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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 60  |  Issue : 4  |  Page : 284-288

Awareness about Glaucoma and Impact of Short Education among Patients Visiting Ophthalmology Outpatient Department at a Tertiary Care Hospital


Department of Ophthalmology, KVG Medical College and Hospital, Sullia (D K), Karnataka, India

Date of Submission10-Feb-2022
Date of Decision27-Aug-2022
Date of Acceptance02-Sep-2022
Date of Web Publication19-Dec-2022

Correspondence Address:
Mahesh Babu
Quarter No. B.26, KVG Doctors' Apartment, Kurunjibhag, Sullia - 574 327, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_22_22

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  Abstract 


Purpose: The purpose of this study is to assess the level of awareness about glaucoma and impact of short education among patients visiting ophthalmology outpatient department (OPD). Methods: A hospital-based cross-sectional study was carried at our institute. The patients were given a pretested questionnaire containing nine questions to assess the awareness level before and after the short education about glaucoma. Microsoft Office Excel and IBM SPSS version 21 were used for statistical analysis. Results: The study showed that only 40% and 38% of the participants were aware of the term intraocular pressure and glaucoma, respectively. It was observed that participants <40 years scored higher than those of >40 years in both pre-test and post-test. Awareness among urban population was 58.92%, while in rural it was 29.85% in pre-test. Of the population 39.89% with formal education while 14.28% patients with no formal education were aware of glaucoma. The mean pre-test score was 1.66 ± 2.35 before the short education programme and the post-test score was 8.49 ± 1.09; the difference was statistically significant with P value < 0.0001. Conclusion: In our study, the awareness of glaucoma in the population was low; however, it was slightly higher in the younger age group, in urban areas and in educated population. Improvement in the knowledge about glaucoma was observed following short education. This waiting period in ophthalmology OPD can be effectively utilized for educating the patients about glaucoma as it has a higher impact than the regularly observed methods of imparting glaucoma education to the masses.

Keywords: Awareness, blindness, glaucoma, intraocular pressure, short education


How to cite this article:
Kadam MD, Abhilash B, Babu M, Sudhakar N A. Awareness about Glaucoma and Impact of Short Education among Patients Visiting Ophthalmology Outpatient Department at a Tertiary Care Hospital. TNOA J Ophthalmic Sci Res 2022;60:284-8

How to cite this URL:
Kadam MD, Abhilash B, Babu M, Sudhakar N A. Awareness about Glaucoma and Impact of Short Education among Patients Visiting Ophthalmology Outpatient Department at a Tertiary Care Hospital. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2023 Feb 3];60:284-8. Available from: https://www.tnoajosr.com/text.asp?2022/60/4/284/364240




  Introduction Top


Glaucoma is an optic neuropathy characterized by cupping of the optic nerve head, with corresponding nerve fibre loss and visual field defects. An elevated intraocular pressure (IOP) is considered to be a risk factor for glaucoma.[1] The two main types of glaucoma are primary open-angle glaucoma (POAG) and primary-angle closure glaucoma.[2] POAG appears to be more prevalent in Asian Indians and Chinese according to various population-based studies.[3] The risk factors for the same include older age, elevated IOP, positive family history and high myopia.[4] Due to its asymptomatic nature and insidious onset, often patients present late in the course of the diseases; hence, routine eye examinations would significantly aid in early detection and treatment and halt the progression of glaucoma. Glaucoma is a public health challenge causing irreversible blindness and is the second leading cause of avoidable blindness globally.[5],[6],[7]

The worldwide prevalence of glaucoma is about 80 million in 2020, with an estimated projection of prevalence to be 111 million by 2040.[8] In India, the estimated prevalence of glaucoma is reported to be 11.96 million that varies among different populations and subgroups with rate being 2.3–4.7%.[6]

Glaucoma is sometimes called 'silent blinder' due to lack of awareness about glaucoma in the general population. According to various population-based studies, awareness and knowledge of glaucoma among both rural and urban population is remarkably low,[9],[10] especially in developing countries where health-care seeking behaviour is lacking due to which patients present in late stages of the disease.[7],[11],[12],[13]

Hence, in our current study, we intend to assess and compare the level of awareness of glaucoma before and after the short education (to know its impact) among patients coming to ophthalmology outpatient department (OPD).


  Methods Top


The current study was a hospital-based cross-sectional study carried out on patients visiting the ophthalmology OPD at a tertiary care centre after obtaining due clearance from the institutional ethics committee. All facets of the study adhered to the declaration of Helsinki guidelines. The study was conducted over a period of 2 months from September 2021 to October 2021. Sample size was calculated using the formula 4pq/l2, where P = 13.5%7 and l = 5% error, 4pq/l2 = 186.84; the total sample size was approximated to 190. Patients visiting ophthalmology OPD who were above the age of 18 years and willing to participate were included in the study, while patients who were unwilling or who were unable to comprehend the details of our study were excluded.

An informed consent was taken from all willing participants who were directed to the questionnaire of the study. The aim of the research design was to compare the awareness before imparting short education (pre-test) and following imparting short education (post-test) about glaucoma with the same set of questions for pre- and post-test. A systematic random sampling method was used and every third patient was selected. The questionnaire was available in local language and reading assistance to patients with no formal education was provided. The short education about glaucoma was provided which included knowledge about the term like IOP, glaucoma, the definition, risk factors, symptoms (mainly its insidious nature), parts of eye affected, visual acuity, tests for diagnosis, treatment, complications, and prevention about glaucoma. Each correct answer for each question was awarded one mark and one question regarding risk factors including more than one correct answer was awarded two marks. The maximum score was thus attempted to be 10 marks.

Statistical analysis

The data were entered into a Microsoft office excel sheet and analysed using IBM SPSS software version 21 (IBM. SPSS statistics for Windows. Version 21.0. Armonk, NY: IBM; 2012). Paired t-test was used to find if any statistical difference in awareness scores between the pre-test and post-test about glaucoma. ANOVA test was used to find statistical differences between more than two means. P value < 0.05 was considered to be statistically significant.


  Results Top


Majority of the study population was in the age group of 40–49 years (28.42%) followed by 21–29 years age group (23.15%), whereas the least number of participants were seen in 80–89 years age group (1.05%). Out of 190 patients enrolled, 104 were males (54.73%) and 86 were females (45.26%). Participants from rural areas accounted for 70.52% (n = 134), whereas 29.47% (n = 56) were from urban areas. With regards to education, 67 (35.26%) of them were graduates, 60 (31.57%) completed high school and 7 (3.68%) were with no formal education [Table 1].
Table 1: Socio-demographic profile of enrolled patients

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Before imparting short education, only 40% were aware of the term IOP and 38% were aware of the term glaucoma. Awareness about glaucoma among various socio-demographic groups before short education is given in [Figure 1]. The fact that the optic nerve would be damaged by glaucoma was known to 6.31% of the population in pre-test. The proportion of participants who agreed that age, family history and high IOP are risk factors for glaucoma were 2.6%, 11.05% and 6.31%, respectively, in the pre-test analysis. Among all the participants, 5.26% were aware that damage caused by glaucoma would be irreversible, 23.15% were aware that glaucoma could be treated in the early stages, 22.63% were aware that damage due to glaucoma could be preventable and 7.89% were aware of investigation modalities for diagnosing glaucoma in pre-test [Table 2].
Figure 1: Awareness about glaucoma among various socio-demographic groups before short education

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Table 2: Questions and frequency of responses regarding awareness about glaucoma

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A Shapiro–Wilk test (P > 0.05) and a visual inspection of the histogram, normal QQ plots and box plot showed that the scores were approximately normally distributed. The skewness and kurtosis values were between − 1.96 and + 1.96.

The mean pre-test score was 1.66 ± 2.35 indicating that the knowledge was very poor before the short education programme. Following the short education programme, the post-test score was 8.49 ± 1.09. This difference in pre-test and post-test scores was statistically significant with P value < 0.0001 [Table 3].
Table 3: Pre-test and post-test scores

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There was a statistically significant difference between pre-test and post-test scores in different age groups, residence and education [Table 4]. There was a statistically significant difference in pre-test scores across the age groups. Similar significant differences in scores were observed in post-test scores too. In both pre-test scores and post-test scores, it was observed that 51 subjects of age group less than or equal to 40 years scored higher than those of 22 subjects of more than 40 years of age. People from urban areas scored higher than rural areas in both pre-test and post-test and the difference was found to be statistically significant.
Table 4: Comparison of pre-test and post-test awareness among various socio-demographic factors

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People with no formal education scored poorly in pre-test when compared to those who had studied till high school or higher. In the post-test scores, it was observed that there was a significant difference between those who had studied till high school and beyond or graduation.


  Discussion Top


Awareness and knowledge of glaucoma among the general public plays an important role in early detection and management of glaucoma.

In the current study, the proportion of patients who were aware of the term IOP was only 40%, whereas only 38% of the participants were aware about the term glaucoma, suggesting low level of awareness. Similar study conducted by Alemu DS et al.[14] on 701 subjects observed that 48.5% of the population were aware of glaucoma which was higher than current study.

Though the awareness and knowledge about glaucoma was slightly more in subjects with higher education (pre-test score of 2.90 ± 2.68), suggesting it was not satisfactory.

Higher proportion of the subjects with formal education had higher awareness and knowledge about glaucoma accounting for 39.89% of the study population. Effect of education on the subject's awareness and knowledge about glaucoma was likely to be following order, tertiary education level > secondary > primary > no formal education. Similar findings were echoed by Alemu et al.[14] and Sathyamangalam et al.[7] Similar findings seconded by Jothi et al.,[15] who studied the impact of education on glaucoma concluded that awareness in patients with formal education was higher than those with no formal education.

On comparison of awareness and knowledge about glaucoma among subjects of urban and rural communities, a higher proportion of the urban population (58.92%) were aware of glaucoma as compared to the rural population (29.85%). This could be due to higher level of education and exposure to health-related educational activities.

In the present study, the awareness about the term glaucoma was 38%, which was higher than a study conducted by Sathyamangalam RV et al.[7] on glaucoma awareness and knowledge, showing overall 13.5%.

Ichhpujani P et al.[16] conducted a KAP study about glaucoma among 119 hospital personnel, out of which 28.57% males (34) and 71.42% females (85) were aware of glaucoma showing higher level of awareness than our current study where 22.40% males and 17.48% females were aware of glaucoma. Most physicians 80.76%, nurses 65.26% and 6.31% people of current study had knowledge that glaucoma was associated with high IOP and had an effect on the optic nerve showing higher knowledge in hospital personnel compared to the general OPD population of present study.

Raiturcar TP et al.[17] conducted a KAP study about glaucoma among 200 glaucoma patients, out of which 79% patients were aware that they were suffering from glaucoma showing higher level of awareness among glaucoma patients than general outpatient population of current study which was about 38.42%. Awareness about irreversible and familial nature of glaucoma was 66% and 18% that was higher compared to current study which was 5.26% and 11.05%, respectively.

After imparting short education about glaucoma among study participants, there was a statistically significant increase in the knowledge and awareness scores across all the categories and strata of participants. Drawing from this idea of short education regarding glaucoma, waiting periods in ophthalmic OPDs can be effectively utilized to educate and improve the knowledge and awareness about glaucoma as it is very effective tool irrespective of age, residential background (rural/urban) or education level.

Executing health-care programs for promoting awareness of common eye diseases can bring forth people to have regular eye examination in older age group.[12],[13]

Limitations of the study

It is a hospital-based study and not community-based and the sample size is relatively smaller.


  Conclusion Top


In our current study, the awareness of glaucoma in the population was low; however, it was slightly higher in the younger (less than 40 years) age group, in urban areas and in educated population. Following short education, a significant improvement in the knowledge about glaucoma was observed irrespective of the demographic backgrounds like age, residence or educational status. This affirms positive impact of short education; the waiting period in ophthalmology OPD can be effectively utilized for the same. Short education can improve health-seeking behaviour of the population leading to regular eye check-ups, early diagnosis and treatment and reduce the risk of ocular morbidity due to glaucoma. Through activities like social media campaigns, other modalities like mass media and community programmes like observation of glaucoma week have helped in spreading knowledge and awareness about glaucoma; short education in OPD for all patients every day has a higher impact than the regularly observed methods of imparting glaucoma education to the masses.

Acknowledgements

We would like to acknowledge the faculty and staff involved in patient care, and lastly, I would like to thank the Dean of KVG Medical College and Hospital, Sullia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Sathyamangalam RV, Paul PG, George R, Baskaran M, Hemamalini A, Madan RV, et al. Determinants of glaucoma awareness and knowledge in urban Chennai. Indian J Ophthalmol 2009;57:355-60.  Back to cited text no. 7
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Thapa SS, Berg RV, Khanal S, Paudyal I, Pandey P, Maharjan N, et al. Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: The Bhaktapur glaucoma study. BMC Ophthalmol 2011;11:2.  Back to cited text no. 13
    
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Alemu DS, Gudeta AD, Gebreselassie KL. Awareness and knowledge of glaucoma and associated factors among adults: A cross sectional study in Gondar Town, Northwest Ethiopia. BMC Ophthalmol 2017;17:154.  Back to cited text no. 14
    
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Jothi R, Siddhartha P, Ismail R, Senthamarai C. Impact of education on knowledge attitude and practice (KAP) of glaucoma patients towards their disease management-a study. J Pharm Res Clin Pract 2013;3:8-12.  Back to cited text no. 15
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Ichhpujani P, Bhartiya S, Kataria M, Topiwala P. Knowledge, attitudes and self-care practices associated with glaucoma among hospital personnel in a tertiary Care Center in North India. J Curr Glaucoma Pract 2012;6:108-12.  Back to cited text no. 16
    
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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