Epidemiology of glaucoma in Sub-Saharan Africa: Prevalence, incidence and risk factors
Fatima Kyari1, Mohammed M Abdull2, Andrew Bastawrous3, Clare E Gilbert3, Hannah Faal4
1 International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK; Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria
2 International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK; Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
3 International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
4 Africa Vision Research Institute, Durban, South Africa; Calabar Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Nigeria
International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT
Source of Support: The authors who are research fellows at the ICEH obtained
funding from the Fred Hollows Foundation (for FK), British Council for the
Prevention of Blindness (for MMA & AB), Medical Research Council (for AB)
and Fight for Sight (for AB), Conflict of Interest: None
Purpose: The purpose of this study is to review the epidemiology of different types of glaucoma relevant to Sub-Saharan Africa (SSA) and to discuss the evidence regarding the risk factors for onset and progression of glaucoma, including risk factors for glaucoma blindness.
Methods: Electronic databases (PubMed, MedLine, African Journals Online- AJOL) were searched using the full text, Medical Subject Headings (MeSH) terms, author(s) and title to identify publications since 1982 in the following areas: population-based glaucoma prevalence and incidence studies in SSA and in African-derived black populations outside Africa; population-based prevalence and incidence of blindness and visual impairment studies in SSA including rapid assessment methods, which elucidate the glaucoma-specific blindness prevalence; studies of risk factors for glaucoma; and publications that discussed public health approaches for the control of glaucoma in Africa.
Results: Studies highlighted that glaucoma in SSA is a public health problem and predominantly open-angle glaucoma. It is the second-leading cause of blindness, has a high prevalence, an early onset and progresses more rapidly than in Caucasians. These factors are further compounded by poor awareness and low knowledge about glaucoma even by persons affected by the condition.
Conclusion: Glaucoma care needs to be given high priority in Vision 2020 programs in Africa. Many questions remain unanswered and there is a need for further research in glaucoma in SSA in all aspects especially epidemiology and clinical care and outcomes involving randomized controlled trials. Genetic and genome-wide association studies may aid identification of high-risk groups. Social sciences and qualitative studies, health economics and health systems research will also enhance public health approaches for the prevention of blindness due to glaucoma.