European Journal of Cardiovascular Medicine

Glaucoma is the one of the leading cause of irreversible blindness worldwide[1] and is estimated to affect over 11 million Indians.[2] Glaucoma is defined as an  acquired chronic optic neuropathy characterised by optic disk cupping and visual field loss, and it is usually associated with elevated intraocular pressure. [3]  It was found that a third percentage of patients have progressed to blindness before they see doctors or get medical care [4], and this is because of the lack of awareness  and knowledge about this disease and its symptoms so the  patient ignore its early signs and thus fail to apply treatment  at the right time [4,6].

As awareness and knowledge about  glaucoma greatly influence the treatment-seeking behaviour of individuals. The prevalence of glaucoma in India is estimated at 11.9  million and most cases are detected late as well [7]. Lack of awareness of  Glaucoma is an important reason for its late  presentation, which significantly increases the risk of  blindness. Lack of awareness influence the timing of the diagnosis and  also the utilisation of eye care services. Therefore, assessment  of awareness should be the first step in the planning of the management. The most important and effective actions for early  detection of glaucoma and its management may be  raising public knowledge and awareness regarding the  disease. A number of  studies indicate that most individuals do not have an  accurate understanding of this disease despite being  aware of this disease, as almost 40% of the study  subjects had inadequate knowledge of glaucoma [8, 9, 10].

A positive family history for glaucoma, which is reported  in 13% to 25% of patients with glaucoma, has been  proven to be a risk factor for the disease [11].

The objective of this study was to assess knowledge and awareness regarding glaucoma in medical students

Objectives- To evaluate the awareness and knowledge  about Glaucoma among medical students.

Study design: Cross-sectional study  

Source of sample: medical, dental and paramedical students studying at subbaiah medical college, Purle, Shimoga.

Method: After taking an informed consent, a self designed questionnaire about Glaucoma was  given to all the participants. Each questionnaire had two sections: The first section  pertaining to information about the participant’s  demographic characteristics, and medical profession. Second section was pertaining to participant’s awareness and  knowledge about Glaucoma respectively through a set of questions. All the questions were framed in English as  the study is done among medical students. At the end of  the study, we have assessed each of the respondents in terms of their awareness and knowledge  associated with Glaucoma.

Inclusion criteria: Medical and dental students. (1st and 2nd year MBBS students)

Exclusion criteria: Patients who have already been  diagnosed and are on treatment for Glaucoma and students who have passed third MBBS exam were excluded.

From a total of 503 participants, 254 were males and 248 were females. We received responses to the questionnaire from  377 (78.5%)medical students, 112 (18.4%) dental students, 5(1.3%) paramedical staff, 6(1.6%) non-teaching staff,  and

2(0.3%)group D words (diagram 2).

KNOWLEDGE

Only 76% were aware of Glaucoma. Only 52.2% were aware that glaucoma runs in the family, 68.6% knew that glaucoma is associated with raised intraocular pressure, 70.5% knew that glaucoma will damage the optic nerve and 70.7% knew that glaucoma could cause blindness.

AWARENESS

82.2% were aware that skipping a few days of treatment will affect the eyes, 71.8% knew that glaucoma will affect

peripheral vision, 70.4% had knowledge that family members should be screened for glaucoma, 76.3% participants knew that using anti-glaucoma medications reduces the progression, 79.4% participants knew periodic follow-up is required and 62.3% knew that the vision loss due to glaucoma is irreversible.

This study was done to assess the awareness and knowledge of Glaucoma among medical professional in a tertiary care centre south Karnataka. The  intention of this study was to evaluate the understanding about the awareness of Glaucoma and the importance of  screening as it has a subtle clinical course leading to  irreversible loss of vision.

A large number of participants had heard about the term  Glaucoma.The process of behaviour change, which culminates in  action and maintenance, but requires awareness and  knowledge as its starting point, has previously been  explained in previous studies [12]. Glaucoma is a highly  prevalent ocular disease that ultimately leads to blindness. Decreased levels of awareness of glaucoma indicates the need for public education  regarding this disease. The current study is a unique  study of the awareness and knowledge of glaucoma in medical professionals (medical students, dental students, paramedical staff, non teaching staff and group D workers).

Glaucoma is an irreversible and asymptomatic condition until the advanced stage. Early detection and treatment plays a pivotal role in control of blindness due to glaucoma. One third of the patients who had become blind from glaucoma had done so even before they had sought medical attention.[^13,14] Awareness of eye diseases in a urban Indian population[¹⁵] and awareness of glaucoma in a rural Indian population have been previously reported.[¹⁶] Awareness does not mean that subject knows everything about the disease; it just means that he/she has heard about the condition.

Previous studies have showed that even though most people claim to be aware of the condition less than a percent could describe its symptoms or patho-physiology correctly.[¹⁸] Knowledge about the disease would be more useful, as it is presumed to influence their ocular health-seeking pattern. Age and sex adjusted prevalence of primary glaucoma in urban Chennai was 4.39%.[²³] The age and sex adjusted glaucoma awareness rate among the general population of Chennai was 13.3% and only 8.7% of the Chennai residents had some knowledge about glaucoma.

India has divisions on many levels, a few of these being religion, language and inherent attitudes to health. The demographics and lifestyles differ from state to state and from rural to urban to tribal ways of life.[¹⁹] Urban Chennai residents (13.3%) seem to be more aware about glaucoma when compared to their counterparts in Hyderabad (2.4%).[¹⁵] The observed difference in glaucoma awareness could be explained by the different definitions used (Andhra Pradesh Eye Disease Study - age > 15 years) across the two studies, the difference in study methodology and tools, and also by the diversity of Indian culture. Knowledge level about glaucoma between the Hong Kong (10.2%)[¹⁸] and Chennai (8.7%) populations were comparable. Dissimilarities exist in awareness levels between the two countries; we presume it could be largely due to easy access to health care and better utilization of eye care services for glaucoma in Hong Kong.

In our study, glaucoma awareness was higher than in Hyderabad but lower than reports from the developed Nations (United States, Australia, Singapore and Hong Kong).[⁶] In well-educated western population (Blue Mountains Eye Study population), 93% of participants were aware of glaucoma, the proportion of undiagnosed glaucoma among all cases was found to be very high;[²⁰] these undiagnosed glaucoma cases are a cause for alarm considering the low levels of awareness regarding the disease in our population.

In our study we have found that awareness and  knowledge of glaucoma was more among medical students as compared to other participant group.

Though this study shows  good awareness regarding Glaucoma among hospital personnel, the knowledge regarding its causes, associations, treatment and complications were limited.

Among the hospital personnel only the medical doctors were found to have higher knowledge regarding Glaucoma. It is, therefore, important to emphasise on intensive eye health education and information dissemination, especially among all other allied health care professionals.

Educating hospital personnel about the presentation and outcome of this ‘silent thief of sight’ can be an important step toward preventive ophthalmic care. Continuing medical education about Glaucoma symptoms and subsequent visual impairment, therefore, must be a priority when designing programs for community outreach.

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