Glaucoma Related Morbidity at A Tertiary Care Eye Hospital

Abstract

Purpose: To report pattern and burden of glaucoma related morbidity in terms of visual impairment and structural damage to optic nerve in patients presenting for the first time at glaucoma clinic of a tertiary care eye hospital. Design of Study: A cross sectional observational study. Participants: All patients aged above 16 years reporting for the first time at glaucoma clinic of Al-Shifa Trust Eye Hospital, Rawalpindi from 1st July 2006 to 30th June 2007. Methods : After taking history, a detailed ocular examination of all the patients including visual acuity using snellen chart, refraction trial for best corrected visual acuity, slit lamp examination, applanation tonometry (with tonopen in unco-operative patients), gonioscopy (with four mirror Posner lens), stereoscopic assessment of the cup disc ratio ( with Heidelberg retinal tomogram) and visual field (Humphery static perimetery, 30-2 program and Frequency doubling technique) testing was performed. All data was recorded on a special proforma and then assessed using statistical software SPSS version 12.0. Results: A total number of 800 new patients were examined in the glaucoma clinic from 1st July 2006 to 30th June 2007. Among these 800 patients, 487 (60.9%) were male and 313 (39.1%) were female. 132 subjects (16.5%) were identified as blind with a visual acuity of <3/60 in both eyes while an additional 325 subjects (40.6%) had a visual acuity of <3/60 in one eye. Crude estimate of the frequency of blindness (Table 2) was slightly higher in women as compared to men (OR, 1.07; 95% CI, 0.87-1.27). Blindness was associated with illiteracy (OR, 2.80; 95% CI, 2.15-3.45), age of patients 60 years and above (OR, 1.38; 95% CI, 1.07-1.69) and advanced cupping in both eyes (OR, 2.75; 95% CI, 2.18-3.32). Blindness was more frequent in patients of neovascular and pseudoexfoliation glaucoma. Regarding the structural damage, 33% of the pati-ents presented to us when the cup disc ratio in their better eye had worsened to 0.8 or more. Conclusion: Glaucoma is leading cause of blindness, and warrents detailed investigation of strategies for prevention. As It is a fact that advanced stage of glaucoma at diagnosis has been one of the most important factors for glaucoma caused blind-ness, targeted screening, breaking down barriers to access and a campaign to create awareness among the people regarding importance of regular eye examinations may be effective in reducing the number of patients going blind from glaucoma. Using the available data from the health surveys, improving awareness, case detection, and early treatment of glaucoma are the fields which need our attention. In short, a combined effort by governments, NGOs, ophthalmologists and primary health care providers can be helpful to prevent the world from glaucoma related blindness.