Abstract
Background: Glaucoma is a heterogeneous group of optic neuropathies characterized by an acquired loss
of retinal ganglion cells, optic nerve atrophy and Visual Field Defects (VFD). Raised Intraocular Pressure (IOP)
is the only causal risk factor for glaucoma that can be therapeutically and surgically manipulated to change
the course of the disease process. Though Goldman Applanation Tonometry (GAT) is the “gold standard”
for IOP measurement, readings of IOP with GAT are believed to be influenced by Central Corneal Thickness
(CCT). The study evaluated the correlation of CCT and IOP with VFD parameters like Mean Deviation (MD),
Pattern Standard Deviation (PSD) and Cup-to-Disc Ratio (CDR) in Primary Open Angle Glaucoma (POAG)
patients.
Objective: To determine the relationship of central corneal thickness, intraocular pressure, visual fields and
optic disc parameters in Zambian primary open angle glaucoma patients.
Methods: A cross-sectional study was conducted in 2014 from January to September and all glaucoma
patients visiting the University Teaching Hospitals – Eye Hospital during the study period were included
if they consented to it and met the inclusion criteria. A total of 166 randomly selected newly diagnosed
glaucoma patients aged 18 years and above were recruited. The CCT was measured using Kacon Ophthalmic
Ultrasound system and IOP was measured by GAT. Analyses were carried out considering the level of
significance at 5%.
Results: One hundred and sixty-six newly diagnosed glaucoma patients aged 18 to 88 years were included
into the study. There were 85 (51.2%) males and 81 (48.8%) females with a mean age being 51.31 years. The
mean IOP was 23.60 (±10.40) mmHg. The mean CCT was 531.9 (±40.59). All the participants had primary
open angle glaucoma POAG. Thin CCT was significantly correlated with vertical CDR (r= - 0.023, and 0.011).
Thin CCT was also significantly associated with worsened MD of visual field (r= - 0.033 and p=0.023) and PSD
(r= - 0.027 and p=0.012).
Conclusions: The mean CCT of Zambian POAG patients is thinner as compared to other races. CCT was
positively correlated with IOP. Patients who had thicker CCT were more likely to have low IOP compared to
patients who had thinner CCT. In the POAG patients thinner CCT was associated with greater cup disc ratio
and Visual Field (VF) damages than those with a thicker CCT.
References
Quigley HA, Broman AT. The number of people
with glaucoma worldwide in 2010 and 2020. Br J
Ophthalmol. 2006; 90:262–267.
National Eye Health Strategic Plan, 2017 – 2021,
Ministry of Health, 2017, Zambia.
Muma MKI, Bailey R, Michelo C. Primary open
angle glaucoma as seen at the University Teaching
Hospital, Lusaka, Zambia. J Ophthalmol East
Centr South Afr. 2018; 22(2): 45-47.
Gelaw Y, Kollmann M, Irunga NM, Ilako DR.
The influence of central corneal thickness on
intraocular pressure measured by Goldmann
applanation tonometry among selected Ethiopian
communities. J Glaucoma. 2010; 19:514–518.
Shih CY, Graff Zivin JS, Trokel SL, Tsai JC.
Clinical significance of central corneal thickness in
the management of glaucoma. Arch Ophthalmol.
; 122:1270–1275.
Thomas R, Korah S, Muliyil J. The role of central
corneal thickness in the diagnosis of glaucoma.
Indian J Ophthalmol. 2000; 48:107–111.
Whitacre MM, Stein RA, Hassanein K. The effect
of corneal thickness on applanation tonometry.
Am J Ophthalmol. 1993; 115:592–596.
Kohlhaas M, Boehm AG, Spoerl E, Pürsten A,
Grein HJ, Pillunat LE. Effect of central corneal
thickness, corneal curvature, and axial length on
applanation tonometry. Arch Ophthalmol. 2006;
:471–476.
Zhang H, Xu L, Chen C, Jonas JB. Central corneal
thickness in adult Chinese: Associations with
ocular and general parameters. The Beijing eye
study. Graefe’s Arch Clin Exp Ophthalmol. 2008;
:587–592.
Nangia V, Jonas JB, Sinha A, Matin A, Kulkarni
M. Central corneal thickness and its association
with ocular and general parameters in Indians:
The central India eye and medical study.
Ophthalmology. 2010; 117:705–710.
Hahn S, Azen S, Ying-Lai M, Varma R. Central
corneal thickness in Latinos. Invest Ophthalmol
Vis Sci. 2003; 44:1508–1512.
Schneider E, Grehn F. Intraocular pressure
measurement—comparison of dynamic contour
tonometry and Goldmann applanation tonometry.
J Glaucoma. 2006; 15:2–6.
Goldmann H, Schmidt T. Applanation tonometry
[article in German]. Ophthalmologica. 1957;
:221–242.
Cockburn DM. Tonometry. In: Eskridge JB, Amos
JF, Bartlett JD, editors. Clinical procedures in
optometry. New York: J P Lippincott Company,
; p. 221–237.
Ehlers N. On corneal thickness and intraocular
pressure. II. A clinical study on the thickness of
the central stroma in glaucomatous eyes. Acta
Ophthalmol. 1970; 48:1107–1112.
Ehlers N, Bramsen T, Sperling S. Applanation
tonometry and central corneal thickness. Acta
Ophthalmol. 1975; 53:34–43.
Eballe AO, Koki G, Ellong A, et al. Central
corneal thickness and intraocular pressure in the
Cameroonian nonglaucomatous population. Clin
Ophthalmol. 2010; 4:717–724.
Ntim-Amponsah CT, Seidu AY, Essuman VA,
et al. A study of central corneal thickness in
glaucoma and nonglaucoma patients in a West
African population. Cornea. 2012; 31:1093–1096.
Pillunat LE, Kohlhaas M, Boehm AG, Puersten A,
Spoerl E. Effect of corneal thickness, curvature and
axial length on Goldmann applanation tonometry.
Invest Ophthalmol Vis Sci. 2003; 44:4237.
Mercieca K, Odogu V, Feibai B, Arowolo O,
Chukwuka F. Comparing central corneal thickness
in a sub-Saharan cohort to African Americans and
Afro-Caribbeans. Cornea. 2007; 26:557–560.
Francis BA, Hsieh A, Lai M, et al. Effects of corneal
thickness, corneal curvature, and intraocular
pressure level on Goldmann applanation tonometry
and dynamic contour tonometry. Ophthalmology.
; 114:20–26.
Brandt JD. Corneal thickness in glaucoma
screening, diagnosis, and management. Curr Opin
Ophthalmol. 2004; 15:85–89.
Dueker DK, Singh K, Lin SC, et al. Corneal
thickness measurement in the management
of primary open-angle glaucoma: A report by
the American Academy of Ophthalmology.
Ophthalmology. 2007; 114:1779–1787.
Kaushik S, Gyatsho J, Jain R, Pandav SS, Gupta
A. Correlation between retinal nerve fiber layer
thickness and central corneal thickness in patients
with ocular hypertension: An optical coherence
tomography study. Am J Ophthalmol. 2006;
:884–890.
Moghimi S, Torabi H, Hashemian H, Amini H,
Lin S. Central corneal thickness in primary angle
closure and open angle glaucoma. J Ophthalmic
Vis Res. 2014; 9:439–443.