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Severity of Visual Field Loss at First Presentation to Glaucoma Clinics in England and Tanzania

Authors
  • Jones, Pete R.1
  • Philippin, Heiko2, 3, 4
  • Makupa, William U.3
  • Burton, Matthew J.2
  • Crabb, David P.1
  • 1 Division of Optometry and Visual Science, School of Health Science, City, University of London, England
  • 2 International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, UK
  • 3 Department of Ophthalmology, Kilimanjaro Christian Medical Centre, Tanzania
  • 4 Eye Center, University Hospital Freiburg, Germany , (Germany)
Type
Published Article
Journal
Ophthalmic Epidemiology
Publisher
Informa UK (Taylor & Francis)
Publication Date
Sep 13, 2019
Volume
27
Issue
1
Pages
10–18
Identifiers
DOI: 10.1080/09286586.2019.1661499
PMID: 31517561
PMCID: PMC7114916
Source
PubMed Central
Keywords
License
Unknown

Abstract

Purpose : To compare severity of visual field (VF) loss at first presentation in glaucoma clinics in England and Tanzania. Methods : Large archives of VF records from automated perimetry were used to retrospectively examine vision loss at first presentation in glaucoma clinics in Tanzania (N = 1,502) and England (N = 9,264). Mean deviation (MD) of the worse eye at the first hospital visit was used as an estimate of detectable VF loss severity. Results : In Tanzania, 44.7% {CI95%: 42.2, 47.2} of patients presented with severe VF loss (< −20 dB), versus 4.6% {4.1, 5.0} in England. If we consider late presentation to also include cases of advanced loss (-12.01 dB to -20 dB), then the proportion of patients presenting late was 58.1% {55.6, 60.6} and 14.0% {13.3, 14.7}, respectively. The proportion of late presentations was greater in Tanzania at all ages, but the difference was particularly pronounced among working-age adults, with 50.3% {46.9, 53.7} of 18–65-year-olds presenting with advanced or severe VF loss, versus 10.2% {9.3, 11.3} in England. In both countries, men were more likely to present late than women. Conclusions : Late presentation of glaucoma is a problem in England, and an even greater challenge in Tanzania. Possible solutions are discussed, including increased community eye-care, and a more proactive approach to case finding through the use of disruptive new technologies, such as low-cost, portable diagnostic aids.

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