A Systematic Review and Meta-analysis

TOPIC

Glaucoma is the leading cause of irreversible blindness, despite having good prognosis with early treatment. We evaluated the global extent of undetected glaucoma and the factors associated with it in this systematic review and meta-analysis.

CLINICAL RELEVANCE

Undetected glaucoma increases the risk of vision impairment, which leads to detrimental effects on the quality-of-life and socioeconomic well-being of those affected. Detailed information on the extent and factors associated with undetected glaucoma aid in the development of public health interventions.

METHODS

We conducted a systematic review and meta-analysis of population-based studies published between January 1, 1990, and June 1, 2020. Article search was conducted in online databases (PubMED, Web-of-Science), grey literatures (OpenGrey), and nongovernment organization reports. Our outcome measure was the proportion of glaucoma cases that were undetected previously. Manifest glaucoma included any form of glaucoma reported in the original studies and may include primary open-angle glaucoma (POAG), primary angle-closure-glaucoma, secondary glaucoma, or a combination thereof. Undetected glaucoma was defined as glaucoma cases that were undetected prior to diagnosis in the respective study. Random-effect meta-analysis was used to estimate the pooled proportion of undetected glaucoma. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines in our study.

RESULTS

We identified 61 articles from 55 population-based studies (n = 189 359 participants; n = 6949 manifest glaucoma). Globally, more than half of all glaucoma cases were undetected previously on average in each geographical region. Africa (odds ratio [OR], 12.70; 95% confidence interval [CI], 4.91-32.86) and Asia (OR, 3.41; 95% CI, 1.63-7.16) showed higher odds of undetected glaucoma as compared with Europe. Countries with low Human Development Index (HDI; <0.55) showed a higher proportion of undetected manifest glaucoma as compared with countries of medium to very high HDI (≥0.55; all P < 0.001). In 2020, 43.78 million POAG cases were projected to be undetected, of which 76.7% were in Africa and Asia.

DISCUSSION

Undetected glaucoma is highly prevalent across diverse communities worldwide and more common in Africa and Asia. Strategies to improve detection are needed to prevent excess visual disability and blindness resulting from glaucoma.

Screening first-degree relatives of glaucoma patients reveals barriers to participation

PURPOSE

To report the results of a glaucoma screening campaign targeting first-degree relatives of glaucoma patients in South India.

METHODS

1598 glaucoma patients were contacted via letter or letter and phone call and asked to bring their siblings and children to a glaucoma screening. Participants underwent standardised eye examinations and completed questionnaires that assessed barriers to participation and awareness of glaucoma risk. Two-proportion z-tests were used to compare categorical data. Costs associated with the screening were recorded.

RESULTS

206 probands (12.9%) attended the screening along with 50 siblings and children. Probands were nearly twice as likely to attend if they had been contacted via both letter and phone call rather than letter only. Over half of probands reported that their relatives could not participate because they did not live in the region, and one-fifth reported that their relatives had other commitments. Fifty-eight per cent of the siblings and children who attended did not know that they were at increased risk for glaucoma due to their family history, and 32.0% did not know that the relative who had invited them to the screening had glaucoma. Thirteen siblings and children (26.0% of those who attended) were found to have findings concerning for glaucoma. The average cost per first-degree relative who was screened was INR2422 (£26).

CONCLUSION

Participation in this glaucoma screening campaign was poor. The major barrier to participation was distance from the screening site and associated indirect costs. Better strategies for bringing first-degree relatives in for examinations are needed.

Ganglion cell layer analysis with deep learning in glaucoma diagnosis

OBJECTIVE

To determine and compare the diagnostic precision in glaucoma of two deep learning models using infrared images of the optic nerve, eye fundus, and the ganglion cell layer (GCL).

METHODS

We have selected a sample of normal and glaucoma patients. Three infrared images were registered with a spectral-domain optical coherence tomography (SD-OCT). The first corresponds to the confocal scan image of the fundus, the second is a cut-out of the first centered on the optic nerve, and the third was the SD-OCT image of the GCL. Our deep learning models are developed on the MatLab platform with the ResNet50 and VGG19 pre-trained neural networks.

RESULTS

498 eyes of 298 patients were collected. Of the 498 eyes, 312 are glaucoma and 186 are normal. In the test, the precision of the models was 96% (ResNet50) and 96% (VGG19) for the GCL images, 90% (ResNet50) and 90% (VGG19) for the optic nerve images and 82% (ResNet50) and 84% (VGG19) for the fundus images. The ROC area in the test was 0.96 (ResNet50) and 0.97 (VGG19) for the GCL images, 0.87 (ResNet50) and 0.88 (VGG19) for the optic nerve images, and 0.79 (ResNet50) and 0.81 (VGG19) for the fundus images.

CONCLUSIONS

Both deep learning models, applied to the GCL images, achieve high diagnostic precision, sensitivity and specificity in the diagnosis of glaucoma.

Glaucoma Awareness and Knowledge Among Ethiopians in a Tertiary Eye Care Center

INTRODUCTION

Glaucoma outcomes are closely associated with patients' awareness of the disease. However, little is known about glaucoma awareness and knowledge in Addis Ababa, a densely populated and ethnolinguistically diverse capital city in Ethiopia, the second largest country in Africa.

METHODS

We performed a cross-sectional survey in the ophthalmology waiting room at St. Paul's Hospital, a tertiary care center in Addis Ababa. Respondents included patients, patient family members, and non-clinical staff. Participants were asked if they had read or heard about glaucoma to gauge basic awareness of the disease; those with awareness were asked to take a quiz to measure their objective glaucoma knowledge. We performed multivariable regression to identify factors associated with glaucoma awareness, quiz performance, and self-rated ability to use eye drops.

RESULTS

Of 298 respondents, 145 (48.7%) were female, and the average age was 44.9 ± 17.2 years. A majority (167; 56.0%) had primary school or less than primary school education. Only 131 (44.0%) had basic glaucoma awareness. Of these, 95 (72.5%) knew that glaucoma causes permanent vision loss, 103 (78.6%) knew glaucoma is often asymptomatic in early stages, 62 (47.3%) identified elevated intraocular pressure as a glaucoma risk factor, and 124 (94.7%) knew glaucoma was treatable. A majority of this subset (126; 96.2%) said they would be willing to use medicated eye drops, and 130 (99.2%) indicated a willingness to undergo surgery if recommended. Education level was independently associated with glaucoma awareness (p < 0.001) and glaucoma quiz performance (p = 0.03).

CONCLUSION

In a population sample from an ophthalmology waiting room in Addis Ababa, glaucoma awareness was poor and most strongly associated with education level. Educational interventions at public health and provider-patient levels are warranted. Our results suggest high receptiveness to both medical and surgical treatment.

Glaucoma among the Malaysian Community

Background

According to the WHO, glaucoma is the second leading cause of blindness worldwide. About 50% of the world's glaucoma cases come from the Asian population, and in Malaysia itself, the prevalence of glaucoma is increasing. However, glaucoma is still a foreign word to our community despite the high prevalence. Therefore, there is an urgent need to determine the awareness of glaucoma among the community and its associated factors.

Results

This study showed that only 25.2% of our respondents were aware of glaucoma and it is associated with ethnicity, religion, education, and household income. Besides, among those who were aware, they fall into the group of poor knowledge of glaucoma. On the other hand, the knowledge of glaucoma was associated with occupation and the awareness of glaucoma by definition. The validated questionnaire was distributed and the data were analyzed by SPSS software using t-test, one-way ANOVA, and chi-square test.

Conclusion

Awareness and knowledge of glaucoma in this population is low. These findings suggest that there is a need for an efficient information and education strategy to be designed and conducted to increase the awareness and knowledge of glaucoma so that early detection can be made and effective management of individuals with this condition can be delivered.

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.

The Genetic and Endoplasmic Reticulum-Mediated Molecular Mechanisms of Primary Open-Angle Glaucoma

Glaucoma is a heterogenous, chronic, progressive group of eye diseases, which results in irreversible loss of vision. There are several types of glaucoma, whereas the primary open-angle glaucoma (POAG) constitutes the most common type of glaucoma, accounting for three-quarters of all glaucoma cases. The pathological mechanisms leading to POAG pathogenesis are multifactorial and still poorly understood, but it is commonly known that significantly elevated intraocular pressure (IOP) plays a crucial role in POAG pathogenesis. Besides, genetic predisposition and aggregation of abrogated proteins within the endoplasmic reticulum (ER) lumen and subsequent activation of the protein kinase RNA-like endoplasmic reticulum kinase (PERK)-dependent unfolded protein response (UPR) signaling pathway may also constitute important factors for POAG pathogenesis at the molecular level. Glaucoma is commonly known as a ‘silent thief of sight’, as it remains asymptomatic until later stages, and thus its diagnosis is frequently delayed. Thereby, detailed knowledge about the glaucoma pathophysiology is necessary to develop both biochemical and genetic tests to improve its early diagnosis as well as develop a novel, ground-breaking treatment strategy, as currently used medical therapies against glaucoma are limited and may evoke numerous adverse side-effects in patients.

Glaucoma blindness-A rapidly emerging non-communicable ocular disease in India: Addressing the issue with advocacy

Glaucoma, a leading cause of irreversible blindness, can be prevented or stabilized the progression if identified early and managed it appropriately. In India, around 12 million people suffer from glaucoma, and 1.5 million are blind due to it, so making the third most common cause of blindness. More than 75% of glaucoma are undiagnosed, which perhaps represent the submerged portion of the iceberg phenomenon of the traditional disease explanations. Though glaucoma per se does not lead to mortality, glaucoma blindness is categorized as a severe form of disability (category VI) out of seven World Health Organization (WHO) classification on the global burden of diseases. Indeed, there is a large gap between the prevailing burden of glaucoma and service being delivered about its prevention compared to other leading causes of blindness in India. Considering the magnitude of the problem as well as the severity of disability, a strong and effective advocacy is an urgent call to deal glaucoma problem in the country. For a resource-limited country, where mass population based-screening programs are not feasible, alternative methods like facility-based opportunistic screening and referring the high-risk groups for early detection and treatment should be aimed. However, glaucoma should not be screened in isolation from other eye problems. In fact, screening of any potential blinding ocular problems, including glaucoma, should be a clear mandate under comprehensive eye program of the WHO to achieve Universal Eye Health Coverages. This paper highlights the strategy inclusive of advocacy to curtail the increasing burden of glaucoma blindness in India.

Awareness of Glaucoma and Associated Factors Among Adults in Gish Abay Town, Northwest Ethiopia

PURPOSE

The purpose of this study was to determine the awareness of glaucoma and associated factors among adults living in Gish Abay town, Northwest Ethiopia.

METHODS

A population-based cross-sectional study was conducted on 594 adults who were selected using systematic random sampling from April to May 2018. Data were entered into Epi Info version 7 and were analyzed by SPSS version 23. Binary and multivariable logistic regression was used to determine factors associated with awareness. Variables with P-value < 0.05 were considered statistically significant.

RESULTS

The proportion of awareness of glaucoma was 24.4% [95% CI; 21.0, 28.1]. It was positively associated with educational status, primary education [AOR: 3.15; 1.72, 5.77], secondary education [AOR; 3.11: 1.66, 5.84], college and above [AOR; 6.10; 2.80, 13.27], history of eye examination [AOR: 6.52; 3.46, 12.25], income level >2000 Ethiopian birr [4.65; 2.59, 8.37] and history of chronic diseases [AOR; 2.93: 1.25, 6.85].

CONCLUSION

The status of glaucoma awareness in Gish Abay town can be said to be low as compared to studies. Higher educational status, eye examination, history of chronic diseases and better income level were significantly associated with awareness of glaucoma.

Knowledge of glaucoma and associated factors among adults in Gish Abay town, Northwest Ethiopia

BACKGROUND

Glaucoma is a global public health problem and it is the leading cause of irreversible blindness worldwide. Even though public knowledge of glaucoma is a key for early case identification and prevention of blindness, it is unknown in the study area, making provision of interventions difficult. Therefore, this study was intended to assess knowledge of glaucoma and associated factors among adults in Gish Abay town, Northwest Ethiopia, 2018.

METHODS

A Community based cross - sectional design study with systematic random sampling technique was used to select 630 adults. The study was conducted from April to May, 2018. Data was entered into Epi Info version 7 and was analysed by Statistical Package for Social Sciences version 23. Binary logistic regression model and adjusted odds ratio with 95% confidence level was used to identify the significant factors associated with knowledge of glaucoma. Variables with P-value ≤0.05 was considered statistically significant.

RESULTS

About 594 adults were participated with a response rate of 94%. Above half of (52%) the participants were females with median age of 28 years. The proportion of good knowledge was demonstrated in 16.8% [95% CI; 14.0, 19.9]. Educational status: primary education [AOR; 2.89: 1.41, 5.90], secondary education [AOR; 3.03: 1.47, 6.24] college and above [AOR; 5.18: 2.21, 12.13], history of eye examination [AOR; 6.52: 3.37, 12.63]; family history of glaucoma [AOR; 12.08: 4.13, 35.30] and higher income level [AOR; 3.11: 1.55, 6.25] were positively associated with good knowledge of glaucoma.

CONCLUSIONS

The proportion of good knowledge of glaucoma was low. Higher educational status, positive family history of glaucoma, eye examination and higher income level were significantly associated with knowledge of glaucoma.

Socioeconomic disparities in the global burden of glaucoma: an analysis of trends from 1990 to 2016

PURPOSE

To assess the global burden of glaucoma by year, age, sex, regions, socioeconomic development, and mean years of schooling (MYS) by using disability-adjusted life year (DALY), then to explore the health inequality with socioeconomic status in glaucoma.

METHODS

Global, national, and regional DALY data of glaucoma by year, age, and sex were extracted from the Global Health Data Exchange. Human development index (HDI) and national MYS in 2015 were obtained from the Human Development Report (HDR) 2016. Mann-Whitney U test was performed to explore the sexual difference in global DALYs. Kruskal-Wallis tests were performed to explore the difference of age-standardized DALY rates across WHO regions and HDI-related country groups. Linear regression analyses were performed to explore the association between age-standardized DALY rates with HDI and MYS. Health-related Gini coefficients and concentration indexes were calculated to evaluate the trends in health inequality of glaucoma since 1990.

RESULTS

DALY numbers, crude DALY rates, and age-standardized DALY rates increased by 118.0%, 55.22%, and 12.12%, respectively, since 1990. Global DALY numbers and crude DALY rates increased with age, and Mann-Whitney U test revealed no significant sex difference in global DALY numbers (P = 0.807) and global crude DALYs rates (P = 0.976) for each age group in 2016. Africa and Eastern Mediterranean had higher age-standardized DALY rates than the global one in 2016. Kruskal-Wallis test indicated significant difference in age-standardized DALY rates across WHO regions (χ² = 94.227, P < 0.001). Linear regression analysis indicated that HDI (adjusted R² = 0.079; F = 16.722, P < 0.001) and MYS (adjusted R² = 0.108; F = 23.048, P < 0.001) had a significant effect on age-standardized DALY rates. Gini coefficients rose from 0.290 in 1990 to 0.292 in 2015 with a peak value 0.299 in 2005, concentration index declined from 1990 (- 0.099) to 2000 (- 0.077) with reaching a low peak value, then rapidly increased to - 0.097 in 2015.

CONCLUSIONS

With population growth and aging, global burden of glaucoma is increasing and older age, lower socioeconomic status, and lower MYS are associated with higher glaucoma burden. Our results help to gain a better understanding of glaucoma and guide future health policies tailored for public.

Update on the genetics of primary open-angle glaucoma

Affecting nearly 80 million individuals, glaucoma is the number one cause of irreversible blindness in the world. This ocular disease describes a set of optic neuropathies of which primary open angle glaucoma (POAG) is the most common. POAG is associated with progressive visual field deterioration resulting from damage to the optic nerve and loss of retinal ganglion cells. Risk factors for POAG include elevated intraocular pressure, aging, African and Hispanic ancestry, and a positive family history of POAG. Multiple genes have been found to contribute to POAG. Much of POAG genetics and pathology has yet to be explained. Recent genome-wide association studies have identified a large number of novel loci associated with POAG and its endophenotypes. Genomic and proteomic profiling of biofluids has contributed to our knowledge of differential gene expression in POAG. Functional studies both in cell culture and animal models have confirmed the effects of variants and differential gene expression on ocular physiology while in silico analyses have increased our understanding of disease risk and progression so that we might better diagnose and treat this complex genetic illness.

A Deep Learning Algorithm to Quantify Neuroretinal Rim Loss From Optic Disc Photographs

PURPOSE

To train a deep learning (DL) algorithm that quantifies glaucomatous neuroretinal damage on fundus photographs using the minimum rim width relative to Bruch membrane opening (BMO-MRW) from spectral-domain optical coherence tomography (SDOCT).

DESIGN

Cross-sectional study.

METHODS

A total of 9282 pairs of optic disc photographs and SDOCT optic nerve head scans from 927 eyes of 490 subjects were randomly divided into the validation plus training (80%) and test sets (20%). A DL convolutional neural network was trained to predict the SDOCT BMO-MRW global and sector values when evaluating optic disc photographs. The predictions of the DL network were compared to the actual SDOCT measurements. The area under the receiver operating curve (AUC) was used to evaluate the ability of the network to discriminate glaucomatous visual field loss from normal eyes.

RESULTS

The DL predictions of global BMO-MRW from all optic disc photographs in the test set (mean ± standard deviation [SD]: 228.8 ± 63.1 μm) were highly correlated with the observed values from SDOCT (mean ± SD: 226.0 ± 73.8 μm) (Pearson's r = 0.88; R² = 77%; P < .001), with mean absolute error of the predictions of 27.8 μm. The AUCs for discriminating glaucomatous from healthy eyes with the DL predictions and actual SDOCT global BMO-MRW measurements were 0.945 (95% confidence interval [CI]: 0.874-0.980) and 0.933 (95% CI: 0.856-0.975), respectively (P = .587).

CONCLUSIONS

A DL network can be trained to quantify the amount of neuroretinal damage on optic disc photographs using SDOCT BMO-MRW as a reference. This algorithm showed high accuracy for glaucoma detection, and may potentially eliminate the need for human gradings of disc photographs.

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.

Compliance to topical anti-glaucoma medications among patients at a tertiary hospital in North India

Purpose

The present study aims to estimate the prevalence of non-compliance and improper drop administration technique among glaucoma patients and describe common obstacles to medication compliance.

Methods

A hospital-based cross-sectional study, using standardized questionnaire and direct observation by study personnel was conducted among glaucoma patients aged 18 years and above at a tertiary care charitable eye hospital in North India. 151 consecutive glaucoma patients on medical therapy following up at the glaucoma clinics for at least 6 months were recruited. Non-compliance was defined as missing at-least one drop of medication per week and (or) the inability to accurately describe the medication regimen. Study personnel also assessed drop administration technique during application of eye drops by patients treating ophthalmologist-provided information, including measures of disease stability. Factors such as socioeconomic status, presence of caregiver, and number of medications with their effect on compliance were studied using chi-square statistics.

Results

Among 151 patients interviewed, around 49% of patients reported problems in using glaucoma medications, with 16% of them reporting total non-compliance. 35% of patients demonstrated improper drop administration technique. Forgetfulness was cited as the main reason for being non-compliant and had a significant association with non-compliance (P = 0.00). Paying patients were more compliant as compared to subsidized patients (P = 0.05). Disease was more stable in compliant patients compared to non-compliant patients (P = 0.05). No other factor had significant association with compliance (P > 0.05).

Conclusions

Over 50% of the patients surveyed were non-compliant, and 35% demonstrated improper administration technique. Glaucoma patients should be educated on the importance of compliance and aids that minimize forgetfulness, and delivery systems facilitating the delivery of medications to the eye could be considered to enhance patient adherence.

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.

Knowledge and Awareness of Glaucoma in Subjects with Glaucoma and their Normal First-Degree Relatives

The objective of this study was to assess knowledge and awareness of glaucoma in subjects with glaucoma and their normal first-degree relatives. Awareness and knowledge of glaucoma were compared between each patient and his/her relative. We designed a questionnaire containing a set of brief and structured questions to gather information regarding the participants' demographics and knowledge and awareness of glaucoma. There were two groups in this study. The first group ("glaucoma" group) comprised patients diagnosed with glaucoma, while the second group ("relatives" group) consisted of the first-degree relatives of the patients. Ninety-one participants aged over 40 years (mean, 48.5 years) filled the questionnaire. Thirty-four participants belonged to the glaucoma group, while the remaining were first-degree relatives of the patients. According to the responses obtained, 26 (76%) participants in the glaucoma group and 47 (82%) participants in the relatives group had heard of the term "glaucoma." There were no statistically significant differences related to age or gender in glaucoma awareness. Glaucoma awareness was positively associated with education level in both groups (p < 0.0001). The definition of "glaucoma" in the glaucoma group and the relatives group was known to 20 (58.8%) and 17 (29.8%) participants, respectively, and the difference was statistically significant (p < 0.0001). The adjusted odds ratios for awareness and knowledge of glaucoma were 75.2 (95% confidence interval [CI], 11.80 to 366.65) and 148.7 (95% CI, 14.07 to 1646.52), respectively, for individuals with a university graduate level of education. In our study, education level was the only demographic indicator that was a predictor of knowledge and awareness of glaucoma. While more scientific evidence is obtained, community education with focus on the promotion of knowledge and awareness of glaucoma would be a practical public health strategy, especially for individuals aged more than 40 years with a family history of glaucoma.

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 and knowledge of glaucoma and associated factors among adults: a cross sectional study in Gondar Town, Northwest Ethiopia

Background

Raising public awareness and knowledge about glaucoma is a key for early case identification and prevention of blindness. However, awareness and knowledge about glaucoma is unknown at community level, making provision of interventions difficult. This study was intended to assess the awareness and knowledge of adults about glaucoma and the factors affecting it in Gondar town, Northwest Ethiopia.

Methods

Community based cross - sectional study was conducted on 701 adults 35 and above years in Gondar from April 12–30, 2016. Multistage sampling technique was used to select study participants. Interviewer administered pretested structured questionnaire was used to collect data after verbal informed consent. Data were entered into EpiData version 3.1 and analyzed by Statistical Package for Social Sciences version 20. Bivariate and multivariate logistic regression models and Odds ratio with 95% interval were used to identify factors. P–value <0.05 was considered statistically significant.

Results

Seven hundred one adults age 35 and above years were participated with a response rate of 99.3%. The male to female ratio was 1:1.6 with median age of 48 years with interqurtile range of 20. The proportion of awareness was 35.1% (95% CI: 31.5%, 38.6%). Good knowledge was demonstrated in 49.6% (95%CI: 43.3%, 55%) of glaucoma aware participants. Education (primary [AOR: 3.21; 1.73, 5.95], secondary [AOR: 4.34; 2.30, 8.22]; college and above [AOR: 9.82; 4.27, 22.60]) and having eye examination [AOR: 2.78; 1.86, 4.15] were positively associated with awareness of glaucoma whereas older age (65 –74 years [AOR: 0.31(0.21, 0.76]) was inversely related. Level of Education (primary[AOR:2.83;1.04,7.71],secondary[AOR:3.45;1.33,9.41],college and above [AOR: 4.86;1.82,12,99] and having eye examination [AOR: 2.61;1.53,4.45] were significantly associated with knowledge.

Conclusion

The study has indicated higher level of awareness and knowledge about glaucoma in urban communities than previous studies. It has also identified educational status, eye examination at least once in life are related with better awareness and knowledge. The present awareness and knowledge should be enhanced through public oriented glaucoma education via mass media and incorporating eye check up as a routine in older people.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-017-0542-z) contains supplementary material, which is available to authorized users.

Deconstructing and Assessing Knowledge and Awareness in Public Health Research

When people's knowledge and awareness are the subject of public health research, the meanings applied to the words knowledge and awareness are often unclear. Although frequently used interchangeably without that being problematic, these words sometimes appear to have different intended meanings but those meanings are not made explicit or, despite the meanings having been made explicit, they are not adhered to. It is necessary to overcome obscurities when knowledge and awareness are intended to represent different domains. This occurs when they are compared with each other; it also occurs when knowledge and awareness are assessed separately in relation to such variables as health behavior; physical, psychological, or socioeconomic statuses; gender; age; and ethnic backgrounds. For those particular research ventures, recommendations are made that knowledge be used to refer to information that is, to a greater or lesser extent, detailed and factual, and that awareness be associated with information that is personally relevant. Some suggestions are made, and issues are raised, about how the psychometric foundations for each of those two domains might be established prior to use in empirical research. Adopting the recommendations and suggestions made in this article provides opportunities for greater conceptual and empirical clarity and success.

Glaucoma awareness amongst glaucoma patients seeking a second opinion

PURPOSE

The aim of the study was to assess level of glaucoma awareness amongst glaucoma patients by studying characteristics amongst urban and rural glaucoma populations in North India.

METHODS

A questionnaire was designed and administered after appropriate validation amongst patients to identify determinants of glaucoma awareness. Trained personnel delivered the 11 questions to 1506 patients, aged 18 and above through random sampling. The questionnaire evaluated source of awareness, education, gender, location and age on the level of awareness of glaucoma. The outcomes were assessed based on patient's responses.

RESULTS

Age and education essay a significant role in glaucoma awareness. Awareness levels increased with the level of education significantly in both rural and urban settings (P value <0.001). Patients from lower educational backgrounds were significantly more likely to share their condition with their spouse compared to those with higher education (P value <0.001). Compared to the middle aged and elderly, young adults were less aware that glaucoma could run in families (P value <0.015).

CONCLUSIONS

There is a significant gap in the knowledge about glaucoma and its risks in both urban and rural set-ups in Northern India necessitating active steps to spread awareness regarding glaucoma and its relation with blindness.

Awareness and knowledge about glaucoma and proportion of people with glaucoma in an urban outreach programme in Southeast Nigeria

Aim

The aim of this study was to determine the level of awareness and knowledge of glaucoma and the proportion of people with glaucoma among participants of a 1-day urban eye outreach programme.

Methods

The study was a cross-sectional survey. Data, collected by means of a structured questionnaire, included participants' demographic details, and awareness, knowledge and ocular status as regards glaucoma. Publicity for the outreach was created through the mass media (radio stations and television), churches, handbills, posters and different hospital staff. Data analysis was by Statistical Package for Social SciencesV.20.0. Associations between participants' demographic and other details were tested using Pearson's χ² test, and a p value of <0.05 was considered significant.

Results

Four hundred and seventy-eight (93.2%) of the 513 people in attendance were eligible and consented to participate. Awareness, knowledge and proportion of people with glaucoma in the study population were 65.5%, 36.8% and 14.5%, respectively. Awareness was significantly associated with attainment of some formal education, awareness of a positive family history, and having had an eye check prior to the outreach. The mass media was the most common information source. Good knowledge level was significantly associated with higher educational attainment and occupation, whereas proportion of people with glaucoma was significantly associated with increasing age.

Conclusion

Improving awareness with suitable content for the target population through effective means such as the mass media may be a veritable first step in combating blindness from glaucoma.

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

BACKGROUND

Blindness from glaucoma is associated with socio-economic deprivation, presumed to reflect poor access to care and poor adherence to treatment.

OBJECTIVES

To determine why people with glaucoma are presenting late for treatment and to understand access to glaucoma care. Additionally, we sought to identify what patients and the community know, do and think about the condition and why the poor are the most affected with glaucoma blindness.

DESIGN

Study participants were from four communities and two hospitals in Abuja-FCT and Kaduna State, Nigeria. A total of 120 participants were involved, including 8 focus group discussions, 7 in-depth interviews with blind/visually impaired glaucoma patients, 5 rapid direct observation visits with these patients and 13 exit interviews of glaucoma patients in the hospital. The data were analysed using content analysis, interpreting participant experiences in terms of three key steps conceptualised as important in the care pathway: what it takes to know glaucoma, to reach a diagnosis and to access continued care.

RESULTS

This article presents multiple narratives of accessing and maintaining glaucoma care and how people manage and cope with the disease. People may be presenting late due to structural barriers, which include lack of knowledge and awareness about glaucoma and not finding an appropriately equipped health care facility. What keeps glaucoma patients within the care pathway are a good hospital experience; a support structure involving family, counselling and shared patients' experiences; and an informed choice of treatment, as well as agency. The high cost of purchasing care is a major factor for patients dropping out of treatment.

CONCLUSION

The findings suggest the need to address economic and social structural drivers as glaucoma presents another case study to demonstrate that poverty is a strong driver for blindness. There is also a need for clear glaucoma care pathways with early case finding in the community, two-way referral/feedback systems, well-equipped glaucoma care hospitals and better eye health care financing.