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vincent saka, Richard Chitedze, Joseph Msosa, William E Sponsel, Stephen Cook; Glaucoma screening in Rural Malawi Using a Risk Scoring Questionnaire. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2703.
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© ARVO (1962-2015); The Authors (2016-present)
Glaucoma is endemic and the leading cause of irreversible blindness in sub-Saharan Africa. Malawi is among the world’s most economically deprived nations, and among those at highest risk for preventable glaucomatous visual debilitation. Most Malawi rural villages are not readily accessible by 4-wheeled vehicles, but can be reached by motorcycle-mounted screening teams with portable tonometers and ophthalmoscopes (Fig 1). This study seeks to assess the practicality in Malawi of a multifactorial glaucoma screening system devised in South Africa (by SC; Fig 2), where the utility of this scoring system has already been confirmed. Identification of patients at highest glaucoma risk would be of great value to best utilize available human and material resources.
Between Aug-Nov 2017 ‘Glaucoma Score’ (www.tinyurl.com/glaucomascore) screening forms (Fig 2) were completed for inhabitants of rural districts nearby the Eyes of Africa Clinic (where FDT, OCT and an array of laser and surgical treatment options are in place with medical director (EC), senior faculty (JM), full time clinical officer (RC) and certified ophthalmic nurse (VS) are available). This study was carried out under auspices of Malawi Ministry of Health by CLI and Sponsel Foundation staff (VS&RC) to assess whether this pre-clinical screening tool might help optimize therapeutic efficacy.
258 voluntarily presenting adults (104M, 154F; mean age 42.5) completed the glaucoma risk screening protocol, among whom 32 (12%; mean score 17: range 11-24) were identified as being at high risk for glaucoma, 22 (8%; mean score 8.5) as glaucoma suspects, and 204 (80%; mean score 3.3) at low risk for glaucoma.
Applying well-established epidemiologic risk factors with tonometry and ophthalmoscopy, 1/5 of those presenting for voluntary screening reached the threshold justifying immediate clinical evaluation for glaucoma. The enormity of the glaucoma problem throughout sub-Saharan Africa welcomes any noninvasive screening tool that can reduce the glaucoma-directed clinical load by 80%. Future studies will help determine the actual sensitivity and specificity of this method by fully evaluating a random cohort of low-risk subjects alongside those identified as high-risk and glaucoma suspects.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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