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Determinants of late presentation of glaucoma in Hong Kong

Eye volume 37, pages 1717–1724 (2023)Cite this article

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Abstract

Background

Glaucoma is the commonest cause of irreversible blindness worldwide. As it is typically asymptomatic until advanced, the risk of blindness from late presentation is higher than other eye diseases. This study aims to investigate the risk factors for late presentation of primary glaucoma patients.

Methods

We undertook a hospital-based case-control study of a random sample of glaucoma patients from a hospital in Hong Kong. Structured questionnaires and existing information from the electronic patient record were used, and the odds of presenting late were analysed by logistic regression.

Results

Of 210 recruited participants, 83 (39.5%) presented with advanced glaucoma unilaterally or bilaterally. The mean age of participants was 61.1 ± 11.9 years, with 110 males (52.4%). Univariate analysis revealed that male sex and primary angle-closure glaucoma (PACG) have 3.06 (CI95:1.71–5.48; P < 0.001) and 2.47 (CI95:1.11–5.49; P = 0.03) times higher odds of late presentation, respectively. Multivariate analysis revealed late presenters were 3.54 (CI95:1.35–9.35; P = 0.01) times more likely to have PACG than primary open-angle glaucoma (POAG). Patients with elevated baseline intraocular pressure (IOP) also had 1.06 times higher odds of presenting with advanced glaucoma (CI95:1.02–1.11; P = 0.002). Linear regression revealed that PACG patients present with 7.12 mmHg higher IOP than POAG patients (CI95:4.23–10.0; P < 0.001).

Conclusion

In conclusion, a high proportion of glaucoma patients present late in Hong Kong, with gender and type of glaucoma being significant determinants. Our study shows that PACG presents with higher IOP and, along with male gender, are more likely to have advanced disease than POAG.

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Fig. 1: Correlation between age and late presentation.

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Data availability

Deidentified individual participant data that underlies the results reported in this article are available for sharing. Data will be available upon request immediately following publication and ending 5 years following article publication, with investigators whose proposed use of the data has been approved by an independent review committee identified for this purpose. Proposals should be directed to laianakinlai2@gmail.com.

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Acknowledgements

This project would not be possible without the help from the staff at ICEH, LSHTM and the Grantham Hospital.

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Authors and Affiliations

  1. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK

    Anakin Chu Kwan Lai, John C. Buchan & Winifred Nolan

  2. Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China

    Anakin Chu Kwan Lai & Jonathan Cheuk-Hung Chan

  3. NIHR Biomedical Research Centre, Moorfields and UCL Institute of Ophthalmology, London, UK

    Winifred Nolan

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Contributions

ACKL was responsible for the development of the methodology, data analysis method, and the drafting of the article under the supervision of JCC, JCB, and WN, JCC, JCB and WN advised on the development of the methodology, interpretation of the findings and drafting of the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Anakin Chu Kwan Lai.

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The authors declare no competing interests.

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This study was approved by the London School of Hygiene and Tropical Medicine Ethics Committee and the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster.

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Lai, A.C.K., Buchan, J.C., Chan, J.CH. et al. Determinants of late presentation of glaucoma in Hong Kong. Eye 37, 1717–1724 (2023). https://doi.org/10.1038/s41433-022-02235-8

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