Juvenile-onset Open-Angle Glaucoma at the University Teaching Hospitals - Eye Hospital, Lusaka Zambia
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 included
visual 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, was
used 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.
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