Piloting targeted glaucoma screening: experiences of eye care services in Ganjam district, Odisha state, India.
India
community-based programme
glaucoma
screening
Journal
International health
ISSN: 1876-3405
Titre abrégé: Int Health
Pays: England
ID NLM: 101517095
Informations de publication
Date de publication:
06 04 2022
06 04 2022
Historique:
received:
06
08
2021
accepted:
02
11
2021
revised:
25
10
2021
entrez:
6
4
2022
pubmed:
7
4
2022
medline:
9
4
2022
Statut:
ppublish
Résumé
The number of patients with visual impairment and blindness from glaucoma is rapidly increasing with wide-ranging impacts for individuals and societies. However, the disease often goes undiagnosed for a long time, especially in low- and middle-income countries where healthcare services are limited. This paper presents the results of a pilot programme, which integrated targeted glaucoma screenings of people aged ≥40 y in community-based eye care services in the Ganjam district of Odisha state, India. Using routine programme data, descriptive statistics were produced for the characteristics of patients participating in the screening programme and the rate and uptake of glaucoma referrals. Bivariate analysis was used to examine associations between patient characteristics, clinical risk factors and glaucoma diagnosis. Out of 23 356 individuals aged ≥40 y screened for glaucoma over a period of 18 mo, 2219 (9.5%) were referred and 2031 presented for further examination. Among them, almost half (n=968, 48%) were diagnosed with glaucoma, representing a screening to diagnosis conversion rate of 4.14% (95% CI 3.9 to 4.4%). A positive diagnosis of glaucoma among suspects was associated with female sex, age >60 y, visual impairment, vertical cap-to-disc ratio ≥0.6:1, intraocular pressure ≥30 mmHg and shallow anterior chamber (p<0.001). The importance of targeted screening for glaucoma using simple referral criteria to identify patients at high risk of vision loss who can benefit from treatment is critical to slow the progression of the disease and the prevention of blindness. Further studies assessing costs of the targeted screening, the role of technology in improving programme effectiveness and efficiency and the longer term compliance with treatment are needed to support glaucoma policy frameworks, guidelines and clinical practice.
Sections du résumé
BACKGROUND
The number of patients with visual impairment and blindness from glaucoma is rapidly increasing with wide-ranging impacts for individuals and societies. However, the disease often goes undiagnosed for a long time, especially in low- and middle-income countries where healthcare services are limited. This paper presents the results of a pilot programme, which integrated targeted glaucoma screenings of people aged ≥40 y in community-based eye care services in the Ganjam district of Odisha state, India.
METHODS
Using routine programme data, descriptive statistics were produced for the characteristics of patients participating in the screening programme and the rate and uptake of glaucoma referrals. Bivariate analysis was used to examine associations between patient characteristics, clinical risk factors and glaucoma diagnosis.
RESULTS
Out of 23 356 individuals aged ≥40 y screened for glaucoma over a period of 18 mo, 2219 (9.5%) were referred and 2031 presented for further examination. Among them, almost half (n=968, 48%) were diagnosed with glaucoma, representing a screening to diagnosis conversion rate of 4.14% (95% CI 3.9 to 4.4%). A positive diagnosis of glaucoma among suspects was associated with female sex, age >60 y, visual impairment, vertical cap-to-disc ratio ≥0.6:1, intraocular pressure ≥30 mmHg and shallow anterior chamber (p<0.001).
CONCLUSIONS
The importance of targeted screening for glaucoma using simple referral criteria to identify patients at high risk of vision loss who can benefit from treatment is critical to slow the progression of the disease and the prevention of blindness. Further studies assessing costs of the targeted screening, the role of technology in improving programme effectiveness and efficiency and the longer term compliance with treatment are needed to support glaucoma policy frameworks, guidelines and clinical practice.
Identifiants
pubmed: 35385872
pii: 6563811
doi: 10.1093/inthealth/ihab078
pmc: PMC8986354
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
i29-i36Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
Références
Indian J Ophthalmol. 2008 Jan-Feb;56(1):45-50
pubmed: 18158403
Ophthalmology. 2003 Aug;110(8):1484-90
pubmed: 12917161
JAMA Ophthalmol. 2016 Apr;134(4):357-65
pubmed: 26747060
Indian J Ophthalmol. 2016 Aug;64(8):578-83
pubmed: 27688279
Acta Ophthalmol. 2019 May;97(3):e349-e355
pubmed: 30790460
Ophthalmology. 2007 Nov;114(11):1965-72
pubmed: 17628686
Adv Ther. 2016 Jun;33(6):959-81
pubmed: 27138604
J Ophthalmol. 2017;2017:4257151
pubmed: 28804646
J Family Med Prim Care. 2020 May 31;9(5):2200-2206
pubmed: 32754474
J Optom. 2017 Apr - Jun;10(2):71-78
pubmed: 27025415
Ophthalmology. 2008 Apr;115(4):655-660.e1
pubmed: 17869343
Br J Ophthalmol. 2016 Jan;100(1):86-93
pubmed: 26286821
J Curr Glaucoma Pract. 2014 Sep-Dec;8(3):107-12
pubmed: 26997821
Cureus. 2020 Nov 24;12(11):e11686
pubmed: 33391921
Indian J Ophthalmol. 2012 Sep-Oct;60(5):446-50
pubmed: 22944757
Indian J Ophthalmol. 2008 Jan-Feb;56(1):57-62
pubmed: 18158405
Ophthalmic Epidemiol. 2020 Dec;27(6):429-437
pubmed: 32449411
Ophthalmology. 2009 Feb;116(2):200-7
pubmed: 19019444
Clin Exp Ophthalmol. 2019 Nov;47(8):1000-1008
pubmed: 31152490
J Med Econ. 2020 Jan;23(1):106-112
pubmed: 31322025
Ophthalmology. 2004 Sep;111(9):1627-35
pubmed: 15350314
Ophthalmology. 2000 Sep;107(9):1710-6
pubmed: 10964834
Ophthalmology. 2014 Nov;121(11):2081-90
pubmed: 24974815
Invest Ophthalmol Vis Sci. 2007 Dec;48(12):5459-63
pubmed: 18055793
Indian J Ophthalmol. 2001 Mar;49(1):25-30
pubmed: 15887712
PLoS One. 2013 Sep 30;8(9):e76434
pubmed: 24098790
Ophthalmic Epidemiol. 2015;22(5):297-307
pubmed: 26395657
J Glaucoma. 2008 Oct-Nov;17(7):546-51
pubmed: 18854731
Arch Ophthalmol. 2002 Oct;120(10):1268-79
pubmed: 12365904
Invest Ophthalmol Vis Sci. 2005 Dec;46(12):4461-7
pubmed: 16303934