CHALLENGES IN THE MANAGEMENT OF GLAUCOMA IN A DEVELOPING COUNTRY; A QUALITATIVE STUDY OF PROVIDERS' PERSPECTIVES

Adekoya B J, Adepoju F G, Moshood K F, Balarabe A H

Available online Jul 19, 2018.

[ Original ] Volume 24, Issue 4, 2015, Pages 315-322


Abstract

BACKGROUND
Glaucoma management is challenging to patients as well as to the eye care providers.The study is aimed at describing
the challenges faced by providers using qualitative methods.
METHODS
In-depth interviews were conducted with selected Ophthalmologists and resident doctors in ophthalmology at
centres offering medical and surgical glaucoma services in Lagos state, Nigeria, according to established qualitative
methods. This was done using semi-structured, open ended questions to explore the providers' perspective on
glaucoma burden, challenges in the management, surgery for glaucoma, acceptance of glaucoma surgery by patients,
and recommendations for improving glaucoma services.The discussions were recorded with the aid of a microcassette
recorder. Familiarisation was done to identify key ideas in the data, then, the main themes and sub-themes
were identified.Quotes that reflect the themes and sub-themes were then identified in the data.
RESULTS
In-depth interviews were conducted with a total of 11 ophthalmologists and resident doctors in training. Majority
were of the opinion that glaucoma is a significant burdenconstituting about 35% of outpatient visits. Identified patient
related challenges include;late presentation,lack of glaucoma awareness,delay in referral from optometrists,and poor
compliance with medications. Shortages in needed equipment were also identified. Availability, affordability and
counterfeiting ofdrugs were the major challenges related to medical treatment. Majority of the participants agreed
that surgery should be offered to the patients as soon as the diagnosis of glaucoma is made. However, continuous
monitoring of the patient on medical treatment is another line of option for them in early cases; if they are convinced
the patients will be compliant.Some respondents considered the current number of glaucoma surgeries as adequate,
while somethink otherwise.Reasons put forward for reluctance to offer glaucoma surgery include;late presentation,
lack of patient satisfaction,complications of surgery,and negative publicity.
CONCLUSION
Even though the challenges in the management of glaucoma indeveloping countries are many, they are not
insurmountable.There is need for concerted and integrated efforts involving all cadres of eye care practitioners,
patients, institutions and governments to address this important eye disease. Improved awareness, provision of
adequate equipment,availability and affordability of medications,need for training and retraining of eye care providers
are all important measures that can lead to better management of the glaucoma patient.


Keywords

management of glaucoma indeveloping,

October -December 2015

Volume 24 | Issue 4

Page Nos. 315-322

Online since Jul 12, 2018

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