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Glaucoma in a Sub-Saharan African Patient

Glaucoma in a Sub-Saharan African Patient

Patient details
- Name: Mr. JD - Age: 55 years - Gender: Male - Ethnicity: Igbo - Occupation: Farmer - Residence: Rural village in Nigeria
Patient case fields
Presenting Complaints

- Chief Complaint: Gradual loss of peripheral vision in both eyes, more pronounced in the left eye

- Duration: Approximately 6 months

- Associated Symptoms: Mild headache, especially after prolonged work under the sun

 

 

 

 

Medical History

Previous Ophthalmic History: Occasional blurred vision over the past year, no formal eye examinations

- Social History: Family History: Positive for glaucoma (mother diagnosed in her late 50s)

- Personal History: No known chronic diseases, non-smoker, occasional alcohol consumption

 Examination Findings:

- Visual Acuity: Right eye: 20/30, Left eye: 20/40

- Intraocular Pressure (IOP): Right eye: 28 mmHg, Left eye: 30 mmHg (normal range: 10-21 mmHg)

- Cup-to-Disc Ratio: Right eye: 0.6, Left eye: 0.7 (normal range: 0.2-0.5)

- Visual Field Test: Significant peripheral vision loss in both eyes, greater in the left eye

- Anterior Segment Examination: Unremarkable

- Posterior Segment Examination: Optic disc cupping in both eyes

Diagnosis

- Primary Open-Angle Glaucoma (POAG)

Management Plan:
  1. Medical Treatment:

- Topical Beta-Blockers (Timolol 0.5%): To reduce aqueous humour production

- Prostaglandin Analogues (Latanoprost): To increase outflow of aqueous humour

  1. Surgical Treatment:

- Consider Trabeculectomy if medical treatment is insufficient to control IOP

  1. Follow-Up:

- Regular follow-up visits every 3 months to monitor IOP, visual fields, and optic nerve health

- Family screening due to hereditary nature of the disease

  1. Patient Education:

- Importance of adherence to medication

- Awareness of symptoms indicating worsening of condition

- Lifestyle modifications to reduce IOP spikes (e.g., avoiding heavy lifting, reducing caffeine intake)

 

 

 

Discussion

Socioeconomic and Environmental Considerations:

- Access to Healthcare: Limited access to specialized eye care services in rural areas

- Economic Factors: Cost of medication and potential loss of income due to vision impairment.

- Cultural Beliefs: Possible reliance on traditional medicine, leading to delayed presentation.

Public Health Implications:

- Awareness Programs: Increase community awareness about glaucoma and the importance of early detection

- Screening Camps: Regular eye screening camps in rural areas to identify at-risk individuals

- Training: Enhance training of local healthcare workers to recognize early signs of glaucoma

Questions
1. What is the primary complaint of Mr. JD?

A). Blurred vision

B). Gradual loss of peripheral vision

C). Severe headaches

D). Double vision

 

2. What significant family history does Mr. JD have?

A). Father with glaucoma

B). Sister with cataracts

C). Mother with glaucoma

D). No significant family history

3. What were the intraocular pressure (IOP) measurements for Mr. JD 's eyes?

A). Right eye: 15 mmHg, Left eye: 16 mmHg

B). Right eye: 22 mmHg, Left eye: 24 mmHg

C). Right eye: 28 mmHg, Left eye: 30 mmHg

D). Right eye: 35 mmHg, Left eye: 36 mmHg

4. What is the cup-to-disc ratio found in Mr. JD’s left eye?

A). 0.3

B). 0.5

C). 0.7

D). 1.0

5. What is the diagnosis for Mr. JD?

A). Cataract

B). Diabetic retinopathy

C). Primary Open-Angle Glaucoma (POAG)

D). Macular degeneration

 

6. Which medications were prescribed to Mr. JD?

A). Timolol and Latanoprost

B). Timolol and Atropine

C). Latanoprost and Prednisolone

D). Atropine and Prednisolone

 

 

7. How often are follow-up visits recommended for Mr. JD?

A). Every month

B). Every 3 months

C). Every 6 months

D). Annually

 

 

 

8. What surgical treatment might be considered if medication is insufficient for Mr. JD?

A). LASIK surgery

B). Trabeculectomy

C). Cataract extraction

D). Corneal transplant

 

 

 

 

 

 

9. What are the key socio-economic challenges faced by Mr. JD?

A). Limited access to specialized care and economic constraints

B). Language barriers and lack of family support

C). High crime rate and political instability

D). Lack of health insurance and dietary restrictions

 

 

10. What public health measures are suggested to improve glaucoma care in Mr. JD’s community?

A). Distribution of free glasses

B). Community awareness programs and regular eye screenings

C). Vaccination campaigns

D). Dental check-up camps

Reveal answers

Answers

  1. B). Gradual loss of peripheral vision
  2. C). Mother with glaucoma
  3. C). Right eye: 28 mmHg, Left eye: 30 mmHg
  4. C). 0.7
  5. C). Primary Open-Angle Glaucoma (POAG)
  6. A). Timolol and Latanoprost
  7. B). Every 3 months
  8. B). Trabeculectomy
  9. A). Limited access to specialized care and economic constraints
  10. B). Community awareness programs and regular eye screenings