Abstract
Purpose :
Although the lack of glaucoma awareness has been widely reported in cross-sectional studies, the longitudinal status of subjects with glaucoma unawareness is unexplored. This study explores this gap by reporting the prevalence and factors associated with the persistent lack of glaucoma awareness.
Methods :
Baseline data (2004-2011) included 10,033 participants, from which 6,762 (78.8%) participated in this 6-year follow-up (2011-2017). Standardized examination and investigations were performed, including slit lamp biomicroscopy, tonometry, pachymetry, gonioscopy, optic disc examination and ocular imaging (fundus photo, visual field, and OCT). Participants diagnosed with major eye diseases were referred to eye clinics for follow-up. Glaucoma was diagnosed using a combination of clinical evaluation, imaging and criteria given by the International Society of Geographical and Epidemiological Ophthalmology (ISGEO). Participants with undiagnosed glaucoma (i.e., answering no to whether they previously had been told by a physician that they had glaucoma, not using glaucoma medication, or not having undergone glaucoma surgery) were identified at baseline and follow-up. Multivariable logistic regression was used to evaluate the risk factors associated with persistent lack of disease awareness.
Results :
Out of the 361 glaucoma participants at baseline, 77.3% (N=279) were previously undiagnosed. 204 remained eligible for follow-up and 152 (74.5%) returned. 30 participants with missing data at follow-up were further excluded. Out of the remaining, 63.1% (N=77) had persistent disease unawareness. By ethnicity, 77.9% Malays (N=46), 52.1% Chinese (N=25) and 40% Indian (N=6) participants had persistent unawareness. Baseline parameters associated with this included Malay ethnicity (vs Chinese: odds ratio [OR], 3.03; 95% CI, 1.18–7.77; P= 0.02), lower IOP (per mmHg: OR, 0.89; 95% CI, 0.81–0.99; P= 0.03) and absence of myopia (OR, 2.55; 95% CI, 1.08–6.03; P= 0.03).
Conclusions :
Our study identified a concerning 77.3% undiagnosed glaucoma at baseline, with 63.1% of returning participants having persistent unawareness. Ethnic disparities, notably among Malays, emphasize the need for targeted awareness and education initiatives to address challenges in glaucoma underdiagnosis and awareness, particularly in high-risk communities.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.