The study has been conducted in accordance with the ethical principles as laid down in the Helsinki Declaration of 1975, as revised in 2000 after approval from the Institutional Ethics Committee.

The descriptive study was conducted in a medical college hospital over a period of three months (july-september) during 2013. The study instrument used was a pre-tested and validated semi-structured questionnaire in English, comprising 13 questions with multiple responses. Nine questions were designed to assess ‘knowledge’ about glaucoma and four questions on ‘self-care practices’ concerning glaucoma. Five questions were open ended (appendix 1).

A convenience sample of 114 participants was included in the study by purposive sampling method after administering an informed written consent.

Participants of either gender working in the hospital and fulfilling the following criteria were included and grouped as follows:

The data was entered in Microsoft excel sheet and was analysed using Contingency table. Appropriate descriptive statistics and chi square test were used for analyses of the data. A p-value of <0.05 was considered as significant.

The results of the study are as follows:

Demographic distribution [Table/Fig-1]: A total of 114 participants were included in the study with a gender ratio was 1.035 males: 1 female and the mean age was 37 years ± 10.43 (age range: 25- 67 years). The professions of the participants were classified as clinicians (31.5%), non-clinical doctors (26.32%) and paramedical staff (42.1%).

The blinding natural course of glaucoma and its high prevalence compounded by the poor awareness of the disease in the population necessities an efficient link between the population at risk and the ophthalmologist. The present study was conducted to assess the knowledge, attitude and practice concerning glaucoma among healthcare professionals who can be considered to form an important link between the population and the ophthalmologist for the early diagnosis of glaucoma.

Good awareness of glaucoma does not mean that the subject knows everything about glaucoma but should have an adequate understanding of the disease. In our study, about 18.8% of the paramedical staff was not even aware of condition called glaucoma. This was similar to a study among health personnel in Nigeria where 4.9% were not aware of the term ‘Glaucoma’ although other studies in Northern India and Africa, all the health personnel were aware of the condition [12–14] [Table/Fig-8]. This wide difference may be due to the selection criteria of the participants and their experience in the practice of ophthalmology.

In our study, the awareness about the tests performed to detect glaucoma was not great. The awareness about tonometry (31.5%) was better than fundus examination (3.5%). The knowledge about association of glaucoma with raised IOP (82.40%) was better than optic nerve damage (32.40%). These observations about awareness of high IOP was comparable with the study conducted by Icchpujani Pin a tertiary hospital in Northern India [12] (67%), whereas in the study conducted by Adegbehingbe BO in Nigeria [13], it was only 39%. In the study conducted by Komolafe OO in Africa [14], 88.3% professionals knew that glaucoma was due to high pressure in the eye. This probably indicates that the general understanding about glaucoma even among health professionals is about its relation to the intra-ocular pressure and not to the optic nerve damage that results. This also points out that the awareness about the occurrence of glaucoma in the absence of raised IOP is not appreciated by them. In India, some of the glaucoma cases were missed by optometrists and rarely by ophthalmologists, possibly because an intensive eye examination was not performed [15]. As a matter of fact, sources other than optometrists who have made diagnosis of glaucoma were 4.5 times likely to be late presenters [12]. Such findings were observed in Barbados eye studies, where many patients did not know about their glaucomatous condition even after their visit to optometrists [15,16]. Since glaucoma is the silent thief of sight and is the second most common eye disease, the hospital staff must be aware of the disease in order to improvise case finding and to start treatment at an early stage.

Even the knowledge of diabetes, hypertension and family history of glaucoma as risk factors for glaucoma was high. But the knowledge of corticosteroid as a risk factor was low (57%). In the study conducted in Africa, 31.7% thought family history to be a strong risk factor but 26.7% had no knowledge of risk factors for glaucoma [14]. The high awareness about the risk factors may be a reflection of the limitations of close ended structured questionnaire, where the participant has the tendency to tick only because the questions are suggestive of the answers. However, the knowledge of corticosteroids as a risk factor for glaucoma was high in clinicians (83.3%) than in non-clinicians (53.3%) and paramedical staff (39.5%) and this may be because of the knowledge of the clinicians about steroids and their adverse effects.

Despite working in a hospital with easy access to health care, only 15.7% have undergone screening for glaucoma. This is low when compared to the study conducted by Icchpujani P (42%) and the study conducted by Adegbehingbe (59%) [12,13]. There are barriers to seek medical health care which may be due to the low knowledge and lack of clear understanding about the disease. Amongst the participants only 19.2% of the family members were screened when compared to 24% in the study conducted by Icchpujani P and 20% in the study conducted by Adegbehingbe [12,13]. Very few clinicians (27.7%), non-clinicians (16.6%) and paramedicals (10.4%) have referred patients for glaucoma screening (chi-square- 2.95, p-value=0.228).

In this study, a startling fact emerged that 65% doctors and 71% nurses had no knowledge that glaucoma affects the optic nerve. This was high when compared to the study conducted in Northern India [12] 20% doctors and 35% nurses were not aware that glaucoma affects the optic nerve. The understanding whether glaucoma affects the optic nerve is 43% in our study, 40% and 49% in other the studies [12,13]. This shows that there is no clear understanding of the disease glaucoma.

“Are the BLIND leading the BLIND?”

The doctors and nurses in the department are often the first point of contact to seek medical advice. Therefore the health care professionals must be well informed about conditions which are painless and irreversibly blinding. If the general awareness among the medical and paramedical professionals about glaucoma increases, then the chances of themselves getting screened and also their family members getting screened for glaucoma will increase. This tendency will translate gradually into a culture of referring cases routinely for glaucoma screening, overall, increasing case detection of glaucoma.

Hence, it is important to emphasize on intensive eye health education and dissemination of information especially among health professionals, continuing medical education about glaucoma symptoms and subsequent visual impairment must be a priority when designing programs for community outreach.