Ethnicity and Deprivation are Associated With Blindness Among Adults With Primary Glaucoma in Nigeria
Journal of glaucoma
The funding organizations had no role in the design and conduct of the research. Conflict of Interest -No conflicting relationship exists for any author. Abstract Purpose: We explored the risk factors for glaucoma blindness among adults aged >40 years with primary glaucoma in Nigeria. Participants and methods: 13,591 participants aged >40 years were examined in the Nigeria National Blindness and Visual Impairment Survey; 682 (5.02%, 95CI 4.60-5.47%) had glaucoma by ISGEO's criteria. This was a
... iteria. This was a case-control study (n=890 eyes of 629 persons): glaucoma blind were cases and glaucoma not-blind were controls. Education level and occupation were used to determine socioeconomic status scores, which were divided into three tertiles (affluent, medium and deprived). We assessed socio-demographic, biophysical and ocular factors by logistic regression analysis for association with glaucoma blindness. Multinomial regression analysis was also performed with nonglaucoma as the reference category. Results: 119/629 (18.9%; 95%CI 15.9-22.4%) persons were blind in both eyes, leaving 510 as controls. There was inter-ethnic variation in odds of blindness; age, male sex, socio-economic status, prior diagnosis of glaucoma, hypertension, intra-ocular pressure and lens opacity were associated with glaucoma blindness. Axial length, mean ocular perfusion pressure and angle-closure glaucoma were associated with blind glaucoma eyes. In multivariate analysis, Igbo ethnicity (OR2.79, 95%CI 1.03-7.57) had higher risk as was being male (OR4.56, 95%CI 1.72-12.09), and unmarried (OR2.46, 95%CI 1.03-5.93). Deprivation (OR3.72, 95%CI 1.55-8.93), prior glaucoma diagnosis (OR5.45, 95%CI 1.67-17.74) and higher intraocular pressure (OR1.07, 95%CI 1.02-1.13) were also independent risk factors for glaucoma blindness. Conclusion: Approximately 1-in-5 people with primary glaucoma were blind, with ethnic variation in risk. Male sex and deprivation were strongly associated with blindness. Services for glaucoma need to improve in Nigeria, focussing on poor communities and men.