Optimizing glaucoma care in Ghana: a mixed-methods study of optometrists' practices, challenges, and capacity needs

• Ghanaian Optometrists actively deliver glaucoma care but lack uniform protocols • Over half fail to apply guideline-based glaucoma management practices • Patient nonadherence, costs, and poor follow-up weaken treatment outcomes • Limited diagnostic tools and unequal resources restrict effective care • Strengthening training, equipment access, and education can improve glaucoma care services in Ghana To assess the practice patterns, challenges, and improvement strategies in glaucoma care among optometrists in Ghana. A cross-sectional study using a mixed-methods approach. Quantitative data on demographics, clinical practices, associated factors, perceived barriers, and recommendations for improved glaucoma care were collected from 293 licensed optometrists registered with the Ghana Optometric Association using a structured questionnaire (distributed both in-person and online via Microsoft Forms), yielding a response rate of 44.1%. Qualitative insights were obtained through semi-structured interviews with nine optometrists, selected using purposive stratified sampling. Most respondents had formal training in glaucoma care through didactic courses and practical training in their completed degree programs. However, over one-third lacked standardized clinical care protocols. Clinical care centered on intraocular pressure measurement and optic nerve evaluation, with medical therapy as the primary treatment. Referrals were commonly triggered by poor treatment response (mainly based on IOP measurement) or advanced disease. The existence of clearly defined clinical protocols demonstrated a statistically significant association with increased provision of glaucoma care among optometrists (p = 0.008). Thematic analysis identified key challenges to the provision of glaucoma care, including patient noncompliance, financial barriers, and limited access to diagnostic tools. Recommended strategies for improvement included enhanced training, improved diagnostic infrastructure, and increased public education. Optometrists play a vital role in glaucoma care in Ghana. However, gaps in guideline awareness, protocol use, and diagnostic capacity remain. Strengthening training, equipping clinics, and promoting public education are essential to improving glaucoma care nationwide.