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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 57  |  Issue : 3  |  Page : 203-207

Knowledge and awareness of glaucoma in South India


Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India

Date of Submission01-Jan-2019
Date of Acceptance12-Feb-2019
Date of Web Publication11-Nov-2019

Correspondence Address:
Dr. Krishnagopal Srikanth
Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry - 607 403
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_1_19

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  Abstract 


Background: Glaucoma is one of the leading causes of preventable blindness worldwide. It is estimated that by 2020, India will become the second largest population affected with glaucoma. Despite the various efforts by government and NGO agencies in conducting various out-reach and screening programmes the burden of glaucoma seems to be rising in India. Aims and Objectives: Our study was aimed to find the awareness about glaucoma and the level of knowledge and the various reasons for the lack of its knowledge. Materials and Methods: A questionnaire based study was done on 1311 participants above 40 years of age attending the OPD. Participants who were aware of the condition glaucoma were further asked about the basic knowledge of the condition pertaining to its symptoms, treatment options and its visual prognosis. Results: The awareness of glaucoma was found to be poor. Around 10% of the aware population had good to excellent knowledge about glaucoma. Relatives of people affected by glaucoma were the most aware and knowledgable. Conclusion: Our study showed that the awareness and knowledge about glaucoma and its risk factors and treatment were poor, especially in a population with lower economic status and literacy levels.

Keywords: Awareness, glaucoma, knowledge, South India


How to cite this article:
Ahmed Z, Srikanth K, Rajalakshmi A R. Knowledge and awareness of glaucoma in South India. TNOA J Ophthalmic Sci Res 2019;57:203-7

How to cite this URL:
Ahmed Z, Srikanth K, Rajalakshmi A R. Knowledge and awareness of glaucoma in South India. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2020 Jan 24];57:203-7. Available from: http://www.tnoajosr.com/text.asp?2019/57/3/203/270685




  Introduction Top


It is estimated about 65 million people worldwide are affected by glaucoma[1] and it is one of the leading causes of preventable blindness worldwide. By 2020, India will be the 2nd largest in terms of people affected by glaucoma.[2] In India, the prevalence rate of primary open-angle glaucoma has been reported between 1.26% and 3.46%, whereas that of angle closure disease as 3.71%–10.43%.[3] Usually, glaucoma is asymptomatic initially and thus remains undiagnosed in a majority of the population as symptoms mostly present in the later stages. High rates of undiagnosed glaucoma are either due to patients not presenting to their ophthalmologist, lack of financial resources or insufficient health-care facilities, or ophthalmologists missing the diagnosis.[4] Evidence suggests that the late diagnosis of glaucoma is a key factor in glaucoma-related blindness and is associated with poor knowledge about the condition.[5] An early diagnosis of glaucoma is thus vital for its effective management and prevention of blindness due to glaucoma. Some people despite being aware of glaucoma have very little knowledge about the symptoms, course of the disease, and the management options.[5] This study aims to find the awareness about glaucoma in the population and to find the level of knowledge about glaucoma in the above population.


  Materials and Methods Top


A population-based study, using a questionnaire as shown in Annexure 1, was conducted in the outpatient department of a tertiary care center between May 2017 and August 2017. The study was approved by the Institutional Medical Ethics Committee. A written informed consent was obtained from all the participants after explaining the nature of the study.

The questionnaire was initially designed in English and then translated into the local language (Tamil) with inputs for framing the questions from the patients attending the outpatient department (OPD) and then again back translated to English, and then internally audited by the authors.

All the patients above 40 years of age belonging to a suburban area attending the OPD were chosen randomly and asked “if they have heard about glaucoma” in their local language (Tamil). If yes, a subsequent question was asked to them if they were being treated for glaucoma or any other ocular disease. Although persons accompanying the patients belonging to the similar ethnic, social, and demographic groups were also included in the study after getting their consent. The patients who were undergoing treatment for glaucoma were excluded from the study.

The questionnaire was handed over to the participants in their preferred language (English or Tamil). If the participants who responded to the 1st question “have they heard of an eye condition called as glaucoma” as “No,” participants's demographic details such as age, gender, education level, and socioeconomic status were noted down and the questionnaire was taken back without asking any further questions. The details about knowledge were obtained from those only who responded to the 1st question as “Yes.” If the patient was illiterate, the questionnaire was read to him/her in their local language by the OPD nurse to avoid interviewer bias.

The questionnaire had two sections – The first section pertaining to information about the patient's demographic characteristics (age, gender, education level, and socioeconomic status).

Section two was designed to know the patient's awareness and knowledge about glaucoma, through seven multiple choice questions (three questions evaluating their awareness and four assessing their knowledge).

The awareness section had one question dealing with the source of information about glaucoma.

The response “having heard of glaucoma” for the study was defined as awareness and having some understanding of the eye disease was defined as knowledge.

Knowledge was graded as good, fair, and poor based on the participant's collective responses to questions on the risk factors of glaucoma, whether it was different to cataract, treatment aspects, and regarding the visual prognosis. The grading has been summarized in [Table 1] and has been taken from the Chennai Glaucoma Study[6] with a similar kind of questionnaire.
Table 1: Grading of knowledge among aware participants

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Results were analyzed using SPSS 19.0 software (IBM SPSS, US) with regression modules installed. Descriptive analyses were reported as percentages. The correlation was used to find the association between knowledge levels and literacy level and socioeconomic status of the participants.


  Results Top


One thousand three hundred and eleven participants were enrolled in the study. 467 (29.5%) females and 844 (53.3%) males participated in the study. Demographic characteristics of all the participants are summarized in [Table 2].
Table 2: Demographic characteristics of all the participants (n=1311)

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One hundred and ninety-one (14.6%) participants were aware of the term glaucoma out of which 79 (41.4%) were female and 112 (58.6%) were male.

The source of awareness among the aware participants is summarized in [Figure 1]. Among the 191 aware participants, 107 (56%) knew that cataract and glaucoma were two different entities, while 61 (31.9%) answered both were the same while 23 (12%) could not say if they were same or different. The participant's responses to risk factors and treatment modalities are shown in [Table 3].
Figure 1: The source of awareness of glaucoma in the aware population (n = 191)

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Table 3: Knowledge regarding risk factors and treatment modalities of glaucoma among the patients who were at least aware of the condition (n=191)

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Knowledge levels among aware participants have been summarized in [Figure 2]. Gender disparity in knowledge was found to be statistically insignificant and is shown in [Table 4]. A correlation between knowledge levels and literacy level was statistically significant and showed knowledge was more in cases of participants with higher levels of literacy. Knowledge levels were also found to be higher in participants who belonged to the upper socioeconomic class.
Figure 2: The grading of knowledge among the aware population (n = 191)

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Table 4: Comparison of knowledge levels with gender, literacy, and socioeconomic status

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  Discussion Top


By 2020, India will become the 2nd highest country with people affected by glaucoma.[2] Early diagnosis and management remains the most effective management in preventing blindness caused by glaucoma, especially in population at risk. Despite the current initiatives by the government and various nongovernmental organizations a mild improvement in awareness of glaucoma has been seen, but the knowledge levels about its risk factors, prognosis, and treatment remain nonexistent. The reported awareness of glaucoma in India ranges from 0.32% to 13.5%.[7-10] Our study reported an awareness of 14.6% among 1311 participants. Developed countries have shown a much higher level of awareness and knowledge among the study participants.[10],[11],[12] This major difference can be explained by various factors seen in our part of the world such as low-literacy rates, poverty, lack of adequate, and accessible health-care facilities, and failure of the various outreach programs.

We found that the awareness and knowledge about glaucoma were higher with higher educational status and the socioeconomic scale. Those who belonged to the upper socioeconomic classes (>5 lakhs/annum) were more aware of glaucoma than those who belonged to the lower classes. Those who were educated above high school level were also found to be more aware of glaucoma than those who were educated below high school. Similar trends have been reported by other awareness and prevalence studies.[6],[10],[11],[13] This only highlights the direct impact of education and socioeconomic levels on the awareness and knowledge levels and the need for improving them.

In our study, we found that males were more aware about the condition, but this could have been due to a significant difference in the number of males that participated in the survey. We could not find any relationship between age and glaucoma awareness which was consistent with other studies.[6]

We also found that people with a family history of glaucoma were more likely to be aware of the condition. Many other studies have also noted family as the main source of awareness[6],[13],[14] and thus highlight the importance of the role of glaucoma patients themselves to educate their relatives and friends about glaucoma and persuade them to undergo screening.

Out of 191 patients, who were aware of the condition, 84 (44%) did not know whether glaucoma and cataract were different entities. Only about 12 participants knew the family history of glaucoma was relevant, and only 10 were aware that glaucoma is due to an increase in pressure of the eye. Of 191 participants, 151 could not even answer 1 risk factor of glaucoma which was of grave concern.

One hundred and fifteen participants could not answer any treatment modality of glaucoma. Fifty-two participants knew that glaucoma could be treated with eye drops and 46 participants were aware a surgical or laser treatment was an option for the treatment of glaucoma. Eighty-five participants answered that spectacles could treat glaucoma which shows us the level of lack of knowledge about glaucoma.

Only three participants were able to answer that glaucoma has an irreversible loss of vision despite surgery.

Our study showed that the awareness and knowledge in a suburban population were poor despite access to eye services. There is a higher likelihood that awareness and knowledge about glaucoma would be even lower in areas with poor health-care facilities and accessibility. This highlights that despite various awareness programs conducted throughout the region, basic knowledge about glaucoma remains nonexistent. Poor socioeconomic status and illiteracy are the key factors for such a poor level of awareness in India. Thus, awareness programs should be planned in such a way that they are accessible to people belonging to all kinds of socioeconomic strata and able to be understood even by the illiterate population. The use of mass media such as television/radio in glaucoma awareness programs needs to be enhanced. A more target-based approach is the need of the hour to educate people about glaucoma as the current screening strategy is found to be not cost-effective.[15] Case detection needs to increase at a greater pace to reduce the existent burden of glaucoma, and it can only be achieved by a much better approach to spread awareness and knowledge. Glaucoma patients attending the outpatient should be encouraged to spread awareness about the condition and persuade family members to get screened early. The need for diagnosing glaucoma early and regular follow-up is the only way forward to prevent glaucoma-related blindness.[3] Target-based outreach programs should be carried out with focus on ways to increase knowledge about glaucoma, its risk factors, and treatment modalities along with general awareness of the disease.


  Conclusion Top


Our study showed that the awareness and knowledge about glaucoma and its risk factors and treatment were poor, especially in a population with lower economic status and literacy levels.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Annexure 1 Top



  Awareness and Knowledge of Glaucoma in a Tertiary Care Center Top


Participant's information:

AGE ......... GENDER M...... F.......

EDUCATION STATUS: Illiterate.....

≤ 12th standard……….

Graduate/ postgraduate.......

SOCIOECONOMIC STATUS (Annual income) <1 lakh …...

1-5 lakh …..

>5 lakh…..

1. Have you heard of an eye disease “Glaucoma”? Yes...... No.....



2. If yes, from where have you heard of it?

TV.... Newspaper...... Radio...... Friends/relatives.........

Doctor...... Anyone in family having glaucoma..........



3. Do you think glaucoma is similar to cataract? Yes....... No....... Can't say……..



4. Tick the possible risk factors for having glaucoma

  • Above 40 years of age
  • Anyone in family having glaucoma
  • Increase in the pressure of the eye
  • Diabetic patient
  • Can't say


5. Is glaucoma treatable?

  • Yes
  • No
  • Can't say


6. Glaucoma can be treated with:

  • Cannot be treated
  • Eye drops/medicine
  • Spectacles
  • Surgery/Laser
  • Can't say


7. Eye sight loss due to glaucoma:

  • Can become better after surgery
  • Will remain same after treatment
  • Will Worsen even after treatment
  • Can't say




 
  References Top

1.
Quigley HA. Number of people with glaucoma worldwide. Br J Ophthalmol 1996;80:389-93.  Back to cited text no. 1
    
2.
Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262-7.  Back to cited text no. 2
    
3.
Ramakrishnan R, Nirmalan PK, Krishnadas R, Thulasiraj RD, Tielsch JM, Katz J, et al. Glaucoma in a rural population of Southern India: The Aravind Comprehensive Eye Survey. Ophthalmology 2003;110:1484-90.  Back to cited text no. 3
    
4.
Vijaya L, George R, Arvind H, Baskaran M, Paul PG, Ramesh SV, et al. Prevalence of angle-closure disease in a rural Southern Indian population. Arch Ophthalmol 2006;124:403-9.  Back to cited text no. 4
    
5.
Saw SM, Gazzard G, Friedman D, Foster PJ, Devereux JG, Wong ML, et al. Awareness of glaucoma, and health beliefs of patients suffering primary acute angle closure. Br J Ophthalmol 2003;87:446-9.  Back to cited text no. 5
    
6.
Sathyamangalam RV, Paul PG, George R, Baskaran M, Hemamalini A, Madan RV, et al. Determinants of glaucoma awareness and knowledge in urban Chennai. Indian J Ophthalmol 2009;57:355-60.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
George R, Ve RS, Vijaya L. Glaucoma in India: Estimated burden of disease. J Glaucoma 2010;19:391-7.  Back to cited text no. 7
    
8.
Dandona R, Dandona L, John RK, McCarty CA, Rao GN. Awareness of eye diseases in an urban population in Southern India. Bull World Health Organ 2001;79:96-102.  Back to cited text no. 8
    
9.
Krishnaiah S, Kovai V, Srinivas M, Shamanna BR, Rao GN, Thomas R, et al. Awareness of glaucoma in the rural population of Southern India. Indian J Ophthalmol 2005;53:205-8.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Baker H, Murdoch IE. Can a public health intervention improve awareness and health-seeking behaviour for glaucoma? Br J Ophthalmol 2008;92:1671-5.  Back to cited text no. 10
    
11.
Gasch AT, Wang P, Pasquale LR. Determinants of glaucoma awareness in a general eye clinic. Ophthalmology 2000;107:303-8.  Back to cited text no. 11
    
12.
Rewri P, Kakkar M. Awareness, knowledge, and practice: A survey of glaucoma in North Indian rural residents. Indian J Ophthalmol 2014;62:482-6.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Hennis A, Wu SY, Nemesure B, Honkanen R, Leske MC; Barbados Eye Studies Group, et al. Awareness of incident open-angle glaucoma in a population study: The Barbados Eye Studies. Ophthalmology 2007;114:1816-21.  Back to cited text no. 13
    
14.
Tenkir A, Solomon B, Deribew A. Glaucoma awareness among people attending ophthalmic outreach services in Southwestern Ethiopia. BMC Ophthalmol 2010;10:17.  Back to cited text no. 14
    
15.
Tuulonen A. Cost-effectiveness of screening for open angle glaucoma in developed countries. Indian J Ophthalmol 2011;59 Suppl: S24-30.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
Annexure 1
Awareness and Kn...
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