METHODS: This was a cross-sectional comparative study comparing primary angle closure glaucoma (PACG) patients (Group A) with primary angle closure and primary angle closure suspect (Group B). Group A was treated with topical pressure-lowering drugs; Group B was not. Data on ocular diagnosis and details of treatment were obtained from medical records. Ocular surface disease incidence was assessed using the Ocular Surface Disease Index (OSDI) questionnaire and from clinical signs using Schirmer's test, tear break-up time and corneal fluorescein stain. Predictive Analytic Software 20 and STATA analysis software were used for statistical analyses.
RESULTS: Group A demonstrated a higher rate of OSD (OSDI 52.3%, Schirmer's test 70.5%, tear break-up time (TBUT) 75%, corneal staining 77.3%) compared to Group B (OSDI 39.0%, Schirmer's test 73.2%, TBUT 58.5% and cornea staining 14.6%) except for Schirmer's test. There was a significant difference in mean score of OSDI (p=0.004), TBUT (p=0.008) and cornea staining (p<0.001) between two groups. Primary angle closure glaucoma treated with more than two medications and for more than three years had worse ocular surface disease parameters but without statistical significant difference.
CONCLUSION: Ocular surface disease is common in PACG patients treated with topical pressure-lowering drugs. Topical pressure-lowering drugs caused significant OSD symptoms and signs except for tear production in PACG patients. Thorough evaluation of ocular surface disease is important to ensure appropriate treatment and intervention in PACG patients.
METHODS: Eleven participants were involved in this qualitative research which utilised the interpretative phenomenological analysis approach more renowned in health psychology research. All interviews conducted at their home. The interviews were recorded, typed verbatim, and the transcripts were analysed using NVivo software version 8.0.
RESULTS: The main barriers identified at the primary care level were 1) nondisclosure of their visual problems originated from their belated needs for better sight, delayed awareness of their visual status and social stigma and 2) patient-provider-related issues namely miscommunication and delayed referral. The first main theme explains their belief for not requiring surgery. This has led to their delayed awareness and impeded disclosure of their visual problems to family members or primary care providers. The second main theme reflects the provider-patient-related issues which retarded cataract detection and referral process required for earlier cataract extraction surgery.
CONCLUSION: Thus, the appropriate approach targeting these specific barriers at primary care level will be able to detect, motivate and assist patients for early uptake of cataract extraction surgery to improve their vision and prevent severe blindness.