Introduction
Cataract is the major cause of reversible blindness in India, reported to be responsible for 50-80% of bilateral blindness in the country.1, 2 In India, around 12 million people suffer from glaucoma and 1.5 million are blind due to it. 3, 4 Early detection of glaucoma is often difficult due to its asymptomatic course in the initial stage. 3, 5 A large proportion of the population are actually aware about it or have knowledge about it. Awareness about the nature and risk factors of a disease is known to affect the behavior for seeking intervention.
Materials and Methods
The study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee of the institute. Informed written consent was obtained from all participants prior to their enrolment in the study. A questionnaire based cross sectional study was carried out. The questionnaire had three sections: The first section pertaining to information about the patient's demographic characteristics (age, gender, education level, occupation). Section two and three pertained to the patient's awareness and knowledge about cataract and glaucoma respectively, through 10 questions (four questions evaluating their awareness and six assessing their knowledge). The questions were divided into awareness and knowledge sub-sections, by applying standard definitions of these terms. Questions asked to assess awareness merely required information, without the need of understanding whereas the questions asked to assess knowledge required information and understanding of the subject gained through some source or learning. Each question had three options, and the respondent had to tick (√) the response of their choice. In our study we defined awareness and knowledge as 50% and 30% correct responses respectively for both cataract and glaucoma.
Hundred individuals, aged above 40 years were enrolled by random sampling. The demographic details and literacy level of the participants were collected. Diagnosed cases of cataract and glaucoma were excluded from participating, as we believed they might have acquired information about the disease after diagnosis, which would affect the true assessment of the general population. The survey was done by trained healthcare professionals, who had optimum knowledge about the diseases and the questionnaire. The questionnaire began with the entry level question in the local language (Hindi) If the response to this question was yes, the participants were allowed to take up the rest of the questions evaluating awareness and knowledge about cataract and glaucoma respectively. Having heard about the term cataract or glaucoma was not considered as awareness, because merely being aware of the term did not ensure awareness about the disease. However, not having heard the term itself meant lack of awareness.
Results
Of the 100 enrolled patients visiting the eye OPD of a tertiary healthcare centre who consented to participate in the study and answered the questionnaire, 56% were males and 44% were females. The mean age of the study population was 58.99 ± 9.51 years.
Figure 1 describes the age wise gender distribution of the study population.
The participants were classified on the basis of their level of education as illiterate, primary school, middle school, 10th pass, 12th pass, graduate and post graduate.
Chart 2 describes the education wise distribution of the study population.
Figure 2 The participants were classified on the basis of occupation as unemployed, unskilled worker, semiskilled worker, skilled worker, clerical/shopkeeper, semi-professional and professionals.
Figure 3 describes the occupation wise distribution of the study population.
81% of the total population had heard about cataract, 73% were aware and 67% had some knowledge about cataract. Awareness of cataract was not statistically significant in terms of age and gender.
Table 1
Cataract entry questions
A total of 41% of the participants had heard about glaucoma, 39% were aware and 27% had some knowledge about glaucoma.
Table 2
Glaucoma entry questions
Table 3
Awareness and knowledge about cataract and glaucoma
|
Cataract awareness |
73% |
|
Cataract knowledge |
67% |
|
Glaucoma awareness |
39% |
|
Glaucoma knowledge |
27% |
Out of the 73% having awareness about cataract, 91.78 % had knowledge about it as well.Table 3
Figure 4 describes the awareness and knowledge about cataract.
Out of 39% having awareness about glaucoma, 69.23% had knowledge about it as well.
Figure 5 describes the awareness and knowledge about glaucoma
Well educated participants were more likely to be aware about both cataract and glaucoma than lesser educated participants. The level of education had a significant association with both awareness as well as knowledge.
Of the 73% of the participants who were aware about cataract, 47.94% were aware about glaucoma as well (p=0.61708), out of which 85.71% were well educated (p=0.00001)4% were aware about glaucoma but not about cataract. Of the 67% who had knowledge about cataract, 35.82% had knowledge about glaucoma as well (p=0.85716), out of which 87.5% were well educated (p=0.00018). 2% had knowledge about glaucoma but not about cataract.
The source of information about cataract for 76.54% participants was “word of mouth” from family or friends. Another 19.75% had received information from visiting hospitals, medical personnel, eye camps or healthcare resources. Maximum participants (70.73% and 76.54% for glaucoma and cataract respectively) quoted their source of information as family or friends.
Chart 8 describes the source of information about cataract and glaucoma.
Of all the participants whose informants were either family or friends, 74.19 % were well aware about cataract and 96.55% were well aware about glaucoma.
Discussion
In this study there was no significant relationship between awareness and knowledge about cataract with age and gender and about glaucoma with gender which was in contrast to a study done by Krishnaiah et al in which males had more awareness (0.50% vs 0.10) and another study done by Sathyamangalam et al in which females had more awareness about glaucoma (Odds ratio - 1.54).6, 7 However the relationship of awareness of glaucoma was significant with age, which was similar to the study done by Sathyamangalam according to which glaucoma awareness increase with increasing age and subjects in the age groups 60 - 79 years were 2.7 to nearly 3 times more likely to be aware about glaucoma when compared to 40 - 49 years old. 6, 7
It was observed that people could confuse glaucoma for other eye conditions due to the similar terminology which was in correlation with a study done by Livington et al in which many respondents confused glaucoma with other eye conditions: 10% described it as cataract or a growth over the eye; 4% described it as trachoma, and 1% linked it with diabetes. 8 In this study, awareness and knowledge was better among individuals with higher education. None of the respondents knew that glaucoma was an asymptomatic disease, which was a matter of great concern which was similar to a study done by Lee et al in which only 10.2% could describe its symptoms correctly.9 Close acquaintances are the most common source of information on cataract and glaucoma which was similar to a study conducted by Tenkir et al in which friends were reported to be the main source (87.5%). 10, 11 Overall, the awareness about cataract and glaucoma in the Indian general population is poor, as estimated by population-based studies, that of glaucoma being worse than that of cataract.12
The limitations of the above study is that the sample size is small and the study population is drawn from a very specific practice environment i.e. a tertiary healthcare centre and thus the findings cannot be generalized to the general population. Also interviewer bias could not be completely eliminated.
Conclusion
Public awareness of both cataract and glaucoma, especially glaucoma is very low. Communicating visual prognosis by primary health clinicians and primary eye care practitioners would help enhance the knowledge among the patients and thus reduce the morbidity of both the conditions. The aims of education should focus not only on modifying individual's perception of risk of vision loss, but also on providing information regarding the benefits of early detection, long term therapy and importance of compliance to treatment. In addition, education programs should also be oriented towards the involvement of friends and family members, in supporting the seeking of eye care and in alleviating the fear or anxiety concerning treatment. Communicating and educating the general population, family members and friends by various methods should be targeted, while they visit any general hospital or eye hospitals, starting from waiting rooms to final prescription in the form of audiovisual clips, placards, charts, pamphlets etc. Initiatives can also be taken to include awareness in the general curriculum at school and college level.
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