Timing Of Opportunistic Check For Glaucoma In An Ophthalmology Clinic Setting In Ghanaians

Abstract

Purpose: To determine the age, timing and determining factors for the evaluation for glaucoma as part of medical eye evaluation in an ophthalmology clinic. Patients and Methods: A cross sectional study in which patients with primary open-angle glaucoma (POAG) attending the ophthalmology clinic, Korle Bu Teaching Hospital, Ghana were recruited from 2004 to 2007. A historic control group of 253 normal samples was included in the data analysis of cup/disc asymmetry. Results: Number of patients recruited was 390 with ages between 15 to 89 years (mean 54±14.86, median 56 and mode 65). Early-onset-glaucoma diagnosed before age 40 years occurred in 62 patients (15.89%) and adult-onsetglaucoma in 328 (84.10%). Fifteen (3.84%) people had positive family history of glaucoma; 13(3.33%) had diabetes mellitus; hypertension 38 (9.74%) and sickle cell disease, 1 (0.25%). Thirteen (3.33%) had myopia of >-4 dioptres (-4.25 to -14.5D). Eighty (20.51%) patients had visual impairment. Five (1.28%) were blind (no perception of light, NPL, bilaterally) from glaucoma. In the early-onset-glaucoma group, 2/62(3.23%) were blind. Pretreatment intraocular pressure, IOP, was >35 mmHg in 46.18% of eyes. In the early-onset-glaucoma group, IOP ranged from 13-64 (mean 36) mmHg. There was cup/disc ratio of at least 0.7 in 99% of eyes. In the 15-24 year age group, 88.6% had cup/disc ratio of 0.7-1.0. Cup/disc asymmetry 0.2 or more was found in 32% (125/390) compared with 0.4% (1/253) in the Normal patients. Conclusions: We suggest that routine measurement of intraocular pressure and evaluation of the optic disc biomicroscopically be carried out as screening for glaucoma every 2 years until age 30 years; in any African African patient aged 20 years and above with eye complaints attending an eye clinic, as well as those aged 25 years and above as part of comprehensive adult medical eye evaluation. However, after age 30 years and those with positive family history of glaucoma, screening should be yearly.