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239]

Original Article

Glaucoma awareness and knowledge in

a tertiary care hospital in a tier‑2 city in
South India
Mridula Prabhu,
Shankargouda H. Patil,
Pravin Chandra R. Kangokar1
Departments of Ophthalmology,
1
Community Medicine, S D M College of
Medical Sciences and Hospital, Sattur,
Dharwad, Karnataka, India
Address for correspondence:
Dr. Mridula Prabhu,
Department of Ophthalmology, S D M
College of Medical Sciences and Hospital,
Sattur, Dharwad, Karnataka, India.
E‑mail: mridulaprabhu@rediffmail.com
Abstract
Background: Awareness of glaucoma is low in spite of being the second leading cause of
preventable blindness in the world. Aim: To study the awareness and knowledge levels
of glaucoma in a tertiary eye care hospital in a tier‑2 city. Materials and Methods: This
is a hospital‑based crosssectional study. A total of 704 patients attending ophthalmology
outpatient department of Sri Dharmasthala Manjunatheshwara College of Medical
Sciences and Hospital (SDM) Dharwad, aged 40 years and above were administered a
questionnaire after a written informed consent to assess their awareness and knowledge
levels of glaucoma. Subjects “having heard of glaucoma” even before they were recruited
for the study were defined as “aware”, and subjects having some understanding of the eye
disease were defined as “knowledgeable”. Results: Out of 704 subjects recruited for the
study, only 34 (4.8%) subjects were aware of glaucoma and 22 (3.1%) had some knowledge of
glaucoma. Determinants of glaucoma awareness were higher levels of education, diabetes,
or glaucoma and family history of glaucoma. Conclusion: Awareness and knowledge of
glaucoma was very low among the subjects. The findings of the study stress the need for
health awareness for effective prevention of blindness due to glaucoma.
Key words: Awareness, glaucoma, hospital‑based study, knowledge, south India

INTRODUCTION There are numerous avenues to improve the prevention

Blindness is a concern world over. It affects a person
socio‑economically, and the government’s spending
toward health.[1] This is more so in a developing country
like India. Glaucoma is the second leading cause of
visual loss in the world. The prevalence of glaucoma
worldwide is 67 million and 6.6 million people are
blind due to glaucoma.[2] Blindness due to glaucoma is
irreversible but preventable. In India, glaucoma is the
third most common cause of blindness with a prevalence
of 5.8% among the blind, next to cataract and uncorrected
refractive errors.[3] Nearly half of the blind people are
unaware of their condition.[4]
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DOI:
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Journal of the Scientific Society, Vol 40 / Issue 1 / January-April 2013
of blindness from glaucoma, but improved early
detection offers the most potential. Social perceptions
of health have changed globally; there is an impetus to
move toward good health by using resources efficiently
for preventive measures.[5]
There are various factors which influence awareness
like level of education, family history, publicity by
media, and information distribution by government
agencies and non‑governmental organizations (NGO).
The reason for undertaking this study is that previous
studies done in India were mainly concentrated in
tier‑1 cities or at the rural level. [5‑7] We conducted
this study at SDM College of Medical Sciences and
Hospital which is a tertiary hospital situated in tier‑2
city namely Dharwad, Karnataka state, India. Tier‑2
cities are more in India and they consist of a mixture
of both urban and rural population. Hence, this
study was aimed at understanding the awareness
and knowledge about glaucoma in a tertiary eye care
hospital in a tier‑2 city.
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Prabhu, et al.: Glaucoma awareness and knowledge in a tier 2 city

MATERIALS AND METHODS Analysis was performed using the statistical software
IBM SPSS Statistics version 20 © copyright IBM
A sample size of 704 was calculated based on 13.3% Corporation 2010, New York 10589, USA. The Chi‑square
prevalence of glaucoma awareness in the population test and Fisher exact probability test were used to
above 40 years with an alpha error of 5% and a precision look for significant associations in awareness and
level of 10%. [5] The subjects were defined as every knowledge about glaucoma with other studied variables.
third patient above 40  years attending ophthalmology A probability (P) value less than 0.05 was considered
outpatient department of SDM medical college on statistically significant.
Tuesday, Thursday, and Saturday which happened to be
the outpatient days allotted to the investigator. We started RESULTS
on Jan 3, 2012 and stopped on June 30, 2012. Patients aged
less than 40 years and patients’ attenders were excluded. The questionnaire was administered to a total of 704
subjects and the answers were analyzed. (Response rate
Written informed consent was obtained from all subjects 100%). Among the subjects, 375 (53.3%) were males and
and the study was performed in accordance with the 329 (46.7%) were females. The mean age of the subjects
tenets of the Declaration of Helsinki. The Institutional was 54 ± 11 years. The minimum age was 40 years and
ethical committee clearance was taken from SDM College the maximum age was 90 years. The proportion of subjects
of Medical Sciences and Hospital. in each age cohort from 40 to 70 years was uniform. The
rural:urban ratio was 48.7:51.3 and the majority religion
Demographic details and literacy levels of all subjects were was Hindu (92.9%). Among the subjects, 153 (21.7%)
obtained. A brief structured open‑ended questionnaire were illiterates and 180 (25.6%) were college educated.
was designed to record information about the subject’s 175 (24.9%) subjects were diabetic, 12 (1.7%) had glaucoma,
awareness and knowledge about glaucoma [Annexure and 5 (0.7%) subjects had family history of glaucoma.
1]. The questionnaire was initially developed in English
and all the questions were translated into the two Table 1 shows frequency distribution of awareness
and knowledge of glaucoma among subjects. Out
most common languages Kannada and Hindi if the
of 704 subjects, only 34 (4.8%) subjects had heard of
subjects could not follow English. The questionnaire
was interviewer administered. The questionnaire was
administered prior to the history taking and examination Table 1: Frequency distribution of awareness and
procedures carried out for glaucoma. Details on the knowledge of glaucoma among subjects
Variables Total n=704
knowledge about glaucoma were obtained only for
Awareness Yes (%)
subjects who were aware of glaucoma.
Have you ever heard of the eye condition 34 (4.8)
glaucoma
Awareness and knowledge about glaucoma Not aware of glaucoma 670 (95.1)
Definition Knowledge
Subjects “having heard of glaucoma” even before being Risk factors for glaucoma
recruited for the study were defined as aware and One factor
patients who were having some understanding of the eye Obesity 3 (0.43)
disease were defined as knowledgeable. Knowledge was Increased IOP 14 (1.99)
graded as good, fair, and poor by two ophthalmologists Steroids 3 (0.43)
independently based on the subjects’ collective responses Chronic smoking+alcohol using 6 (0.85)
to questions on glaucoma. Family history of glaucoma 11 (1.56)
Diabetes 15 (2.13)
Two factors
Subjects were considered to have good knowledge, if they
IOP and steroids 2 (0.28)
were able to identify the risk factors for glaucoma such as
IOP and family history 7 (0.99)
increased intraocular pressure, family history, steroid use,
Steroids and family history 3 (0.43)
and able to meaningfully describe the condition along Three factors
with identifying treatment options. Fair knowledge was IOP, steroids and family history 2 (0.28)
considered if at least two of the risk factors were identified Risk factors not known 15 (2.13)
and a description of at least one treatment option was Meaningful description of glaucoma
correctly provided. Subjects were considered to have poor Increased IOP, eye pressure 14 (1.99)
knowledge, if they were not able to identify more than Loss of side vision 9 (1.28)
a single/no risk factor or treatment option for glaucoma. IOP=Intraocular pressure

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Prabhu, et al.: Glaucoma awareness and knowledge in a tier 2 city

glaucoma (awareness  =  4.8%). In the latter group, 12
had only heard about glaucoma but had no further
knowledge of glaucoma. Among the 22 (3.1%) subjects
who had knowledge, 12 had poor knowledge, 5 had fair
knowledge, and remaining 5 had good knowledge. Only
18 subjects knew that glaucoma was treatable.
Table 2 shows determinants of awareness of glaucoma.
There was no association between awareness and gender,
age group, residence, religion. The awareness was
significantly related to the educational status, diabetics,
glaucoma patients, and subjects with family history of
glaucoma.
Table 3 shows awareness comparison across genders
with education level. There was no significant difference
in awareness across genders.
The source of information for awareness of glaucoma was
A doctor in 16 (2.27%) subjects
Mass media in 14 (1.99%) subjects
Friend or glaucoma person in 4 (0.57%) subjects.
7 (0.99%) subjects thought that visual loss due to glaucoma
was permanent, 4 (0.57%) thought it was reversible, and
the remaining 23 (3.27%) subjects did not know whether
visual loss due to glaucoma was permanent or reversible.
Table 4 shows the subjects knowledge level on treatment
options for glaucoma.
Table 5 compares the current and past studies on
awareness and knowledge.
DISCUSSION
Glaucoma is one of the leading causes of irreversible
blindness in developing nations. It is one of the major
causes of ocular morbidity that needs urgent attention.[8] As
the population of elderly group is increasing the incidence
of glaucoma is bound to increase. To our knowledge this
is the first tertiary care hospital‑based study in a tier‑2
city conducted to know the awareness about glaucoma in

Table 2: Determinants of awareness of glaucoma

Variable Rate Aware Not aware Odds ratio and P by (Chi‑square/
in % n=34 n=670 95% CI Fisher exact test)
Gender 0.17 NS
Male 5.87 22 353 1
Female 3.65 12 317 0.61 (0.30-1.25)
Age group 0.47 NS
40‑49 3.74 7 180 1
50‑59 6.09 12 185 1.67 (0.64‑4.33)
60‑69 6.03 12 187 1.65 (0.64‑4.29)
70‑79 1.98 2 99 0.52  (0.10−2.55)
>80 5.0 1 19 1.35  (0.16−11.60)
Residence 0.11 NS
Rural 3.50 12 331 1
Urban 6.09 22 339 1.79 (0.87-3.68)
Religion 0.36 NS
Hindu 4.59 30 624 1
Muslim 7.14 3 39 1.60 (0.47‑5.47)
Christian 20 1 4 5.2 (0.56‑47.96)
Others 0 3
Literacy <0.00 Significant
Illiterate 0.65 1 152 1
Primary 0.74 1 134 1.93  (0.07−18.31)
Secondary 4.24 10 226 6.73 (0.85‑53.08)
College 12.2 22 158 21.16  (2.81−158.97)
Diabetic status 0.02 Significant
Non‑diabetic 3.7 20 509 1
Diabetic 8% 14 161 2.21 (1.09‑4.48)
Glaucoma status <0.00 Significant
Non‑glaucoma patient 3.6 25 667 1
Glaucoma patient 75 9 3 80.04 (20.41-313.83)
Family history of glaucoma <0.00 Significant
No 4.15 29 670 1
Yes 100 5 0 infinity

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Prabhu, et al.: Glaucoma awareness and knowledge in a tier 2 city

India. There are two such studies reported from Ethiopia 3.1% which was less compared to urban Chennai and
and Singapore in tertiary hospitals.[9,10] Hong Kong studies.[5,12]

In our study, 4.8% (34/704) of people were aware In our study, awareness with respect to gender, age,
of glaucoma, which appears to be lower than that residence, and religion is not significant; this was consistent
found in urban Chennai (13.3%), while higher than with studies done elsewhere.[9] But when we compared the
that found in rural (0.33%) southern India and urban awareness with respect to literacy rate, out of 34 people
Hyderabad (2.4%).[5‑7] It is noteworthy that these Indian except 1, all had basic primary education. Among the
studies were population‑based epidemiologic surveys educated, the awareness increased exponentially [Table 2].
on either rural or urban population, and different age It was more significant in people educated above college
group criteria were used in two of these studies; hence, a level. This shows that higher the education level, they are
direct comparison may not be applicable. The awareness more likely to be aware of glaucoma which was similarly
level was very low compared to reports from developed noted in other studies.[5‑7,9‑14] Another point in our study
nations but higher compared to developing nations like is that there was no significant gender difference in terms
Nepal (2.4%) and Ethiopia (2.4%).[9,11] Knowledge was of numbers who were educated till secondary level in
the aware group. But there was a tendency toward low
Table 3: Awareness comparison across genders (n=34) awareness in women in college level educated people
Education level Males Females Total though statistically not significant  (P  =  0.08) [Table 3].
Up to secondary level 6 6 12 This point again stresses that female education needs to
College level 16 6 22 be given more importance in India. In the present study,
Total 22 12 34 12 (1.7%) persons were having glaucoma, but among
Chi square=2.89, DF=1, P Yates=0.089 these, 9 people were aware of glaucoma and 3 people
were unaware of their glaucoma status and all the 3 were
Table 4: Frequency distribution of treatment procedures illiterates. This point highlights the above literacy factor.
for glaucoma among subjects
Variables: Therapies for treating glaucoma Total n=704 Diabetic patients were more aware of glaucoma. This
Yes (%)
is probably because there are an estimated 50.8 million
Is glaucoma treatable? 18 (2.56)
diabetics in India.[15] At some point of time, these people
Awae of only a single therapyre of only a
single therapy
visit doctor where the treating doctor might have given
Eye drops 11 (1.56) education regarding ocular problems in diabetes. This
Surgery 9 (1.28) also supports our study report that doctors were the main
Laser treatment 6 (0.85) source of information in 16 (2.27%) patients regarding
Aware of two therapies awareness of glaucoma, which was followed by media
Eye drops and surgery 4 (0.57) 14  (1.99%), and family history 4  (0.57%). This differs
Eye drops and laser 4 (0.57) from other studies that the media in rural area and the
Surgery and laser 1 (0.14) family/friend in urban area were the main sources of
Aware of more than two therapies awareness in previous studies.[6,7] Those with family
Eye drops, surgery and laser 2 (0.28) history of glaucoma and glaucoma patients themselves
Treatment not known 11 (1.56) were more aware similar to other studies.[5,10,13] Family
Can’t say/No Answer 5 (0.71) history of glaucoma certainly plays a significant role in

Table 5: Glaucoma awareness and knowledge levels across the globe

Author Year Country Study population Awareness of Knowledge of
Glaucoma % Glaucoma %
Present study 2012 India Tertiary eye hospital patients‑Adults 40 years and above 4.8 3.1
Sathyamangalam et al. 2004 India Urban population–Adults above 40 years 13.30 8.70
Dandona et al. 2001 India Urban population–Above 15 yrs 2.30 2.0
Krishnaiah et al. 2005 India Rural population: Above 15 yrs 0.27 Not reported
Thapa et al. 2011 Nepal Community‑aged 40 years and above 2.4 Not reported
Tenkir et al. 2011 Ethiopia Community aged 40 years and above 2.4 Not reported
Saw et al. 2003 Singapore Tertiary eye hospital patients‑Adults 35 yrs and above 23 Not reported
Lau et al. 2002 Hong Kong Community‑Adults above 40 years 78.40 10.20
Gasch et al. 2000 United States General eye service patients–All Ages 72 Not reported
Livingston et al. 1995 Australia Community–Adults above 40 yrs 79 19

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Prabhu, et al.: Glaucoma awareness and knowledge in a tier 2 city
creating awareness. There were five aware subjects with
family history even though four were non‑glaucoma
subjects. Even though doctors and family history create
good awareness, it reaches a limited group of people
only. Hence, we believe that media can play a bigger role
in creating awareness as it is cost effective and reaches the
masses, as telecast reaches every corner of the country.
LIMITATIONS OF OUR STUDY
It was a hospital‑based study and not community based.
The community‑based studies may yield much lower
awareness and knowledge proportions as the public
have much less contact with the patients.
Though there are many eye camps conducted by
government for comprehensive eye care, the public
awareness of potentially blinding condition like
glaucoma remains low. Effective health education may
influence individuals to undergo screening for eye
diseases. This may lead to early detection of glaucoma
and prevention of blindness. Educating the public on
the consequences of delayed treatment of glaucoma
will be an important factor in promotion of preventive
ophthalmic care. It is understood that health education
sessions have to be conducted in a language which the
target individual understands.
CONCLUSION
Awareness and knowledge of glaucoma is low. An efficient
Information, Education and Communication (IEC)
strategy needs to be designed to increase the awareness
and knowledge levels of glaucoma and thus reduces
blindness due to glaucoma.
ACKNOWLEDGMENT
We would like to acknowledge and thank Dr. Praveen Bagalkot
for all the support and help in completing this study
Annexure 1: Questionnaire
Name
Age
Sex  Male
Address  Rural
Religion  Hindu
Literacy  Illiterate
 Primary (1-5 years of education)
 Secondary (5-10 years of education)
 College (10+2 to degree or more)
Journal of the Scientific Society, Vol 40 / Issue 1 / January-April 2013
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8. Thomas R, Korah S, Padma P. Glaucoma an emerging cause for preventable
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attending ophthalmic outreach services in southwestern Ethiopia. BMC
Ophthalmol 2010;10:17.
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Awareness of glaucoma and health beliefs of patients suffering primary
acute angle closure. Br J Ophthalmol 2003;87:446‑9.
11. Thapa SS, Berg RV, Khanal S, Paudyal I, Pandey P, Maharjan N, et al.
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How to cite this article: Prabhu M, Patil SH, Kangokar PR.
Glaucoma awareness and knowledge in a tertiary care hospital in
a tier-2 city in South India. J Sci Soc 2013;40:3-8.
Source of Support: Nil. Conflict of Interest: None declared.
 Female
 Urban
 Christian  Muslim
(Contd...)
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Prabhu, et al.: Glaucoma awareness and knowledge in a tier 2 city

Annexure 1: Questionnaire (Contd....)

Mother tongue  Kannada  Hindi  English Others
Diabetic status  Non-diabetic  Diabetic
Glaucoma status  Non- glaucoma  Glaucoma
Family h/o glaucoma  yes  No

Awareness of glaucoma
Have you ever heard of the eye condition glaucoma  Yes  No  Can’t say
Source of awareness  TV  Newspapers  Radio  Magazines
 Friends  Glaucoma person  Doctor

Knowledge about glaucoma

1. Tick the possible risk factors for glaucoma
 Obesity  Increased IOP
 Steroids  Chronic smoking and alcohol intake
 Family h/o of glaucoma  Diabetes
 None of the above  Can’t say
2. Description of glaucoma- record all mentioned symptoms
 Increased IOP, eye pressure
 Loss of side vision
3. Is visual loss  Permanent  Reversible  Can’t say
4. Is glaucoma treatable  Yes  No  Can’t say
5. What are the therapies for treating glaucoma that are currently available. Tick the appropriate choices
 Medicines – eye drops
 Surgery
 Laser treatment
 No treatment available
 Can’t say

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