Abstract
Background: The prevalence of glaucoma is highest in Africa compared to the rest of the world. The lack of glaucoma symptoms in early disease leads to delayed presentation, especially in resource-constrained regions in Sub-Saharan Africa (SSA). In order to develop a comprehensive and efficient strategy for glaucoma management in SSA, it is important to have an in-depth understanding of glaucoma presentation and current diagnostic and treatment strategies. Early detection and appropriate management are important strategies to reduce the burden of glaucoma.Methods: The Severity Treatment and Acceptability of Glaucoma thErapy in Sub-Saharan Africa (STAGE) was a descriptive, multi-centre cross-sectional study which assessed the severity, treatment and acceptability of glaucoma therapy across Sub- Saharan Africa in newly diagnosed and follow-up-glaucoma-patients. In addition, an uncontrolled, experimental, before-and-after study in which non-ophthalmic DR graders were trained to screen for glaucoma using optic nerve photos in Vietnam was conducted.
Results: A total of 1214 newly diagnosed patients were enrolled on this study. More than half presented with severe glaucoma in the worse eye, and one-third had severe glaucoma in both eyes. Physician and patient preference was medical therapy. Laser therapy was underutilized, and although 99% of the patients had access to trabeculectomy, physicians offered it to only 14% of patients at presentation. In the diabetic retinopathy grading study, graders’ mean baseline score (33.3% ± 14.3%) improved significantly after training (55.8% ±12.6%, P Conclusion: The results of this work provide evidence that glaucoma is still a huge problem in SSA and that diabetic retinopathy (DR) graders can be trained to screen for glaucoma. This model may be key to the effective screening of glaucoma patients in LMICs.
Thesis is embargoed until 31 December 2025.
| Date of Award | Dec 2023 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Sponsors | Northern Ireland Department for the Economy |
| Supervisor | Ving Fai Chan (Supervisor), Nathan Congdon (Supervisor) & Augusto Azuara-Blanco (Supervisor) |
Keywords
- Glaucoma
- severity
- Sub-Saharan Africa
- glaucoma screening
- diabetic retinopathy graders