Glaucoma care and clinical profile in Priest Hospital, Thailand.

OBJECTIVE

To assess the prevalence, mechanism and status of glaucoma, and to investigate the magnitude of visual impairment from glaucoma and its relating factors in Buddhist priest and novices.

MATERIAL AND METHOD

Cross-sectional study of 190 patients treated in Glaucoma service, Priest hospital was performed. One hundred thirty seven patients with glaucoma and suspected glaucoma had comprehensive ophthalmic examination included interview on medical and ocular history, visual acuity, applanation tonometry, gonioscopy, optic disc, visual field evaluation, and retinal nerve fiber layer thickness measurement (Stratus Optical Coherence Tomography; Stratus OCT).

RESULTS

Glaucoma was diagnosed in 106 (77%) patients (181 eyes); 31 patients (23%) were glaucoma suspects. Open angle glaucoma (OAG) was found in 53 (50%) cases and classified into 36 (33%) primary open angle glaucoma and 17 (16%) normal tension glaucoma (NTG). Five (4.6%) patients had pseudoexfoliative glaucoma, 24 (23%) had primary angle-closure glaucoma (PACG), 10 (9.4%) had angle-closure glaucoma secondary to other causes (SACG), seven (6.6%) had secondary open angle glaucoma and seven (6.6%) were diagnosed of juvenile glaucoma. Among 31 glaucoma suspects, 18 cases were diagnosed based on disc appearance, eight based on intraocular pressure (IOP), two based on visual field and three cases had primary angle closure (PAC). The prevalence of glaucoma increased with age, with the highest prevalence (33%) in the age range 71 to 80 years. The Glaucoma service of Priest hospital diagnosed glaucoma in 53% of the priest. Rate of glaucoma was higher in priest from rural area than those from Bangkok and urban area. The mean baseline IOP was 26.5 +/- 14.7 mmHg. The mean treated IOP was 14.5 +/- 7.9 mmHg. The average mean deviation (MD) was -14.45 +/- 11.11. OCT showed average RNFL thickness of 70.8 +/- 35.6 microm. Glaucoma medications was received by 72% of the priest, 18% had laser treatment, and 22 % had glaucoma surgery. At diagnosis, two patients were blind according to WHO criteria, 29 (28%) patients were unilaterally blind, and seven (6.5%) had low vision. After treatment, 31 (29%) patients had unilateral blindness and none had bilateral blindness. The main associated diseases were hypertension, dyslipidemia, and diabetes. Transportation and financial condition were the major barriers in receiving eye care.

CONCLUSIONS

OAG comprised 50% of all glaucoma, 23% of PACG, and 16% of all subtypes of secondary glaucoma. The prevalence of glaucoma in priest rose significantly with age. In the treated glaucoma patients, 47% retained good visual outcome. Delayed diagnosis was a major factor for unsatisfactory outcome as 28% of patients had monocular blindness at diagnosis and 53% were previously unaware of their disease.