Intraocular pressure screening during high-volume cataract surgery outreach in Ethiopia

INTRODUCTION: Glaucoma is the leading cause of irreversible blindness worldwide and is often undetected in resource-limited settings. Early screening and treatment of elevated intraocular pressure (IOP) reduces both the development and progression of visual field defects. IOP screening in developing countries is limited by access to ophthalmic equipment, trained ophthalmic staff, and follow up. High-volume cataract surgery outreaches in resource-limited countries provide ample opportunity for glaucoma screening, intervention and follow up. METHODS: This prospective cross-sectional study took place during a cataract outreach campaign sponsored by the Himalayan Cataract Project (HCP) in partnership with Felege Hiwot Hospital in Bahir Dar, Ethiopia, during April 5th – April 10th 2021. IOP was measured on the surgical eye of patients before undergoing small incision cataract surgery (SICS) using rebound tonometry with an iCare tonometer model IC100. RESULTS: Intraocular pressure (IOP) was measured in 604 eyes of 595 patients who received SICS. Mean IOP was 12.1 mmHg (SD = 5.0 mmHg). A total of 29 patients had an IOP greater than 21 mmHg representing 4.8% of total IOP measurements. A total of 17 patients received oral acetazolamide prior to surgery to acutely lower IOP. Six of these patients had their surgery delayed due to elevated IOP and 9 patients received excisional goniotomy at the time of SICS. A temporal approach during SCIS was taken for all patients with elevated IOP to allow for possible trabeculectomy at a future date. DISCUSSION: IOP screening during high-volume cataract outreach campaigns can be performed safely, accurately and on a large scale with minimal resources and supplemental training. Pre-operative IOP measurement can improve surgical care at the time of cataract surgery as well as help establish long-term follow up for patients with glaucoma.