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Awareness of incident open-angle glaucoma in a population study: the Barbados Eye Studies.

Hennis A, Wu SY, Nemesure B, Honkanen R, Leske MC,

Chronic Disease Research Centre, Tropical Medicine Research Institute, University of the West Indies, Bridgetown, Barbados.

PURPOSE: To evaluate factors related to awareness of incident open-angle glaucoma (OAG) in the Barbados Eye Studies. DESIGN: Cohort study with 81% to 85% response rate over 9 years. PARTICIPANTS: Four thousand three hundred fourteen participants of African descent, 40 to 84 years old at baseline. METHODS: Standardized study visits included an interview on demographic, medical, health care, and other factors; various ophthalmic measurements; fundus photography; and comprehensive ophthalmologic examinations for those referred. MAIN OUTCOME MEASURES: Definite OAG was defined by both visual field and optic disc criteria after ophthalmologic confirmation, regardless of intraocular pressure (IOP). Definite incident participants without prior OAG diagnosis/treatment were considered unaware. Logistic regression analyses evaluated factors associated with OAG unawareness. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Over 9 years, 125 participants newly developed definite OAG, of whom 53% were previously unaware. At baseline, the unaware group had significantly lower mean IOP (OR, 0.86; 95% CI, 0.79-0.94) and more hyperopia (OR, 2.69; 95% CI, 1.08-6.69) than those aware. Most unaware and aware participants had > or =2 medical care visits in the previous year (72.7% vs. 83.1%). However, those in the unaware group sought eye care less frequently than those aware (last visit in preceding year, 33.4% vs. 64.4%); these visits were mainly for eyeglasses (71.4% vs. 12.5%), with most having glaucoma tests only during study visits (72.7% vs. 37.3%). The unaware group reported more visits to opticians/optometrists than to private ophthalmologists (OR, 4.20; 95% CI, 1.00-17.66) and fewer visits to a public ophthalmologic clinic (OR, 0.18; 95% CI, 0.04-0.86). CONCLUSIONS: Over half of participants with incident OAG were unaware of their diagnosis. Unawareness was related to lower IOP, hyperopia, and eye care utilization patterns. Although persons in the unaware group had regular visits for medical care, visits for eye care and OAG testing were limited. Unawareness was 4 times more likely when opticians/optometrists were the regular eye care source, compared with private ophthalmologists, and about 80% less likely with a public ophthalmologic source. These findings highlight the high frequency of undiagnosed OAG and importance of comprehensive examinations in disease detection.

Published 2 October 2007 in Ophthalmology, 114(10): 1816-21.
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