{"id":168,"date":"2011-10-11T10:40:48","date_gmt":"2011-10-11T10:40:48","guid":{"rendered":"http:\/\/www.eyecarecaribbean.com\/site\/eyecarecaribbean\/2011\/10\/11\/glaucoma-study-fish-april-may-2010-jamaica\/"},"modified":"2011-10-11T10:40:48","modified_gmt":"2011-10-11T10:40:48","slug":"glaucoma-study-fish-april-may-2010-jamaica","status":"publish","type":"post","link":"https:\/\/www.eyecarecaribbean.com\/site\/ecc\/vision-2020-caribbean\/glaucoma-study-fish-april-may-2010-jamaica\/","title":{"rendered":"Glaucoma Study – FISH April-May 2010 Jamaica"},"content":{"rendered":"

A cross-sectional, descriptive study to measure: Knowledge, attitudinal and behavioural (social practices) effects which a positive diagnosis of glaucoma may have on affected patients of the Eye Department of the FISH Medical Clinic, Gordon Town Road, St. Andrew, Jamaica.<\/strong><\/p>\n

Researcher: Arvel Grant, B.Sc-Sw (Hons) DPA, MPH<\/strong><\/p>\n

(download the full report in pdf format here<\/a><\/em>)<\/p>\n

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Chapter 1 – Introduction<\/strong><\/p>\n

1.1           The Research Question<\/p>\n

A cross-sectional, descriptive study to measure psychological or social effects which a positive diagnosis of glaucoma may have on affected patients.<\/p>\n

1.2           The Rationale For The  Study<\/p>\n

In 2006, this researcher  undertook graduate work leading to the  Master of Public Health (MPH) in the Faculty of Medical Sciences, UWI Mona. In executing the programme, I undertook a Knowledge Attitude and Practices KAP study (with technical supervission by Dr Kenneth James, Epidemiologists and  Coordinator of the MPH programme.<\/p>\n

In analyzing the data, I noted a significant level of (seeming) fear and apprehension among glaucoma patients, towards the disease. That experience is the basis for me embarking upon this study. Preparations for this study were significantly informed by that research exercise. That study provided me with valuable insight into the presentation, treatment and prognosis of glaucoma; as well as aspects of study methods which could inform this research.<\/p>\n

Further, I have concluded that glaucoma is a major cause of incurable blindness. Such studies have identified Open Angle Glaucoma (OAG) as the leading cause of incurable blindness among persons of African descent. In a graphic illustration of this reality, a Barbados Eye Study concluded that the prevalence of glaucoma among Barbadians over-40 is one in eleven persons (BES 1992).<\/p>\n

1.3       Basis for the Study<\/p>\n

Glaucoma is currently being diagnosed in eye clinics across Jamaica. To that end, this researcher believes that every effort should be made to expand existing knowledge about how the condition (or group of disease) is understood by patients. What feelings and attitudes they have toward the condition and how their status as glaucoma patients, affect positively or negatively their social circumstances.<\/p>\n

1.4       Likely Usefulness of Study Results<\/p>\n

Inadequate knowledge, negative feelings and attitudes as well as poor social relationships and contacts, could represent an immediate and dangerous shortcoming which could lead to poor treatment compliance and incurable blindness. The extent to which such conditions are found to exist among patients diagnosed with glaucoma may   provide a basis for the implementation of appropriate patient education and counseling programs at the Eye Clinic and (possibly) encourage other eye departments to examine the phenomenon for possible action.<\/p>\n

1.5       The Hypothesis<\/p>\n

Based on a similar study done at the Eye Department of the Mandeville Regional Hospital, Jamaica, (A. Grant 2006), it is reasonable to hypothesize that glaucoma patients at the FISH Medical Clinic Jamaica, have a positive psychological disposition toward the condition.<\/p>\n

1.6       Context<\/p>\n

Increasingly, different types of studies are being undertaken about Glaucoma (mostly) in industrialized countries. However (with the exception of Barbados) no other country in the English-speaking Caribbean has benefited from the implementation of a scientifically approved study of glaucoma in its population.<\/p>\n

A search of available data bases, have revealed no evidence of studies done on the psychological effects which glaucoma may have on persons, affected by the condition, in Jamaica. At the same time, Jamaica (which has the largest segment of people of African descent in the English-speaking Caribbean) is likely to have a high prevalence of Glaucoma. Therefore, this study focuses attention on a (likely) major gap in the nation\u2019s public health. <\/span><\/p>\n

1.7       Justification and Objectives<\/p>\n

Generally, Glaucoma is an insidious condition; it is often without symptom; and very difficult to diagnose. Because of its insidious nature, the disease does not inspire its victims to urgent action to control it. Therefore, inadequate knowledge, incorrect beliefs, negative feelings and  attitudes as well as poor social relationships and contacts, could inhibit treatment compliance and lead to incurable blindness.<\/p>\n

In sum, the objectives of the study are to determine whether Glaucoma patients attending the Eye Clinic of the FISH Medical Center, experience measurable psychological and social dispositions, occurring after a diagnosis of the condition.<\/p>\n

Chapter 2 \u2013 Literature Review <\/strong><\/p>\n

A look at the available knowledge suggests that: the World Health Organization (WHO) considers Glaucoma to be the third leading cause of blindness around the World.  In the United States, Open Angle Glaucoma is considered to be the leading cause of blindness among persons of African descent. The Barbados Eye Study confirms that the disease is a major cause of blindness in the country with a prevalence of more than 9% in persons over fifty years of age. In Jamaica, not much is known about the public\u2019s understanding about the: Causes, symptoms, diagnosis, social and psychological   implications of the disease.<\/p>\n

2.1       WHO\u2019S Definition of Glaucoma<\/p>\n

According to the Bulletin of the World Health Organization (WHO) A major difficulty with glaucoma and the blindness that it can lead to is the lack of a uniformed case definition, (WHO, 2005).<\/p>\n

This International Public Health Organization confirms that \u201cGlaucoma commonly refers not to a single disease, but to a group of disorders that have certain common features, in particular:<\/p>\n

–       Cupping and atrophy of the optic nerve head;<\/p>\n

–       Characteristic visual field loss; and<\/p>\n

–       Often, but not invariably, increased intraocular pressure.\u201d WHO (2005).<\/p>\n

In emphasizing the contribution of glaucoma to blindness around the world, WHO noted that:  If available data on blindness from 1984 are updated to the 1990 global population, it can be assumed that there are currently 35 million blind persons in the world, applying the international definition of blindness as the inability to count fingers at a distance of 3 meters or 10 feet, (WHO, (2005). the organization makes the point that,  Of the above estimate, 5.2 million individuals are blind due to glaucoma indicating that this condition is responsible for 15% of global blindness. This implies that glaucoma is the third most important global cause of blindness, after cataract and trachoma, (WHO, 2005).<\/p>\n

2.2       Impact of Glaucoma on Black People:<\/p>\n

Glaucoma is the leading cause of incurable bilateral blindness among persons who are black and over forty years of age. In her article entitled Screening for Glaucoma, Mary Calvagna noted that:  In black people, open-angle glaucoma is the leading cause of blindness, and is six to eight times more common than in Caucasians. In addition, the risk among black people increases after age 40, (Calvagna M., 2005).<\/p>\n

Glaucoma develops \u2013 largely without symptoms. As the leading cause of incurable blindness among persons who are black, glaucoma is often without symptoms, until it approaches what is known as \u201cend-stage\u201d glaucoma. In her article, Calvagna argues that:   In the early stages of the disease, most cases of open-angle glaucoma present no noticeable signs or symptoms. Vision stays normal and there is no pain but even without symptoms, irreversible damage can be happening to your optic nerve, (Calvagna M., 2005).<\/p>\n

She makes the point that, the main symptom of glaucoma is loss of peripheral vision. This means that you can see things clearly in front of you, but objects to the side and out of the corner of your eye may be missed, (Calvagna, M. 2005).<\/p>\n

Glaucoma is difficult to diagnose and treat. To that end, diagnosis, treatment and prognosis of the condition are complex, but critical steps in the management of the disease. The National Eye Institute, a division of the National Institutes of Health (USA), is a leading supporter of research and related activities to manage and control Glaucoma. The Institute produces regular bulletins on the disease. In a publication posted on its Website, it was noted that the management of Glaucoma includes the following stages:<\/p>\n

–           Visual acuity test.<\/p>\n

–           Visual field test.<\/p>\n

–           Dilated eye exam.<\/p>\n

–           Tonometry (The measurement of the pressure inside the eye.)<\/p>\n

–           Tachymetry (Use of an ultrasonic wave instrument, to measure the thickness of the patient\u2019s cornea, (National Institutes of Health USA).<\/p>\n

2.3       The Barbados Eye Study (BES)<\/p>\n

Prior to 1988, meaningful population-based research on glaucoma was not undertaken in any country in the English-speaking Caribbean. Between 1988 and 1992, the National Eye Institute (USA) and the Ministry of Health (Barbados) undertook a population-based study of Open-Angle Glaucoma (OAG). The study was entitled, The Barbados Eye Study, Prevalence of Open Angle Glaucoma.<\/p>\n

The study consisted of a simple random sample of Barbadian-born citizens 40 through 84 years old. Some of the conclusions of this study included:  To our knowledge, the Barbados Eye Study is the largest glaucoma study ever conducted in a black population and identified more people with OAG than did any previous population study.<\/p>\n

The study found that \u201cThe prevalence of OAG was high, especially at older ages, and in men. Among participants 50 years or older, 1 in 11 had OAG, and prevalence increased to one in six at age 70 years or older, (Barbados Eye Study, 1994).  The researchers concluded that, the results highlight the public health importance of OAG in the Afro-Caribbean region and have implications for other populations, (Barbados Eye Study, 1994).<\/p>\n

Perhaps one of the most challenging features of glaucoma management is to prevent blindness from the condition; and not to improve vision. The whole purpose of treatment is to prevent further loss of vision. This is imperative as loss of vision due to glaucoma is irreversible, (Glaucoma foundation USA). <\/em> <\/em><\/p>\n

2.4       Psychological State of Persons with a Chronic Ailment that may lead to blindness<\/p>\n

Although the researcher was unable to find empirical data on the psychological and social effects of glaucoma, the scientific literature has quite useful data and conclusions on the psychological state of persons diagnosed with diabetes.<\/p>\n

Because (like glaucoma) diabetes is a chronic condition   which causes permanent blindness (among other disabilities) it is likely that the psychological and social effects may be similar to mental health and social consequences which may arise from a diagnosis of glaucoma.<\/p>\n

Therefore, in an effort to establish a  (possible) grounding in   psychology  for this study, this researcher examined two studies with varying conclusions regarding the psychological implications of a diagnosis of diabetes. In a randomized controlled trial of 461 outpatients with diabetes who were randomly assigned to standard care or to the monitoring condition a team of researchers in Holland investigated,  whether monitoring and discussing psychological well-being in outpatients with diabetes improves mood, glycemic control, and the patient\u2019s evaluation of the quality of diabetes care, (Francois Pouwer et al, 2001).<\/p>\n

Interestingly, the researchers found that some patients who indicated abnormal psychological states, following a diagnosis of diabetes, benefited from counseling and other types of mental health interventions. The monitoring group reported better mood compared with the standard care group, as indicated by significantly lower negative well-being and significantly higher levels of energy, higher general well-being, better mental health, and a more positive evaluation of the quality of the emotional support received from the diabetes nurse, (Francis Pouwer et al, 2001).<\/p>\n

Similar (but not identical) results were reported   in a study undertaken in two outpatient diabetes mellitus clinics in Pretoria, South Africa. The objective of that study was given as:   To determine the underlying dimensions of a social support measure and investigate the effects of social support on health, well-being and management of diabetes mellitus (metabolic control and blood pressure) BP) control,  (Margaret S. Westaway, John R. Seager et al,  2005).<\/p>\n

This researcher considers the findings of that study, most pertinent to the Jamaican situation, because of the race profile of the participants, and the likelihood of some genetic and basic cultural factors which could have resonance in the Jamaican context. It is noteworthy that the participants were 263 black diabetes mellitus outpatients (174 women and 89 men), aged between 16 and 89 years, (Margaret S. Westaway, John R. Seager, et al, 2005).<\/p>\n

Interestingly, but not surprisingly, the study found in favour of benefits to be derived from higher levels of support to persons diagnosed with diabetes. Patients with lower levels of social support had poorer general health and well-being than patients with higher levels of social support, (Margaret S. Westaway, John R. Seager, et al, 2005).<\/p>\n

The broader findings of this study seem to point the way toward more in depth studies, regarding the effects of psychological, social and in-kind support, on persons diagnosed with a range of chronic non-communicable conditions, including glaucoma. The study demonstrated that: (1) socio-emotional and tangible support was the underlying dimensions of social support; (2) socio-emotional support is an important determinant of health and well-being; and (3) social support is beneficial for one aspect of diabetes mellitus management, namely, blood pressure control, (Margaret S. Westaway, John R. Seager, Et Al, 2005).<\/p>\n

While the literature is silent regarding the possible social and psychological effects of a diagnosis of glaucoma, the data seem to suggest that, persons diagnosed with diabetes, are at risk of some degree of psychological and social deficit. This study will seek to narrow the search for evidence specifically relating to persons diagnosed with glaucoma, and attending the Foundation for International Self Help Medical Center, in Jamaica.<\/p>\n

Chapter 3 – Methodology <\/strong><\/p>\n

3.1       The Study Population<\/p>\n

The study sample of 98 (ninety eight) was   taken from the patient population of 3,963  glaucoma patients being treated at the Eye Clinic of the FISH Medical Center, in Jamaica.  The parent population for the study (case load of the Eye Clinic) stood at 13,369 patients at the end of 2008; of which 3,963 had Glaucoma. The Clinic serves a primary catchment population of 666,182 residents. The population represents the parishes of Kingston and St. Andrew.<\/p>\n

3.2       Independent Variables<\/p>\n

The study proposes to develop an \u201cobjective\u201d understanding of the issues by measuring the effects of a diagnosis of glaucoma (the independent variable) on a selection of dependent psychological variables.<\/p>\n

3.3           Dependent Variables<\/p>\n

The main dependent variables being examined are: knowledge; feelings, attitudes and social relationships.<\/p>\n

3.4       Method of data collection<\/p>\n

A structured interview, based on a pre-designed questionnaire, with accompanying instructions for the interviewer, was used. This method of data collection is based on a number of considerations, including the fact that many of the patients may, in fact, be visually impaired and\/or affected by poor levels of literacy.<\/p>\n

3.5       Research procedures:<\/p>\n

This involved the following activities:<\/p>\n