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Prevalence of glaucoma in a rural East African population
R R Buhrmann1, H A Quigley, Y Barron
1Dana Center for Preventive Ophthalmology and the Glaucoma Service, Wilmer Ophthalmologic Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Purpose:
To determine the prevalence of glaucoma in an adult population in rural central Tanzania.
Methods:
Six villages were randomly selected from eligible villages in the Kongwa district, and all residents more than 40 years of age were enumerated and invited to a comprehensive eye examination including presenting visual acuity, refraction, automated 40-point Dicon (San Diego, CA) suprathreshold screening field test, Tono-Pen (Bio-Rad, Inc., Boston, MA) intraocular pressure (IOP) measurement, and standardized examination by an ophthalmologist of anterior segment, optic nerve head, and retina after pupil dilation. Gonioscopy and Glaucoma-Scope (Ophthalmic Imaging Systems, Sacramento, CA) optic disc imaging were performed on those with IOP higher than 23 mm Hg and cup-to-disc ratio (c/d) more than 0.6 and on a 20% random sample of participants.
Results:
Of 3641 eligible persons, 3268 (90%) underwent ophthalmic examination. The prevalence of glaucoma of all types was 4.16% (95% confidence interval [CI] = 3.5, 4.9%). Primary open-angle glaucoma (OAG) was diagnosed in 3.1% (95% CI = 2.5, 3.8%), primary angle-closure glaucoma (ACG) in 0.59% (95% CI = 0.35, 0.91%), and other forms of glaucoma in 0.49%. The prevalence of glaucoma was found to be sensitive to changes in the diagnostic criteria.
Conclusions:
The high prevalence of OAG in this group was similar to that of African-derived persons in the United States but less than in African-Caribbean populations. ACG was more prevalent in east Africans than suggested by anecdotal reports.