Purchase this article with an account.
Shaheen P. Shah, Priya Morjaria, Clare Gilbert; Variation In The Provision Of Services For Glaucoma, By Level Of Socioeconomic Development. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6387.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Glaucoma is an important cause of blindness in all regions. There is anecdotal evidence that this may, in part, be due to inadequate services for diagnosis and management of glaucoma in less developed countries. The aim of this study is to provide a description of the services in these settings.
An online network of ophthalmologists (International Eye Research Network) has already been established through a range of sources. Members were requested to report information on their services and management of glaucoma in 2010 via an online survey. Data collected included type and capacity of hospital, availability of a glaucoma specialist, availability and functionality of equipment as well as preferred management options. Hospitals were categorised by their country’s United Nations Human development Index (HDI) as low (<0.5), middle-low (≥0.5-<0.6) and middle-high (≥0.6-<0.9). No high developed country (HDI ≥0.9) was included.
81 ophthalmic hospitals in 24 countries participated. 70% were non governmental institutions. 30% were in low HDI and 31% in middle-low HDI countries. Hospitals had an average of 9 full time ophthalmologists with a median of 100 glaucoma outpatient visits/month. Only 17% of hospitals in low HDI settings had an ophthalmologist with sub-speciality training in glaucoma compared to 97% in middle-high HDI settings. Hospitals with a subspecialist were more likely to offer information leaflets about glaucoma to patients (84.3% vs 30%, p<0.001) and have glaucoma management protocols (77.5% vs 39.3%, p<0.001). There was a trend for lack of essential equipment in hospitals in low HDI settings e.g. 75% had a functioning field analyser vs. 97% in middle-high HDI hospitals ( p=0.05); 37.5% had a Yag laser for peripheral iridotomy compared with 81% in middle-high HDI hospitals (p=0.001). The presence of a subspecialist was significantly associated with a greater number of trabeculectomies. This association remained significant after adjusting for HDI (p=0.031).
Glaucoma subspecialists are lacking in low HDI settings affecting quality of care. Emphasis should be placed on strengthening eye departments to enable them to accurately diagnose and manage glaucoma patients who present to them before strategies are put in place to increase case finding in the community.
This PDF is available to Subscribers Only