|Year : 2013 | Volume
| Issue : 1 | Page : 3-8
Glaucoma awareness and knowledge in a tertiary care hospital in a tier-2 city in South India
Mridula Prabhu1, Shankargouda H Patil1, Pravin Chandra R Kangokar2
1 Department of Ophthalmology, S D M College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
2 Department of Community Medicine, S D M College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
|Date of Web Publication||28-Mar-2013|
Department of Ophthalmology, S D M College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Awareness of glaucoma is low in spite of being the second leading cause of preventable blindness in the world. Aim: To study the awareness and knowledge levels of glaucoma in a tertiary eye care hospital in a tier-2 city. Materials and Methods: This is a hospital-based crosssectional study. A total of 704 patients attending ophthalmology outpatient department of Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital (SDM) Dharwad, aged 40 years and above were administered a questionnaire after a written informed consent to assess their awareness and knowledge levels of glaucoma. Subjects "having heard of glaucoma" even before they were recruited for the study were defined as "aware", and subjects having some understanding of the eye disease were defined as "knowledgeable". Results: Out of 704 subjects recruited for the study, only 34 (4.8%) subjects were aware of glaucoma and 22 (3.1%) had some knowledge of glaucoma. Determinants of glaucoma awareness were higher levels of education, diabetes, or glaucoma and family history of glaucoma. Conclusion: Awareness and knowledge of glaucoma was very low among the subjects. The findings of the study stress the need for health awareness for effective prevention of blindness due to glaucoma.
Keywords: Awareness, glaucoma, hospital-based study, knowledge, south India
|How to cite this article:|
Prabhu M, Patil SH, Kangokar PR. Glaucoma awareness and knowledge in a tertiary care hospital in a tier-2 city in South India. J Sci Soc 2013;40:3-8
|How to cite this URL:|
Prabhu M, Patil SH, Kangokar PR. Glaucoma awareness and knowledge in a tertiary care hospital in a tier-2 city in South India. J Sci Soc [serial online] 2013 [cited 2017 Mar 26];40:3-8. Available from: http://www.jscisociety.com/text.asp?2013/40/1/3/109674
| Introduction|| |
Blindness is a concern world over. It affects a person socio-economically, and the government's spending toward health.  This is more so in a developing country like India. Glaucoma is the second leading cause of visual loss in the world. The prevalence of glaucoma worldwide is 67 million and 6.6 million people are blind due to glaucoma.  Blindness due to glaucoma is irreversible but preventable. In India, glaucoma is the third most common cause of blindness with a prevalence of 5.8% among the blind, next to cataract and uncorrected refractive errors.  Nearly half of the blind people are unaware of their condition. 
There are numerous avenues to improve the prevention of blindness from glaucoma, but improved early detection offers the most potential. Social perceptions of health have changed globally; there is an impetus to move toward good health by using resources efficiently for preventive measures. 
There are various factors which influence awareness like level of education, family history, publicity by media, and information distribution by government agencies and non-governmental organizations (NGO). The reason for undertaking this study is that previous studies done in India were mainly concentrated in tier-1 cities or at the rural level. ,, We conducted this study at SDM College of Medical Sciences and Hospital which is a tertiary hospital situated in tier-2 city namely Dharwad, Karnataka state, India. Tier-2 cities are more in India and they consist of a mixture of both urban and rural population. Hence, this study was aimed at understanding the awareness and knowledge about glaucoma in a tertiary eye care hospital in a tier-2 city.
| Materials and Methods|| |
A sample size of 704 was calculated based on 13.3% prevalence of glaucoma awareness in the population above 40 years with an alpha error of 5% and a precision level of 10%.  The subjects were defined as every third patient above 40 years attending ophthalmology outpatient department of SDM medical college on Tuesday, Thursday, and Saturday which happened to be the outpatient days allotted to the investigator. We started on Jan 3, 2012 and stopped on June 30, 2012. Patients aged less than 40 years and patients' attenders were excluded.
Written informed consent was obtained from all subjects and the study was performed in accordance with the tenets of the Declaration of Helsinki. The Institutional ethical committee clearance was taken from SDM College of Medical Sciences and Hospital.
Demographic details and literacy levels of all subjects were obtained. A brief structured open-ended questionnaire was designed to record information about the subject's awareness and knowledge about glaucoma [Annexure 1]. [Additional file 1] The questionnaire was initially developed in English and all the questions were translated into the two most common languages Kannada and Hindi if the subjects could not follow English. The questionnaire was interviewer administered. The questionnaire was administered prior to the history taking and examination procedures carried out for glaucoma. Details on the knowledge about glaucoma were obtained only for subjects who were aware of glaucoma.
Awareness and knowledge about glaucoma
Subjects "having heard of glaucoma" even before being recruited for the study were defined as aware and patients who were having some understanding of the eye disease were defined as knowledgeable. Knowledge was graded as good, fair, and poor by two ophthalmologists independently based on the subjects' collective responses to questions on glaucoma.
Subjects were considered to have good knowledge, if they were able to identify the risk factors for glaucoma such as increased intraocular pressure, family history, steroid use, and able to meaningfully describe the condition along with identifying treatment options. Fair knowledge was considered if at least two of the risk factors were identified and a description of at least one treatment option was correctly provided. Subjects were considered to have poor knowledge, if they were not able to identify more than a single/no risk factor or treatment option for glaucoma.
Analysis was performed using the statistical software IBM SPSS Statistics version 20 © copyright IBM Corporation 2010, New York 10589, USA. The Chi-square test and Fisher exact probability test were used to look for significant associations in awareness and knowledge about glaucoma with other studied variables. A probability (P) value less than 0.05 was considered statistically significant.
| Results|| |
The questionnaire was administered to a total of 704 subjects and the answers were analyzed. (Response rate 100%). Among the subjects, 375 (53.3%) were males and 329 (46.7%) were females. The mean age of the subjects was 54 ± 11 years. The minimum age was 40 years and the maximum age was 90 years. The proportion of subjects in each age cohort from 40 to 70 years was uniform. The rural:urban ratio was 48.7:51.3 and the majority religion was Hindu (92.9%). Among the subjects, 153 (21.7%) were illiterates and 180 (25.6%) were college educated. 175 (24.9%) subjects were diabetic, 12 (1.7%) had glaucoma, and 5 (0.7%) subjects had family history of glaucoma.
[Table 1] shows frequency distribution of awareness and knowledge of glaucoma among subjects. Out of 704 subjects, only 34 (4.8%) subjects had heard of glaucoma (awareness = 4.8%). In the latter group, 12 had only heard about glaucoma but had no further knowledge of glaucoma. Among the 22 (3.1%) subjects who had knowledge, 12 had poor knowledge, 5 had fair knowledge, and remaining 5 had good knowledge. Only 18 subjects knew that glaucoma was treatable.
|Table 1: Frequency distribution of awareness and knowledge of glaucoma among subjects|
Click here to view
[Table 2] shows determinants of awareness of glaucoma. There was no association between awareness and gender, age group, residence, religion. The awareness was significantly related to the educational status, diabetics, glaucoma patients, and subjects with family history of glaucoma.
[Table 3] shows awareness comparison across genders with education level. There was no significant difference in awareness across genders.
The source of information for awareness of glaucoma was
A doctor in 16 (2.27%) subjects
Mass media in 14 (1.99%) subjects
Friend or glaucoma person in 4 (0.57%) subjects.
7 (0.99%) subjects thought that visual loss due to glaucoma was permanent, 4 (0.57%) thought it was reversible, and the remaining 23 (3.27%) subjects did not know whether visual loss due to glaucoma was permanent or reversible.
[Table 4] shows the subjects knowledge level on treatment options for glaucoma.
|Table 4: Frequency distribution of treatment procedures for glaucoma among subjects|
Click here to view
[Table 5] compares the current and past studies on awareness and knowledge.
| Discussion|| |
Glaucoma is one of the leading causes of irreversible blindness in developing nations. It is one of the major causes of ocular morbidity that needs urgent attention.  As the population of elderly group is increasing the incidence of glaucoma is bound to increase. To our knowledge this is the first tertiary care hospital-based study in a tier-2 city conducted to know the awareness about glaucoma in India. There are two such studies reported from Ethiopia and Singapore in tertiary hospitals. ,
In our study, 4.8% (34/704) of people were aware of glaucoma, which appears to be lower than that found in urban Chennai (13.3%), while higher than that found in rural (0.33%) southern India and urban Hyderabad (2.4%). ,, It is noteworthy that these Indian studies were population-based epidemiologic surveys on either rural or urban population, and different age group criteria were used in two of these studies; hence, a direct comparison may not be applicable. The awareness level was very low compared to reports from developed nations but higher compared to developing nations like Nepal (2.4%) and Ethiopia (2.4%). , Knowledge was 3.1% which was less compared to urban Chennai and Hong Kong studies. ,
In our study, awareness with respect to gender, age, residence, and religion is not significant; this was consistent with studies done elsewhere.  But when we compared the awareness with respect to literacy rate, out of 34 people except 1, all had basic primary education. Among the educated, the awareness increased exponentially [Table 2]. It was more significant in people educated above college level. This shows that higher the education level, they are more likely to be aware of glaucoma which was similarly noted in other studies. ,,,,,,,, Another point in our study is that there was no significant gender difference in terms of numbers who were educated till secondary level in the aware group. But there was a tendency toward low awareness in women in college level educated people though statistically not significant ( P = 0.08) [Table 3]. This point again stresses that female education needs to be given more importance in India. In the present study, 12 (1.7%) persons were having glaucoma, but among these, 9 people were aware of glaucoma and 3 people were unaware of their glaucoma status and all the 3 were illiterates. This point highlights the above literacy factor.
Diabetic patients were more aware of glaucoma. This is probably because there are an estimated 50.8 million diabetics in India.  At some point of time, these people visit doctor where the treating doctor might have given education regarding ocular problems in diabetes. This also supports our study report that doctors were the main source of information in 16 (2.27%) patients regarding awareness of glaucoma, which was followed by media 14 (1.99%), and family history 4 (0.57%). This differs from other studies that the media in rural area and the family/friend in urban area were the main sources of awareness in previous studies. , Those with family history of glaucoma and glaucoma patients themselves were more aware similar to other studies. ,, Family history of glaucoma certainly plays a significant role in creating awareness. There were five aware subjects with family history even though four were non-glaucoma subjects. Even though doctors and family history create good awareness, it reaches a limited group of people only. Hence, we believe that media can play a bigger role in creating awareness as it is cost effective and reaches the masses, as telecast reaches every corner of the country.
| Limitations of Our Study|| |
It was a hospital-based study and not community based. The community-based studies may yield much lower awareness and knowledge proportions as the public have much less contact with the patients.
Though there are many eye camps conducted by government for comprehensive eye care, the public awareness of potentially blinding condition like glaucoma remains low. Effective health education may influence individuals to undergo screening for eye diseases. This may lead to early detection of glaucoma and prevention of blindness. Educating the public on the consequences of delayed treatment of glaucoma will be an important factor in promotion of preventive ophthalmic care. It is understood that health education sessions have to be conducted in a language which the target individual understands.
| Conclusion|| |
Awareness and knowledge of glaucoma is low. An efficient Information, Education and Communication (IEC) strategy needs to be designed to increase the awareness and knowledge levels of glaucoma and thus reduces blindness due to glaucoma.
| Acknowledgment|| |
We would like to acknowledge and thank Dr. Praveen Bagalkot for all the support and help in completing this study
| References|| |
|1.||Shamanna BR, Dandona L, Rao GN. Economic burden of blindness in India. Indian J Ophthalmol 1998;46:169-72. |
|2.||Quigley HA. Number of people with glaucoma worldwide. Br J Ophthalmol 1996;80:389-93. |
|3.||Thomas R, Paul P, Rao GN, Muliyil JP, Mathai A. Present status of eye care in India. Surv Ophthalmol 2005;50:85-101. |
|4.||Tielsch JM, Sommer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary open angle glaucoma. The Baltimore Eye Survey. JAMA 1991;266:369-74. |
|5.||Sathyamangalam RV, Paul PG, Ronnie G, Baskaran M, Hemamalini A, Madan RV, et al. Determinants of glaucoma awareness and knowledge in urban Chennai. Indian J Ophthalmol 2009;57:355-60. |
|6.||Dandona R, Dandona L, John RK, McCarty CA, Rao GN. Awareness of eye diseases in an urban population in southern India. Bull World Health Organ 2001;79:96-102. |
|7.||Krishnaiah S, Kovai V, Srinivas M, Shamanna BR, Rao GN, Thomas R. Awareness of glaucoma in the rural population of southern India. Indian J Ophthalmol 2005;53:205-8. |
|8.||Thomas R, Korah S, Padma P. Glaucoma an emerging cause for preventable blindness. Indian J Commun Health 1997;3:52-63. |
|9.||Tenkir A, Solomon B, Deribew A. Glaucoma awareness among people attending ophthalmic outreach services in southwestern Ethiopia. BMC Ophthalmol 2010;10:17. |
|10.||Saw SM, Gazzard G, Friedman D, Foster PJ, Devereux JG, Wong ML, et al. Awareness of glaucoma and health beliefs of patients suffering primary acute angle closure. Br J Ophthalmol 2003;87:446-9. |
|11.||Thapa SS, Berg RV, Khanal S, Paudyal I, Pandey P, Maharjan N, et al. Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: The Bhaktapur Glaucoma Study. BMC Ophthalmol 2011;11:2. |
|12.||Lau JT, Lee V, Fan D, Lau M, Michon J. Knowledge about cataract, glaucoma, and age related macular degeneration in the Hong Kong Chinese population. Br J Ophthalmol 2002;86:1080-4. |
|13.||Gasch AT, Wang P, Pasquale LR. Determinants of glaucoma awareness in a general eye clinic. Ophthalmology 2000;107:303-8. |
|14.||Livingston PM, McCarty CA, Taylor HR. Knowledge, attitudes, and self care practices associated with age related eye disease in Australia. Br J Ophthalmol 1998;82:780-5. |
|15.||Ramachandran A, Das AK, Joshi SR, Yajnik CS, Shah S, Kumar KM. Current status of diabetes in India and need for novel therapeutic agents. Suppl JAPI 2010;58:7-9. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]