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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. & 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


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 (, 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 & Psychological Sciences > Optometry & Visual Sciences
Text - Accepted Version
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