|Year : 1965 | Volume
| Issue : 4 | Page : 123-126
Glaucomatous blindness in India
BR Shukla, SD Vijay
Institute of Ophthalmology and Gandhi Eye Hospital, Aligarh, India
|Date of Web Publication||25-Feb-2008|
B R Shukla
Institute of Ophthalmology and Gandhi Eye Hospital, Aligarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shukla B R, Vijay S D. Glaucomatous blindness in India. Indian J Ophthalmol 1965;13:123-6
Although the exact figure of total blind population of the world is not known, the number certainly exceeds ten millions, and in the opinion of some it is likely to exceed fifteen milions (Wilson, 1962). The existence of so variable a range in the estimates of the blind exposes the inaccuracy of our statistics. Inspite of some pitfalls in these estimates, it is an undisputed fact that glaucoma is undoubtedly an important cause of blindness all over the world. Statistically, in our country, glaucoma as a cause of blindness has either been ignored in a survey like Trachoma Control Pilot Project, India (1962) or has been calculated on a very small number of hospital patients (Venkataswamy and Rajgopalan, 1961).
Cooper (1960) tried to determine the incidence of glaucoma cases in relation to those of cataract and iritis in India by handing out of a questionnaire to the different hospitals all over India. The response though poor, indicates its incidence as about equal with that of iritis and about a fourth that of cataract. However it does not indicate the degree of blindness due to glaucoma.
In any case the information advanced under these surveys is indirect and therefore not quite dependable. Therefore, the position regarding the incidence of glaucomatous blindness in India still remains incomplete. The present communication deals with our observations based on a survey of blindness made in the out-patient department of Gandhi Eye Hospital, Aligarh.
Materials and Methods:
Between January 1, 1963, and July, 1963, 13923 patients attending the cut-patient department of Gandhi Eye Hospital, Aligarh, were screened for blindness. The criterion of selection of the blind was a person who was totally blind or whose vision did not improve beyond counting fingers at 3 metres with one or both eves after refractive correction. The particulars and clinical findings of the individual cases were recorded on separate blindness cards. In the cases included here the diagnosis of glaucoma as the cause of blindness was adequately established. The data so obtained were analysed subsequently.
Incidence of Glaucomatous Blindness:-
Out of a total of 13923 patients examined during the period, 3642 (26.2%) were found to be blind, glaucoma being responsible in 511 (14.0%) cases. The known world figures of blindness due to glaucoma are shown in [Table - 1]. It may be worthwhile mentioning that although a comparision of this nature may not be very correct as the sources of the data have not been identical, still these figures could be looked upon indirectly as fairly representative of limited regional incidence.
Maximum incidence of blindness due to glaucoma was recorded between the ages of 41 to 60 years.
The sex distribution of glaucomatous blindness revealed that incapacitation dominates in females. The figures for males and females were found to be 3.04% and 4.84% respectively calculated on total attendance. The difference is significant (t = 5.05 for infinite d.f. P < .001). The higher incidence of blindness in females conforms with the greater prevalence of glaucoma in females.
Incidence of glaucomatous blindness and economic status. Not only glaucomatous blindness, but blindness as a whole is wedded with igncrance and poverty to a large extent, 59.49% of the blind belong to this class in the present survey [Table - 2].
Glaucoma Blindness and Literacy. This is a corolary of the former for poverty and illiteracy go hand in hand. It is not surprising that analysis of the data shows a greater prevalence of blindness due to glaucoma amongst illiterates as compared to literates and the educated. [Table - 3].
The few attempts to make people glaucoma conscious do not reach the mass of our population. Progressive loss of vision and pain are tolerated till they become intolerable and then when they seek medical advice it is invariably too late. The table proves the great value of making people glaucoma-conscious through health- education, broadcasts and newspaper propaganda.
Glaucomatous blindness and laterality:-
It was depressing to record that 42.07% cases had bilateral loss of vision. In the present survey glaucomatous blindness was relatively more common in the left eye than in the right, amongst the monocular blinds [Table - 4].
The incidence of glaucomatous blindness was higher amongst the farmers (33.86%) as compared to patients having other occupations [Table - 5], but such a conclusion is not logical as the hulk of the patients attending our out-patient department belong to the former category.
Blindness due to various types of Glaucomas:-
No gonioscopic classification of the type of glaucoma was attempted in our cases. Instead they were grouped clinically into primary, secondary and congenital glaucoma. Incidence of various types is show in [Table - 6].
Associated diseases with Glaucoma:-
Of interest is the association of other diseases with glaucomatous blindness obtained in this survey. Sometimes it is very difficult or even impossible to evaluate which comes first, or to judge the visual impairment on the basis of a single disease. Trachoma in different degrees of severity was seen in the majority of cases; such a finding supports our earlier observations (Nema, Saiduz-zafar, Nath Shukla, 1964) that chronic cases of trachoma with marked conjunctival scarring could be predisposed to glaucoma.
Inference and conclusion:-
Although an increasing interest in the control of trachoma and the surgical management of cataract have been shown of late in India, we do not find the requisite awareness in the assessment of glaucoma (in totality) as a blinding cause. There is a definite need for the institution of a detailed comprehensive survey for detecting this ocular disease in the pre-clinical phases in every state of this country. Glaucoma, from any point of view, is a national health problem meriting top consideration of the Government of India which calls-for vital reorientation in our approaches to the problem of glaucoma in India. The purpose of the article is to highlight the importance of glaucoma with a view to promote adequate remedial steps which may he considered under some national scheme.
| References|| |
Bagchi, S. (1934-35), Calcutta Med. J., 29 : 283.
Bagchi, S. (1936), Ibid,
30 : 460, 525, 724.
Cooper, S. N. (1960) Proceed. All-India Ophth. Soc. 19, 142.
Megaw, Sir J.
(1939), In "Blindness in India." Cited by Sorshy in 5.
Nema, H. V. Saiduzzapar, H., Nath, K. and Shukla, B. R. (1964) Brit. J. Ophthal., 48 : 563.
Sorshy, A. (1950) The Incidence and causes of blindness (An International Survey) Brit. J.
Ophthal, Supplement 1950.
Venkataswamy, G. & Rajgopalan. A. V. (1961), J. All India Ophthal. Soc. 12: 77.
Wilson, J. F. (1962), Blind Welfare 4, 5.
[Figure - 1]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7]