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

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% {CI_95%: 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.

KEYWORDS:

• Glaucoma
• visual fields
• late presentation
• epidemiology
• public health
• perimetry
• disease detection
• disease referral
• global challenges

Acknowledgments

This study was funded by a Fight For Sight (UK) project grant (#1854/1855). Professor Matthew Burton is supported by The Wellcome Trust (207472/Z/17/Z). The funding organizations had no role in the design or conduct of this research. The authors would also like to thank Andrew McNaught (Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham and Cranfield University, Bedford), James Kirwan (Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth), and Nitin Anand (Calderdale and Huddersfield NHS Foundation Trust) for helping to provide access to visual field data from their respective hospitals in 2012.

Meeting Presentation

None.

Financial support

This study was funded by a Fight For Sight (UK) project grant (#1854/1855). Professor Matthew Burton is supported by The Wellcome Trust (207472/Z/17/Z), Dr. Heiko Philippin by CBM International. The funding organizations had no role in the design or conduct of this research.

Conflicts of interest

No conflicting relationship exists for any author. DPC reports unrestricted grants from Roche UK, Santen UK, Novartis UK and personal fees from Allergan UK; these are outside the submitted work.

Supplementary material

Supplemental data for this article can be accessed here.