Knowledge, Attitudes and Practices of Diabetic Patients on Ocular Complications of Diabetes in Lomé(Togo)

Introduction: The frequency and severity of eye complications from diabetes make patient education essential, which is the basis for adequate management. What is the level of education of diabetic patients in Lomé? The aim of this study was to assess the knowledge, attitudes and practices of diabetic patients on the ocular complications of diabetes in Lomé. Methods: We conducted a cross-sectional study by surveys on diabetic patients from April 1 to June 31, 2020, in 6 diabetes management centers in Lomé. The correct response rate was established for each component. Knowledge: poor (≤ 50%), low (50% - 65%), medium (65% - 85%) and good (≥ 85%). Attitudes: harmful (≤ 50%), erroneous (50% - 65%), approximate (65% - 85%) and fair (≥ 85%). Practice: harmful (≤ 50%), inadequate (50% - 65%) and adequate (>65%). Results: Over the study period, 150 patients were enrolled. The mean age was 56.98 ± 13.37 years with a sex ratio of 1.1 (79 men/71 women). The overall level of knowledge was insufficient (50.6%) with 65.5% for general knowledge about diabetes and 35.8% for ocular complications of diabetes. Attitudes were approximate (68.7%). In the case of hyperglycemia, 31.3% of patients would confide in a diabetologist and 22.0% in a general practitioner. If decrease in vision, 84.3% of patients would contact the ophthalmologist. The level of practice was harmful (20.4%). For diabetic follow-up, 36.7% of patients have already seen an ophthalmologist, 41.3% have performed a fundus examination, 17.3% retinal angiography, 4% laser retinal photocoagulation and 2.7% intravitreal injection (IVT). An awareness session on the ocular complications of diabetes was followed by 52.7% of patients and 50.7% of patients followed a therapeutic education session. Conclusion: This study has shown that the level of knowledge was poor, attitudes approximate and practices harmful. It is therefore important to raise awareness about diabetes and its ocular complications with the aim to change behavior.

Direct Cost of Primary Open Angle Glaucoma Management

Background: There are few studies on the cost of glaucoma management in developing country, especially in Togo, there are no data on the cost of POAG management. Aims: To determine the annual direct cost of the management of POAG, to evaluate the annual economic weight of the management of POAG and to determine the factors associated with the annual economic weight of the management. Methods: We conducted a retrospective and descriptive study over a period of 12 months from January 1 to December 31, 2019 based on the records of patients followed for POAG in AFIA Eye Clinic in Lomé-Togo. The annual direct cost was defined by the sum of the costs of consultations, explorations and treatments. We defined the direct cost per patient and per year and related to the average annual income. It was said to be catastrophic at 20% or more of the estimated annual income. Chi 2 and Fisher tested the comparison of proportions. We conducted univariate and multivariate logistic regression to search correlations. Results: During the study period, 150 patient records were included. The average age was 47.24 ± 17.09 years and the sex ratio was 0.82. The cost of the diagnosis was 112.18 ± 22.26 €. The average cost of consultations was 19.46 ± 11.35 € and that of explorations was 92.71 ± 10.91 €. The annual cost of treatment per patient was 165.52 ± 110.16 €. The annual global direct cost of POAG management per patient was 277.69 ± 132.42 €. Compared to the annual income of 1166.29 €, the economic weight of the glaucoma management was 23.8%. This direct cost was catastrophic for 32.1% of patients in the study (44/150 of people with no care). Compared to the guaranteed inter-professional minimum wage (SMIG) of 640.30 €, the economic direct cost weight was 43.3%. Risk factors significantly associated with the direct cost were age over 40 (OR = 1.05 and p = 0.032), liberal profession (OR = 4.72 and p = 0.04), the absence of health insurance (OR = 6.68 and p = 0.017) and the use carbonic anhydrase inhibitors (OR = 7.4 and p = 0.012) and prostaglandin analogues (OR of 38.2 and p Conclusion: This first study on the direct cost of POAG management in Lomé showed that the economic burden glaucoma represents for the patient, his family and society. The data from this study will allow health decision-makers to adopt strategies to mitigate the effects of glaucoma on the economy.

Progression of Primary Open Angle Glaucoma on Optical Coherence Tomography of the Optic Nerve Head

Aims: To describe the progression of Primary open angle glaucoma (POAG) on Optical Coherence Tomography (OCT) of the optic nerve head and retinal nerve fiber layers (RNFL). Method: We conducted a descriptive retrospective study from January 1, 2015 to December 31, 2019, a period of 5 years from the files of patients followed for POAG and having carried out at least two OCT examinations of the optic nerve head (ONH), one automated visual field and Intraocular pression (IOP). The variables studied were: age, sex, mean IOP, glaucoma stage, progression of ONH parameters, and progression of RNFL parameters. Results: During the period, 112 eyes of 56 patients were included. The mean age was 48.96 ± 16.57 [12 - 83] years with a sex-ratio of 1.33 (32 M/27 F). The mean IOP was 21 ± 4.54 [10 - 36] mm Hg. According to the mean deviation (MD) of the visual field, 98 eyes or 87.5% were stage 1 of POAG, 10 eyes or 8.9% at stage 2 and 4 eyes or 3.6% at stage 3. The mean time between the 1st and 2nd OCT examination was 28.91 ± 11.07 [6 - 56] months, corresponding to an average of 2.18 OCT per patient in 5 years of follow-up. There was an average increase of 6.2% of the Cup area and an increase in the vertical Cup/Disc ratio of 1.79% per year. The thinning average of neuro-retinal ring area was 1.64% per year. The RNFL thickness had decreased on average by 4.28 μ or 0.93% per year. The lower quadrant had the highest fiber loss with 1.08% per year followed by the upper quadrant with a loss of 1.05% per year. Conclusion: OCT of the ONH and RNFL proves to be an essential tool in the follow-up of POAG. A subsequent study taking into account the OCT of the macular ganglion complex will enable to study its contribution in the follow-up of glaucomatous patients in the same population.