title: Is glaucoma blindness a disease of deprivation and ignorance? A case-control study for late presentation of glaucoma in India.
abstract: OBJECTIVE
  The aim was to identify the presenting symptoms and social risk factors for late presentation of primary glaucoma in newly diagnosed cases.
  
  
  METHODS
  It was a case-control study in a tertiary eye care center in Maharashtra, India. Newly diagnosed patients with primary glaucoma were classified as cases (late presenters) where there was no perception of light in one eye or severe visual field loss affecting an area within 20° of fixation or a cup-disc (C:D) ratio ≥0.8 and controls (early presenters), presenting relative scotoma within 20° of fixation or a C:D ratio <0.8, but >0.5. All patients underwent a comprehensive ocular examination including gonioscopy, perimetry, and detailed family and social history. Occupation, education, and socioeconomic status were graded. SPSS version 12.0 was used, and univariate and multivariate logistic regression analysis was performed.
  
  
  RESULTS
  Gradual progressive painless loss of vision was the commonest symptom (175, 87.5%). Primary angle closure glaucoma was more common in females (P = 0.001) and lower socioeconomic groups (P = 0.05). Patients who were less educated were more likely to have late presentation of glaucoma (P < 0.001, odds ratio = 0.07; 95% CI, 0.02-0.25). Knowledge of family history of glaucoma (P = 0.80, odds ratio = 1.16; 95% CI, 0.36-3.71) and eye clinic attendance in past 2 years still resulted in late presentation (P = 0.45, odds ratio = 1.34, 95% CI, 0.63-2.82).
  
  
  CONCLUSIONS
  Lack of education and awareness of glaucoma were major risk factors for late presentation.
authors.affiliation: HV Desai Eye Hospital, Pune, Maharashtra, India. parikshitgogate@hotmail.com
authors.forename: Parikshit
authors.initials: P
authors.lastname: Gogate
authors.forename: Roma
authors.initials: R
authors.lastname: Deshpande
authors.forename: Vidya
authors.initials: V
authors.lastname: Chelerkar
authors.forename: Swapna
authors.initials: S
authors.lastname: Deshpande
authors.forename: Madan
authors.initials: M
authors.lastname: Deshpande
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D018450:Disease Progression; D005192:Family Health; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012607:Scotoma / Q000209:etiology; D017678:Sex Distribution; D012959:Socioeconomic Factors