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A. Hennis, S.Y. Wu, B. Nemesure, R.A. Honkanen, M.C. Leske, The BESs Study Group; Factors Related to Non–Detection of Incident Open–Angle Glaucoma (OAG) – the Barbados Eye Studies (BESs) Experience . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3432.
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© ARVO (1962-2015); The Authors (2016-present)
Although under–diagnosis of OAG is a common finding in population studies, its underlying reasons (which have high public health relevance) are not well known. We evaluate factors related to non–detection of incident OAG over 9 years of follow–up in the BESs cohort.
4,709 randomly selected residents of Barbados, W.I. participated in the BESs, with 81–85% response over 9 years; this report is based on participants of African descent (n= 4,314; 40–84 yrs at baseline). Definite OAG was defined by visual field and optic disc criteria after excluding other possible causes; intraocular pressure (IOP) was not a diagnostic criterion. Persons without OAG in both eyes at baseline but developing OAG in at least one eye during follow–up were defined as incident cases. Study visits included a comprehensive questionnaire, which ascertained demographic, medical, health care and other factors. Incident OAG cases without prior OAG diagnosis or treatment were considered undetected. Logistic regression analyses were used to evaluate factors associated with such non–detection.
125 cases of incident OAG were identified in the BESs black participants over 9 years. Of these, 53% were previously undetected. Compared to those participants with prior OAG diagnosis, the unaware group had lower (P<0.05) mean (SD) IOP at baseline (20.7 (4.6) vs. 24.0 (6.7) mmHg). Age, gender, and occupation were unrelated to non–detection, although the previously diagnosed group had significantly more years of education (10.5 (3.2) vs. 9.6 (2.4) years). The undetected group sought eye care less frequently (last visit ≤1 year ago: 33.3% vs. 64.4%). After adjusting for age, gender, and education, the undetected group was 3.8 times more likely to seek care from opticians (OR [95% CI]): 3.8 [1.1, 12.4] and 90% less likely from the single tertiary care hospital (OR: 0.1 [0.0, 0.4]) than the detected group. Their main reasons for eye care visits were routine checkups (14.3% vs. 2.5%) or glasses (71.4% vs. 12.5%), rather than specific eye problems (14.3% vs. 85.0%).
Baseline IOP, education and eye care–seeking behaviors influenced the detection of OAG. Many in the undetected group visited opticians/optometrists, but did not undergo OAG evaluation. These health care professionals have a potentially major role to play in the early detection of OAG in this high–risk population. 11/22/05
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