Clinic-based burden of glaucoma among Sahrawi refugees in the Tindouf camps.

objectiveTo estimate the clinic-based frequency of glaucoma among Sahrawi refugees attending humanitarian ophthalmology missions in the Tindouf camps (Algeria), to identify demographic and clinical factors associated with glaucoma and to contextualise the clinic-based frequency of other ophthalmic diseases. METHODS AND ANALYSIS: We conducted a clinic-based cross-sectional study among Sahrawi refugees during Médicos del Mundo ophthalmology missions. All participants underwent a standardised ophthalmological examination including targeted history, visual acuity assessment, slit-lamp biomicroscopy and intraocular pressure (IOP) measurement. Glaucoma diagnosis relied on structural optic nerve head assessment and elevated IOP, with independent confirmation by a second ophthalmologist. Age-standardised and sex-standardised clinic-based frequencies were calculated using camp population demographics. Multivariable logistic regression identified factors associated with glaucoma.

resultsA total of 900 symptomatic care-seeking individuals were examined (56% men; median age 70 years). Overall clinic-based glaucoma frequency was 13.3% (95% CI 11.1% to 15.5%), representing the main disease of interest. After standardisation, the estimated clinic-based frequency was 6.7% (95% CI 3.8% to 9.7%). Older age was independently associated with glaucoma (adjusted OR per year 1.02; 95% CI 1.01 to 1.03; p=0.003). Inverse associations with cataract and keratopathy, likely reflected selection patterns and diagnostic overshadowing. Cataract was the most common coexisting diagnosis (59.8%), followed by keratopathy (9.1%) and retinopathy (3.4%). Among participants, 37.8% (n=340) had severe bilateral visual impairment, and 40.9% (n=368) had monocular vision; 17.5% (n=60/340) of those with bilateral impairment were blind from glaucoma.

conclusionsGlaucoma represents a substantial clinic-based burden among symptomatic Sahrawi refugees attending humanitarian missions, with a high proportion of irreversible visual loss. Other ophthalmic conditions were common but functioned as coexisting causes of visual impairment in this care-seeking sample. These findings highlight the need for pragmatic, context-appropriate strategies for opportunistic glaucoma detection and continuity of care in refugee settings, acknowledging limitations including the non-probabilistic, mission-based sampling and absence of visual-field testing.