Kyari Fatima, Wormald Richard, Murthy Gudlavalleti V S, Evans Jennifer R, Gilbert Clare E
*Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine †Moorfields Eye Hospital, London, UK ‡Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Andhra Pradesh, India.
J Glaucoma. 2016 Oct;25(10):e861-e872. doi: 10.1097/IJG.0000000000000487.
We explored the risk factors for glaucoma blindness among adults aged 40 years and above with primary glaucoma in Nigeria.
A total of 13,591 participants aged 40 years and above were examined in the Nigeria Blindness Survey; 682 (5.02%; 95 CI, 4.60%-5.47%) had glaucoma by ISGEO's criteria. This was a case-control study (n=890 eyes of 629 persons): glaucoma blind persons were cases and glaucoma not-blind were controls. Education and occupation were used to determine socioeconomic status scores, which were divided into 3 tertiles (affluent, medium, deprived). We assessed sociodemographic, biophysical, and ocular factors by logistic regression analysis for association with glaucoma blindness. Multinomial regression analysis was also performed with nonglaucoma as the reference category.
A total of 119/629 (18.9%; 95% CI, 15.9%-22.4%) persons were blind in both eyes; 510 were controls. There was interethnic variation in odds of blindness; age, male sex, socioeconomic status, prior diagnosis of glaucoma, hypertension, intraocular pressure, and lens opacity were associated with glaucoma blindness. Axial length, mean ocular perfusion pressure, and angle-closure glaucoma were associated with blind glaucoma eyes. In multivariate analysis, Igbo ethnicity (OR=2.79; 95% CI, 1.03-7.57) had higher risk as was being male (OR=4.59; 95% CI, 1.73-12.16) and unmarried (OR=2.50; 95% CI, 1.03-6.07). Deprivation (OR=3.57; 95% CI, 1.46-8.72), prior glaucoma diagnosis (OR=5.89; 95% CI, 1.79-19.40), and intraocular pressure (OR=1.07; 95% CI, 1.04-1.09) were also independent risk factors for glaucoma blindness.
Approximately 1 in 5 people with primary glaucoma were blind. Male sex, ethnicity and deprivation were strongly associated with blindness. Services for glaucoma need to improve in Nigeria, focusing on poor communities and men.
我们探讨了尼日利亚40岁及以上原发性青光眼成年人青光眼致盲的危险因素。
在尼日利亚失明调查中，共检查了13591名40岁及以上的参与者；根据国际青光眼流行病学学会（ISGEO）的标准，682人（5.02%；95%可信区间[CI]，4.60%-5.47%）患有青光眼。这是一项病例对照研究（629人共890只眼）：青光眼致盲者为病例组，青光眼未致盲者为对照组。通过教育程度和职业来确定社会经济地位得分，并将其分为三个三分位数（富裕、中等、贫困）。我们通过逻辑回归分析评估社会人口统计学、生物物理学和眼部因素与青光眼致盲的相关性。还以非青光眼为参照类别进行了多项回归分析。
629人中共有119人（18.9%；95%CI，15.9%-22.4%）双眼失明；510人为对照组。失明几率存在种族差异；年龄、男性、社会经济地位、青光眼既往诊断、高血压、眼压和晶状体混浊与青光眼致盲有关。眼轴长度、平均眼灌注压和闭角型青光眼与青光眼致盲眼有关。在多变量分析中，伊博族（比值比[OR]=2.79；95%CI，1.03-7.57）、男性（OR=4.59；95%CI，1.73-12.16）和未婚者（OR=2.50；95%CI，1.03-6.07）风险较高。贫困（OR=3.57；95%CI，1.46-8.72）、青光眼既往诊断（OR=5.89；95%CI，1.79-19.40）和眼压（OR=1.07；95%CI，1.04-1.09）也是青光眼致盲的独立危险因素。
约五分之一的原发性青光眼患者失明。男性、种族和贫困与失明密切相关。尼日利亚需要改善青光眼服务，重点关注贫困社区和男性。
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