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.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/14374 |
| Date | 28 March 2014 |
| Creators | Kraukamp, Philip |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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