{
  "abstract": "Objective To 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.Results A 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.Conclusions Glaucoma 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.",
  "authors": [
    {
      "affiliations": [
        "Intermunicipal Hospital Centre Poissy-Saint-Germain-en-Laye Poissy Site, Poissy, France"
      ],
      "name": "Ouafa Mhamdi-Lehebib"
    },
    {
      "affiliations": [
        "Ophthalmology Department, Hospital Clinico San Carlos, Madrid, Spain",
        "Biomedical Research Foundation of Hospital Clínico San Carlos, Madrid, Spain",
        "Ramon Castroviejo Institute of Ophthalmic Research (IIORC), Department of Inmunology, Ophthalmology and ENT, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain"
      ],
      "name": "Carmen Mendez-Hernandez"
    }
  ],
  "title": "Clinic-based burden of glaucoma among Sahrawi refugees in the Tindouf camps",
  "uid": "0ed40cbc-1812-56fe-a5f7-8de924d634a6"
}