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PROFILE OF PATIENTS OF GLAUCOMA IN JAMMU PROVINCE (A HOSPITAL BASED STUDY)

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PROFILE OF PATIENTS OF GLAUCOMA IN JAMMU PROVINCE (A HOSPITAL BASED STUDY)

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Background: Glaucoma comprises group of disorder which cause damage to the ganglion cells and optic nerve fibers resulting in permanent loss of vision. Glaucoma is a silent killer of vision, the only treatable factor is IOP which can be lowered by medical means, laser treatment or surgery. Objectives: The objective of the study was to see profile of patients of glaucoma in jammu province. Material and method: The present prospective study involved 200 patients was conducted in the out-patient department of ophthalmology at tertiary care hospital of North India. After meeting inclusion & exclusion crieteria the patients underwent detailed clinical history, general examination, complete ophthalmological examination including dilated fundus examination, intra ocular pressure measurement, gonioscopy etc was done to diagnose different types of glaucoma. Results: Maximum number of patients i.e.128 were seen in age group of ≥50yrs followed by 60 in 41-50 yrs. Males i.e. 127 outnumbered females in present study. Total of 139 were from rural area. Maximum patients complain of diminution of vision ie 180 followed by pain in 135. Vision of 6/24-6/18 i.e. 59 (R/E) & 57 (L/E) followed by PL to <6/60 in 48(R/E) & 47(L/E) patients whereas PL absent was seen in 12 patients. Gonioscopically angle was open in 172(R/E) & 174(L/E) patients. Total of 102 patients had POAG. Conclusion: From present study we may conclude that glaucoma problem was more common in elderly age group and in males. It can lead to loss of vision among patient who suffer extreme optic nerve damage without realizing it. Therefore, for everybody above the age of 40years, it is mandatory to have IOP checked once a year especially if there is any risk factor for glaucoma like diabetes mellitus, myopia, family history of glaucoma, prolonged use of topical steroids etc. Keywords: Glaucoma, Gonioscopy, Intraocular Pressure(IOP), Visual acuity.
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|| ISSN(online): 2589-8698 || ISSN(print): 2589-868X ||
International Journal of Medical and Biomedical Studies
Available Online at www.ijmbs.info
PubMed (National Library of Medicine ID: 101738825)
Index Copernicus Value 2018: 75.71
Original Research Article Volume 3, Issue 10; October: 2019; Page No. 111-115
111 | P a g e
PROFILE OF PATIENTS OF GLAUCOMA IN JAMMU PROVINCE (A HOSPITAL BASED STUDY)
Angli Manhas,1 Rameshwar S Manhas,2* Gaurav S Manhas,3 Dinesh Gupta4
1 Senior Resident, Department of Ophthalmology, Government Medical College Jammu, J&K, India.
2 Senior Resident, Department of Psychiatry, Government Medical College Jammu, J&K, India.
3 Resident Scholar, Department of Radiodiagnosis, Government District Hospital, Ramban, J&K, India.
4 Professor & Head, Department of Ophthalmology, Government Medical College, Jammu, J&K, India.
Article Info: Received 20 September 2019; Accepted 14 October 2019
DOI: https://doi.org/10.32553/ijmbs.v3i10.622
Corresponding author: Rameshwar S Manhas
Conflict of interest: No conflict of interest.
Abstract
Background: Glaucoma comprises group of disorder which cause damage to the ganglion cells and optic nerve fibers
resulting in permanent loss of vision. Glaucoma is a silent killer of vision, the only treatable factor is IOP which can be
lowered by medical means, laser treatment or surgery.
Objectives: The objective of the study was to see profile of patients of glaucoma in jammu province.
Material and method: The present prospective study involved 200 patients was conducted in the out-patient department
of ophthalmology at tertiary care hospital of North India. After meeting inclusion & exclusion crieteria the patients
underwent detailed clinical history, general examination, complete ophthalmological examination including dilated fundus
examination, intra ocular pressure measurement, gonioscopy etc was done to diagnose different types of glaucoma.
Results: Maximum number of patients i.e.128 were seen in age group of ≥50yrs followed by 60 in 41-50 yrs. Males i.e. 127
outnumbered females in present study. Total of 139 were from rural area. Maximum patients complain of diminution of
vision ie 180 followed by pain in 135. Vision of 6/24-6/18 i.e. 59 (R/E) & 57 (L/E) followed by PL to <6/60 in 48(R/E) &
47(L/E) patients whereas PL absent was seen in 12 patients. Gonioscopically angle was open in 172(R/E) & 174(L/E)
patients. Total of 102 patients had POAG.
Conclusion: From present study we may conclude that glaucoma problem was more common in elderly age group and in
males. It can lead to loss of vision among patient who suffer extreme optic nerve damage without realizing it. Therefore, for
everybody above the age of 40years, it is mandatory to have IOP checked once a year especially if there is any risk factor for
glaucoma like diabetes mellitus, myopia, family history of glaucoma, prolonged use of topical steroids etc.
Keywords: Glaucoma, Gonioscopy, Intraocular Pressure(IOP), Visual acuity.
Introduction:
A chronic, progressive optic neuropathy which is
caused by group of ocular conditions which lead to
damage of optic nerve with loss of visual function by
killing retinal ganglion cell is glaucoma. The strongest
known risk factor for glaucoma is high IOP but to
induce neuropathy high IOP is neither necessary nor
sufficient.1 Glaucoma cause irreversible blindness, it
is responsible for 14% of blindness worldwide, of
whom 10% are believed to be bilaterally blind. Optic
nerve damage is irreversible and it is imperative to
detect glaucoma early so that visual morbidity can be
avoided.2 About 50-90% of the glaucoma cases
remain undiagnosed whereas majority of cases are
diagnosed at an advanced stage of the disease. One
of the probable reason for the late presentation
which significantly increase the risk of glaucoma
blindness is the lack of awareness about glaucoma. In
early diagnosis of glaucoma eye health education is
significant step that influences people to take part in
regular ophthalmologic care. Population who are at
maximum risk for developing the disease need to be
recognized and targeted.3 Of all glaucomas in blacks,
whites & some asian populations POAG accounts for
90%. In south asian population PACG predominates.
From POAG risk of blindness is 5-10% and POAG is
the greatest reservoir of preventable blindness in the
world in undiagnosed or preclinical where less than
50% of cases have been diagnosed yet.4 Due to
chronicity, insidious nature of disease, closed follow
up is required by patients throughout life. A good
baseline evaluation and record of all parameters-
intraocular pressure, perimetry, optic nerve head
evaluation and gonioscopy over the year should be
available for proper management. It is important to
collect data in order to identify patients at risk and to
monitor their management. Even where the
Angli Manhas et al.
International Journal of Medical and Biomedical Studies (IJMBS)
112 | P a g e
incidence is low, regular collection of data helps to
identify high-risk patients and to confirm that they
are being managed appropriately. Monitoring of
glaucoma patients is associated with a reduction in
the incidence of blindness due to glaucoma.
Material and method:
The present prospective study involved 200 patients
over a period of 1 year was conducted in the out-
patient department of ophthalmology at tertiary care
hospital of North India. The informed consent from
all the participants were undertaken before inclusion
in the current study. The data was recorded by
independent observer.
Inclusion criteria: Patients of age ≥20 yrs, either sex,
patient having symptoms of gradual painless loss of
vision, pain, blurred vision, redness, frequent changes
of presbyopic glass, amid dilated oval pupil,
symptoms related to eyes but routine cause is not
found or routine treatment is not responding, history
of glaucoma/family history of glaucoma, any previous
surgical procedures (trab, iridotomy/iridectomy)
undertaken on the eyes, trauma, past glaucoma
diagnosis.
Exclusion criteria: Patient not willing for enrolment,
anterior segment pathology precluding the
visualization of angle e.g. Any corneal opacity.
The patients were diagnosed having glaucoma on
basis of :
1. Detailed history
2. Complete ocular examination
3. Related investigations to substantiate the diagnosis
of glaucoma and to monitor its progress as well as
response to treatment.
History was taken in regard to chief complaints, any
history of pain, redness, watering, decrease in vision,
frequent change of glasses, colored haloes,
photophobia, any history of previous eye surgery,
trauma, any laser treatment of the eye, use of topical
steroids, any family history of glaucoma, any history
of systemic disease like diabetes mellitus,
hypertension, asthma etc.
Ocular examination included visual acuity and the
best corrected visual acuity. Examination of the eye
in diffuse light for any gross abnormality of the
anterior segment was done. Slit Lamp Examination,
Fundus examination was done by slit lamp
biomicroscopy using a plus 78D lens. The Optic disc
was examined in minute details in regard to its size,
cup disc ratio, state of the neuroretinal rim, any
hemorrhage on the disc, blood vessels, any
peripapillary atrophy etc. The posterior pole was
examined with red free light to note early changes of
retinal nerve fibre layer in the arcade.
Intra ocular pressure was recorded by applanation
tonometer, Gonioscopy was done by Goldmanns two
mirror gonioscope in all the cases which helped in
classifying the glaucoma into the various subtypes
and to record changes like peripheral anterior
synaechia, pigmentation of trabeculum strampollis
line, angle configuration, any neovascularisation, PXE
material, angle recession etc.perimetry was also
performed to see field defects.
Statistical analysis: The data was analysed using
statistical software MS Excel / SPSS version 17.0 for
windows. Data presented as number as discussed
appropriate for quantitative & qualitative variables.
Observation & Results:
Glaucoma is responsible for 14% of blindness
worldwide, it is imperative to detect glaucoma early
so that visual morbidity can be avoided. Glaucoma
cause irreversible blindness by causing permanent
optic nerve damage.2
Table no.1 shows out of total 200 patients maximum
number i.e.128 were seen in age group of ≥50yrs
followed by 60 in 41-50 yrs. Males i.e. 127
outnumbered females in present study. Total of 139
were from rural area.
Table no.2 shows that maximum patients complain of
diminution of vision ie 180 followed by pain in 135.
Pain was mild in nature except in angle closure
glaucoma where it was very severe in nature.
Table no.3 shows that maximum patients had vision
of 6/24-6/18 i.e.59 (R/E) & 57 (L/E) followed by PL to
<6/60 in 48(R/E) & 47(L/E) patients whereas PL
absent was seen in 12 patients.
Table no.4,5,6 shows out of total 200 patients, IOP
>21-30 was seen in 84(R/E) & 81(L/E) while IOP of
>40 was seen in 21(R/E) & 23(L/E). Regarding disc
changes: 118 had CD ratio between 0.4 to 0.6 & 80
patients had CD ratio of >0.6. When gonioscopy was
done, angle was open in 172(R/E) & 174(L/E)
patients.
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International Journal of Medical and Biomedical Studies (IJMBS)
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Table no.7 shows out of total 200 patients maximum
number i.e. 102 had POAG followed by 54 who had
secondary glaucoma.
Table 1: Demographic characteristics of studied subjects
Characteristics
Number of studied subjects
Age (in years)
≤40
12
41-50
60
≥51
128
Sex
Males
127
Females
73
Residence
Rural
139
Urban
61
Table 2: Frequency of symptoms among studied subjects.
Number of studied subjects
180
52
135
96
56
Table 3: Best corrected visual acuity of studied subjects.
Visual Acuity
Right Eye (no.)
Left Eye (no.)
PL absent
12
12
PL to <6/60
48
47
6/60-6/36
42
44
6/24-6/18
59
57
6/12-6/6
39
40
Total
200
200
PL-perception of light
Table 4: Distribution of IOP among studied subjects.
IOP
Right Eye (n)
Left Eye (n)
≤20
53
57
>21-30
84
81
>31-40
42
39
>40
21
23
Total
200
200
Table 5: Shows C: D ratio changes among studied subjects.
C:D ratio
Number of studied subjects
0.4-0.6
118
>0.6-0.8
40
>0.8-optic atrophy
42
Total
200
Table 6: Gonioscopy in studied subjects.
Gonioscopy
Right Eye (n)
Left Eye (n)
Open
172
174
Closed/Narrow
28
26
Total
200
200
Table 7: Final diagnosis of glaucoma among studied
subjects.
Diagnosis
Number of studied subjects (n)
NTG
12
POAG
102
PACG
24
Ocular Hypertention
8
Secondary glaucoma
54
Total
200
NTG=normal tension glaucoma, POAG=primary open
angle glaucoma, PACG-primary angle closure
glaucoma
Discussion:
Glaucoma is a silent killer of vision2 & a major global
health problem in causing immense damage in terms
of economy and causing irreversible damage to vision
if not diagnosed and not managed adequately.
Glaucoma comprises group of disorder which cause
damage to the ganglion cells and optic nerve fibers
resulting in permanent loss of vision. Numerous
equipment based on advanced technology is
available but basic assessment is of optic disc, nerve
fiber layer, visual field and IOP, however the only
treatable factor is IOP which can be lowered by
medical means, laser treatment or surgery.5
In the present study out of total 200 patients
maximum number i.e.128 were seen in age group of
≥50yrs followed by 60 in 41-50 yrs. Srivastava VK in
his study showed that majority of the glaucoma
patients were from age >60 i.e. (28.12%) followed by
50-60 (21.87%).The problem of glaucoma is more
prevalent as the age increases which could be
because of the associated condition like hypertension
and diabetes.5
Males i.e. 127 outnumbered females in present
study. Srivastava VK in his study showed that majority
of the patients were male 65.62 % followed by
females i.e 34.37% in his study.5 Yadav RS et al in a
study of 193 patients found that 106(54.9%) were
males and 87 (45.07%) were females.2
Total of 139 patients were from rural area in the
present study. This might be due to reason that many
patients from urban area may visit private
Angli Manhas et al.
International Journal of Medical and Biomedical Studies (IJMBS)
114 | P a g e
practitioner during evening hours whereas patients
coming from rural far flung area has to go back so
came GMC, so that they should be checked early.
Rashid W et al in their study found that 71% were
from rural areas and 29% belonged to the urban
population.6
Maximum patients complain of diminution of vision
ie 180 followed by pain in 135 in present study. Pain
was mild to moderate in nature except in angle
closure glaucoma where it was very severe in nature.
Rashid W et al in their study found that 96.5%
patients presented with decreased visual acuity
followed by 63% patients presented with pain ranging
from severe in angle closure glaucoma to
moderate/mild in other glaucomas.6
In the present study maximum patients had vision of
6/24-6/18 i.e.59 (R/E) & 57 (L/E) followed by PL to
<6/60 in 48(R/E) & 47(L/E) patients whereas PL
absent was seen in 12 patients.The cause for absent
PL was glaucomatous optic atrophy. Rashid W et al in
their study found that PL was absent in 16 patients in
their study.6
Out of total 200 patients in the present study, IOP
>21-30 was seen in 84(R/E) & 81(L/E) while IOP of
>40 was seen in 21(R/E) & 23(L/E) patients. Higher
IOP is one of the factor which causes diminution of
vision & pain in our patients. Soni P et al in their
study found that 52 eyes (45.61%) had IOP in the
range of 25-29 mmHg while 48 eyes (42.10%) had IOP
in the range of 30-34.7
About 118 patients in the present study had CD ratio
between 0.4 to 0.6 & 80 patients had CD ratio of
>0.6. Soni P et al in their study on 114 eyes found
that 32 patient had C:D ratio of 0.6 whereas 30
patient had C:D ratio 0.7.7 Rashid W et al in their
study found that 69% had CD ratio between 0.4 to 0.8
, 14 % had CDR of > 0.9.6
In the present study when gonioscopy was done
angle was open in 172(R/E) & 174(L/E) patients.
Rashid W et al in their study found that
gonioscopically : 90% open angle;3% narrow angle &
7% closed Angle.6 Srivastava VK in his study found
that majority of the patients were having open angle
glaucoma i.e. 64.06% followed by Close angle/
narrow angle in 35.95.5
Out of total 200 patients in the present study
maximum number i.e. 102 had POAG wheras PACG
was seen in 24 patients only. Among all secondary
glaucomas i.e 54, pseudoexfoliative glaucoma(44)
form largest number followed by phacomorphic(2),
neovascular(2) & others(6) . The prevalence of POAG
increases with age i.e. after 50years.2 The prevalence
of angle closure glaucoma increases substantially
with age as lens thickness increases with age and may
be an important explanation for the progressive
shallowing of the anterior chamber and increased
prevalence of PACG observed in older age groups.8
Srivastava VK in his study showed that majority of the
patients were having open angle glaucoma (64.06%);
35.95% cases had narrow angle/ angle closure. The
most common associated factors with glaucoma
patients were diabetes (18.75%) followed by systemic
hypertension (14.06%); phacomorphic (7.81%); post
iridocyclitis (4.68%); steroid induced glaucoma
(3.12%); traumatic glaucoma (3.12%). In 45.31% no
associated factors were detected.5 Hollow & Graham
in 1966 reported that 33% of glaucoma patients had
P.O.A.G. 9 Yadav RS et al in their study found primary
angle closure glaucoma is more common (44.5%).2
Palimker A et al. in their study showed the prevalence
of glaucoma was 3.68% in district of Chhattisgarh.
The percentage of primary open angle glaucoma was
13.1%, primary angle closure glaucoma was 21.29%,
secondary glaucoma was 21.2%, ocular hypertension
was14.5%.10 Rashid W et al in their study found that
29% of patients had P.O.A.G. In their study PXE
glaucoma formed the largest group of glaucoma
prevalent in the Valley ie 40.25% of all the patients
studied.6 Moreno-Montanes et al also found in their
study PXE glaucoma was present in 44.5% of open
angle glaucomas in Spain. According to them visual
field loss was more in PXE glaucoma as compared to
POAG.11 Various other studies show the prevalence of
PXE glaucoma as 1.6 %, 5.2%,7.5% & 13%
respectively12-15 while the incidence of PXE glaucoma
was as high as 50% of glaucoma patients in
Sweden.16,17 The incidence of PXE glaucoma observed
by Rashid W et al in their study was higher than any
study done in India and this could be attributed to
climatic or genetic factors. POAG was the second
largest group of glaucoma in their study comprising
29% of the patients of glaucoma.6 Various studies put
the incidence of P.O.A.G between 27% , 37% &
41%.18-20
Perimetry was done only in 158 cases & field changes
vary from no field loss to mild- moderate-advanced
field loss. Proper management (medical/surgical) of
all the patients were done depending upon the type
of glaucoma & all the patients were explained about
their disease & advised to come for regular check up.
Angli Manhas et al.
International Journal of Medical and Biomedical Studies (IJMBS)
115 | P a g e
Limitation of study: Congenital glaucomas were not
included in the study
Conclusion: From present study we may conclude
that glaucoma problem was more common in elderly
age group and in males. It can lead to loss of vision as
seen in present study perception of light was absent
in 12 patients which means the patient had suffered
extreme optic nerve damage without realizing it.
Therefore, proper training of medical professionals to
do a basic IOP measurement & fundus examination,
awareness that glaucoma & cataract can co exist in
the same patient & gradual painless visual loss could
be due to glaucoma, all these can help to prevent
vision loss in glaucoma patient by early detection &
proper management.
Recommendations: Authors recommend that for
everybody above the age of 40years, it is mandatory
to have IOP checked once a year especially if there is
any risk factor for glaucoma like diabetes mellitus,
myopia, family history of glaucoma, prolonged use of
topical steroids etc. Also awareness in the community
should be created by various programs about
glaucoma, by providing detailed disease related
information to patients, likesymptoms, prevention,
management etc.
Acknowledgement: Thanks from the core of my heart
to GOD & my parents.
Declaration:
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
institutional ethics committee
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PurposeTo determine the prevalence of glaucoma and risk factors for primary open-angle glaucoma in a rural population of southern India.
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In a well defined population, the observed incidence of different types of glaucoma during the years 1980-82 is presented. The great majority of glaucoma patients was found to have primary open angle glaucoma, and of these approximately 3/4 had capsular glaucoma. The observed annual incidence of all types of glaucoma increases with increasing age to a maximum of 0.7% in the age group 81-85 years. In the same age group, the annual incidence of primary open angle glaucoma with visual field defects was 0.44%.
Article
To determine prevalence of glaucoma subtypes and legal blindness in patients on their first visit to an ophthalmic center in the western region of Saudi Arabia a chart review analysis was carried out of new patients in 2006 with glaucoma diagnosis in our Glaucoma Unit. Diagnosis was confirmed clinically and by glaucoma workup. The main outcome was prevalence of glaucoma types and legal blindness from glaucoma. Of 2,354 new patients in 2006, 417 were glaucomatous. Mean age was 56.4 years and mean intraocular pressure (IOP) was 26.5 mmHg; 54.4% had prior glaucoma diagnosis. Prevalence of primary open-angle glaucoma was 30.5%, primary angle-closure 24.7%, neovascular 7.6%, surgically induced 6.5%, and exfoliative 5.2%. One-third of patients were unilaterally legally blind, whereas 11.3% were bilateral. Primary glaucoma represents two-thirds of glaucoma cases in Saudi Arabia. Approximately one-half of patients were legally blind in at least one eye at time of presentation.