Examination of First-Degree Relatives of Patients With Glaucoma: A Randomized Trial of Strategies to Increase Use in an Eye Hospital in Africa

Objective: To determine the best approach to examine first-degree relatives (FDR) of glaucoma patients in a rural African setting. Methods: Randomized controlled trial of FDR aged 40 years and older of (index) open angle glaucoma patients who presented to KCMC Hospital. Two strategies of uptake were tested. The main outcome measure was FDR presentation for examination for glaucoma. Results: From 182 index cases, 484 FDR were enrolled in the study, 256 randomized to free examination, and 228 randomized to standard (pay) examination. Overall, 8.1% (95% CI: 5.7–10.5) came for examination. FDR who were offered examination free of charge were 1.87 times (95% CI: 0.94–3.73) more likely to present than those offered standard examination. Among those offered free examination, living near the hospital was associated with presentation (OR = 2.85; 95% CI: 1.10–7.36) whereas among those offered standard examination the association with residence was weak (OR = 2.27; 95% CI: 0.72–7.15). Conclusions: Providing good quality counseling of index cases and offering glaucoma examination free of charge is not sufficient to reach those at risk of glaucoma, suggesting that the indirect costs of accessing services are significant barriers to use of examination services. Other means of encouraging FDR to come for glaucoma examination should be investigated.