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Editors Selection IGR 24-1
Screening and Prevention: Relatives of OAG patients in Tanzania
Comment by Harry Quigley on:
19322 Examination of first-degree relatives of patients with glaucoma: A randomized trial of strategies to increase use in an eye hospital in Africa, Munachonga EM; Hall AB; Courtright P, Ophthalmic Epidemiology, 2007; 14: 155-159
With 90% of glaucoma undiagnosed worldwide, methods to bring more cases in for care may be considered theoretically worthwhile. Yet, it may be premature to increase the number diagnosed in the developing world until effective care can be given. Since parents, siblings and children of OAG cases are five to ten times more likely to develop OAG, one approach is to bring in family members (cf: Okeke C, et al. Targeting relatives of patients with primary open-angle glaucoma. J Glaucoma 2007; 16: 549-55). Munachonga et al. (830) sought to bring in relatives of persons seen in a Tanzanian hospital glaucoma clinic both by educating the proband patient about higher family risk and by offering a free exam to a random half. Of 484 relatives of 182 cases, only 39 presented, with an insignificantly greater number coming if the exam was free. One new OAG was diagnosed. This study didn't define 'glaucoma' or the severity of glaucoma among cases. Persons with minimal vision loss might be less motivated or effective in exhorting family than those with severe loss. We are not told what treatment is offered for OAG at this facility. One wonders whether the prevailing approach (eyedrops? Surgery?) would affect the likelihood of presentation. Few came, despite free exams, and travel distance was the only additional impediment identified. Persons would be more likely to come if there was a perceived benefit. Formerly, cataract surgery in the developing world was done in eye camps, using ICCE followed by cokebottle glasses. It was difficult to motivate persons to present, even for free surgery. Once ECCE-IOL surgery was perceived by patients as providing excellent function, families not only began presenting for care, but were willing to pay. Is there a lesson for glaucoma care here? Would the failure to present be improved by making the case that diagnosis and treatment is inherently beneficial? Do we do that any better in developed countries?
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