Determinants for Late Presentation of Glaucoma and Predictive Accuracy of Intra Ocular Pressure to Diagnose Late Glaucoma Among Adult Glaucomatous Patients Attending University of Gondar Comprehensive and Specialized Hospital Tertiary Eye Care and Training Center, northwest Ethiopia: A Case Control Study, 2020.

Abstract

ABSTRACT Introduction: Glaucoma is among the leading causes of irreversible blindness in developing countries including Ethiopia. It remains as a major public health concern that impedes the quality of life of patients and late presentation has significantly contributed for the increased incidence of blindness. Though late presentation is a major risk factor for glaucoma induced blindness, there is paucity of information on the determinants for the late presentation and the predictive ability of intra ocular pressure for the diagnosis of late glaucoma. Objective: To assess determinants for late presentation of glaucoma and the predictive accuracy of intra ocular pressure to diagnose late glaucoma among glaucomatous patients attending University of Gondar tertiary eye care and training center. Methods: A hospital-based unmatched case control study (1:1) was conducted on 492 patients. Data was entered into EPI Info and exported to SPSS version 22 for analysis. Bivariable and multivariable logistic regression was used to identify determinants. Variables with p<0.05 was considered as statistically significant. Receiver operating characteristic curve analysis was done to determine the predictive accuracy of baseline intra ocular pressure to diagnose late glaucoma. Result: From the total of 492 study participants, 452 (91.87%) responded to the survey. The mean age was 55.12 with a standard deviation of 13.22. Being > 60 years of age (AOR: 4.51; 95% CI: 1.74, 11.67), resided > 53 Km ) away from the University of Gondar hospital (AOR: 6.02; 2.76, 13.14), presenting intra ocular pressure of > 30 mmHg (AOR: 4.49, 95% CI: 2.10, 9.12), poorly knowledgeable about glaucoma (AOR: 4.46, CI: 2.62, 7.58) were significantly associated with late presentation of glaucoma. On the other hand, regular eye checkup (AOR: 0.42, 95% CI: 0.18, 0.98) and having a known history of diabetes mellitus (AOR = 0.16, 95% CI: 0.68, 0.38) were protective against late presentation of glaucoma. The receiver operating characteristic curve analysis showed that area under the curve of 0.674 and a cut-off intra ocular pressure ? 25.03 mmHg. Conclusion: Increasing age, intra ocular pressure, Poor knowledge about glaucoma and those who resided at far distance from University of Gondar tertiary eye care and training center had strong positive association with late presentation of glaucoma. Known history of diabetes mellitus and regular eye checkup were associated negatively with late glaucoma. The predictive accuracy of intra ocular pressure as a diagnostic consideration for late glaucoma was poor. Key words: Glaucoma, Determinants, IOP, Late presentation, ROC curve