Glaucoma detection training of community healthcare workers using portable devices in Nigeria

Background: Glaucoma, an irreversible blinding eye disease caused by optic nerve damage, remains a major public health challenge in sub-Saharan Africa, where it occurs earlier and progresses more aggressively than in other regions. Accessibility and affordability remain major barriers to timely diagnosis and treatment in low- and middle-income countries (LMICs). Purpose: To assess the ability of community health workers (CHWs) without prior ophthalmic training to use portable diagnostic tools for early detection and referral of possible glaucoma cases in Abuja, Nigeria. Methods: This feasibility study was conducted from June to September 2024 in three community health centres in Abuja. Fifteen CHWs (14 females, 1 male) were trained over 3 days using didactic lectures, practical demonstrations, and hands-on sessions on four portable devices: PEEK Acuity, iCare tonometer, Eyecatcher visual field analyser, and Remidio handheld fundus camera. Pre- and post-training assessments were conducted, with an 80% pass mark required. A simplified scoring system based on test findings guided referral decisions. Results: All CHWs achieved scores of 80% or higher post-training, showing significant improvement in glaucoma knowledge and testing proficiency. Initial challenges with the iCare tonometer and fundus camera improved with practice. Conclusion: Community health workers can effectively use portable diagnostic tools for glaucoma screening and referral in primary care settings. Their involvement could enhance early detection and contribute substantially to reducing glaucoma-related blindness in resource-limited settings.