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 eyecare, and a more proactive approach to case finding through the use of disruptive new technologies, such as low-cost, portable diagnostic aids.

Handheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma

“…7 40 41 Although that may decrease the specificity of HCP for glaucoma, the ability to uncover multiple ocular diseases is valuable for screening strategies. 3 In conclusion, our proof-of-concept study highlights the feasibility and high accuracy of chromatic pupillometry delivered using a handheld device for the objective detection of functional loss in glaucoma in a clinical setting. Further community-based or opportunistic screening studies, as well as cost-effectiveness analyses, are necessary to confirm whether HCP is a useful tool for glaucoma screening.…”

“…Thus, HCP has the potential to alleviate burden of blindness on first presentation to glaucoma clinics in developing countries. 3 Future studies should evaluate the potential of pupillometry in general and HCP in particular for the tracking of glaucoma progression.…”

Glaucomatous Perimetric Alteration at Screening: Experience of Cades/O Donka in Conakry

“…En termes de déficits moyens, ceux compris entre -0,01 et -6,00 dB prédominaient à droite tandis qu'à l'OG les déficits moyens les plus représentés étaient ceux ›0,00 dB. Nos résultats sont contraires avec ceux de Jones P. et al [16] en 2020 en Tanzanie, qui ont retrouvé, une prédominance des déficits moyens ‹ -20,01 dB. Cette différence pourrait se justifier par les réalités socio-économiques dans nos pays qui expliquerait la réticence des patients à se faire consulter à temps.…”

Cohort Study of Race/Ethnicity and Incident Primary Open-Angle Glaucoma Characterized by Autonomously Determined Visual Field Loss Patterns

“…14 VF mean deviation (MD), pattern standard deviation, and the glaucoma hemifield test represent useful indices, but the outputs provide little information regarding which specific region in the VF shows glaucomatous loss. 15 , 16 Archetype analysis is an artificial intelligence (AI) algorithm that analyzes data clustered on the edges of the data space to ascertain dimensional patterns in a dataset. 17 For example, when applied to Humphrey VF data from a tertiary care glaucoma clinic, archetype analysis objectively identified weighted patterns of VF loss that were strikingly similar to manually documented VF patterns for patients with new-onset POAG.…”