Primary glaucoma amongst Gold Coast Africans.

GLAUCOMA has been reported to be common in many tropical countries, observations having been based on various criteria. Elliot (1920) noted that in the Madras Eye Hospital the proportion of surgical operations for glaucoma and cataract were in the ratio of one to four. Chang (1951) reported that 1 75 per cent. of 13,807 ophthalmic out-patients in Peking suffered from primary glaucoma. Dodds (1952) found that glaucoma was the cause of blindness in 20 per cent. of 356 patients at the Lagos Eye Clinic. Budden (1952) in Northern Nigeria found that, in just under 3 per cent. of 144 persons blind in both eyes, the cause was glaucoma. Boase (1952) has commented on the frequency with which chronic primary glaucoma is seen in Uganda, and he emphasizes the youth of some of his cases. During the past 3 years the writer has noted an apparent high incidence of chronic primary glaucoma amongst Gold Coast Africans. However, analysis of 2,312 consecutive out-patients drawn mainly from urban populations, who attended the Ophthalmic Department of the Gold Coast Hospital in Accra, showed that 49, or a little over 2 per cent. were suffering from chronic primary glaucoma. The ratio of filtration operations for glaucoma to cataract extractions during one year was 55:153. There is no blind registration in the Gold Coast, but 45 (approximately 19 per cent.) of 241 patients blind in both eyes from the same cause when first seen were suffering from chronic primary glaucoma. The characteristics of chronic glaucoma amongst Africans differ little from thQse seen amongst Europeans. Two features necessitated certain further investigations before a rational study could be made. Concomitant hypertension with primary glaucoma appeared to be extremely common in Gold Coast Africans, and it was necessary to obtain a normal for the population. Language difficulties and the natural politeness of the patients, whose primary aim seems to be to please the doctor, make the results of campimetry confusing. Diagnosis often rests on the findings of repeated tonometry. It was therefore necessary to establish a basic average intra-ocular tension and response to provocative tests. With these objects in view, a preliminary investigation was carried out on a Control Group " A ", consisting of 81 African clerical employees in Government offices in Accra who