Blindness in Africa: present situation and future needs

A Phase 1, Randomized, Double-Blind, Placebo-Controlled, Single Ascending Dose Trial of AWZ1066S, an Anti-Wolbachia Candidate Macrofilaricide

AWZ1066S has been developed as a potential treatment for the neglected tropical diseases lymphatic filariasis and onchocerciasis. AWZ1066S targets the Wolbachia bacterial endosymbiont present in the causative nematode parasites. This phase 1, first-in-human study aimed to assess the safety and pharmacokinetics of AWZ1066S in healthy human participants. In a randomized double-blind, placebo-controlled, single ascending dose study, healthy adults received a single oral dose of AWZ1066S (or placebo) and were followed up for 10 days. The planned single doses of AWZ1066S ranged from 100 to 1600 mg, and each dose was administered to a cohort of 8 participants (6 AWZ1066S and 2 placebo). In total 30 people participated, 18 (60%) female, median age 30.0 years (minimum 20, maximum 61). The cohorts administered 100, 200, 300, and 400 mg of AWZ1066S progressed unremarkably. After single 700-mg doses all 4 participants developed symptoms of acute gastritis and transient increases in liver enzymes. The severity of these adverse events ranged from mild to severe, with 1 participant needing hospital admission. Pharmacokinetic analysis indicated that AWZ1066S is rapidly absorbed with predictable pharmacokinetics. In conclusion, safety concerns prevented this study from reaching the human exposures needed for AWZ1066S to be clinically effective against lymphatic filariasis and onchocerciasis.

Management of painful blind eye in Africa: A review

Background

Painful blind eye conditions in Africa constitute a compelling area of concern within public health, presenting substantial complexities for healthcare systems and the individuals afflicted. This comprehensive review delves into recent research and advancements concerning the management of these conditions across the African region. Drawing upon contemporary studies and data, we scrutinise the multifaceted aspects, including prevalence rates, causative factors, and regional variations.

Objective

To review existing articles on the current state of the management of blind painful eye conditions in Africa.

Materials and Methods

Articles regarding the subject were obtained from Google Scholar, AJOL, and PubMed using the keywords, painful, blind eye (PBE), Africa.

Results

Forty-four relevant articles were reviewed. They were further categorized into epidemiology, management approaches and challenges to management.

Conclusion

The management of the PBE poses a huge challenge and can either be medical or surgical. Collaborative efforts should be targeted at preventing the causes of a PBE. As the burden of painful blind eye conditions continues to exert a profound impact across Africa, this article underscores the pressing need for collaborative efforts involving governments, non-governmental organisations, and international entities. By prioritising awareness and enhancing healthcare accessibility, we collectively strive towards the alleviation of suffering and the prevention of avoidable visual impairment in this region.

Child eye health in Ethiopia: a mixed methods analysis of policy and commitment to action

BACKGROUND

Child eye health is a serious public health issue in Ethiopia, where children under the age of 15 account for over half of the population. Our aim was to review Ethiopian health policy and practice to reveal approaches and commitment to promotion and delivery of child eye health services.

METHODS

We conducted a mixed-methods situational analysis employing documentary analysis and key informant interview methods. Government publications touching on any element of child eye health were included. Key informants were eligible if they were leaders, authorities, researchers or clinicians involved in child health. Data was combined and analysed by narrative synthesis, using an adaptation of the Eye Care Situation Analysis Tool as a framework.

FINDINGS

Eleven documents developed by the Ministries of Health and Education were included and interviews with 14 key informants were conducted. A focus on child eye health was lacking in key health policy documents, demonstrated by limited allocation of funds, a shortage of human resources, and a subpar referral system across all levels of child eye care.

CONCLUSION

The study identified several gaps and limitations in child eye health in Ethiopia. There is a need for health policies that strengthen ownership, finance and partnerships for improved coordination, and collaboration with line ministries and other stakeholders to improve child eye health services in Ethiopia.

Exploring the knowledge, attitudes, and practice towards child eye health: A qualitative analysis of parent experience focus groups

BACKGROUND

The majority of childhood blindness causes in low-income countries are treatable or avoidable. Parents or guardians are responsible for making decisions regarding a child's eye care. Understanding parents' awareness and perception of eye problems in crucial in helping to know parents' eye care-seeking behavior.

OBJECTIVE

To determine parental knowledge, attitudes and practice regarding child eye health.

METHODS

Seven focus groups were carried out in Northwest Ethiopia on knowledge, attitude and practice of parents towards child eye health. Their responses were tape-recorded and later transcribed. A thematic phenomenological approach was used for the analysis.

RESULT

Seventy-one parents participated in the focus groups. Participants were aware of common eye problems like trachoma, trauma, and glaucoma. However, they were unaware of the causes and etiologies of childhood blindness. Participants perceived that eye problems could be treated with hygiene and food, and often held misconceptions about the cause of strabismus and utilization of wearing spectacles.

CONCLUSION

The study revealed that parents are often unaware of the causes and etiologies of common childhood eye diseases, which has downstream effects on health-seeking behavior. Health promotion efforts, potentially through mass and social media, could be helpful to raise awareness, coupled with training of health professionals at primary and secondary health facility levels.

Corneal blindness and eye banking: Current strategies and best practices

Corneal blindness (CB) is one of the leading causes of blindness in India and globally, affecting around 8 million population worldwide. Many of these corneal blind patients may be visually rehabilitated by corneal transplantation (CT). Eye banking plays a crucial role in facilitating CT and ocular research. Many countries have adopted regulatory frameworks, quality assurance programs, and technological advancements to enhance the efficacy and safety of CT. Various infrastructural and organizational frameworks of eye banks (EBs) in India, according to the Eye Bank Association of India (EBAI), aid in establishing guidelines and standards for EB practices. Initiatives such as the National Programme for Control of Blindness (NPCB) have significantly contributed to eye donation rates and improved access to donor corneas. This review article discusses the established eye banking networks in countries such as India, the United States (USA), and Europe, where dedicated EB organizations work collaboratively to ensure efficient procurement, processing, and distribution of corneal tissue. It also highlights specific strategies employed in India and global countries to address EBs' challenges. These challenges include the shortage of donor corneas, improving donor screening and tissue processing techniques, ensuring timely distribution of corneal tissue, and maintaining high-quality standards. Interestingly, the comparative analysis between India and other developed countries highlights the similarities and differences in eye banking strategies. By understanding the strategies employed by different regions, EBs can learn from each other's experiences and work toward achieving optimal outcomes in CT and ocular research worldwide. It underscores the importance of knowledge sharing and collaborative efforts in addressing common challenges and implementing best practices in eye banking.

Bacterial Profile of External Ocular Infections, Its Associated Factors, and Antimicrobial Susceptibility Pattern among Patients Attending Karamara Hospital, Jigjiga, Eastern Ethiopia

Background

External ocular infection is a global public health problem. Frequently, bacteria cause an ocular infection that ranges from morbidity to loss of vision. The increasing bacterial resistance in ocular infections leads to the risk of treatment failure with possibly serious consequences.

Objective

The study aimed to assess the bacterial profile of external ocular infections, their associated factors, and antimicrobial susceptibility pattern among patients admitted to Karamara hospital, Jigjiga, Eastern Ethiopia.

Method

Institutional-basedcross-sectional study was conducted on 288 conveniently selected patients among patients admitted to Karamara hospital from May 1 to June 30, 2020. Data were collected using a structured questionnaire. The ocular sample was collected and cultured in the appropriate culture media and identified using a series of biochemical tests. Antimicrobial susceptibility testing of isolates was performed by using the disk diffusion method. Data were double entered onto EpiData version 3.1 then exported to SPSS version 20 and analyzed to calculate descriptive frequency and odds ratio, and p value ≤0.05 was taken as the significant value.

Result

The prevalence of bacterial infection in external ocular samples was 62.2% (95% CI: 56.6%, 68.4%). Out of the 179 isolates, the majority of the bacterial isolates (87.7%) were Gram-positive. Staphylococcus aureus (53.1%) was the predominant isolate. Using soap for washing the face (AOR = 0.43; 95% CI: 0.29, 0.95), having diabetes mellitus (AOR = 3.11; 95% CI: 1.45, 6.75), and history of hospitalization (AOR = 2.82; 95% CI: 1.44, 5.54) were significantly associated with external ocular infection. Most (95.5%) of the Gram-positive bacteria showed resistance to penicillin, but they were susceptible to vancomycin, clindamycin, and ciprofloxacin.

Conclusion

The study showed a high prevalence of bacterial infections with the predominant isolate was S. aureus. Penicillin-resistant bacteria were identified among Gram-positive bacterial isolates. Soap usage, hospitalization, and diabetes mellitus were associated with the infection. Antibiotics that were susceptible to the specific bacteria should be used as a drug of choice and using soap for washing the face is advisable to protect against external ocular infection.

Ophthalmic services utilisation and associated factors in the Ashanti region, Ghana

Objective

This survey determined the utilisation of eye care services and associated factors among adults in the Ashanti region of Ghana.

Design

A population-based cross-sectional descriptive study.

Method

Data for this study was collected from 1615 randomly selected individuals in the Ashanti region of Ghana, using a structured, pretested interviewer-guided questionnaire. Information regarding the accessibility and determinants of, and barriers to, eye care services was based on self-reports, using the WHO Eye Care Services Assessment Questionnaire. Inferential analyses were performed using the chi-square test for statistical significance, set at p=0.05.

Setting

Ashanti Region, Ghana.

Participants

One thousand six hundred and fifteen randomly selected adults.

Results

Public eye care facilities were used by 58.2% of the participants for their last eye exam. Of the participants, 47.0% had travelled less than five kilometres for their last eye exam. Waiting time and service cost were participants' most frequently cited challenges in seeking care. No need felt (40.1%), self-medication (37.7%) and cost (22.2%) were the most frequently mentioned barriers to seeking ophthalmic services.

Conclusion

The major challenges encountered in seeking eye care services were waiting time and cost of service. Major barriers to ophthalmic services utilisation were no need felt, self-medication and cost. Factors such as cost, lack of felt need and self-medication, which serve as barriers to utilising eye care services, should be addressed by stake-holders through eye health education and promotion.

Funding

None declared.

The social construction of genomics and genetic analysis in ocular diseases in Ibadan, South-western Nigeria

Genomics, an emerging field to improve public health practice, has potential benefits to understanding ocular diseases. This study explored the social construction of genomics in ocular diseases in the blind community in Ibadan, Nigeria, through two focus group discussions and twelve in-depth interview sessions conducted among people living with ocular disorders. The data were thematic and content-analysed. Although the participants had limited knowledge about ocular diseases, genomics, and their nexus, they maintained a positive attitude toward its potential benefits. This informed their willingness to participate in genomics testing for ocular diseases. The participants preferred saliva-based sample collection over blood-based, and expressed concern for the procedure and accrued benefits of genomics studies. Thus, public sensitisation about ocular diseases and client-centred genomics testing procedures should be engendered.

Prevalence and patterns of refractive error among adults in Sagamu, South-West Nigeria

Background: The study was part of community-based research towards strengthening the provision of optical services within a local governmental area in Nigeria.Aim: To describe the prevalence of refractive errors in the southwestern Nigerian adult population.Setting: Adults of age 30 years and above who were regular residents of the local governmental area.Methods: A multistage stratified random cluster sampling method was used to select the subjects. The sampling unit was the different households. A random sample of them were refracted and then refractive errors were analysed. Analyses excluded participants with history of cataract surgery. Associations with myopia (−0.50 dioptres [D] or more) and hyperopia (≥ 0.50 D) were evaluated in logistic regression analyses.Results: The prevalence of refractive error in the study sample was 33.8% (95% confidence level [CI]: 27.1–34.4) using study participants with 6/9 presenting visual acuity but improvement by at least a line with pin hole. The prevalence of hyperopia was 46.9% and higher in women (51.8%), while that of myopia was 21.9% but higher in men (25.0%). The prevalence of hyperopia increased from 29% for 40–49 years of age to 65% for 50–59 years of age and tended to decline thereafter. Prevalence of myopia decreased from 17% in persons 40–49 years of age to 11% in those 50–59 years of age but increased after 60 years of age. A higher prevalence of myopia was positively associated (p  0.05) with lifetime occupations requiring near work, nuclear opacities, posterior subcapsular opacities and glaucoma. Factors associated with hyperopia were the same as for myopia, except for occupation, and in the opposite direction.Conclusion: The high prevalence of refractive errors strongly supports the need for an affordable and accessible optical service in the local government.

Biaxial Estimation of Biomechanical Constitutive Parameters of Passive Porcine Sclera Soft Tissue

This study assesses the modelling capabilities of four constitutive hyperelastic material models to fit the experimental data of the porcine sclera soft tissue. It further estimates the material parameters and discusses their applicability to a finite element model by examining the statistical dispersion measured through the standard deviation. Fifteen sclera tissues were harvested from porcine' slaughtered at an abattoir and were subjected to equi-biaxial testing. The results show that all the four material models yielded very good correlations at correlations above 96%. The polynomial (anisotropic) model gave the best correlation of 98%. However, the estimated material parameters varied widely from one test to another such that there would be need to normalise the test data to avoid long optimisation processes after applying the average material parameters to finite element models. However, for application of the estimated material parameters to finite element models, there would be need to consider normalising the test data to reduce the search region for the optimisation algorithms. Although the polynomial (anisotropic) model yielded the best correlation, it was found that the Choi-Vito had the least variation in the estimated material parameters, thereby making it an easier option for application of its material parameters to a finite element model and requiring minimum effort in the optimisation procedure. For the porcine sclera tissue, it was found that the anisotropy was more influenced by the fiber-related properties than the background material matrix-related properties.

The study of simultaneous bilateral ocular trauma in Northern India: clinical presentation, epidemiology and patterns of injury

PURPOSE

This study is aimed to determine the frequency, sociodemographic profile, clinical presentation, patterns of injury, treatment and outcomes of cases of simultaneous bilateral ocular trauma treated in a teaching hospital of Northern India.

METHODS

This retrospective study was conducted from May 2015 to April 2019. The medical records of patients presenting with bilateral ocular injuries were reviewed.

RESULTS

Among the 402 patients presenting with ocular injuries, 34 (8.5%) had simultaneous bilateral ocular trauma. The majority were male (70.6%), and the mean age was 26.82 ± 15.86 years (range: 2-70 years). The most frequently affected age group has been 16-25 years (35.3%). Most injuries occurred away from home (64.7%), mainly on roads (32.4%) or playgrounds (14.7%), and the vast majority (91.2%) were non-occupational in nature. Mechanical injuries were most frequent (47.1%), followed by cracker (17.7%), chemical (17.7%) and thermal (11.8%) injuries. Most cases occurred due to assault (26.5%), road traffic injury (20.6%) or sports/recreational activities (17.7%). The majority of victims were not using protective devices at the time of injury (82.4%) and had associated polytrauma (58.8%). Closed and open globe injuries accounted for 29.4% and 14.7% of cases, respectively, mostly involving zones I (55.0%) and II (40.0%). Orbital fractures occurred in 27.9% of eyes. Category I and II ocular trauma scores were noted in 5.9% and 7.4% of eyes, respectively. Overall, 13.2% were blinded as a result of the trauma.

CONCLUSION

Simultaneous bilateral ocular trauma is rare and occurs mostly following road traffic accidents, assault or recreational activities. In particular, young-adult males are more prone to bilateral ocular injuries, the majority of which are severe and associated with poor outcomes. The study also highlights that poor initial visual acuity, multiple ocular structure involvement, large open globe injury, presence of intraocular hemorrhage, posterior segment injury, multiple orbital fractures and lower OTS were the poor prognostic factors.

Knowledge and practices of teachers about child eye healthcare in the public sector in Swaziland

Background: Vision-related problems have a negative impact on the learning abilities and school performance of a child. Adequate knowledge and practices of teachers enable the early identification and intervention of school children with visual deficits.Aim: This study aimed to investigate the knowledge and practices of teachers about child eye healthcare in the public education system in Swaziland.Setting: The setting for this study was Swaziland.Methods: This was a cross-sectional quantitative study using a survey instrument containing closed-ended questions to investigate the knowledge and practices of teachers about child eye health in the public sector.Results: Two hundred and forty-three (N = 243) teachers responded to the questionnaire. The majority (90.1%) of teachers indicated that they were able to detect signs and symptoms of eye diseases. Most teachers without a family member wearing spectacles were more likely to be informed about eye health (p = 0.001) than those who had family wearing spectacles. A significant proportion (44%) of teachers indicated that refractive errors were not serious among school children. Above one-third (38.7%) of the teachers indicated that they referred children with vision problems to public hospitals. One hundred and fifty-five (63.8%) reported that health officials have never visited their schools. One hundred and forty-nine (61.3%) teachers agreed that they did not monitor children wearing spectacles and 94 (38.7%) monitored them. Monitoring children wearing spectacles was significantly associated with teachers who indicated being well informed about eye health (p 0.001) and teachers who were more likely to advise parents to take their children for eye testing (p = 0.003).Conclusion: The lack of adequate knowledge by some teachers may contribute to the already existing barriers for children to access eye health. Addressing the broader issues of child eye health requires the participation of well-trained and knowledgeable teachers.

Cost Analysis and Rational Use of Anti-Glaucoma Therapy in a Tertiary Hospital in Ghana

Introduction

Glaucoma is the leading cause of irreversible blindness worldwide. In Ghana, 19.4% of all blindness recorded is due to glaucoma. Reducing intraocular pressure medically (using eye drops) is the evidence-based therapeutic option.

Objective

To determine the rational use and undertake cost analysis of anti-glaucoma drugs among patients attending clinic at the Lions International Eye Centre (LIEC), Korle-Bu Teaching Hospital.

Methods

In this cross-sectional study, we reviewed all prescriptions presented to the pharmacy unit from 01/12/2015 to 31/03/2016. The dispensed drops were classified, and all anti-glaucoma drugs were identified. This was followed by cost analysis.

Results

A total of 588 prescriptions were captured, 27.3% (161/588) contained an anti-glaucoma medication. The mean number of anti-glaucoma medications was 1.71 of which 52.7% was prescribed to females. Prostaglandin analogs (PGA) were the most prescribed (37% (102/276)), followed by beta blockers (25.4% (70/276)), carbonic anhydrase group of medicines (16.3% (45/276)), combined beta blockers (11.2% (31/276)), alpha agonists (8.7% (24/276)) and miotics (1.4% (4/276)). The median (IQR) cost of anti-glaucoma therapy per prescription per month was GHC 65.00 (GHC38.5-GHC140) about [US$16.25 (US$ 9.6–US$35)]. Azopt (Brimonidine) was the most expensive with daily treatment cost of GHC 5.8 (about US$ 1.45), whilst the least expensive drug with a daily treatment cost of GHC 0.14 (about US$ 0.035) was timolol eye drops.

Conclusion

Prostaglandin analogs though expensive remain the most preferred treatment for managing glaucoma at the Korle-Bu Eye Centre in Ghana. This may adversely affect treatment among the poor since prostaglandins analogs are currently not covered by insurance.

Practice of orthokeratology in Algeria: a retrospective study

PURPOSE

To report the practice of orthokeratology (OK) in Algeria and to investigate the visual outcomes, safety and subjective responses with this technique in myopes.

METHODS

A retrospective chart review of 48 participants using OK lenses since January 2010 were included in the study. Lenses were selected and fitted according to the manufacturer's recommendations using their respective software and the number of lenses required for a successful fit was recorded. Visual acuity (VA) in logMAR units and biomicroscopic findings were recorded for each visit. Subjective ratings was determined with analogue rating scale was filled in by the investigator, the participants were divided into Group 1 (> 4.00D) and Group 2 (< 3.75D) myopic groups for analysis.

RESULTS

First lens fitting success rate of 64.58%. There was also a significant difference between the BCVA at baseline and VA at Day 1 (P < 0.05), and no significant difference at Day 7, Day 30 and the final visit (P = 0.51, P = 0.93, P = 0.62, respectively), for Group 2. There was a significant difference between the BCVA at baseline and VA at Day 1, 7, 30 and the final visit (P < 0.05), for Group 1. the patients of the second group were happier but the results from the survey were not statistically significant (P = 0.10), no serious complication was reported.

CONCLUSION

the technique was efficient and safe as we didn't have any serious complication, with a high success rate for first lens fitting.

Socio-demographic factors modify awareness, knowledge, and perceived risk of glaucoma in rural and urban residents in Ghana: a population-based survey

Purpose:

To evaluate the awareness, knowledge and the perception of risks of glaucoma among rural and urban dwellers in Ghana, a high prevalent country, in order to provide information for health promotion planning.

Method:

In a population-based descriptive cross-sectional survey, 1200 adults were selected from household settings, using a two-stage cluster and simple systematic random sampling. Quantitative data collection, using interviewer-administered questionnaire, was employed. Descriptive statistics were performed using chi-square, ordinal univariate, multinomial and multivariate logistic regression models used to calculate odds ratio with 95% confidence interval (CI) to identify predictive factors.

Results:

Overall, only 326 (27.2%, 95% CI = 24.6–29.7) indicated they were aware of glaucoma, whereas 331 (27.6%, 95% CI = 24.6–29.7) had ever undergone an eye screening. Low knowledge was demonstrated in 152 (46.6%, 95% CI = 41.2–52.0) and high knowledge in 99 (30.4%, 95% CI = 25.4–35.4) glaucoma-aware participants. Only 238 (19.8%, 95% CI = 17.6–22.1) of respondents presumed themselves to be at risk of developing glaucoma. Having eye examination (within the last 6 months) was positively associated with knowledge (adjusted odds ratio (AOR) = 1.413; 95% CI = 0.9–1.896) and awareness (AOR = 1.13; 95% CI = 0.938–2.449). Three levels of education (no education (AOR = 0.041; 95% CI = 0.016–0.11), primary (AOR = 0.057; 95% CI = 0.018–0.179), and middle school (AOR = 0.254; 95% CI = 0.127–0.51)) were associated with low knowledge while all levels of education were inversely associated with awareness. Perceived risk of glaucoma was also influenced by area of residence (rural (AOR = 0.344; 95% CI = 0.21–0.57)), being young (18–24 years (AOR = 4.308; 95% CI = 2.36–7.88)) and having previously undergone screening for glaucoma (AOR = 13.200; 95% CI = 5.318–32.764).

Conclusion:

The main modifiers of glaucoma awareness and knowledge were education and previous eye examination, but awareness had additional factor of area of residence. Perceived risk of glaucoma was influenced by being young and living in urban areas.

Prevalence and associated factors of vision loss in the South African National Health and Nutrition Examination Survey (SANHANES-1)

BACKGROUND

Vision loss is a major public health concern that significantly affects developing countries, including South Africa. Although existing literature have reported on the prevalence, causes, and impact of vision loss on the quality of life of affected individuals (children and adults) in parts of South Africa, there is no evidence of the prevalence and associated factors of vision loss in the general population. Hence, this study aimed to determine the prevalence of vision loss and its associated factors in South Africa using a population-based survey.

METHODS

Secondary analyses were conducted using data from the South African National Health and Nutrition Examination Survey (SANHANES-1), a population-based national health survey conducted from 2011 to 2012. Vision loss was defined as presenting visual acuity (PVA) worse than Snellen 6/12 in the better eye. Visual acuity was assessed by clinicians and participants' subjective response to vision-related questions. Univariate and multiple logistic regression models were used to examine the association of the independent variables with vision loss.

RESULTS

The analytic sample comprised 4346 individuals with a mean age of 39.1 years. Female sex accounted for 55.6% of the participants. The prevalence of vision loss among participants was 9.2% (95% CI: 7.7-10.9). Older age (45-54 years, OR = 2.99, p < 0.001; 55-64 years, OR = 5.78, p < 0.001 and ≥ 65 years, OR = 5.12, p < 0.001), female sex (OR = 1.50, p = 0.016), and previous diabetes diagnosis (OR = 2.28, p = 0.001) were significantly associated with increased odds of vision loss. Further, secondary school education (OR = 0.71, p = 0.031), white ethnicity (OR = 0.11, p = 0.007), residing in Mpumalanga province (OR = 0.12, p < 0.001) and having never had an eye examination (OR = 0.56, p = 0.003) were significantly associated with reduced odds of vision loss.

CONCLUSION

Almost one in ten participants had vision loss. Adopting strategies targeted at reducing barriers to the utilization of eye care services will promote early detection and management of blinding conditions, and thereby, decrease the burden of vision loss in South Africa.

Eye care utilization pattern in South Africa: results from SANHANES-1

BACKGROUND

Eye examinations are recommended for all persons throughout life. However, there is disparity in the uptake of eye care services in different populations. Using data from a nationally representative population-based cross-sectional study (the South African National Health and Nutrition Examination Survey, [SANHANES-1]), this paper investigates the utilization of eye care services and its associated factors in South Africa.

METHODS

Participants aged 15 years and older who participated in interviews and clinical examination were enrolled in the SANHANES from 2011 to 2012. Eye care utilization was assessed from participants' responses to whether they had their eyes examined by a medical professional and when they were last examined. Data were analysed using multiple logistic regression models employing a hierarchical approach to add predisposing (e.g. age, sex), enabling (e.g. health insurance) and need (e.g. hypertension) factors sequentially.

RESULTS

The study sampled 3320 participants, with 64.9% being females. 73.4% (95% CI [69.7-76.7]) of participants had never had an eye examination. After statistical adjustment, age groups (compared with 15-29 years: 30-44 years Odds Ratio [OR] = 1.76; 45-59 years OR = 2.13; 60-74 years OR = 2.74; ≥75 years OR = 3.22), ethnicity (compared with African descent: white OR = 4.71; mixed-race OR = 1.87; Indian OR = 7.67), high risk alcohol use (OR = 1.83), wealth index (compared with lowest quintile: third quintile OR = 1.75; fourth quintile OR = 2.23; fifth quintile OR = 2.49), health insurance (OR = 2.19), diabetes (OR = 1.75), high cholesterol (OR = 2.51), having assessed healthcare in the past 5 years (OR = 2.42), and self-reported vision problems (OR = 1.51) were significantly associated with eye care utilization.

CONCLUSION

Almost three-quarters of South Africans sampled were not utilizing eye care services. It is imperative to strengthen current public health measures (including eye health promotion programs) to address the alarmingly low uptake of eye care services as well as the disparities in eye care utilization in South Africa.

Association of sex with the global burden of glaucoma: an analysis from the global burden of disease study 2017

PURPOSE

To investigate the association of sex with the global burden of glaucoma by year, age and socio-economic status using disability-adjusted life years (DALYs).

METHOD

The global, regional and national sex-specific DALY numbers, crude DALY rates and age-standardized DALY rates caused by glaucoma, by year and age, were obtained from the Global Burden of Disease Study 2017. Human development index (HDI) in 2017 as a national socio-economic indicator was obtained from the Human Development Report. t-Test and linear regression were performed to explore the association between sex difference in age-standardized DALY rates and HDI.

RESULTS

Globally, changes in glaucoma DALY number and crude rates were similar of both sexes between 1990 and 2017. After controlling for population size and age structure, age-standardized DALY rates decreased consistently from 10.7 in 1990 to 9.4 in 2017 among men and from 8.8 in 1990 to 8.0 in 2017 among women. In 2017, the global average age-standardized DALY rates were 11.6 ± 8.6 (mean ± standard deviation) in women and 14.9 ± 12.1 in men. The sex difference in age-standardized DALY of 195 countries was significant (t = 3.109; p < .01) in 2017. Men had higher rates than women of the same age, and sexual differences increased with age. t-Test revealed that age-standardized DALY rates among men were higher than those among women for low-HDI countries (t = 3.102; p < .01) and high-HDI countries (t = 2.110; p < .05). The difference (male minus female) in age-standardized DALY rates (standardized β = -0.434, p < .001) and the female-to-male age-standardized DALY rate ratios (standardized β = -0.315, p < .001) were inversely correlated with HDI.

CONCLUSION

Although global glaucoma health care is progressing, sexual differences in glaucoma burden showed little improvement in the past few decades. Worldwide, men have higher glaucoma burden than women. Older age and lower socio-economic status are associated with greater sex differences in glaucoma burden. Our findings may enhance public awareness of sexual differences in global glaucoma burden and emphasize the importance of making sex-sensitive health policy to manage global vision loss caused by glaucoma.

Comparison of the Morphology of the Foveal Pit Between African and Caucasian Populations

Purpose

The purpose of this study was to characterize foveal pit morphology in an African (Ghanaian) population, to compare it to that of a Caucasian group and to determine if it varied with age in the two populations.

Methods

The depth, diameter, slope, and volume of the foveal pit were interpolated from optical coherence tomography volume scans recorded in 84 Ghanaian and 37 Caucasian individuals. Their association with age, sex, and ethnicity was investigated using multilevel regression models.

Results

The foveal pit differed significantly in width, slope, and volume between Ghanaian men and women (P < 0.001), but only in width and volume between Caucasian men and women (P < 0.01). In Ghanaians, age was associated with a narrowing of the foveal depression and a reduction of its volume. Overall, these changes were more pronounced in women as compared to men and were largely absent from the Caucasian group. When controlled for age, the foveal pit of Ghanaians was significantly wider and larger in volume as compared to the Caucasian group (P < 0.001).

Conclusions

The morphology of the foveal pit differs between African and Caucasian individuals. These anatomic differences should be considered when examining differences in prevalence and clinical features of vitreoretinal disorders involving the fovea between the two populations.

Translational Relevance

Differences in retinal anatomy may partly explain variations in the prevalence and clinical features of retinal diseases between Africans and Caucasians. Such differences should be adequately considered in diagnoses and monitoring of ocular diseases in patients with African ancestry.

Severity of Visual Field Loss at First Presentation to Glaucoma Clinics in England and Tanzania

Purpose: To compare severity of visual field (VF) loss at first presentation in glaucoma clinics in England and Tanzania.Methods: Large archives of VF records from automated perimetry were used to retrospectively examine vision loss at first presentation in glaucoma clinics in Tanzania (N = 1,502) and England (N = 9,264). Mean deviation (MD) of the worse eye at the first hospital visit was used as an estimate of detectable VF loss severity.Results: In Tanzania, 44.7% {CI_95%: 42.2, 47.2} of patients presented with severe VF loss (< -20 dB), versus 4.6% {4.1, 5.0} in England. If we consider late presentation to also include cases of advanced loss (-12.01 dB to -20 dB), then the proportion of patients presenting late was 58.1% {55.6, 60.6} and 14.0% {13.3, 14.7}, respectively. The proportion of late presentations was greater in Tanzania at all ages, but the difference was particularly pronounced among working-age adults, with 50.3% {46.9, 53.7} of 18-65-year-olds presenting with advanced or severe VF loss, versus 10.2% {9.3, 11.3} in England. In both countries, men were more likely to present late than women.Conclusions: Late presentation of glaucoma is a problem in England, and an even greater challenge in Tanzania. Possible solutions are discussed, including increased community eye-care, and a more proactive approach to case finding through the use of disruptive new technologies, such as low-cost, portable diagnostic aids.

Knowledge and practices of eye health professionals about the availability and accessibility of child eye care services in the public sector in Swaziland

Background: International and African rights instruments stipulate that children have the right to access quality general and eye health care. Lack of access to quality eye care can have a significant negative impact on the child, family and society in general.Aim: To determine the knowledge and practices of eye care professionals about the availability and accessibility of child eye care services in the public sector in Swaziland.Setting: The study was conducted in Swaziland.Methods: This was a quantitative study design, and 15 public eye health professionals completed and returned the Questionnaire for Eye Health Professionals (QEHP).Results: Thirteen (86.7%) eye health practitioners reported that both standard practice guidelines and paediatric national guidelines for ophthalmic services were unavailable. The majority (66.7%) identified cost and unawareness of available services by parents as the most common barrier to accessing eye care services. Nine (60%) felt that they were less informed about eye health problems and 6 (40%) reported being well informed. Eight (53.3%) respondents indicated that there were no outreach programmes and 7 (46.7%) reported that their clinics offered these services. Thirteen (86.7%) eye health practitioners indicated that they were not part of teachers’ training for supporting visually impaired children, while 2 (13%) reported that they were.Conclusion: Formulation of guidelines to support eye health care service delivery in Swaziland is essential in order to improve availability, accessibility, affordability and effectiveness in the public health system.

Patient preferences for prenatal testing and termination of pregnancy for congenital anomalies and genetic diseases in Ethiopia

OBJECTIVE

As prenatal diagnostic services expand throughout low-income countries, an important consideration is the appropriateness of these services for patients. In these countries, services now include prenatal ultrasound and occasionally genetic testing. To assess patient interest, we surveyed pregnant patients at a hospital in Addis Ababa, Ethiopia, on their preferences for prenatal testing and termination of affected pregnancies for congenital anomalies and genetic diseases.

METHOD

One hundred one pregnant patients were surveyed on their preferences for prenatal testing and termination of affected pregnancies using a survey covering various congenital anomalies and genetic diseases.

RESULTS

Eighty-nine percent of patients reported interest in testing for all conditions. Three percent of patients were not interested in any testing. Over 60% of patients reported interest in termination for anencephaly, early infant death, severe intellectual disability, hemoglobinopathy, and amelia. Patients were more likely to express interest in prenatal testing and termination for conditions associated with a shortened lifespan.

CONCLUSION

Ethiopian patients were interested in prenatal testing and termination of pregnancy for many conditions. Advancing prenatal diagnostic capacities is a potential strategy for addressing the incidence of congenital anomalies and genetic disease in Ethiopia. Importantly, there exist many factors and technological limitations to consider before implementation.

Profile of ocular trauma in patients presenting to the department of ophthalmology at Hawassa University: Retrospective study

Purpose

To assess the pattern, presentation and risk factors of ocular trauma among patients treated at Hawassa University, Referral Hospital, Ophthalmology Department, South Ethiopia, 2014

Methods

The medical records of all patients treated for ocular trauma at Hawassa University, Referral Hospital, Ophthalmology Department, during the period January 01, 2012 to July 31, 2014, were retrospectively reviewed. Trained optometrists, ophthalmic nurses and ophthalmic officer collected the data using a pretested data abstraction form. The descriptive and analytic statistics was carried out.

Results

A total of 773 patients (549 males and 224 females) were included in the study. Closed globe injury was more common in males (P = 0.019) and open globe injury was significantly common in children (P < 0.001). Corneal tear was the most frequently observed finding (39.33%). Surgery, secondary to trauma, was common in open globe injury (P < 0.001). About 98% of the patients presented after 6 hours post trauma. Among 84.61% patients whose visual acuity (VA) was recorded at presentation, 12.23% had VA of 6/6 and 65.90% had VA of <3/60.

Conclusion

Ocular trauma was more common in males and children. Majority of patients (98%) presented after 6 hours post trauma. Cornea was the most commonly affected ocular structure by trauma.

Adherence to topical glaucoma medications and associated factors in Gondar University Hospital Tertiary Eye Care Center, northwest Ethiopia

Purpose:

The purpose of the study was to determine proportion of adherence to topical glaucoma medications and associated factors among glaucoma patients in Gondar University Hospital Tertiary Eye Care and Training Center, northwest Ethiopia.

Methods:

This cross-sectional design study was conducted on 360 participants from April–May 2017. Structured questionnaire was completed and adherence was assessed by patients’ self-report survey. The data were analyzed by SPSS version 20. Multivariate logistic regression was used to identify the determinant factors. The significance was considered at p value less than 0.05.

Result:

More than half, 221 (61.4%) (95% confidence interval: 56.1–66.7), of the study participants were found to adhere well to glaucoma medications. Male sex (adjusted odds ratio = 1.86 (95% confidence interval: 1.13–3.06)), urban residence (adjusted odds ratio = 2.33 (95% confidence interval: 1.46–3.72)), normal visual acuity (adjusted odds ratio = 2.23 (95% confidence interval: 1.13–4.42)), low visual acuity (adjusted odds ratio = 1.74 (95% confidence interval: 1.05–2.88)), and self-sponsor for medications (adjusted odds ratio = 0.21 (95% confidence interval: 0.12–0.38)) were significantly associated with good adherence

Conclusion:

The level of medication adherence to topical glaucoma medications is not good enough as compared to other studies done in Ethiopia. Male sex, urban residence, normal, and low visual acuity were positive predictors, whereas self-sponsored for medications was negative predictors for good adherence to glaucoma medications.

Population need for primary eye care in Rwanda: A national survey

Background

Universal access to Primary Eye Care (PEC) is a key global initiative to reduce and prevent avoidable causes of visual impairment (VI). PEC can address minor eye conditions, simple forms of uncorrected refractive error (URE) and create a referral pathway for specialist eye care, thus offering a potential solution to a lack of eye health specialists in low-income countries. However, there is little information on the population need for PEC, including prevalence of URE in all ages in Sub-Saharan Africa.

Methods

A national survey was conducted of people aged 7 and over in Rwanda in September-December 2016. Participants were selected through two-stage probability proportional to size sampling and compact segment sampling. VI (visual acuity<6/12) was assessed using Portable Eye Examination Kit (PEEK); URE was detected using a pinhole and presbyopia using local near vision test. We also used validated questionnaires to collect socio-demographic and minor eye symptoms information. Prevalence estimates for VI, URE and need for PEC (URE, presbyopia with good distance vision, need for referrals and minor eye conditions) were age and sex standardized to the Rwandan population. Associations between age, sex, socio-economic status and the key outcomes were examined using logistic regression.

Results

4618 participants were examined and interviewed out of 5361 enumerated (86% response rate). The adjusted population prevalence of VI was 3.7% (95%CI = 3.0–4.5%), URE was 2.2% (95%CI = 1.7–2.8%) and overall need for PEC was 34.0% (95%CI = 31.8–36.4%). Women and older people were more likely to need PEC and require a referral.

Conclusions

Nearly a third of the population in Rwanda has the potential to benefit from PEC, with greater need identified in older people and women. Universal access to PEC can address unmet eye health needs and public health planning needs to ensure equitable access to older people and women.

Causes of Childhood Vision Impairment in the School for the Blind in Eritrea

SIGNIFICANCE

Our study provides the much-needed evidence on causes of childhood blindness in Eritrea. This will assist authorities to plan appropriate strategies and implement preventive, curative, and rehabilitative services to address these causes of vision loss in children in this resource-limited country.

PURPOSE

This study aims to identify the causes of severe vision impairment and blindness in children attending the only school for the blind in Eritrea.

METHODS

All children enrolled in the school were examined, and the World Health Organization form for the examination of visually impaired children was used to record the data. Examination included visual acuity, refraction, anterior segment, and fundus assessment. Causes of vision loss for children with severe vision impairment (visual acuity <6/60 to 3/60) and blindness (visual acuity <3/60) are reported. Causes were classified by the anatomical site affected and by underlying etiology based on the timing of the insult and causal factor.

RESULTS

A total of 92 children were examined, and 71 (77.2%) of them had severe vision impairment and blindness. The major causes of vision loss were corneal scars (16.9%), cataract (12.7%), phthisis bulbi (11.3%), congenital eye deformities (11.3%), optic atrophy (9.3%), and presumed chorioretinal Toxoplasma scars (7.0%). Hereditary factors were the major known etiological category (15.5%) followed by the sequel of eye injuries (12.7%). Blindness due to vitamin A deficiency was not found, whereas infectious causes such as measles and ophthalmia neonatorum were relatively absent (one case each). Potentially avoidable causes of vision impairment were accounted for in 47.9% of children.

CONCLUSIONS

This study provides the first direct evidence on childhood vision impairment in Eritrea. Despite the limitations, it is clearly shown that nearly half of the vision loss is due to avoidable causes. Thus, preventive public health strategies, specialist pediatric eye care, and rehabilitative services are recommended to address childhood vision impairment in Eritrea.

Awareness of Glaucoma and Eye Health Services Among Faith-based Communities in Kumasi, Ghana

PURPOSE

To determine awareness of glaucoma, "hinta anifraye" and available eye health services among urban communities in Kumasi, Ghana. "Hinta anifraye" is a recently developed term for glaucoma in the local Twi language.

MATERIALS AND METHODS

Convenience sampling was used to survey the communities of 4 churches and 2 mosques in Kumasi, recruiting participants as they arrived to attend religious services. Ten interviewers collected data by quantitative, interviewer-administered questionnaires. An awareness grading system was devised to categorize participant knowledge from level 0 to 4.

RESULTS

Of a total 484 respondents, 269 (56%; 95% confidence interval, 52%-60%) had heard of glaucoma, and 284 (60%; 95% confidence interval, 56%-64%) had heard of either glaucoma or hinta anifraye. Only 142 (29%) had disease-specific knowledge of symptoms or causes. TV and radio were the main reported sources of information. Education, religious community, English language, male sex, and older age were all found to be significant indicators of awareness, with education shown to be a key confounding factor. Overall 436 (90%) mentioned either a hospital or doctor as a place they knew they could seek help for an eye problem.

CONCLUSIONS

Awareness of glaucoma is higher than previously suggested from similar studies, but still very low from a global perspective. The findings suggest that media is a useful tool in disseminating health messages. Awareness of professional care was found to be remarkably high. Eye health promotion is recommended to raise awareness of glaucoma among this population.

Prevalence and Causes of Visual Impairment and Blindness among Cocoa Farmers in Ghana

PURPOSE

To determine the prevalence and causes of visual impairment and blindness among cocoa farmers in Ghana in order to formulate early intervention strategies.

METHODS

A cross-sectional study using multistage random sampling from four cocoa growing districts in Ghana was conducted from November 2013 to April 2014. A total of 512 cocoa farmers aged 40 years and older were interviewed and examined. The brief interview questionnaire was administered to elicit information on the demographics and socioeconomic details of participants. The examination included assessment of visual acuity (VA), retinoscopy, subjective refraction, direct ophthalmoscopy, slit-lamp biomicroscopy and intraocular pressure (IOP). For quality assurance, a random sample of cocoa farmers were selected and re-examined independently.

RESULTS

Moderate to severe visual impairment (VA <6/18 to 3/60 in the better-seeing eye) was present in 89 participants (17.4%) and 27 (5.3%) were blind (presenting VA <3/60 in the better eye) defined using presenting VA. The main causes of visual impairment were cataract (45, 38.8%), uncorrected refractive error (42, 36.2%), posterior segment disorders (15, 12.9%), and corneal opacity (11, 9.5%).

CONCLUSION

The prevalence of visual impairment and blindness among cocoa farmers in Ghana is relatively high. The major causes of visual impairment and blindness are largely preventable or treatable, indicating the need for early eye care service interventions.

Glaucoma awareness, knowledge, perception of risk and eye screening behaviour among residents of Abokobi, Ghana

BACKGROUND

Although glaucoma is the lead cause of irreversible blindness globally, the condition shows no signs or symptoms until later stages. Knowledge about the disease is known to influence utilization of eye screening services. This study aimed at understanding knowledge and perception of risk for glaucoma, as well as eye screening behaviour among residents of Abokobi, a peri-urban community.

METHODS

This was a cross-sectional study that employed quantitative data collection methods, with the use of a questionnaire. Descriptive statistics were used to describe the socio-demographic characteristics, knowledge about glaucoma and eye screening behaviour. Also, associations between socio-demographic factors and awareness as well as perception of risk were analysed using Chi-square test or Univariate Fisher's exact test.

RESULTS

Out of a total of 300 respondents, 60.3 % were females and 39.3 % were aware of glaucoma. Majority (99.1 %) of respondents aware of glaucoma also agreed the disease can result in blindness with only (28 %) affirming that blindness from glaucoma is irreversible. Nearly half (49.7 %) of the respondents perceived themselves to be at risk of developing glaucoma. The results showed that age and education (p <0.0001) were statistically significant with glaucoma awareness. Approximately, 20.7 % of the respondents have had their eye screened with just a few (4.3 %) screening for glaucoma.

CONCLUSION

Although glaucoma awareness was high, the findings display inadequate knowledge about glaucoma. There is a need to effectively inform and educate people about the disease.

Reasons for poor follow-up of diabetic retinopathy patients after screening in Tanzania: a cross-sectional study

Background

Diabetes is an emerging public health problem in sub-Saharan Africa. Diabetic retinopathy is the commonest microvascular complication of diabetes and is a leading cause of blindness, mainly in adults of working age. Follow-up is crucial to the effective management of diabetic retinopathy, however, follow-up rates are often poor in sub-Saharan Africa. The aim of this study was to assess the proportion of patients not presenting for follow-up and the reasons for poor follow-up of diabetic patients after screening for retinopathy in Kilimanjaro Region of Tanzania.

Methods

All diabetic patients referred to a tertiary ophthalmology hospital after screening for retinopathy in 2012 were eligible for inclusion in the study. A randomly selected group of patients from the community-based diabetic retinopathy screening register were identified; among this group, follow-up was assessed. Interviews were conducted within this group to inform on the reasons for poor follow-up.

Results

Among the 203 patients interviewed in the study 50 patients (24.6 %) attended the recommended referral appointment and 153 (75.4 %) did not. Financial reasons were self-reported by 35.3 % of those who did not attend the follow-up appointment as the reason for non-attendance. Multiple logistic regression analysis showed that the patient report of the clarity of the referral process (p = 0.014) and the patient report of whether a healthcare worker told the patient that diabetic retinopathy could be treated (p = 0.005) were independently associated with attendance at a follow-up appointment. Income per month was not associated with attendance at a follow-up appointment on multivariate analysis.

Conclusions

Financial factors are commonly cited as the reason for non-compliance with follow-up recommendations. However, the reasons for poor compliance are likely to be more complicated. This study highlights the importance of health system factors. Improving the clarity of the referral process and frequent reminders to patients that diabetic retinopathy can be treated are practical strategies that should be incorporated into screening programmes to increase attendance at subsequent follow-up appointments. The results from this study are applicable to other screening programmes as well as those for diabetic retinopathy.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-016-0288-z) contains supplementary material, which is available to authorized users.

Corneal Transplantation in the Developing World: Lessons Learned and Meeting the Challenge

PURPOSE

To describe the current state of corneal blindness (CB) and corneal transplantation in the developing world.

METHODS

Information on corneal transplantation was obtained from published articles, direct communication with corneal specialists in developing countries, data sourced from eye banks in the United States and abroad, and personal experience.

RESULTS

CB is the fourth leading cause of global blindness. Most of those with CB live in India and Africa. Many developing countries lack sustainable eye banks, and there is a shortage of corneal transplant surgeons. India has started programs to address both these issues, whereas Africa seems the least prepared. Brazil and the Philippines have also made significant progress in eye banking. In addition, studies indicate a role for the use of a keratoprosthesis in select settings. Several international organizations and academic centers have targeted these system-wide deficiencies.

CONCLUSIONS

There are an unacceptable number of people with cornea blindness in the developing world. Programs have been initiated to address eye bank sustainability and to increase surgeon capacity. However, much more work and effort will be needed to improve the current statistics.

Solar ultraviolet radiation in Africa: a systematic review and critical evaluation of the health risks and use of photoprotection

The majority of the African continent experiences high solar UVB radiation throughout the year. The adverse consequences of this on the health of populations living in Africa are reviewed.

Opinions of South African optometry students about working in rural areas after graduation

BACKGROUND

Eye and vision problems have been reported to be more prevalent in rural than urban areas; and a large proportion of South Africans live in the rural areas.

AIM

To investigate the opinions of South African optometry students about working in rural areas after completion of their training and to identify factors that may influence their decisions.

METHOD

This was a cross-sectional quantitative study using a survey instrument containing both closed and open-ended, semi-structured questions.

RESULTS

Four hundred and thirty-eight students responded to the questionnaire (85.4% response rate). Overall, many of the respondents did not want to open their first (66%) or second practices (64.6%) in the rural areas. However, most respondents from rural backgrounds reported that they would open their first (77.2%) or second (79.4%) practice in the rural areas. The main reasons cited by the respondents for their unwillingness to work in the rural areas were financial concerns (81.2%), personal safety (80.1%) and poor living conditions (75.3%), with a significantly higher number (p < 0.05) being from urban respondents for the latter two issues only.

CONCLUSION

Many students were not in favour of opening practices in rural areas, but were willing to work for the government or a non-governmental organisation after graduation. Efforts should be made to address financial incentives, safety and living conditions in the rural areas. The results of this study have implications for the future of availability and accessibility of eye care services to those living in the rural and remote areas of the country.

RETINAL DISEASES IN A TERTIARY HOSPITAL IN SOUTHERN NIGERIA

BACKGROUND

Retinal diseases are an important and common cause of ophthalmic consultation.

AIM

To determine the pattern of retinal diseases in the ophthalmic department of a tertiary hospital in Southern Nigeria.

PATIENTS AND METHODS

A retrospective review of the case folders of patients with retinal pathologies seen between 2012 and 2013 was performed. Relevant demographic and clinical data was recorded. Analysis was performed for frequencies, proportions and percentages with the GraphPad Instat Software, Inc. version V2.05a program, San Diego, CA.

RESULTS

There were 185 patients made of 94 (50.8%) males and 91 (49.2%) females with a peak age group of 61-70 years, (range 1-85 years) who made consultations for retinal diseases. Age related macular degeneration, 37(15.0%), and macula hole, 10(4.0%), were the common macula pathologies while retinal detachment, 11(4.5%), was the most common condition that required emergency vitreo-retinal surgical intervention. Diabetic retinopathy/maculopathy, 31(12.6%), hypertensive retinopathy 22(8.9%), and retinal vascular occlusion 12(4.8%), were the common retinal vascular diseases found. Bilateral visual impairment (low vision and blindness) from retinal diseases was present in 28(14.4%) persons. The common vitreo-retinal treatment options were use of intravitreal antivascular endothelial growth factors 32(13.0%), laser 16(6.5%), and vitreoretinal surgery in 22(8.9%) eyes.

CONCLUSION

Retinal diseases remain an important cause of ophthalmic consultation and visual loss. Provision of facilities to manage these conditions will improve service delivery and quality of lives of affected patients.

Barriers to use of refractive services in Mozambique

PURPOSE

Uncorrected refractive error remains a leading cause of visual impairment (VI) across the globe with Mozambique being no exception. The establishment of an optometry profession in Mozambique that is integrated into the public health system denotes significant progress with refractive services becoming available to the population. As the foundations of a comprehensive refractive service have now been established, this article seeks to understand what barriers may limit their uptake by the general population and inform decision making on improved service delivery.

METHODS

A community-based cross-sectional study using two-stage cluster sampling was conducted. Participants with VI were asked to identify barriers that were reflective of their experiences and perceptions of accessing refractive services. A total of 4601 participants were enumerated from 76 clusters in Nampula, Mozambique.

RESULTS

A total of 1087 visually impaired participants were identified (884 with near and 203 with distance impairment). Cost was the most frequently cited barrier, identified by more than one in every two participants (53%). Other barriers identified included lack of felt need (20%), distance to travel (15%), and lack of awareness (13%). In general, no significant influence of sex or type of VI on barrier selection was found. Location had a significant impact on the selection of several barriers. Pearson χ analysis indicated that participants from rural areas were found to feel disadvantaged regarding the distance to services (p ≤ 0.001) and adequacy of hospital services (p = 0.001).

CONCLUSIONS

For a comprehensive public sector refractive service to be successful in Mozambique, those planning its implementation must consider cost and affordability. A clear strategy for overcoming lack of felt need will also be needed, possibly in the form of improved advocacy and health promotion. The delivery of refractive services in more remote rural areas merits careful and comprehensive consideration.

[Ophthalmology and urban underprivileged. Experience of 150 patients]

INTRODUCTION

An ophthalmology consultation was carried out at the Hôtel-Dieu to facilitate eye care in underprivileged patients referred by the general medicine PASS (socialized health care) of the same hospital.

MATERIALS AND METHODS

The files of 150 consecutive patients examined by a single ophthalmologist between January 2012 and June 2013 were reviewed. A standard examination was performed in these patients, sent with a consult sheet, to which a response was sent to PASS. As necessary, prescriptions were also written for the patients.

RESULTS

Most patients (89/150) were immigrants from sub-Saharan Africa. Additionally, there were 25 Europeans with only 5 French, and 17 Asians. The mean age was 41 years with 90 men (mean age 43) and 60 women (mean age 36). The most common systemic diseases observed were hypertension, (13), diabetes (6), and hepatitis (6). The mean best-corrected visual acuity (129 patients) was a slightly more than 8/10 (16/20) (measurable in 143 patients). Refractive state (measured in 129 patients) was myopia (46), hyperopia (41), presbyopia (isolated in 12 cases), astigmatism (26), and emmetropia (28). Optical correction was prescribed in 87 patients. The main pathological conditions included pingueculae (19), cataracts (19), trauma (13) of which 4 patients were monocular, and pterygia (9).

DISCUSSION AND CONCLUSION

Refractive errors were the main abnormality observed in these underprivileged patients. Apart from cataract as a pathologic condition observed in the general population, more characteristic of this sub-Saharan population were pinguecula, pterygium and trauma. This study highlights the more general question of access to eye care for all underprivileged patients.

The Impact of Nurses on Neglected Tropical Disease Management

Although Neglected Tropical Diseases (NTDs) are largely endemic in the developing nations of Africa, Asia, and South and Central America, they are reemerging with increasing frequency in developed countries. Their diagnosis, treatment, and control are an increasing public health concern that requires a different awareness by health care providers. Neglected tropical diseases (NTDs) are chronic infectious diseases which disproportionately burden poor, rural, and marginalized populations with significant mortality and high morbidity (disability, disfigurement, impaired childhood growth and cognitive development, increased vulnerability to coinfection) that reinforces their poverty. What can we learn from the nurses in developing countries already battling NTD's that could be useful in the developed world? This article provides an overview of distribution, pathophysiology, symptoms, and management of 13 NTDs, with particular attention to the role of nurses in delivering cost-effective integrated interventions. Case studies of schistosomiasis, Chagas disease, and leishmaniasis address recognition and treatment of infected individuals in developed nations where NTD infection is limited primarily to immigrants and travelers.

Retinal dystrophy and congenital glaucoma as major causes of vision loss in students attending two institutions for the visually disabled in Tunis city, Tunisia

PURPOSE

To assess vision loss, identify affected anatomical sites, determine etiologies and potentially avoidable causes in students attending two institutions for the visually disabled in Tunis city.

METHODS

A visit for a complete ophthalmological examination was performed. All students attending these schools were recruited in our study. The World Health Organisation Programme for the Prevention of Blindness (WHO/PBL) examination record for children was used. Data was analysed by the SPSS version 17 statistical software.

RESULTS

A total of 172 students were recruited with mean age of 11.9±3.3 years (between 6 and 18 years). One hundred and thirty-seven (79.6%) were under 16 years. The sex-ratio was 1.17. Ninety students (52.3%) had low vision and eighty-two (47.7%) were blind. We reported retina (29%), whole globe (29%), globe appears normal (11%) and optic nerve (9.8%) as the common sites of ocular abnormalities. Retinal dystrophy (22.7%) and congenital glaucoma (22.7%) were the most reported ocular diseases. The main etiologies were hereditary (54.1%) and unknown (30.8%). Consanguinity was reported in 108 students (62.8%), and fifty-five students (32%) had a positive family history. Overall, 50.5% (87/172) of ocular diseases were potentially treatable or preventable.

CONCLUSION

Retinal dystrophy and congenital glaucoma were the most common eye diseases. Heredity was the main etiology, and consanguinity was high. To decrease their incidence, awareness of the family members of the risks of consanguinous marriage and appropriate therapy for congenital glaucoma/cataract may significantly improve the child's visual prognosis.

Ocular morbidity and health seeking behaviour in Kwara state, Nigeria: implications for delivery of eye care services

BACKGROUND

There is currently limited information as to which conditions are most prevalent in communities in developing countries. This makes effective planning of eye services difficult.

METHODS

3,899 eligible individuals were recruited and examined in a cross-sectional survey in Asa Local Government Area, Nigeria. Those who self-reported an ocular morbidity were also asked about their health-seeking behaviour. Health records of local facilities were reviewed to collect information on those presenting with ocular morbidities.

RESULTS

25.2% (95% CI: 22.0-28.6) had an ocular morbidity in at least one eye. Leading causes were presbyopia and conditions affecting the lens and conjunctiva. The odds of having an ocular morbidity increased with age and lower educational attainment. 10.1% (7.7-13.0) self-reported ocular morbidity; 48.6% (40.4-56.8) of them reported seeking treatment. At the facility level, 344 patients presented with an ocular morbidity over one month, the most common conditions were red (26.3%) or itchy (20.8%) eyes.

CONCLUSION

Ocular morbidities, including many non vision impairing conditions, were prevalent with a quarter of the population affected. The delivery of eye care services needs to be tailored in order to address this need and ensure delivery in a cost-effective and sustainable manner.

Blindness and Visual Impairment among Egyptian Glaucoma Patients

Purpose. Glaucoma is the second commonest cause of blindness worldwide. Visual fields and intraocular pressures are optimum outcomes to be assessed in developed countries. Visual acuity as an outcome is the key player when assessing blindness in developing countries. The aim of this study is to assess visual impairment and blindness in glaucoma patients and to identify the bulk they represent in comparison to nonglaucoma patients in the same practice setting. Methods. Patients attending outpatient clinics of Cairo University Hospitals were enrolled in this cross-sectional study. Clinical data collected for these patients included their demographic data, best obtained visual acuity, and whether or not they have had an established diagnosis of glaucoma. Results were compared at 95% confidence intervals. Results. 988 eyes of 494 patients were included for this study. Their mean visual acuity was 6/24 (±3 Snellen lines). Legal blindness was found in 5% and 4% of glaucoma and nonglaucoma groups, respectively. There were high odds for finding eyes with total blindness due to glaucoma. That was statistically significant (P < 0.05). Conclusions. A large proportion of glaucoma patients suffered from blindness in at least one eye. Interventional strategies are recommended regarding visual disability among Egyptian glaucoma patients.

Corneal blindness and xenotransplantation

Approximately 39 million people are blind worldwide, with an estimated 285 million visually impaired. The developing world shoulders 90% of the world's blindness, with 80% of causative diseases being preventable or treatable. Blindness has a major detrimental impact on the patient, community, and healthcare spending. Corneal diseases are significant causes of blindness, affecting at least 4 million people worldwide. The prevalence of corneal disease varies between parts of the world. Trachoma, for instance, is the second leading cause of blindness in Africa, after cataracts, but is rarely found today in developed nations. When preventive strategies have failed, corneal transplantation is the most effective treatment for advanced corneal disease. The major surgical techniques for corneal transplantation include penetrating keratoplasty (PK), anterior lamellar keratoplasty, and endothelial keratoplasty (EK). Indications for corneal transplantation vary between countries, with Fuchs' dystrophy being the leading indication in the USA and keratoconus in Australia. With the exception of the USA, where EK will soon overtake PK as the most common surgical procedure, PK is the overwhelming procedure of choice. Success using corneal grafts in developing nations, such as Nepal, demonstrates the feasibility of corneal transplantation on a global scale. The number of suitable corneas from deceased human donors that becomes available will never be sufficient, and so research into various alternatives, for example stem cells, amniotic membrane transplantation, synthetic and biosynthetic corneas, and xenotransplantation, is progressing. While each of these has potential, we suggest that xenotransplantation holds the greatest potential for a corneal replacement. With the increasing availability of genetically engineered pigs, pig corneas may alleviate the global shortage of corneas in the near future.

Prevalence and causes of vision loss in sub-Saharan Africa: 1990-2010

AIM

To estimate the magnitude, temporal trends and subregional variation in the prevalence of blindness, and moderate/severe vision impairment (MSVI) in sub-Saharan Africa.

METHODS

A systematic review was conducted of published and unpublished population-based surveys as part of the Global Burden of Disease, Risk Factors and Injuries Study 2010. The prevalence of blindness and vision impairment by country and subregion was estimated.

RESULTS

In sub-Saharan Africa, 52 studies satisfied the inclusion criteria. The estimated age-standardised prevalence of blindness decreased by 32% from 1.9% (95% CI 1.5% to 2.2%) in 1990 to 1.3% (95% CI 1.1% to 1.5%) in 2010 and MSVI by 25% from 5.3% (95% CI 0.2% to 0.3%) to 4.0% (95% CI 0.2% to 0.3%) over that time. However, there was a 16% increase in the absolute numbers with blindness and a 28% increase in those with MSVI. The major causes of blindness in 2010 were; cataract 35%, other/unidentified causes 33.1%, refractive error 13.2%, macular degeneration 6.3%, trachoma 5.2%, glaucoma 4.4% and diabetic retinopathy 2.8%. In 2010, age-standardised prevalence of MSVI in Africa was 3.8% (95% CI 3.1% to 4.7%) for men and 4.2% (95% CI 3.6% to 5.3%) for women with subregional variations from 4.1% (95% CI 3.3% to 5.4%) in West Africa to 2.0% (95% CI 1.5% to 3.3%) in southern Africa for men; and 4.7% (95% CI 3.9% to 6.0%) in West Africa to 2.3% (95% CI 1.7% to 3.8%) in southern Africa for women.

CONCLUSIONS

The age-standardised prevalence of blindness and MSVI decreased substantially from 1990 to 2010, although there was a moderate increase in the absolute numbers with blindness or MSVI. Significant subregional and gender disparities exist.

A preliminary descriptive analysis of Corneal Transplant Registry of National Eye Bank in India

PURPOSE

To describe and analyze the Corneal Transplant Registry of National Eye Bank and also evaluate graft outcomes in India.

METHODS

All patients who underwent corneal transplant at our center within six months of setting up of Corneal Transplant Registry and installation of database at National Eye Bank were included in the study. The established database was analyzed for utilization, donor and recipient details and graft outcomes. Outcome was assessed at the end of one year follow up. The influence of various donor and recipient factors affecting outcome were evaluated. Visual outcome was analyzed in terms of shift in visual handicap category. Statistical tests like analysis of variance, Kruskal-Wallis test and Chi square tests were applied for determination of clinical significance wherever required.

RESULTS

326 corneas were received from 168 donors; of these, 234 (71.7%) were utilized for transplantation. Out of 177 patients with adequate (one year) follow up (75.6% patients), optical corneal replacement was performed in106 patients and therapeutic keratoplasty in71. 78% (82/106) patients in the optical group retained clear grafts at the end of follow up. 59.7% (49 of 82) of patients who attained clear grafts belonged to visual disability category 3 or worse pre-operatively. 59.1% of these achieved BCVA of ≥6/60 at the end of follow up; thus shifting up their visual handicap category. Primary graft failure was found to be associated with full thickness keratoplasty and not with lamellar procedures (p<0.05) and occurred in 4.2% patients (5) with optical corneal replacement whereas 7.5% patients (8) developed secondary graft failure. Age of donor (p=0.54), death enucleation time (p>0.05), cause of donor death (p=0.15), type of surgical procedures (p=0.538) and indication for surgery did not have any significant effect on outcome. 76% patients who underwent therapeutic graft achieved elimination of corneal infection.

CONCLUSIONS

The development of corneal graft registry established an effective means to evaluate our corneal transplantation services. Outcomes of sight restoring corneal transplants performed were comparable to results of graft registries from developed nations.