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Purpose: To evaluate current delivery of glaucoma care in Botswana; in particular, the service infrastructure available and glaucoma-related workload. Methods: A multi-center cross-sectional study was undertaken comprising government eye care institutions and ophthalmic personnel across Botswana. Data on human resources, equipment types and numbers, diagnostic criteria routinely used, treatments routinely provided, and new and repeat glaucoma consultations were obtained through quantitative and qualitative surveys. Results: In 27 government eye care institutions there were two general ophthalmologists, neither of whom had a subspecialty interest in glaucoma, 64 ophthalmic nurses, two optometrists, one low vision therapist, one refractionist, and two equipment technicians. Only 8.5% of available ophthalmic human resources were taken up with provision of glaucoma care. About 1/3 of hospitals did not have tonometers, most primary hospitals lacked slit lamp biomicroscopes and most hospitals lacked sensitive diagnostic equipment. A diagnosis of glaucoma was made by either an ophthalmic nurse or an ophthalmologist, but only 10% of institutions could meet recommendations for follow-up assessment. Topical glaucoma medications were prescribed by almost all hospital clinics, usually by ophthalmic nurses. Drug choices were largely determined by local availability. Glaucoma surgery accounted for 0.8% of total eye operations. Glaucoma patients took up 8.5% of total clinic visits. The total number of glaucoma visits was highest in the two hospitals with ophthalmologists. New glaucoma cases took up 10.3% of total glaucoma visits. Conclusion: This study highlights the challenges faced in caring for glaucoma patients in Botswana; in particular, lack of professional human resources, equipment and availability of effective treatments. [ABSTRACT FROM AUTHOR]

Purpose: To determine if a community screening with Frequency Doubling Technology perimetry (FDT) results in a high proportion of follow-up with an eye care provider and the factors associated with follow-up. Design:Cross-sectional study. Setting: Telephone survey Methods: We conducted a telephone survey of participants with abnormal results 3-6 months after the community screening. Results: We were able to interview 121 participants (57% of 212 eligible subjects). Sixty-nine percent (83 of 121) of participants visited an eye care provider after the screening. Patients were more likely to attain an eye exam if they were female, older, or had an educational level of high school or more (p < 0.05). Of those participants who did not visit an eye care provider, 41% (18/38) did not believe the results of the test, 21% (8/38) reported not having insurance or an eye care provider, 11% (4/38) did not have time for an eye exam, and 11% (4/38) reported not knowing they needed to see an eye care provider. Conclusion: A community screening program with FDT encouraged more than two thirds of participants with abnormal results to seek an eye exam. The most common reason not to attain an eye exam was failing to recognize the importance of an abnormal test result. [ABSTRACT FROM AUTHOR]