Background: Being a developing country and having a literacy rate of mere 49%, people of Pakistani in general have misperceptions about even the most prevalent of the diseases. This includes cataract and glaucoma. They still believe that glaucoma like cataract can be surgically treated and thus refrain from seeking early medical advice and end up losing their eyesight.

Objective: The objective of study is to find out the awareness and knowledge of cataract and glaucoma in patients aged 45 and above coming to outpatient department of Jinnah Hospital Lahore

Study design: Cross-sectional study.

Study setting and duration: Jinnah Hospital Lahore affiliated with Allama Iqbal Medical College located at Moulana Shabbir Ahmed, Usmani Road, Lahore 54550, Pakistan.

1 month Duration from May-June 2017.

Inclusion criteria: Patients presenting to OPD of Jinnah Hospital Lahore, Pakistan

Patients above 45 years of age

Both genders, male and female

Data collection and analysis: 250 subjects fulfilling the inclusion criteria were included in our study. After a verbal informed consent, a structured questionnaire was handed over or all the questions were directly asked from the patient by the group members in cases of illiterate patients. All the information was collected in this structured questionnaire.

Data was analyzed by SPSS version 17.0 or 21.0. For quantitative variables, mean and standard deviation were computed and for qualitative variables, frequency and percentages were computed

Results: Among our sample population, 75.2 % (188) people had heard about cataract and among those 80.8% correctly knew that in cataract lens become opaque. Awareness of glaucoma was low, with only 43.2% being aware.

Conclusion: Cataract awareness and knowledge was found fairly well due to its high prevalence and occurrence, in almost every aging person. Glaucoma awareness and knowledge were both poor. Lack of health education is the main factor contributing to these results.

• Cataract

• Glaucoma

• Awareness

• Outpatient

• Blindness

• Prevalence

• Intraocular pressure

• Literacy

• Knowledge

• Blurry vision

Rashid HI, Saif-ur-Rehman, Waheed I, Jabbar I, Tahir H, et al. (2018) To Assess the Awareness about Glaucoma and Cataract in Patients (Aged 45 and Above) Presenting to Outpatient Department (OPD) of Jinnah Hospital Lahore, Pakistan. Ann Public Health Res 5(2): 1077.

A cataract is a clouding of the lens in the eye which leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry vision, and halos around light, trouble with bright lights, and trouble seeing at night [1]. This may result in trouble driving, reading, or recognizing faces [2]. Glaucoma is an irreversible and asymptomatic condition and is defined as a chronic progressive optic neuropathy, for which elevated intraocular pressure (IOP) is the only modifiable risk factor [3]. Glaucoma can be classified into 2 broad categories: open-angle glaucoma and angle-closure glaucoma. In the United States, more than 80% of cases are openangle glaucoma; however, angle-closure glaucoma is responsible for a disproportionate number of patients with severe vision loss [4,5]. Both open-angle and angle-closure glaucoma can be primary diseases. Secondary glaucoma can result from trauma, certain medications such as corticosteroids, inflammation, tumor, or conditions such as pigment dispersion or pseudo-exfoliation [6].

Cataract is the major cause of blindness worldwide. It is estimated that 41.8% of all global blindness is caused by cataract [7]. Glaucoma is the second leading cause of visual loss in the world. Quigley estimates that there will be 60.5 million people with glaucoma in 2010 and Asians are expected to represent 47% of those with glaucoma [8]. Blacks are four to five times more likely to have glaucoma than whites [9]. The rates of primary angle closure glaucoma are higher in Asians than in Whites [10]. Women may be slightly more likely to suffer from glaucoma than men, when adjusting for age [11]. About 2 million people are blind in Pakistan - Various conditions responsible for blindness are: [12].

• Cataract 66.7% 1.33 million 

• Corneal opacity 12.6% 0.25 million 

• Refractive errors 11.4% 0.23 million 

• Glaucoma 3.9% 0.08 million 

• Other causes 5.4% 0.11 million 

This high rate of prevalence of Cataract and Glaucoma is due to a number of factors. Long waiting times, cost of surgery, complexity of the steps involved in treatment, lack of surgical capacity and low awareness of regional eye health [13], financial reasons, lack of support or other obligations [14] were the factors leading up to cataract prevalence. Lack of education and lower socioeconomic status are the major risk factors for late presentation of glaucoma [15]; long term exposure to sunlight and smoking are some other causes [16,17] . Another research in Korea showed people with higher intraocular pressure (IOP), myopia, older age, male gender, hypertension, and overweight status required more attention and support [18].

In a research carried out at Eye Clinic of a Teaching Hospital in Ghana, a total of 117 participants took part, 61 males and 56 females. The median and modal age group was 50 and 59 years. Amongst the participants, 74% were aware of glaucoma [19]. Another research in Iran showed out of a total of 1,084 eligible people including 52.9% women and 47.1% men were included and 957 subjects (response rate, 88.3%) completed the interview. Awareness regarding glaucoma, cataract and DR was 46.6%, 82.9% and 86.2% respectively. In addition, 19.2%, 57.3% and 72% of respondents could give at least a basic definition of the mentioned diseases, respectively [20]. Another research carried out in India, showed that out of 1400 participants, overall 27% (n = 380/1400) of the participants were aware of glaucoma [21]. A study conducted in Punjab, Pakistan included 729 participants. Majority were females (60.1%) and adults (76.1%). Literacy level of 40.2% subjects was up to matriculation level. Only one-third of respondent’s i.e.32.6% had an idea about the symptoms of the disease and 27.4% participants had an awareness of glaucoma as a blinding eye disease [22].

Cataract was commonly known to be a ‘pearl like dot’ white opacity in the eye while glaucoma was known to cause blindness. Awareness remained unchanged in different age groups for cataract, while for glaucoma there was an increase in awareness with age [23]. A recent study in Ghana showed that 99.1% of respondents aware of glaucoma agreed the disease can result in blindness with only 28 % affirming that blindness from glaucoma is irreversible [24].

Techniques including confocal scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography, have improved the identification of early disease and also enhanced the observation of progressive optic nerve fiber loss over time [25-29]. This research is aimed to study the awareness of glaucoma and cataract in (45 years and above) patients coming to Jinnah Hospital Lahore, Outpatient Department. The goal of this review is to show medical educators and leaders the general awareness statistically, and help spread awareness through them so patients with glaucoma would come earlier to prevent permanent blindness and patients with cataract would get themselves treated cost free in government hospitals hence decreasing prevalence and increasing quality of life of existing cases. The objective of study is find out the awareness of cataract and glaucoma in patients aged 45 and above (as both these diseases are more common in old age) coming to JHL OPD and if they know about the diseases and what they know about it.

Study design

Cross sectional study.

Study setting

Jinnah Hospital Lahore affiliated with Allama Iqbal Medical College located at Moulana Shabbir Ahmed, Usmani Road, Lahore 54550, Pakistan.

Duration of study

One Month May 2017- June 2017.

Sample size

250

Sampling technique

Non probability/ purposive technique

Inclusion criteria

Patients coming to OPD of Jinnah Hospital Lahore

Patients above 45 years of age

Both genders

Exclusion criteria

All patients who were in serious/ critical conditions

All Patients who did not give consent

Data collection procedure

250 subjects fulfilling the inclusion criteria were included in our study. After a verbal informed consent, a structured questionnaire was handed over or all the questions were directly asked from the patient by the group members in cases of illiterate patients. All the information was collected in this structured questionnaire.

Data analysis procedure

Data was analyzed by SPSS version 17.0 or 21.0. For quantitative variables, mean and standard deviation were computed and for qualitative variables, frequency and percentages were computed.

We took 250 patients and their attendants aged 45 and above coming to Jinnah Hospital Lahore outpatient department (OPD) to conduct a research about the awareness of cataract and glaucoma. Out of 250, 176(70.4%) were male and 74 (29.60%) were female (Figure 1).

Figure 1: Pie chart showing gender percentage of patients who participated in study

The minimum age of the participants was 45 and maximum was 80. The mean age was 56 and standard deviation 2.28. For our research, we took 46.8% participants from age group 45-55, 46.4% from age group 55-65, 6% from age group 65-75 and 0.8% from age group 75 and onwards (Table 1).

Table 1: Age Groups of patients that participated in the study.

High proportion of study subjects was illiterate (23.2%). About 42.4% had education till matriculation or less and about 34.4% had higher education (including bachelors and Masters) (Table 2).

Table 2: Level of education in Patients investigated.

71.6% (179) were from urban areas while 28.40% (71) were from rural areas (Figure 2).

Figure 2: Percentage of patients belonging from urban and rural areas respectively

Most of them worked privately (60%) while 24% were unemployed (Table 3).

Table 3: Profession.

About 46.4% were earning 30000-60000 PKR; while about the same frequency (42.4%) were earning 10,000-30,000 PKR. Only 11.2% had income higher than 60,000PKR (Table 4).

Table 4: Relative monthly income among patients.

For our study we put different questions to know the awareness about cataract and glaucoma. Among our sample population, 75.2% (188) people had heard about cataract and among them 80.8% correctly knew that in cataract lens become opaque (Figure 3).

Figure 3: Percentage of Patients who had heard about cataract

Majority had heard it from relatives (40.4%). 83.5% correctly answered that cataract increases with age.70.7% knew about the intra-ocular implantation which is done in cataract surgery. 91.5% answered positively that cataract can cause blindness and only 79.3% believed blindness was reversible (Table 5,6).

Table 5: Patients' general definition of cataract.

Table 6: Patients' source of information of cataract.

A fair 85.6% had the information that it was treatable by surgery while the rest 14.4% believed other means such as taking medicines or going to hakims to be effective (Table 7).

Table 7: General Awareness about Cataract.

Out of 250 samples size, 56.8% never heard about glaucoma, 43.2% knew about glaucoma and among them, 26.85% knew correctly that glaucoma is caused by high pressure in the eye (Figure 4).

Figure 4: Bar Chart: Patients' source of information of glaucoma

51.9% believed that there is a positive correlation between glaucoma and familial predisposition. 86.1% said that coming early or late will affect prognosis of glaucoma. 88.9% knew glaucoma could affect vision enough to cause blindness and among them only 38.9% knew that the damage causing blindness was reversible (Table 8 and 9).

Table 8: General Awareness about Glaucoma.

Table 9: Patients' general definition of glaucoma.

The study investigated awareness of glaucoma and cataract, and general information pertaining to them among patients coming to OPD JHL. Awareness of cataract was found to be significantly high (75.2%), this finding is inconsistent with the finding of researches carried out in Bhaktapur district, Nepal (6.7%) [30], and in urban slum population of Delhi, India (42% were aware of any symptoms of cataract) [31]. This is because the research involves people mostly from urban area i-e Lahore who had greater communicative exposure (ex: Radios, newspaper, internet, TV, other people).

In our research, male (70%) were more aware of cataract than female (40.5%). This is consistent with research conducted in a tertiary care hospital in India [32]. The main reason being TV as the main source of information in which men actively took interest in.

In this study, participants with matriculation were more aware than those with primary and secondary level education. This was also seen in studies conducted by Lander et al, [33]. It was also found that many illiterate were aware because of someone from their family being involved in the disease. It was also found that a high number of participants (85.6%) had a valid knowledge of cataract treatment, with surgery being the only option and awareness about intra ocular lens implantation (70.7%). This is due to the fact that cataract has the highest prevalence in Pakistan among all the blinding diseases. This has led to its awareness and hence it’s treatment knowledge being widely spread among people.

Awareness of glaucoma was low, with only 43.2% being aware. This finding is consistent with the findings of many other researches, such as one carried out in Ebonyi state, Nigeria (21.1%) [34]. It was found that information about glaucoma spread by eye camps or doctor was only 8%. This is due to the perception that visual loss is a normal consequence of aging, hence the visit to a doctor for a checkup is deemed unnecessary. This is also one of the causes of low awareness of glaucoma and its knowledge.

Here again men were more aware than female although in other researches in Canada [35] and tertiary care of India, women were found to be more aware than men. The involvement of radio and TV was found being the major contributing factors and greater percentage of men being more educated than females.

The influence of positive family history on awareness was very significant on this study. As expected, respondents with relatives suffering from glaucoma were more likely to be aware of glaucoma and have good knowledge regarding this disease. This trend has been observed in other studies conducted in Southern India, Nigeria and Washington DC.

Here as well, educational level remained as a key determinant of awareness. People with matriculation or higher level were more aware than illiterate or those with primary education. This finding is consistent with Franzco et al. [36], who reported that participants with higher educational level were 1.8 times more likely to report awareness of glaucoma than those with lower educational level.

However It was found that there was no relationship between awareness (having heard of the disease glaucoma) of glaucoma and level of knowledge (specific information such as signs, symptoms, treatment) regarding glaucoma. This agrees with report by Mbadugha and Onakoya in Lagos Nigeria [37]. Knowledge of glaucoma was significantly lower than its awareness. Participants thought blindness by glaucoma was reversible (38.9%). This is due to no or very less awareness programs held by the government or other educational societies.

This is also consistent with this study in which it was found that educational status was not found to be related to knowledge regarding glaucoma. This highlights the need to include eye health education at school level.

The surprisingly thing to note was that although men were more aware of glaucoma, female had greater knowledge of glaucoma than men. This could be because while men may watch TV or listen to radio more, women were more likely to go to hospitals or eye camps with their children for general care. Here in consideration of these results it is dire need to take prompt actions to increase awareness of both cataract and glaucoma to prevent increasing prevalence of blindness in Pakistan.

Cataract awareness and knowledge was found fairly well due to its high prevalence and occurrence in almost every aging person. Also because of the fact that cataract has a very obvious presentation i-e white opacity in the eye. Glaucoma awareness and knowledge were both poor. Lack of education is the main factor contributing to these results.

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