Abstract
Purpose: To demonstrate the socioeconomic, demographic and clinical characteristics associated with patients of juvenile-onset open-angle glaucoma (JOAG) at the University Teaching Hospitals Eye Hospital (UTHs - EH).
 Methods: This was a cross-sectional survey for Juvenile Open Angle Glaucoma (JOAG) conducted at the UTHs - EH in, Lusaka, Zambia from January to December 2013. All participants aged between 18 and 39 years had a full ocular examination after capturing demographic and socioeconomic information. The ocular examination includedvisual acuity, intraocular pressure (IOP) and cup disc ratio (CDR) and tests performed were central corneal thickness (CCT) and visual fields. Severity was graded based visual field (VF) in the worse eye using the advanced glaucoma intervention study score. Univariate and multivariate logistic regression, stratified by age group and gender, wasused to determine the association between demographic factors and JOAG and between clinical factors and JOAG.Results: Of the 1625 patients recruited for the study, 309 were POAG patients. Of the 309 POAG patients, 140 aged 20 to 39 years old had bilateral JOAG. The distribution of the 140 participants was 98 (70.9%) females and 42 (29.4%) males. Thirteen (9.3 %) were aged 20 – 24 years, 29 (20.7%) 25 – 29 years, 44 (31.4%) 30 – 34 years, and 54 (38.6%) 35 –39 years. The mean age of the patients was 25.1 ± SD 8.7 years. The prevalence of JOAG was 8.6% (140/1625) distributed as 2.6% (95% CI 1.3, 3.9) males and 6.0% (95% CI 4.7, 9.2) females. There was a female preponderance of (71.2% vs. 28.8%; OR 2.98, 95% CI 2.3, 6.7, p=0.021). Eighty-five (60.7%) had complained of poor vision and 24 (17.1%) of eye pain. However, 24 (17.1%) presented with no definite symptoms. Patients with a positive family history presented 3.7 years earlier (P = 0.034, CI; 1.37-7.9) compared to those without a family history. Lower socioeconomic status (Odds ratio [OR] 3.5, P = 0.013, CI: 1.2-17.2), and higher IOP (OR 6.7, P = 0.002, CI: 2.6-21.8) were associated with severe glaucomatous visual field defects. High myopia (-6.47 ± 5.00 Diopters) was present in 70.9% of patients. The patients with myopia also had a severe elevation of IOP of (35.8 ±18.5 mmHg).
 Conclusions: The study found a high prevalence of JOAG at 8.6%. The patients with JOAG presented late with advanced disease and high IOP. Clinical, socioeconomic, and demographic factors are contributory to the severity of JOAG among JOAG patients.
 Recommendation: Early detection of cases during eye health care outreach programmes such as school and community screening of children and adults could be of great benefit in creating awareness, d ema n d , e a r l y d e t e c t i o n a n d p r omp t commencement of treatment. Glaucoma should no longer be considered a condition of the people aged 40 years and above.
Highlights
Glaucoma is a heterogeneous group of optic nerve diseases divided into congenital, juvenile-onset and adult-onset categories.[1]
Socioeconomic, and demographic factors are contributory to the severity of juvenile-onset open-angle glaucoma (JOAG) among JOAG patients
Glaucoma should no longer be considered a condition of the people aged 40 years and above
Summary
Glaucoma is a heterogeneous group of optic nerve diseases divided into congenital, juvenile-onset and adult-onset categories.[1]. JOAG is a rare subset of POAG characterized by an autosomal dominant pattern of inheritance.[2,3]. The affected age range is between three and 39 years and commonly present with myopia and severely elevated IOP with large fluctuations.[4]. Advanced glaucomatous optic neuropathy and severe VFD are other clinical features associated with JOAG.[5]. Some studies have reported that a considerable number of patients with JOAG tend to present late with advanced disease.[7,8]. The difference between JOAG and the late congenital glaucoma is that the JOAG would not have clinical features such as buphthalmos, Haab's striae, anterior segment dysgenesis and ocular or other systemic developmental anomalies.[4] Some studies have reported that a considerable number of patients with JOAG tend to present late with advanced disease.[7,8] The difference between JOAG and the late congenital glaucoma is that the JOAG would not have clinical features such as buphthalmos, Haab's striae, anterior segment dysgenesis and ocular or other systemic developmental anomalies.[4]
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