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Advances in Social Sciences Research Journal – Vol. 11, No. 1
Publication Date: January 25, 2024
DOI:10.14738/assrj.111.16321.
Miray, L. G., Rafanomezantsoa, R., Rachid, A. L., Andriamampionona, T. F., & Raobela, L. (2024). Epidemiological and Clinical Aspects
of Primary Open Angle Glaucoma in Fianarantsoa Madagascar. Advances in Social Sciences Research Journal, 11(1). 258-266.
Services for Science and Education – United Kingdom
Epidemiological and Clinical Aspects of Primary Open Angle
Glaucoma in Fianarantsoa Madagascar
Miray, L. G.
Department of Ophthalmology,
University Hospital of Tambohobe Fianarantsoa
Rafanomezantsoa, R.
Department of Ophthalmology, University Hospital of
Joseph Ravoahangy Andrianavalona Antananarivo
Rachid, A. L.
Department of Ophthalmology, University Hospital of
Joseph Ravoahangy Andrianavalona Antananarivo
Andriamampionona, T. F.
Department of Anatomopathology,
University Hospital of Andrainjato
Raobela, L.
Department of Ophthalmology, University Hospital of
Joseph Ravoahangy Andrianavalona Antananarivo
ABSTRACT
Introduction: Primary open-angle glaucoma (POAG) is a chronic, progressive,
bilateral optic neuropathy corresponding to a loss of retinal ganglion cells and
characterised by morphological changes in the optic disc associated with typical
visual field damage. Methods: This was a prospective, cross-sectional, descriptive,
monocentric study conducted over a 5-month period from September 2020 to
February 2021 in the ophthalmology department of the university hospital of
Tambohobe Fianarantsoa Madagascar. The purpose of this study was to evaluate
the prevalence of primary open-angle glaucoma and to describe its epidemiological
and clinical aspects. Results: The prevalence of primary open-angle glaucoma in our
study was 21.25% with a female predominance of 68.63%. The mean age was 50 ±
15 years. The majority of patients (80.39%) with POAG in our study had visual
acuity greater than or equal to 20/63. 49 eyes or 48.94% of the 102 eyes had ocular
hypertoni greater than 21 mm Hg. The Cup/Disc ratio greater than 0.5 was found in
99 eyes (97.06%). In our study, 61 of 102 eyes had a slightly altered visual field
(59.80%), 30 eyes had a moderately altered visual field (29.41%) and 11 eyes had
a severely altered visual field (10.78%). Conclusion: Primary open-angle glaucoma
is a chronic progressive bilateral optic neuropathy corresponding to a loss of retinal
ganglion cells and characterised by morphological changes in the optic disc
associated with typical visual field damage. This pathalogy is very common in
Fianarantsoa.
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Alsaedi, B. (2024). Epidemiological and Clinical Aspects of Primary Open Angle Glaucoma in Fianarantsoa Madagascar. Advances in Social Sciences
Research Journal, 11(1). 258-266.
URL: http://dx.doi.org/10.14738/assrj.111.16321
Keywords: Glaucoma, intraocular pressure, prevalence, visual field
INTRODUCTION
Primary open-angle glaucoma (POAG) is a chronic, progressive, bilateral optic neuropathy
corresponding to a loss of retinal ganglion cells and characterised by morphological changes in
the optic nerve head associated with typical visual field damage. It most commonly occurs after
the age of 40 [1].
PAOG is the leading cause of irreversible blindness worldwide and the second leading cause of
blindness after cataract [2]. In Madagascar, very few studies have been carried out on primary
open-angle glaucoma. For this reason, we conducted this study in the Ophthalmology
Department of the University Hospital of Tambohobe Fianarantsoa. Our aim was to determine
the prevalence of primary open-angle glaucoma and to describe its epidemiological and clinical
aspects.
METHODS
This was a prospective, cross-sectional, descriptive, monocentric study conducted over a 5-
month period from September 2020 to February 2021 in the ophthalmology department of the
university hospital of Tambohobe Fianarantsoa Madagascar. All patients attending the
ophthalmology department on an outpatient basis, regardless of the reason for consultation,
were included. We included in this study all patients presenting symptoms suggestive of
glaucoma such as blurred vision, scotoma, fluctuating vision, tearings, headache, ocular pain,
ocular hypertonia who consulted during the study period and consented to participate in the
study. We excluded from our study all patients who refused to participate in the study or to
answer the questionnaire. The study parameters were socio-demographic, such as age and
gender. The clinical parameters studied were the reasons for consultation, measurement of
visual acuity using the Monoyer and Snellen scale, placed at 5 m, measurement of ocular tonus
using the Goldmann applanation tonometer after instillation of fluorescein and oxybuprocaine.
The normal value is 15±6 mmHg, that means 9 to 21 mmHg, and is pathological above 21
mmHg; an examination of a fundus examination using indirect ophthalmoscopy after pupillary
dilation to measure the cup/disc ratio of the optic disc, the normal value of which is less than
0.3. The paraclinical parameters investigated were the visual field examination. The results of
the visual field examination were classified into three categories:
• slightly altered visual field: paracentral scotoma, nasal notch, Bjerrum's arciform
scotoma, central scotoma
• moderately altered visual field: temporal island with preservation of central vision
• severely altered visual field: residual central island
The diagnosis of primary open-angle glaucoma was defined by the presence of at least two of
the following abnormalities:
• ocular hypertoni;
• xcavation of the optic disc c/d >0.5;
• visual field alteration.
We drew up a patient form to collect our variables. The data were then entered into Excel for
statistical analysis. The data were entered using Microsoft Word 2013. Graphs were created
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Advances in Social Sciences Research Journal (ASSRJ) Vol. 11, Issue 1, January-2024
Services for Science and Education – United Kingdom
using Microsoft Excel 2013. Data analysis was carried out using EPI-INFO® version 7.2.2.6. For
statistical tests, the difference was significant for a p ≤ 0.05 with the Chi-2 test. We explained
the study and the procedure to the patient, as well as its objectives, and requested free and
informed consent signed by the patient. The patient's anonymity and the confidentiality of data
and results were respected. We also respected the patient's choice to refuse to respond to the
questionnaire or the examination, or to participate in the study altogether.
RESULTS
Study Population
During the study period, 300 outpatients attended the ophthalmology department of
Tambohobe University Hospital and 249 patients were included. 09 patients were excluded
because of non-cooperation and refusal to answer the questionnaire. This makes a total of 240
patients retained, that means 480 eyes examined.
Prevalence of Primary Open Angle Glaucoma
In our study, 51 patients (21.25%) had primary open-angle glaucoma.
Socio-Epidemiological Data
Age and Gender:
Patients aged over 59 years had the most primitive open-angle glaucoma (27.49%). The mean
age of patients was 50 ± 15 years, with extremes of 14 and 83 years. In our study, there were
statistically significant correlations (p ˂ 0.001) between patients aged less than 40 years and
between 49 and 50 years. The population was predominantly female. The POAG rate in women
was 68.63%. The sex ratio was 0.45. There was no statistically significant correlation between
gender and primary open-angle glaucoma (p=0.43) (Table I).
Table I: Socio-demographic parameters
Reasons for Consultation
The main reasons for consultation were blurred vision and headaches, which accounted for
74.51% and 72.55% respectively, with a p-value of ˂ 0.001. There was therefore a statistically
significant correlation between PAOG and headaches and nlurred vision (Table II).
POAG YES
n (%)
POAG NO
n (%)
p
Age
˂40 ans 12 (23,53) 106 (56,08) ˂0 ,001
[40 à 49 ans [ 06 (11,76) 19 (10,05) 0,44
[49 à 50 ans [ 06 (11,76) 01 (0,53) ˂0 ,001
[50 à 59 ans [ 13 (25,49) 28 (14,81) 0,05
≥59 ans 14 (27,45) 35 (18,52) 0,11
Gender
Men 16(31,37) 64(33,86)
Women 35(68,63) 125(66,14) 0,43
Sex-ratio 0,45