Glaucoma

Open angle glaucoma – cupped disc

Caption: Markedly cupped optic disc indicating advanced disease. Many glaucoma patients in African countries are already blind in one eye when they present to eyecare departments.

Glaucoma:

  1. In Africa
  2. In Asia

1. In Africa

Good communication with patients is an important element of glaucoma care. NIGERIA © Mohammed Abdull

Caption: Interviewer counseling a glaucoma patient using motivational interviewing techniques in Bauchi, NE Nigeria

Improving the management and control of glaucoma in Africa

Glaucoma, in which the optic nerve is irreparably damaged, is the commonest cause of irreversible blindness. Glaucoma causes more blindness in Africa than elsewhere as the disease is more aggressive; patients do not know about the condition and often present with advanced disease – blind in one or both eyes; not all eye units have adequate equipment, skills, experience and treatment options; patients do not adhere to treatment and follow up due to lack of understanding, cost and distance.

Two studies in Nigeria are investigating glaucoma to help address the challenges of developing and adopting strategies to control glaucoma in in Africa.

Prevalence and types of glaucoma in Nigeria physicians’ management practice patterns and knowledge of glaucoma.

In this study data collected during the Nigeria national blindness and low vision survey, which was supported by Sightsavers and CBM, are being analysed to estimate the prevalence and types of glaucoma. In a separate study ophthalmologists in Nigeria were asked to describe how they manage glaucoma and the equipment they have available. In a further study patients with glaucoma and community members were interviewed to find out what they knew about the condition and its management. All the findings will be used to recommend strategies for the control of blindness due to the glaucoma in Nigeria.

Evaluation of a counselling intervention on acceptance of surgery or laser for glaucoma.

It is known that patients often present very late with glaucoma in Africa and are reluctant to accept surgery which is often the treatment of choice. A randomized trial is currently underway in Nigeria to compare rates of acceptance of trabeculectomy (glaucoma surgery) or laser treatment in groups of glaucoma patients randomised to a form of counselling called motivational interviewing with standard explanation of the disease and its treatment, or standard explanation alone. This form of counselling can be delivered by non-specialists after training and if the trial shows that motivational interviewing increases acceptance of treatment it can readily be taken to scale in other settings in Africa.

Acknowledgements

We would like to thank the funders of these studies:

Publications

  • Abdull M. and Gilbert C. Stage at presentation of primary open angle glaucoma in northern Nigeria. Submitted to BMC. Ophthalmol. In press
  • Abdull MM, Gilbert C, McCambridge J, Evans J. Adapted motivational interviewing to improve the uptake of treatment for glaucoma in Nigeria: study protocol for a randomized controlled trial. Trials. 2014 Apr 29;15(1):149. Article
  • Kyari F, Abdull MM, Bastawrous A, Gilbert CE, Faal H. Epidemiology of glaucoma in Sub-Saharan Africa: Prevalence, incidence and risk factors. Middle East Afr J Ophthalmol 2013;20:111-25. Article
  • Fatima Kyari, Mohammed M Abdull, Ferenc Sallo, Paul G Spry, Richard Wormald, Tunde Peto, Hannah Faal, Clare E Gilbert. On behalf of the Nigeria national blindness and visual impairment study group. Nigeria normative data for the classification of glaucoma in prevalence surveys. Oph Epi 2015; 22(2): 98–108. Abstract.
  • Abdull MM. and Gilbert C. Primary open angle glaucoma in northern Nigeria: stage at presentation and acceptance of treatment. BMC Ophthalmol. 2015 Aug 22;15(1):111. doi: 10.1186/s12886-015-0097-9.
  • Kyari F, Entekume G, Rabiu M, Spry P, Wormald R, Nolan W, Murthy GV, Gilbert CE; Nigeria National Blindness and Visual Impairment Study Group. A Population-based survey of the prevalence and types of glaucoma in Nigeria: results from the Nigeria National Blindness and Visual Impairment Survey. BMC Ophthalmol. 2015 Dec 12;15(1):176
  • Abdull MM., Chandler C. and Gilbert C. Glaucoma, “the silent thief of sight”; Patients’ perspectives and health seeking behaviour in Bauchi, northern Nigeria. BMC Ophthalmol. 2016 Apr 21;16:44. doi: 10.1186/s12886-016-0220-6
  • Abdull MM; Chandler C; Gilbert C. Glaucoma, “the silent thief of sight”: patients’ perspectives and health seeking behaviour in Bauchi, northern Nigeria. BMC Ophthalmol. 2016 16(1):44; DOI: 10.1186/s12886-016-0220-6; PMID: 27102524
  • Kyari F, Wormald R, Murthy GV, Evans JE, Gilbert CE On behalf of the Nigeria National Blindness and Visual Impairment Study Group. Ethnicity and deprivation are associated with blindness among adults with primary glaucoma in Nigeria. Journal of Glaucoma. 25(10):e861-e872, October 2016.
  • Kyari F and Gilbert C. Agreement in measurement of optic cup-to-disc ratio with stereo bio-microscope funduscopy and digital image analysis. Ophthalmic Epidemiol. 2016 Dec 14:1-6.
  • Kyari F, Nolan W, Gilbert C. Ophthalmologists’practice patterns and challenges in achieving optimal management for glaucoma in Nigeria: results from a nationwide survey. BMJ Open 2016;6:e012230. doi:10.1136/bmjopen-2016-012230
  • Kyari F., Chandler CI., Martin M. and Gilbert CE.  So let me find my way, whatever it will cost me, rather than leaving myself in darkness: Experiences of glaucoma in Nigeria. Global Health Action. 2016 Dec 6;9:31886
  • Kyari Fatima, Mohammed M. Abdull, Richard Wormald, Jennifer R. Evans, Winifred Nolan, Gudlavelleti V. S. Murthy, Clare E. Gilbert and On behalf of the Nigeria National Blindness and Visual Impairment Study Group. Risk factors for open-angle glaucoma in Nigeria: results from the Nigeria National Blindness and Visual Impairment Survey. BMC Ophthalmology (2016) 16:78 DOI 10.1186/s12886-016-0264-7
  • Kyari F., Gilbert C., Blanchet K. and Wormald W. Improving services for glaucoma care in Nigeria: implications for policy and programmes to achieve universal health coverage. Br J Ophthalmol 2017;0:1–5. doi:10.1136/bjophthalmol-2016-310040

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Contact us for more information on our research.

 

2. In Asia

Dr Jennifer Yip examining a participant in the Mongolian clinical trial of peripheral iridomomy

Caption: Dr Jennifer Yip examining a participant in the Mongolian clinical trial of peripheral iridomomy

Primary angle closure glaucoma is more prevalent in SE Asian populations, and is more likely to lead to blindness. A community based clinical trial was undertaken in Mongolia to assess the impact on disease progression of prophylactic peripheral iridotomy.

Publications

  • Yip JLY., Nolan W., Uranchimeg D., Lee PS., Bassanhuu J., Foster A., Gilbert CE., Khaw PT., Johnson GJ. and Foster PJ. Incidence of occludable angles in a high risk Mongolian population. Brit J Ophthalmol. 2008 92 30-33. Abstract.
  • Yip JLY., Foster PJ., Uranchimeg D., Javzandulam B., Javzansuren D., Munhzaya T., Lee PS., Bassanhuu J., Gilbert CE., Khaw PT., Johnson GJ and Nolan WP. Randomised Controlled Trial of Screening and Prophylactic Treatment to Prevent Primary Angle Closure Glaucoma. Brit J Ophthalmol. 2010 94: 1472-77. Abstract.
  • Yip JLY., Nolan WP., Gilbert CE., Uranchimeg D., Baassanhuu J., Lee PS., Khaw PT., Johnson GJJ and Foster PJ. Prophylactic Laser Peripheral Iridotomy and Cataract Progression. Eye 2010 24: 1127–1135. Abstract.
  • Jennifer L.Y.Yip., Winifred P. Nolan, Davatseren Uranchimeg, Jamyanjav Baassanhuu, Pak S.Lee,  T.Khaw, Gordon J.Johnson, Paul J.Foster and Clare E.Gilbert.   Primary angle closure glaucoma in East Asia: Educational attainment as a protective factor. Ophthalmic Epi 2011 18: 217-25. Abstract.

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