Advanced glaucoma at presentation is associated with poor follow-up among glaucoma patients attending a tertiary eye facility in Southern Nigeria

ABSTRACT

Purpose: Globally, particularly in Africa, poor compliance with medication is a major problem in glaucoma management but little is known about follow-up rates among African glaucoma patients. The aim of this study was to determine rates of follow-up among glaucoma patients attending a tertiary hospital in southern Nigeria and investigate predictors of poor follow-up.

Methods: Data were extracted from medical records of new glaucoma patients who attended the hospital between June 2011 and May 2013. Socio-demographic and clinical parameters (visual acuity; stage of glaucoma) recorded at diagnosis were extracted using a pre-tested form. Follow-up was defined as good if they had attended within 9 months of the study date, inadequate when the last follow-up was more than 9 months and failed if they did not attend any follow-up or the most recent visit was more than 14 months from the study date. Univariate and multivariable analyses were undertaken to explore predictors of poor follow-up (inadequate plus failed).

Results: Three hundred forty-eight patients were recruited, 54% were male and the mean age was 52.7 (range 16–88) years. Follow-up was as follows: good 28.4%, inadequate 46.6%, failed 25%. Overall, 71.6% had poor follow-up. Independent predictors of poor follow-up were poorer visual acuity (OR 3.85, 95% confidence interval (CI) 1.25–11.80 for visual impairment; OR 4.11, 95% CI 1.32–12.81 for blind) and end-stage glaucoma (OR 3.55 (1.31–9.62), p = 0.01).

Conclusion: Enhanced counselling of patients with moderate to advanced glaucoma and visual impairment is required to improve follow-up and hence glaucoma management.

KEYWORDS:

• Advanced glaucoma
• follow-up
• Nigeria
• predictors
• rates

Acknowledgements

We acknowledge the contributions of our research assistants, Drs. Bright Azeta, Efe Akpata, Onoriode Umolo, and Darlingtess Oronsaye, as well as the health records assistants, Mr Linus Odiagbe and Mrs Oriakhi.

Sources of Support

The study is derived from a Masters dissertation for Public Health for Eye Care at the London School of Hygiene & Tropical Medicine funded by the School Trusts Fund (LSHTM), the Hooper Scholarship (LSHTM), and TETFUND, Nigeria (for ROM).

Conflict of interest

None of the authors

Declaration

This work has not been published anywhere previously and is not being considered for any other publication. Parts of this work were presented at the 23^rd International Society for Geographical and Epidemiological Ophthalmology Congress held in London in September 2014.