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Editors Selection IGR 13-1

Epidemiology: Types of glaucoma in indigenous Africans

Comment by Rupert Bourne on:

55212 Prevalence and types of glaucoma among an indigenous African population in southwestern Nigeria, Ashaye A; Ashaolu O; Komolafe O et al., Investigative Ophthalmology and Visual Science, 2013; 54: 7410-7416

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Population-based studies that detect glaucoma have confirmed Africa as being the region with the highest prevalence of primary open-angle glaucoma. Meta-analyses of glaucoma prevalence,^1-2 draw attention to the scarcity of data in regions such as Africa and the Caribbean. It is therefore of great interest to see Ashaye et al. report for a region of Nigeria a primary open-angle glaucoma (POAG) prevalence of 6.2% in those aged 40 years and older. The authors compare the POAG prevalence with another West-African study in Ghana where for a similar age group, the prevalence was 9.2%.³ The Nigerian study used a cluster sampling technique to randomly select 811 people who were examined close to their homes with an anterior segment slit-lamp examination. Those that failed a statistical cut-off for vertical cup/disc ratio (VCDR) or asymmetry were referred to a base hospital for white-on-white perimetry. The use of the widely adopted ISGEO criteria⁴ by this group to assign categories of glaucoma diagnosis is very helpful.

The high glaucoma prevalence of which most remains undiagnosed (90%) emphasizes the need forstructured eyecare programs in West Africa that integrate glaucoma detection and treatment

Of the 59 subjects with any form of glaucoma, twothirds (39 subjects, 66%), were given a Category 2 diagnosis which entails a very abnormal optic disc (VCDR ≥ 0.9/ asymmetry ≥ 0.3) and inability to complete perimetry, while a third of the subjects (16, 27.1%) had less abnormal discs (VCDR ≥ 0.7; asymmetry ≥ 0.2; notch) but with a testable glaucomatous visual field defect. These findings emphasize the severity of glaucoma in this population, in whom 6% of those with POAG were bilaterally blind and 10% blind in one eye. The study population was largely ethnically homogenous (Yoruba) and therefore cannot be representative of Nigeria as a whole. However, the high glaucoma prevalence of which most remains undiagnosed (90%) emphasizes the need for structured eyecare programs in West Africa that integrate glaucoma detection and treatment.

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