Knowledge, attitudes and practices of glaucoma patients attending clinic at Kenyatta National Hospital

Abstract

Background: Glaucoma is a characteristic optic neuropathy which typically results in specific patterns of progressive visual field loss and who’s most important risk factor is raised intraocular pressure (IOP). It is second to cataract as a leading cause of global blindness and is the leading cause of irreversible visual loss. In Kenya it is ranked third after cataract and trachoma. Glaucoma is often diagnosed late and accompanied by poor patient compliance and follow-up as it is very slowly progressive and commonly asymptomatic until a very advanced stage of the disease is reached. Results: We interviewed 78 patients, 47 were male and 31 were female. Age ranged from 19-89 years with a mean age of 61.1 (SD +11.5) years. Seventy nine percent of patients presented with normal visual acuity but 5 (6.4%) presented with bilateral blindness. Mean IOP at presentation was 23.85mmHg with a wide range of 9-60mmHg. Fifty three (67.9%) patients were classified as having some knowledge using a predefined classification system, having poor knowledge of risk factors and treatment options. On compliance to medication, 62 (78.7%) patients reported compliance while 54 (69.2%) reported compliance to all clinic visits. The most common challenges reported with drug use were drops falling on cheeks (41%), cost of drugs (23.1%), and side effects of drugs used (19.2%).The most common impediments to clinic attendance were forgetting (16.7%) and other incidental events (62.5%). Patients had wrong expectation of both treatment and surgery with 29.5% and 32.5% expecting cure from medical and surgical treatment respectively. Compliance to glaucoma medication was perceived to be very important in 88.5% of patients, while 89.7% of patients perceived compliance to follow-up clinics as being very important. Conclusion: Forty four (56.4%) patients presented late with advanced disc damage and 40 (51.3%) had undergone surgery, the most common being trabeculectomy. There is still a wide gap in knowledge that exists and that needs to be addressed through counseling and further patient education. Self-reported compliance was high and patients had good attitudes towards treatment and follow-up of glaucoma.