OBJECTIVES: To determine the association between various ocular and non-ocular factors and late presentation of glaucoma. DESIGN & METHOD: This study represents a comparative study between patients who at their first clinic presentation were assessed as having advanced chronic glaucoma and glaucoma patients who presented early in the course of their disease. The study adhered to the tenets of the declaration of Helsinki. 133 Glaucoma patients who attended the St John Eye Hospital in Soweto from December 2008 to October 2009 consented to participate in the study. They completed a questionnaire, underwent a complete ophthalmological examination and their hospital records were reviewed. 68 of the patients were assessed to be 'late presenters' with typical glaucomatous field loss and a mean deviation (MD) of greater than -14 dB in the better seeing eye, as well as typical glaucomatous cupping of 0.8 or more. 65 of the patients were assessed to be 'early presenters' with typical glaucomatous field loss and a MD between 0 dB and -11 dB in the worse eye as well as a cup to disc ratio of 0.5 or more or an interocular difference of 0.2 or greater between the discs. RESULTS: Presenting IOP in 'late presenters' (OD 33.56mmHg +/- 9.61: OS 33.46mmHg +/-10.37) was significantly higher (P<0001) than those of 'early presenters' (OD 18.37mmHg +/-5.95 : OS 19.24mmHg +/- 7.21). Other factors associated with late presentation include poor English language ability (52.9% vs. 16.9%)(P<0001), previous/current rural inhabitants (44.1% vs. 27.7%)(P=0.048), informal housing (17.6% vs. 6.1%)(P=0.041), smoking (16.1% vs.4.6%)(P=0.029) and smaller optic discs [(OD 1.98mm+/-0.27 : OS 1.97mm+/-0.27) vs.(OD 2.11mm+/-0.35 : OS 2.10mm+/-0.37)](P<0.05). A history of previous eye trauma was more common in 'early presenters' (18.4% vs 5.8%)(P=0.025) as was a medical history of diabetes mellitus (33.8% vs 16.1%)(P=0.018). The following factors were found to be statistically insignificant: age, sex, hypertension, primary vascular dysregulation, patient education, a positive family history of glaucoma and the presence of pseudocapsular exfoliation. CONCLUSION: In this patient cohort we found that the IOP at presentation was significantly higher in patients presenting with advanced glaucoma than in those presenting earlier in the disease process. Our data has also identified other factors which may be associated with late presentation.

Orientador: Bernardo Beiguelman / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-07-16T13:36:59Z (GMT). No. of bitstreams: 1 Maciel-Guerra_AndreaTrevas_M.pdf: 1446924 bytes, checksum: 5cf002e9c47d68492f0773d332d2786e (MD5) Previous issue date: 1986 / Resumo: A visão clássica sobre o mecanismo de herança do glaucoma congênito primário é a que essa anomalia é sempre transmitida de modo autossômico recessivo monogênico. A análise dos dados familiais de 1408 portadores dessa anomalia mostra que o glaucoma congênito primário é, na verdade, uma entidade genética heterogênea, visto que foi possível detectar pelo menos duas formas autossômicas monogênicas dessa doença, sendo uma dominante e outra recessiva. Há, ainda, um grande contingente de anômalos cuja etiologia (genética) não fui passível determinar. Assim sendo é fundamental, tanto para o geneticista quanto para o o oftalmologista, que se procure distinguir as diferentes entidades genético-clínicas ao nível anatômico e/ou bioquímico / Mestrado

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Thesis (M.P.H.)--University of Sydney, 2001. / Includes tables. Title from title screen (viewed Apr. 23, 2008). Submitted in fulfilment of the requirements for the degree of Master of Public Health to the Dept. of Public Health and Community Medicine, Faculty of Medicine. Includes bibliography. Also available in print form.

M.Phil. / The record cards of all patients (21 554) examined by the eye clinic on the Phelophepa Mobile Health Care train during January and September, 1995 were analysed. The prevalence of. POAG in the sample was 0-.8% (177 of 21 554 persons). Differences in POAG prevalence were observed with respect to sex, age and geographical region. There was a significant difference (p<0.001) in the number of males (1.1%, 92 of 8113), compared to females (0.6%, 85 of 13 441) diagnosed with POAG. In persons over 40 years of age the prevalence rate was 1.2 % (166 of 14 254 persons) and in persons over 60 years the rate was 1.7% (110 of 6375 persons). The highest prevalence rate was found in the Western Cape (1.84%) and the lowest in the Eastern Cape (0.33%). POAG patients were compared to a control group to investigate the role of certain demographic, systemic and ocular factors. Risk factor analysis identified old age(> 60 years) (OR = 7.2, 95% CI = 4.4 - 11.7), geographical area (Western Cape, OR =2.5, 95% CI = 1.7 - 3.9), systolic hypertension (OR = 2.2, 95% CI = 1.3 - 3.7), diastolic perfusion pressure (< 40 mmHg, OR = 12.9, 95% CI = 4.2 - 52.9), myopia (OR = 2.7, 95% CI = 1.7 - 4.4) and elevated IOP (21 - 30 mmHg, OR = 12.6, 95% CI = 6.4 - 25.0) as significant risk factors. The effectiveness of employing certain blood pressure (BP) and intraocular pressure (TOP) variables as screening tools for glaucoma was evaluated. The systolic BP/IOP ratio was the most valid of the four tests evaluated (sensitivity = 66.0%, specificity = 98.2%, phi coefficient = 0.72). The study recommends that glaucoma screening programmes need to be developed which include sphygmomanometry as part of a battery of tests, and these programmes be targeted specifically at high risk populations (elderly, hypertensives). Further epidemiological studies are required which investigate reasons for the geographical differences found with respect to glaucoma prevalence.

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