|Year : 1975 | Volume
| Issue : 1 | Page : 1-5
Prevalence study of glaucoma in rural areas
P Awasthi1, KP Sarbhai1, SC Banerjee2, BB Maheshwari3
1 Department of Ophthalmology, Sarojini Naidu Medical College, Agra, India
2 Department of Social and Preventive Medicine, Sarojini Naidu Medical College, Agra, India
3 Lecturer in Statistics and Demography, Obst. and Gynaecology, Sarojini Naidu Medical College, Agra, India
Sarojini Naidu Medical College, Agra
|How to cite this article:|
Awasthi P, Sarbhai K P, Banerjee S C, Maheshwari B B. Prevalence study of glaucoma in rural areas. Indian J Ophthalmol 1975;23:1-5
|How to cite this URL:|
Awasthi P, Sarbhai K P, Banerjee S C, Maheshwari B B. Prevalence study of glaucoma in rural areas. Indian J Ophthalmol [serial online] 1975 [cited 2013 May 21];23:1-5. Available from: http://www.ijo.in/text.asp?1975/23/1/1/31340
Primary glaucoma is a disease of unknown etiology. In one of our studies it was found out that 19% of the out door ophthalmic patients suffered from the raised intraocular pressure of which they had no complaint and were suspected during refraction. The examination of 1400 blind patients who attended the Ophthalmic out patients department revealed that 12.7% of them were blind due to glaucoma. Thus glaucoma is one of the most important causes of blindness in aged. While conducting eye relief camps in rural areas for cataract surgery, the team had seen a lot of blind patients due to glaucoma. These patients were ignorant about the disease as the onset of it in most of the cases was insidious. At present no data about the prevalence of glaucoma in rural areas of Agra district and other parts of India are available as no systematic study has been done so far.
| Objects of the Study|| |
- To find out the prevalence rate of glaucoma and the nature of disease as it occurs in a typical rural setting.
- To study the various factors associated with the occurrence of glaucoma in the area particularly socio-economic status, sex, habits and other levels of living and the extent to which such association is significant.
| Material and Method|| |
The block Bichpuri in Agra district was selected for the purpose. It has 56 villages and its head-quarter Bichpuri is located about 12 km. from Agra. As the block has got no industrial or urban area, the population presents an uniform structure as may be expected in any rural area in this part of the country. The villages have the people of generally known castes and have almost usual social class distribution. The block has got a primary health centre with it's head quarter at Bichpuri. In view of the fact that glaucoma is a chronic process one would not expect the existing health services to modify the development, prevalence and course of the disease in any effective manner. As such no stratification was necessary to select the population in the villages for this study. The list of villages in the block was prepared and sample size of 20% was taken using random numbers, avoiding repetition. The selected villages have a population of 18,263. Out of these, the persons above the age of 30 years numbering about 4800 were selected for the study. In all, 12 villages were selected for the study.
| Method of Study|| |
A census by visiting door to door was carried out in all the selected villages and a list of all persons above the age of 30 years was prepared. A schedule of enquiry was drawn containing identifying data, habits, work, social and economic status etc., complaints of the persons and columns to enter results of examination of the eyes with torch, lens and loupe, intraocular tension and fundus examinations etc. Prior intimation was sent to the people in the village of visit and the purpose of visit was explained. The key for diagnosis of glaucoma and suspected glaucoma cases was prepared based on the following criteria
A. Diagnosis of glaucoma
- Raised intraocular tension i.e. more than 20 mm Hg by Schiotz.
- Glaucomatous field defects.
- Glaucomatous fundus changes and
- Facility of aqueous outflow less than 0.13. Presence of one or more of the above would confirm the diagnosis.
B. Suspected glaucoma
- Tension below or 20 mm Hg by Schiotz.
- Field findings suspicious of glaucoma.
- Fundus findings suspicious of glaucoma.
Other concomitant ocular conditions were also observed and recorded. Detailed examination of all the cases were made in the villages square (Chopal) The suspected cases of glaucoma were advised to come to S. N. Hospital, Agra for the investigations.
| Observations|| |
The villages had a population of 18263 and those above 30 years were 4607, out of this 691 persons had left the villages and were staying outside as non-residents. 313 persons could not be contacted in spite of repeated efforts. Actual examinations were made in cases of 1814 males and 1789 females. Amongst those who could not be contacted, there were 259 males and 54 females. In all there yr ere 50 suspected cases who were persuaded to come to S. N. Hospital, Agra for diagnosis. We succeeded to assign 43 cases as glaucoma. The remaining 7 cases (4 females and 3 males) did not turn up and have been excluded as non response. Out of the persons examined 195 were diagnosed as glaucoma and the prevalence rate worked out as 4.2%
The above table shows that 127(2.8)% cases were of secondary glaucoma of which leucoma adherence were 44 (0.9%), males 13 (0.3%) and females 31 (0.6%) and lens induced glaucoma were 83 (1.8%) males 26 (0.6°%a) females 57 (1.2%). Of the lens induced glaucoma, couching accounted for 49 (1.07%) males 15 (0.3%) females 34 (0.7%). Absolute glaucoma were 6 (0.1%) males 3 (0.6%) and operated glaucoma 7 (0.1%), males 6 (0.06%) and female 1 (0.6%). The types of distribution of glaucoma depended upon sex and is just significant at 5% level of significance (X 2 =9 for 4 d.f.)
[Table - 2] shows that glaucoma is more common in females than males. This finding is statistically significant. The value of (X 2 =15.9 for 1 d.f., p <0.1).
Glaucoma is more common in the age group of 45 to 50 years and the least in the age group above 70 years. It is interesting to note that we find the largest number of cases in the age group of 45 to 60 years. Again statistically the distribution of glaucoma cases, the age group is not dependent on sex. It is also statistically insignificant. The value of (X 2 =8.8 for d.f. p>0.05). The average age for males and females are 55.5 and 54.5 years respectively and this difference is highly significant (t=4.0 for 193 d.f. p. >0.01).
It is observed in [Table - 4] that glaucoma is more common in social class IV (86.2%) than class 1110 3.8%). It is not possible to compare the relative prevalence in the various social classes in such a limited study particularly because the population consists of predominantly social class III and IV. Occurrence of glaucoma in both the social classes have a relationship with sex which is only significant at 5% level of significance (X 2 =4.1 for 1 d. f. n <0.05).
The prevalence of glaucoma is more common in vegetarian 144 cases (73.8%) than non vegetarian 51 (26.2%). Glaucoma is more common in females (63.6%) who are usually vegetarian. Vegetarians show a greater occurrence of glaucoma in the population studied in which most of the people are vegetarian.
It is seen that glaucoma is more common in the persons who do light work including kitchen work (63.0%), less common in the hard workers (28.8%) and least in these who do very hard work (7.2%). Difference in type of work in glaucoma patients have a great relationship with sex which shows that females predominate in light work which is highly significant. (X 2 =45.31 d.f. p. <0.01).
| Discussion|| |
Sood et al  observed a rate of 7.2% in a semi-urban population of Pondicherry by a door to door survey. An urban population may be different as far as the variation of age and occupational class distribution is concerned. Even then the rate of 7.2% is far too high as compared to the rate in the present study. The prevalence of primary glaucoma in our service works out to be 1.1 % where as Loh  found the rate of 1.08% amongst the patients in the Ophthalmic out patient department.
Observations by Sukras  in Russia also showed a high prevalence rate (almost three times more) than our observations. It may be that besides a higher life expectancy, Russia may be having a higher prevalence rate. On the other hand Chilaris  in Greece observed a rate of 2.1% of glaucoma. It is observed that had there been no lens induced glaucoma (Hypermature cataract and couching) in the rate would be 2.4% which is comparable to the rates in Greece. Thus, neglected cases of cataract and quack treated cases is an be important cause for a higher rate in our country even with a low expectancy of life.
Daniel et al  observed a rate of 8% of glaucoma in the adult patients attending the eye clinic at Ludhiana. This however can not be representative for the population as it is drawn from a highly selected group attending out patient department.
In our series the prevalence rate for the females is 6.9%. This is consistent with all other observations referred in the paragraph above. Loh  observed that while the sex distribution of open angle glaucoma is same, the rate is 6 times higher in the females for closed angle glaucoma. This in our series is almost 10 times more. The studies of Sukra et al  in Russia also bear out this observation that females have a higher prevalence. Our series show a significantly higher rate than males in all age groups and also in both primary and secondary glaucomas.
In our series the highest distribution was found in the age group 45-60 years and least above 70 years of age group. India has a low expectancy of life compared to Russia and it may be that many do not live beyond 60 years. This fact can explain a higher prevalence rate in a developed country referred above.
It may thus be concluded from our observation that a higher prevalence is definitely associated with poorer social class where living conditions, ocular and general health are of a lower level. Smoking habit does not influence over glaucoma. Glaucoma is very high (63.0%) amongst those who do light work including kitchen work and progressively diminishes with hard and very hard work which are usually out door work. Females are mainly engaged in cooking and are exposed to smoke which is feature of the village kitchen, wood and cow dung cake being the usual fuels. It has also been observed in the study that females have a higher prevalence of trachoma (27.6%) which may lead to conjunctival fibrosis affecting the aqueous out flow and lead for wised intraocular tension. An analysis of the trachoma cases observed during the study also corroborate that females have higher distribution of trachoma particularly stage III and IV compared to males, as shown in the [Table - 6].
| Conclusion|| |
This study has shown a higher prevalence of both primary and secondary glaucoma amongst the females quite out of proportion to the sex distribution of the population and also the rate increases with age, being highest in the age group 45-60 years. With higher age groups there is a decline as the proportion of population also declines sharply. One of the reasons for a higher prevalence of glaucoma is the presence of trachoma contributed by working in a smoky kitchen etc. However, it does not explain a higher rate of primary glaucoma in females.
| References|| |
|1.||Awasthi, P. and Bhatia, R.P.S., 1970. Acta Ophthalmologica. 48. |
|2.||Broadfield, A., A text book of statistical method in clinical and preventive medicine Page 395 Ed. 1962. |
|3.||Borisiuk, Y.S., 1968 of Oftal Ze. 23, 611-612. |
|4.||Chilaris, G.A., November 1, 1968. Incidence and heredity of glaucoma. Amer Opthal. Athens 5, 15-22 |
|5.||Daniel, R., Frankle and Chopra, S.K., 1971, Oriental Arch. Ophth. 9, 6-12. |
|6.||Government of India, 1962, Standard industrial and occupational Classification-central statistical organization, New Delhi. |
|7.||Loh, R.C.K., 1968. Medical Journal 9, 76-80. |
|8.||Sood, N.N. et al, 1968. Orient Arch. Ophthal. 8, 352-242. |
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]