Glaucoma Severity Stage at First Visit at a University Eye Clinic in Congo

Abstract

Précis: Initial presentation of glaucoma at a major eye clinic mostly features advanced disease with a high proportion of blindness. This is likely a microcosm of a nationwide issue requiring concerted strategies to detect glaucoma early. Purpose: To characterize the severity stage of new glaucoma patients in Congolese attending a university eye clinic. Methods: New glaucoma patients (n=118) were labeled as early or late presenters based on visual field sensitivity in the worse eye. Results: Mean age was 58.9±15.7 years, 51.7% were males. Overall, the worse eye had advanced, whereas the better eye had moderate glaucoma, with an asymmetry of −7.4 dB (P<0.001). Blindness was present in 30.5% of worse and 5.1% of better eyes. Seventy-two patients (61.0%) were late presenters. Visual acuity was lower (P<0.001), intraocular pressure (IOP) higher (P=0.02), cup-to-disc ratio larger (P=0.011), and retinal nerve fiber layer thinner (P=0.001) in late presenters’ worse than better eye. The worse and better eyes of late presenters had advanced glaucoma, with a −9.6 dB interocular asymmetry (P<0.001); 40.3% and 8.3% were blind, respectively. In early presenters, the worse and better eyes had moderate and early disease, respectively; the asymmetry was −3.2 dB (P<0.001), and 15.2% were blind. Overall, 58.5% and 65.3% presented with advanced disease in the worse eye based on visual field and cup-to-disc ratio criteria of the Canadian Ophthalmological Society staging scale, respectively. Conclusions: Most new glaucoma patients had bilateral advanced but asymmetric disease. These findings call for the establishment of community-based measures for early detection of glaucoma and a referral network system connecting community healthcare to tertiary eye clinics.