Knowledge about primary open angle glaucoma among medical students

Saulo Costa Martins Marcos Henrique Mendes Ricardo Augusto Paletta Guedes Vanessa Maria Paletta Guedes Alfredo Chaoubah About the authors

Abstracts

Objetivo:

Avaliar o conhecimento dos alunos de graduação do curso de Medicina da Universidade Federal de Juiz de Fora em relação ao glaucoma primário de ângulo aberto.

Métodos:

Neste estudo transversal, aplicou-se aos alunos dos 5º e 6º ano um questionário contendo 11 questões referentes a epidemiologia, fatores de risco, sintomas, diagnóstico, tratamento, consequências do glaucoma e por último se consideram os conhecimentos adquiridos na universidade como suficientes. Características dos alunos (idade, sexo, especialidade pretendida) foram identificadas.

Resultados:

Entre os estudantes, 52,9% eram mulheres. A origem genética da doença foi identificada por 22,5%. Quase a metade (46,1%) não sabia que o glaucoma na maioria das vezes é assintomático. Aproximadamente 1 em cada 3 alunos não sabia que a cegueira do glaucoma era irreversível. A grande maioria (91,2%) identificou corretamente que a tonometria era um exame importante na avaliação do glaucoma e que o tratamento poderia ser clínico (70,6%) ou cirúrgico (71,6%). Porém, poucos alunos deram a real importância para os exames de fundoscopia (35,3%) e campimetria (28,7%). Quase a totalidade (95,1%) dos entrevistados considerou o próprio conhecimento como insuficiente.

Conclusão:

A maioria dos entrevistados acha que o conhecimento sobre glaucoma primário de ângulo aberto adquirido na graduação é insuficiente. Tal desconhecimento pode levar a oportunidades de diagnóstico perdidas e gerar consequências graves tanto do ponto de vista individual (cegueira) quanto do ponto de vista coletivo (impacto para o sistema de saúde e sociedade).

Glaucoma de ângulo aberto/diagnóstico; Glaucoma de ângulo aberto/prevenção & controle; Oftalmologia/educação; Estudantes de Medicina; Educação em graduação de Medicina


Objective:

To assess the knowledge of primary open-angle glaucoma among medical students from Federal University of Juiz de Fora.

Methods:

In this cross sectional study, we conducted a survey among students attending the last two years of Medical School. The questionnaire consisted in 11 questions about epidemiology, risk factors, symptoms, diagnosis, treatment and primary openangle glaucoma (POAG) consequences. The students were also asked if they considered their knowledge about POAG sufficient. Students’ characteristics (age, sex and intended area of specialization) were identified.

Results:

Women comprised 52.9% of the students. Only 22.5% identified POAG as having a genetic origin. Almost half of them (46.1%) did not know that POAG is asymptomatic and 1 out of 3 students did not know that glaucoma blindness is irreversible. The great majority (91.2%) correctly identified tonometry as an important tool for diagnosis and that glaucoma can be treated through medications (70.6%) or surgery (71.6%). However, few students identified fundoscopy (35.3%) and perimetry (28.7%) as important tools for glaucoma assessment. Almost everyone (95.1%) considered their knowledge insufficient.

Conclusion:

The majority of the participants believe that their knowledge of POAG is insufficient. This gap can lead to some serious consequences from both individual (blindness) and collective (negative impact in health system and society) perspectives.

Glaucoma, open-angle/diagnosis; Glaucoma, open-angle/prevention & control; Ophthalmology/education; Medical, students; Education, medical


INTRODUCTION

Glaucoma is a chronic optic neuropathy with marked changes in the optic disc and the retinal nerve fibre layer, leading to significant visual field changes(1Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
http://www.sbglaucoma.com.br/pdf/consens...

National Health and Medical Research Council (NHMRC). A guide to glaucoma for primary care providers. A companion document to NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma. Camberra, Australia: NHMRC; 2011. Disponível em: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp113_b_glaucoma_guide_healthcare_workers.pdf
http://www.nhmrc.gov.au/_files_nhmrc/pub...
-3Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363(9422):1711-20. Review.).

The disease is classified according to the mechanisms of obstruction of aqueous humour drainage as primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG), and secondary glaucoma(4Shields MB, Ritch R, Krupin T. Classifications of the glaucomas. Ritch R, Shields MB, Krupin T, editors. The glaucomas. 2nd ed. St. Louis: Mosby; 1996. vol. 2.).

According to the World Health Organization, glaucoma is the second leading cause of blindness in the world (12.3%) after cataract (47.8%). Studies in Brazil have found a prevalence of 3,4% for glaucoma, with POAG being the most prevalent type (2.4%)(1Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
http://www.sbglaucoma.com.br/pdf/consens...
). It is important to note that cataract blindness can be reversed with surgical treatment, while glaucoma blindness is irreversible(5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.).

Several predictive and prognostic risk factors have been described for POAG, such as increased intraocular pressure (IOP), family and genetic history, ethnic origin, myopia, and diabetes mellitus(1Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
http://www.sbglaucoma.com.br/pdf/consens...
,2National Health and Medical Research Council (NHMRC). A guide to glaucoma for primary care providers. A companion document to NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma. Camberra, Australia: NHMRC; 2011. Disponível em: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp113_b_glaucoma_guide_healthcare_workers.pdf
http://www.nhmrc.gov.au/_files_nhmrc/pub...
). Of these, IOP is more consistently associated with glaucoma and is the most important factor, as it is the only one that can be acted upon effectively(1Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
http://www.sbglaucoma.com.br/pdf/consens...

National Health and Medical Research Council (NHMRC). A guide to glaucoma for primary care providers. A companion document to NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma. Camberra, Australia: NHMRC; 2011. Disponível em: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp113_b_glaucoma_guide_healthcare_workers.pdf
http://www.nhmrc.gov.au/_files_nhmrc/pub...
-3Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363(9422):1711-20. Review.).

The disease is asymptomatic in its early stages, and its insidious onset often leads to late diagnosis(1Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
http://www.sbglaucoma.com.br/pdf/consens...

National Health and Medical Research Council (NHMRC). A guide to glaucoma for primary care providers. A companion document to NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma. Camberra, Australia: NHMRC; 2011. Disponível em: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp113_b_glaucoma_guide_healthcare_workers.pdf
http://www.nhmrc.gov.au/_files_nhmrc/pub...
-3Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363(9422):1711-20. Review.).Thus, it is estimated that over half of glaucoma cases remain undiagnosed and untreated(6Guedes RA, Guedes VM. Custo crescente em glaucoma: atualidades e seu impacto na saúde coletiva. Revista APS. 2008;11(4):444-50.,7Póvoa CA, Nicolela MT, Valle AL, Gomes LE, Neustein I. Prevalência de glaucoma identificada em campanha de detecção em São Paulo. Arq Bras Oftalmol. 2001;64(4): 303-7.).

Given that ophthalmic consultations represent 9% of all medical visits and that ophthalmologists are unevenly distributed throughout the country, it is clear that general practitioners have an important role in the prevention of blindness(8Manica MB, Corrêa ZM, Marcon IM, Telichevesky N, Loch LF. O que os pediatras conhecem sobre afecções oculares na criança? Arq Bras Oftalmol. 2003;66(4):489-92.,9Silva MR. O Ensino da Oftalmologia. Rev Bras Oftalmol. 2009; 68(3):127-8.).

In this context, medical education should train medical students to diagnose, refer patients appropriately, and even treat some of the most prevalent and disabling eye diseases, including glaucoma(5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.,1010 Lopes Filho JB, Leite RA, Leite DA, Castro AR, Andrade LS. Avaliação dos conhecimentos oftalmológicos básicos em estudantes de Medicina da Universidade Federal do Piauí. Rev Bras Oftalmol. 2011;70(1):27-31.,1111 Temporini ER, Kara-José N, Gondim EL, Dantas FJ. Conhecimentos sobre saúde ocular entre profissionais de um hospital universitário. Medicina (Ribeirão Preto). 2002;35(1):53-61.). For POAG in particular, students should learn to identify its key risk factors, refer patients for glaucoma testing, and stress the importance of prevention, especially in higher-risk cases. Medical education should also stress the need to promote adhesion to continuous treatment, which contributes to reducing disease progression(5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.).

However, studies have shown that the basic knowledge of ophthalmology among undergraduate students is insufficient, suggesting the need to reassess the way ophthalmology is taught in medical school(8Manica MB, Corrêa ZM, Marcon IM, Telichevesky N, Loch LF. O que os pediatras conhecem sobre afecções oculares na criança? Arq Bras Oftalmol. 2003;66(4):489-92.,1010 Lopes Filho JB, Leite RA, Leite DA, Castro AR, Andrade LS. Avaliação dos conhecimentos oftalmológicos básicos em estudantes de Medicina da Universidade Federal do Piauí. Rev Bras Oftalmol. 2011;70(1):27-31.).

It is thus important to study the knowledge of POAG among students who will soon become general practitioners, offer them appropriate training, and contribute to discussions on curriculum reform.

The aim of this study was to assess the level of knowledge of POAG among students in the last two years of Medical School in the Federal University of Juiz de Fora, Brazil.

METHODS

A cross-sectional observational study was conducted from August to September 2012.The sample included medical students of the Federal University of Juiz de Fora (UFJF), and a sampling error of ±4.5% was considered. The study subjects were approached while in the university, being randomly selected and invited to answer the questionnaire voluntarily, free of any charge.

Inclusion criteria were: medical students over 18 years of age attending the 9th, 10th, 11th or 12th semesters and immediately available to answer the questionnaire. Students in other semesters, who were not immediately available to answer the questionnaire, who refused to participate, who did not answer the questionnaire in full, or who did not provide their Free and Informed Consent were excluded from the study.

Participants were approached in a standardised manner by a trained researcher, having previously provided their free and informed consent to answer the questionnaire individually and voluntarily. Two medical students were responsible for data collection. Training on data collection was done during a pilot study conducted on 16 subjects in order to test the instrument, identify difficulties in understanding the questions, make appropriate changes to the questionnaire, and organise the field work.

The data collection instrument was a structured questionnaire (Appendix 1) including 11 questions on the risk factors, symptoms, diagnosis, treatment, and consequences of glaucoma, aimed at testing the knowledge of subjects about the condition. Student characteristics (age, sex, and the medical specialty they intended to pursue) were collected.

SPSS software (SPSS Inc., Chicago, USA) was used to prepare the database and for statistical analysis. Results were analysed using a confidence interval of 95% and a p-value under 0.05.

The study followed the guidelines on human research provided for in Resolution 196/96 of the Brazilian National Health Council/Ministry of Health. The study was submitted to the Research Ethics Committee of Santa Casa de Misericórdia Hospital in Juiz de Fora, having been approved under Opinion 73374/2012.

RESULTS

In total, 102 students were invited and agreed to participate in the study.They were distributed as follows: 25 in the 9th semester, 27 in the 10th semester, 25 in the 11th semester, and 25 in the 12thsemester. The mean age (± standard deviation) of respondents was 24.9 (±2.2) years. Most respondents (52.9%) were female.

Only 2.9% of respondents intended to specialise in ophthalmology, while 80.4% intended to pursue another medical specialty and 16.7% had not yet chosen a specialty.

A family history of glaucoma was found in 15.7% of respondents. Approximately 7% were unaware of glaucoma cases in their family, while most respondents (76.5%) stated there were no cases of the disease in their family.

Figure 1 shows the responses of students when asked about the leading cause of irreversible blindness worldwide. Most students (59.8%) gave the correct answer, glaucoma. However, 25.5% of respondents chose diabetic retinopathy. All students intending to specialise in ophthalmology answered correctly, but among the other students (those intending to pursue another specialisation, or still undecided), 26.3% thought the correct answer was diabetic retinopathy.

Figure 1
Leading cause of irreversible blindness, according to respondents.

Glaucoma blindness was classified as irreversible by 64.7% of respondents, but 17.6% thought it was reversible with some treatment, and a similar number did not know the answer, i.e. 35.3% of students (approximately 1 in 3) did not know that glaucoma blindness is irreversible. There were no significant differences between answers when respondents were grouped based on their intended medical speciality (p = 0.964, chi-squared test), study semester (p = 0.076, chi-squared test), or a family history of glaucoma (p = 0.122, chi-squared test).

POAG was identified as the most common type of glaucoma by 58.8%, but 19.6% (1 in 5) did not know what the answer. Again, no differences were found between groups based on intended medical speciality (p = 0.387, chi-squared test), study semester (p = 0.045, chi-squared test), or a family history of glaucoma (p = 0.782, chi-squared test).

Most students (67.6%) wrongly thought IOP was a causal factor of POAG. Only 22.5% correctly identified genetic factors as a cause of POAG, and 16.7% did not know the answer. There were no differences between groups based on intended medical speciality, study semester, or a family history of glaucoma.

Figure 2 shows the variables identified by the respondents as risk factors for POAG. High IOP was mentioned by 88.2% of students, but many other important factors were missed by most students, including: hypertension (49%); diabetes mellitus (26.5%); myopia (4.9%); ocular trauma (15.7%); corticosteroids (43.1%); and black race (15.7%). A family history of glaucoma was correctly identified as a risk factor by 72.5% of respondents. There were no differences between groups based on intended medical speciality, study semester, or a family history of glaucoma.

Figure 2
Risk factors of primary open-angle glaucoma, according to respondents.

In total, 15.7% of respondents stated they did not know what the signs and symptoms of POAG were. Only 53.9% correctly replied that POAG was asymptomatic. Several signs and symptoms were mentioned by respondents as part of the clinical picture of POAG: sudden loss of central vision (24.5%); eye pain (33.3%); red eye (9.8%); tearing (11.8%); periocular headache (24.5%); frontal headache (5.9%); photophobia (11.8%). There were no differences between groups based on intended medical speciality, study semester, or a family history of glaucoma.

The vast majority of respondents (91.2%) correctly replied that tonometry (IOP measurement) is an important test in the assessment of glaucoma. However, only 35.3% considered fundus examination and 28.7% considered perimetry as important tests for glaucoma. There were no differences between groups based on intended medical speciality, study semester, or a family history of glaucoma.

Figure 3 shows the distribution of answers regarding the treatment of glaucoma. Most respondents correctly replied that glaucoma can be treated medically (70.6%) and surgically (71.6%). Laser therapy, however, was only mentioned as a treatment alternative by 23.5% of respondents. There were no differences between groups based on intended medical speciality, study semester, or a family history of glaucoma.

Figura 3
Possibilidades de tratamento do glaucoma primário de ângulo aberto segundo os entrevistados

Figure 4 shows the proportion of respondents who considered they had learned enough about POAG during their medical studies.

Figura 4
Proportion of respondents who thought they had acquired sufficient knowledge on primary open-angle glaucoma during medical school.

DISCUSSION

This study found that students in the last two years of medical school at the Federal University of Juiz de Fora feel unable to identify the main epidemiological and clinical characteristics and the therapeutic possibilities for POAG. This was confirmed by their responses to the standardised questionnaire used in this study.

General clinical knowledge is key to increasing the number of early POAG diagnoses and therefore the number of patients who receive treatment. Furthermore, misconceptions and knowledge gaps are important barriers to preventive eye health actions(5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.,1212 Espíndola RF, Rodrigues BA, Penteado LT, Tan-Ho G, Gozzan JO, Freitas JA. Conhecimento de estudantes de medicina sobre o processo de doação de córneas. Arq Bras Oftalmol. 2007;70(4):581-4.). Assessing the knowledge of medical students in the last years of medical school is a tool that can be used to prompt reflections on the knowledge of physicians, as many of those students will soon be managing patients(5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.).

This assessment is particularly relevant because an increase in the prevalence of glaucoma is expected worldwide as a result of population ageing and insufficient ophthalmic resources for effective intervention against the condition(5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.).

In our sample, most respondents correctly ranked glaucoma as the most prevalent cause of irreversible blindness worldwide, although approximately one quarter of them thought the correct answer was diabetic retinopathy. This could suggest that preventive campaigns led by organisations such as the American Diabetes Association and the Brazilian Diabetes Society raise more awareness than glaucoma campaigns. This is evidenced by the continuous, broad-scope nature of programmes like the Hiperdia (Hypertension and Diabetes) campaign and the National Diabetic Retinopathy Campaign(1313 Brasil. Ministério da Saúde. Portal da Saúde. Campanha: Dia Mundial do Diabetes. 2012. Disponível em: http://portalsaude.saude.gov.br/portalsaude/
http://portalsaude.saude.gov.br/portalsa...
,1414 Brasil. Ministério da Saúde. Secretaria Executiva. Departamento de Apoio à Descentralização. Coordenação-Geral de Apoio à Gestão Descentralizada. Diretrizes operacionais dos Pactos pela Vida, em Defesa do SUS e de Gestão. 2a. ed. Brasília: Ministério da Saúde, 2006. 76p.) and the lack of investment and programme continuity in actions such as the Glaucoma Campaign by the Brazilian Ministry of Health(5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.,1414 Brasil. Ministério da Saúde. Secretaria Executiva. Departamento de Apoio à Descentralização. Coordenação-Geral de Apoio à Gestão Descentralizada. Diretrizes operacionais dos Pactos pela Vida, em Defesa do SUS e de Gestão. 2a. ed. Brasília: Ministério da Saúde, 2006. 76p.). Furthermore, there is a greater focus on diabetes during medical education because it involves more subjects in the medical curriculum, while glaucoma is only studied during the ophthalmology course.

As regards the classification of glaucoma, most students correctly identified POAG as the most common type of glaucoma, but it is noteworthy that 1 in 5 respondents did not know what the most common type of glaucoma was.

One of the most common sources of error in the assessment of glaucoma is to consider elevated intraocular pressure as a causal factor. High IOP is only a risk factor(1Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
http://www.sbglaucoma.com.br/pdf/consens...
), and there are cases of ocular hypertension that never progress to glaucoma. Likewise, there are cases of glaucoma with normal IOP levels(1Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
http://www.sbglaucoma.com.br/pdf/consens...
). When asked about the causal factor of POAG, most respondents incorrectly answered that an elevated IOP was a causal factor. Only 22.5% correctly mentioned genetic factors as the cause of POAG.

On the other hand, and contradictorily (a causal factor cannot be a risk factor at the same time!), most respondents correctly identified elevated IOP as an important risk factor for glaucoma. A family history of glaucoma was correctly identified as a risk factor by 72.5% of respondents. POAG is a multifactorial disease, and it is essential that physicians know its risk factors(1Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
http://www.sbglaucoma.com.br/pdf/consens...
). The subjects of this study were medical students who will soon become medical doctors, a large part of which will probably work in Primary Health Care. Since primary care is the gateway to a network of services providing universal access, it is responsible for coordinating care in the network in all of its dimensions(5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.). The results of this study, however, indicate a gap in the functions of primary care with regard to eye health, i.e. the need to recognise risk factors in order to prevent and control certain causes of preventable blindness and visual impairment(5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.).

Recognising the clinical presentation of glaucoma is key to preventing and controlling the condition(5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.). Glaucoma is a neurodegenerative disorder characterised by insidious and progressive retinal ganglion cell degeneration(3Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363(9422):1711-20. Review.), and it is asymptomatic in its early stages(1Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
http://www.sbglaucoma.com.br/pdf/consens...
,2National Health and Medical Research Council (NHMRC). A guide to glaucoma for primary care providers. A companion document to NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma. Camberra, Australia: NHMRC; 2011. Disponível em: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp113_b_glaucoma_guide_healthcare_workers.pdf
http://www.nhmrc.gov.au/_files_nhmrc/pub...
,5Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.).Thus, physicians should know that patients with suspected or confirmed glaucoma will not present with exuberant symptoms or directly complaining of ocular involvement. This assessment of the knowledge of the clinical features of POAG among medical students found that 15.7% did not know the signs and symptoms of POAG, and just over half of respondents (53.9%) correctly stated that POAG is most often asymptomatic.

When asked about the key tests for diagnosing POAG, the vast majority of respondents correctly identified tonometry as an important test. However, important tests such as fundus examination and perimetry and were only mentioned by a few respondents. This study indicates a serious deficiency in medical education, as glaucoma is a disease of the optic nerve (optic neuropathy) whose evaluation (diagnosis and management) can only be done through adequate and reliable fundus examination and perimetry(1Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
http://www.sbglaucoma.com.br/pdf/consens...
).

Current recommendations for the treatment of POAG include lowering the IOP, which remains the only demonstrated treatable risk factor for the disease(3Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363(9422):1711-20. Review.). This can be done through medical, surgical and laser treatment. In our study, most respondents correctly stated that glaucoma can be treated medically and surgically. Laser treatment is also an alternative, but it was only mentioned by 23.5% of participants.

In all questions there were no differences between groups based on intended medical speciality, study semester, or a family history of glaucoma. This shows that misconceptions regarding important factors related to glaucoma are not limited to a particular class in medical school. It also suggests that patients with glaucoma and their families do not receive proper guidance and have insufficient knowledge about the condition.

In this study, almost all participants felt their knowledge of glaucoma was insufficient. A similar study conducted with students in the last semesters of medical schools in the state of São Paulo found significant gaps in the knowledge of ophthalmology of future general practitioners(1515 Ginguerra MA, Ungaro AB, Villela FF, Kara-José AC, Kara-José N. Aspectos do ensino de graduação em oftalmologia. Arq Bras Oftalmol. 1998;61(5):546-50.), while a study conducted at the Federal University of Piauí in 2011 found that 99.1% of students felt insecure about treating eye disorders(1010 Lopes Filho JB, Leite RA, Leite DA, Castro AR, Andrade LS. Avaliação dos conhecimentos oftalmológicos básicos em estudantes de Medicina da Universidade Federal do Piauí. Rev Bras Oftalmol. 2011;70(1):27-31.). The results of our work are thus in line with those of studies conducted in other medical schools, showing that students recognise the gaps in their ophthalmology training and consequently feel unprepared to manage patients with eye complaints. This suggests the need to change how the subject is taught — ophthalmology courses should be targeted at primary care(1616 Kara-José AC, Passos LB, Kara-José FC, Kara-José, N. Ensino extracurricular em Oftalmologia: grupos de estudos/ligas de alunos de graduação. Rev Bras Educ Med. 2007;31(2):166-72.), with a stronger focus on prevention and early diagnosis.

CONCLUSION

The results of this study show that most respondents think the knowledge of glaucoma they acquired during medical school was insufficient. This gap creates major misconceptions about key issues such as the aetiology, risk factors, clinical picture, and treatment of glaucoma, which can lead to missed diagnoses with serious individual (blindness) and collective (impact on the healthcare system and society) consequences.

  • Work conducted at the Federal University of Juiz de Fora (UFJF), Juiz de Fora/MG, Brazil.

Appendix 1


Questionnaire applied to medical students.

References

  • 1
    Sociedade Brasileira de Glaucoma. 3º Consenso Brasileiro. glaucoma primário de ângulo aberto. São Paulo: BestPoint; 2009. Disponível em: http://www.sbglaucoma.com.br/pdf/consenso03.pdf
    » http://www.sbglaucoma.com.br/pdf/consenso03.pdf
  • 2
    National Health and Medical Research Council (NHMRC). A guide to glaucoma for primary care providers. A companion document to NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma. Camberra, Australia: NHMRC; 2011. Disponível em: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp113_b_glaucoma_guide_healthcare_workers.pdf
    » http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp113_b_glaucoma_guide_healthcare_workers.pdf
  • 3
    Weinreb RN, Khaw PT. Primary open-angle glaucoma. Lancet. 2004;363(9422):1711-20. Review.
  • 4
    Shields MB, Ritch R, Krupin T. Classifications of the glaucomas. Ritch R, Shields MB, Krupin T, editors. The glaucomas. 2nd ed. St. Louis: Mosby; 1996. vol. 2.
  • 5
    Guedes RA. As estratégias de prevenção em saúde ocular no âmbito da saúde coletiva e da Atenção Primária à Saúde - APS. Revista APS. 2007;10(1): 66-73.
  • 6
    Guedes RA, Guedes VM. Custo crescente em glaucoma: atualidades e seu impacto na saúde coletiva. Revista APS. 2008;11(4):444-50.
  • 7
    Póvoa CA, Nicolela MT, Valle AL, Gomes LE, Neustein I. Prevalência de glaucoma identificada em campanha de detecção em São Paulo. Arq Bras Oftalmol. 2001;64(4): 303-7.
  • 8
    Manica MB, Corrêa ZM, Marcon IM, Telichevesky N, Loch LF. O que os pediatras conhecem sobre afecções oculares na criança? Arq Bras Oftalmol. 2003;66(4):489-92.
  • 9
    Silva MR. O Ensino da Oftalmologia. Rev Bras Oftalmol. 2009; 68(3):127-8.
  • 10
    Lopes Filho JB, Leite RA, Leite DA, Castro AR, Andrade LS. Avaliação dos conhecimentos oftalmológicos básicos em estudantes de Medicina da Universidade Federal do Piauí. Rev Bras Oftalmol. 2011;70(1):27-31.
  • 11
    Temporini ER, Kara-José N, Gondim EL, Dantas FJ. Conhecimentos sobre saúde ocular entre profissionais de um hospital universitário. Medicina (Ribeirão Preto). 2002;35(1):53-61.
  • 12
    Espíndola RF, Rodrigues BA, Penteado LT, Tan-Ho G, Gozzan JO, Freitas JA. Conhecimento de estudantes de medicina sobre o processo de doação de córneas. Arq Bras Oftalmol. 2007;70(4):581-4.
  • 13
    Brasil. Ministério da Saúde. Portal da Saúde. Campanha: Dia Mundial do Diabetes. 2012. Disponível em: http://portalsaude.saude.gov.br/portalsaude/
    » http://portalsaude.saude.gov.br/portalsaude/
  • 14
    Brasil. Ministério da Saúde. Secretaria Executiva. Departamento de Apoio à Descentralização. Coordenação-Geral de Apoio à Gestão Descentralizada. Diretrizes operacionais dos Pactos pela Vida, em Defesa do SUS e de Gestão. 2a. ed. Brasília: Ministério da Saúde, 2006. 76p.
  • 15
    Ginguerra MA, Ungaro AB, Villela FF, Kara-José AC, Kara-José N. Aspectos do ensino de graduação em oftalmologia. Arq Bras Oftalmol. 1998;61(5):546-50.
  • 16
    Kara-José AC, Passos LB, Kara-José FC, Kara-José, N. Ensino extracurricular em Oftalmologia: grupos de estudos/ligas de alunos de graduação. Rev Bras Educ Med. 2007;31(2):166-72.

Publication Dates

  • Publication in this collection
    Sep-Oct 2014

History

  • Received
    25 Sept 2012
  • Accepted
    29 Aug 2014
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