Severity of Primary Open Angle Glaucoma at First Presentation and Associated Factors in Tertiary Hospital

Abstract

Introduction: Glaucoma is one of the leading causes of irreversible blindness worldwide. Late presentation in glaucoma significantly increases the economic burden and risk of subsequent blindness.

Objective: To determine the severity of glaucoma at diagnosis and identify the factors associated with severe disease at presentation in a tertiary eye hospital in Nepal.

Methodology: A hospital-based, analytical, cross-sectional study was performed at Himalaya Eye Hospital from 2023 January to 2023 December among 173 eyes of 173 newly diagnosed cases of primary open angle glaucoma (POAG) after ethical clearance. Convenience sampling technique was used. The severity of glaucoma was assessed in terms of visual field (VF) loss using mean deviation (MD) and the Hoddap-Parrish-Anderson criteria. Patients were categorised into two groups based on severity: Group I (mild to moderate) and Group II (severe). A multivariate-model-adjusted binary logistic regression analysis was performed to identify the factors associated with severe glaucoma.

Result: Half of the patients (50.29%) in this study had severe glaucoma at diagnosis. Older age {adjusted odds ratio (AOR) = 1.046; 95% confidence interval (CI): 1.017-1.076; p = 0.002}, higher baseline intraocular pressure (IOP) (AOR = 1.183; 95% CI: 1.086-1.289; p <0.001), and thinner central corneal thickness (CCT) (AOR = 0.983; 95% CI: 0.971-0.995; p = 0.005) were significant predictors of severe glaucoma at presentation. Whereas, a personal history of systemic hypertension (AOR = 0.409; 95% CI: 0.177-0.947; p = 0.037) significantly decreased the odds of late presentation. Gender, travel time to the nearest eye-care centre, awareness about glaucoma, family history of glaucoma, and personal history of diabetes mellitus did not have significant association with the severity of glaucoma at presentation.

Conclusion: Approximately half of the patients with POAG presented with severe glaucoma at diagnosis. Older age, elevated IOP, and thin CCT were key predictors of severe glaucoma at diagnosis, while patients with systemic hypertension were associated with earlier detection.