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Severity of Visual Field Loss at First Presentation to Glaucoma Clinics in England and Tanzania

Jones, P. R. ORCID: 0000-0001-7672-8397, Philippin, H., Makupa, W. U., Burton, M. J. and Crabb, D. P. ORCID: 0000-0001-8754-3902 (2020). Severity of Visual Field Loss at First Presentation to Glaucoma Clinics in England and Tanzania. Ophthalmic Epidemiology, 27(1), pp. 10-18. doi: 10.1080/09286586.2019.1661499

Abstract

Purpose: To compare severity of visual field (VF) loss at first presentation in glaucoma clinics in England and Tanzania.

Methods: Large archives of VF records from automated perimetry were used to retrospectively examine vision loss at first presentation in glaucoma clinics in Tanzania (N = 1,502) and England (N = 9,264). Mean deviation (MD) of the worse eye at the first hospital visit was used as an estimate of detectable VF loss severity.

Results: In Tanzania, 44.7% {CI95%: 42.2, 47.2} of patients presented with severe VF loss (< −20 dB), versus 4.6% {4.1, 5.0} in England. If we consider late presentation to also include cases of advanced loss (-12.01 dB to -20 dB), then the proportion of patients presenting late was 58.1% {55.6, 60.6} and 14.0% {13.3, 14.7}, respectively. The proportion of late presentations was greater in Tanzania at all ages, but the difference was particularly pronounced among working-age adults, with 50.3% {46.9, 53.7} of 18–65-year-olds presenting with advanced or severe VF loss, versus 10.2% {9.3, 11.3} in England. In both countries, men were more likely to present late than women.

Conclusions: Late presentation of glaucoma is a problem in England, and an even greater challenge in Tanzania. Possible solutions are discussed, including increased community eye-care, and a more proactive approach to case finding through the use of disruptive new technologies, such as low-cost, portable diagnostic aids.

Publication Type: Article
Additional Information: © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords: Glaucoma, visual fields, late presentation, epidemiology, public health, perimetry, disease detection, disease referral, global challenges
Subjects: R Medicine > RE Ophthalmology
Departments: School of Health Sciences > Optometry & Visual Science
URI: https://openaccess.city.ac.uk/id/eprint/23782
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