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Annoh R, Buchan J, Gichuhi S, Philippin H, Arunga S, Mukome A, Admassu F, Lewis K, Makupa W, Otiti-Sengeri J, Kim M, MacLeod D, Burton MJ, Dean WH. The Impact of Simulation-Based Trabeculectomy Training on Resident Core Surgical Skill Competency. J Glaucoma 2023; 32:57-64. [PMID: 36001526 PMCID: PMC7614002 DOI: 10.1097/ijg.0000000000002114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/27/2022] [Indexed: 02/08/2023]
Abstract
PRCIS Simulation-based surgical education shows a positive, immediate, and sustained impact on core surgical skill competency in trabeculectomy among resident ophthalmologists in training. PURPOSE To measure the impact of trabeculectomy, surgical simulation training on core surgical skill competency in resident ophthalmologists. MATERIALS AND METHODS This is a post hoc analysis of the GLAucoma Simulated Surgery trial, which is a multicenter, multinational randomized controlled trial. Resident ophthalmologists from 6 training centers in sub-Saharan Africa (in Kenya, Uganda, Tanzania, Zimbabwe, and South Africa) were recruited according to the inclusion criteria of having performed zero surgical trabeculectomies and assisted in <5. Participants were randomly assigned to intervention and control arms using allocation concealment. The intervention was a 1-week intensive trabeculectomy surgical simulation course. Outcome measures were mean surgical competency scores in 8 key trabeculectomy surgical skills (scleral incision, scleral flap, releasable suturing, conjunctival suturing, sclerostomy, tissue handling, fluidity, and speed), using a validated scoring tool. RESULTS Forty-nine residents were included in the intention-to-treat analysis. Baseline characteristics were balanced between arms. Median baseline surgical competency scores were 2.88/16 [interquartile range (IQR): 1.75-4.17] and 3.25/16 (IQR: 1.83-4.75) in the intervention and control arms, respectively. At primary intervention, median scores increased to 11.67/16 (IQR: 9.58-12.63) and this effect was maintained at 3 months and 1 year ( P =0.0001). Maximum competency scores at primary intervention were achieved in the core trabeculectomy skills of releasable suturing (n=17, 74%), scleral flap formation (n=16, 70%), and scleral incision (n=15, 65%) compared with scores at baseline. CONCLUSIONS This study demonstrates the positive impact of intensive simulation-based surgical education on core trabeculectomy skill development. The rapid and sustained effect of resident skill acquisition pose strong arguments for its formal integration into ophthalmic surgical education.
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Affiliation(s)
- Roxanne Annoh
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - John Buchan
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Heiko Philippin
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Eye Centre, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Simon Arunga
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Mbarara University & Referral Hospital Eye Centre (MURHEC), Mbarara University of Science and Technology, Mbarara, Uganda
| | - Agrippa Mukome
- Department of Ophthalmology, Parirenyatwa Hospitals, University of Zimbabwe, Harare
| | | | - Karinya Lewis
- Ophthalmology Department, Salisbury Hospitals NHS Foundation Trust, UK
- Eye Foundation Hospitals, Lagos, Nigeria
| | | | - Juliet Otiti-Sengeri
- Department of Ophthalmology, School of Medicine, Makerere University, Kampala, Uganda
| | - Min Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London; UK
| | - David MacLeod
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London; UK
| | - Matthew J. Burton
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, United Kingdom
| | - William H. Dean
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Division of Ophthalmology, University of Cape Town, South Africa
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Energy Dose-Response in Selective Laser Trabeculoplasty: A Review. J Glaucoma 2022; 31:e49-e68. [PMID: 35701875 PMCID: PMC9362340 DOI: 10.1097/ijg.0000000000002062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
PRCIS A literature review of selective laser trabeculoplasty (SLT) energy dose-response found no definitive relationship between intraocular pressure (IOP) reduction with respect to total or pulse energy, race, pigmentation, or application pattern. PURPOSE SLT is a safe and effective treatment for lowering IOP. Although evidence is mounting for the advantage of its use as a first-line treatment for IOP reduction, the SLT procedures in use vary widely. The purpose of this literature review was to investigate whether there were any relationships between SLT energy and efficacy for lowering IOP in the published literature. METHODS A literature review was undertaken that included studies in which energy levels required for successful SLT treatment were investigated: in general, with respect to angle pigmentation, race or ethnicity, and treatment arc extent. RESULTS There was no indication that higher (or lower) energy used in the treatment leads to greater (or less) IOP reduction. Similar results were obtained regarding the level of trabecular meshwork pigmentation. Race was not found to be associated with altered dose response in SLT. There were indications that treating the full 360 degrees, as opposed to smaller arcs, could be beneficial for more IOP reduction. IOP reduction from SLT was found to be similar to that provided by topical medications. CONCLUSIONS The optimal energy level of SLT needed for IOP reduction has not yet been definitively established, with all reported pulse energies resulting in similar IOP reduction. Furthermore, similar lack of conclusive findings exists regarding optimal SLT energy dosage for use in different races and degrees of trabecular meshwork pigmentation. This parameter and each of the abovementioned factors requires further research.
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Gari FS, Gelcho GN. Bivariate Survival Copula Analysis of Glaucoma Patients during Blindness: Glaucoma Cases at Alert Hospital in Addis Ababa City of Ethiopia. J Res Health Sci 2022; 22:e00547. [PMID: 36511259 PMCID: PMC9818039 DOI: 10.34172/jrhs.2022.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/26/2022] [Accepted: 04/17/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Glaucoma is a worldwide problem that causes vision loss and even blindness, with a prevalence rate ranging from 1.9% to 15%. In Ethiopia, glaucoma is the fifth cause of blindness. This study aimed to explore the dependence between blindness of the right and the left eyes of glaucoma patients and assess the effects of the covariates under the dependence structure. STUDY DESIGN A retrospective cohort study. METHODS The study population included the glaucoma patients at Alert hospital from January 1, 2018, to December 30, 2021. The copula model was used to estimate the time to the blindness of the right and the left eyes of the glaucoma patients by specifying the dependence between the event times. RESULTS Out of 537 glaucoma patients, 224 (41.71%) became blind at least in one eye during the follow-up period. The results of the Clayton copula model revealed that factors, such as age, residence, diabetes mellitus, stage of glaucoma, and hypertension are considered the most prognostic factors for blindness in glaucoma patients. The findings also revealed that there was a strong dependence between the time to the blindness of the right and the left eyes in the glaucoma patients (τ = 0.43). CONCLUSION Based on the obtained results, high age, urban residence, hypertension, diabetes mellitus, and higher stage of glaucoma were factors associated with time to the blindness in the glaucoma patients. There was also a dependence between the right and the left eyes of the glaucoma patients. The results revealed that the Clayton Archimedean copula model was the best statistical model for accurate description of glaucoma patients' datasets.
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Affiliation(s)
- Firomsa Shewa Gari
- Department of Statistics, College of Natural and Computational Science, Assosa University, Assosa, Ethiopia
| | - Gurmessa Nugussu Gelcho
- Department of Statistics, College of Natural Science, Jimma University, Jimma, Ethiopia,Corresponding author: Gurmessa Nugussu (MSc) Tel:+25 1912007548
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Assessment of eye drop instillation techniques among patients with primary open angle glaucoma in a Nigerian tertiary hospital. Int Ophthalmol 2021; 42:1031-1040. [PMID: 34655378 DOI: 10.1007/s10792-021-02085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the technique of eye drop instillation and its determinants among patients with primary open angle glaucoma (POAG) attending a Nigerian tertiary hospital. METHODS This study was a cross-sectional observational study conducted among 130 participants. Systematic sampling technique was used. Inclusion criteria were the presence of POAG, in individuals ≥ 18 years, and self-instilling their ocular hypotensive medications for at least 6 months. Demographic data and clinical characteristics were obtained using an interviewer-administered questionnaire and clinical examination. All participants underwent eye drop instillation of sterile water. Administration techniques were observed and graded using a comprehensive grading scheme. Patients with poor techniques were educated. Determinants of poor eye drop administration technique were also explored. RESULTS One hundred and thirty patients with POAG were studied. The mean age was 57.13 ± 13.20 years, and 63% percent of the participants had poor eye drop administration technique. On multivariate analysis, previous eye drop instillation education significantly influenced eye drop instillation technique (p = 0.02; OR = 3.230; 95% CI = 1.173-8.896). Among the participants, 47 (36%) touched the globe, 128 (98.5%) did not wash their hands, and 126 (97%) did not occlude the punctum. Sequel to the training, mean score of subjects improved from 2.8 ± 1.1 to 4.1 ± 1.3 (p value < 0.001). CONCLUSION This study demonstrated that a high proportion of POAG patients had poor eye drop instillation technique despite long-term self-use of topical medication. Thus, this aspect of therapy deserves periodic scrutiny by the clinician.
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Ocansey S, Abu EK, Abraham CH, Owusu-Ansah A, Acheampong C, Mensah F, Darko-Takyi C, Ilechie A. Socio-demographic factors modify awareness, knowledge, and perceived risk of glaucoma in rural and urban residents in Ghana: a population-based survey. Ther Adv Ophthalmol 2021; 13:2515841421998099. [PMID: 33796815 PMCID: PMC7968030 DOI: 10.1177/2515841421998099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Stephen Ocansey
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast. PMB University Post Office, Cape Coast, Ghana, CC-167-5809
| | - Emmanuel K Abu
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Carl Halladay Abraham
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Andrews Owusu-Ansah
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana; Glaucoma Research Group, 2nd Xiangya Hospital of Central South University, Changsha, China
| | | | | | - Charles Darko-Takyi
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Alex Ilechie
- Department of Optometry and Vision Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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Marco SA, Amin S, Virani A, Rudnisky CJ, Ishani S, Kiage D, Damji KF. Detecting Glaucoma in Rural Kenya: Results From a Teleglaucoma Pilot Project in Nyamira, Kenya. J Glaucoma 2021; 30:e99-e104. [PMID: 33449582 DOI: 10.1097/ijg.0000000000001742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Abstract
PRECIS A teleglaucoma (TG) case-finding model was used in Kenya. Of the patients, 3.46% had definite glaucoma and 4.12% were glaucoma suspects. Most cases were of moderate to advanced stage and referred for further assessment. PURPOSE The aim was to evaluate glaucoma prevalence in a high-risk population using a TG model. METHODS Patients aged 35 or over were referred to the TG program from the outpatient diabetic and hypertensive clinics at Nyamira District Hospital (NDH) and from community awareness programs. Comprehensive ophthalmic examination included structured history, visual acuity, intraocular pressure, central corneal thickness, stereoptic nerve, and macular images. A glaucoma specialist provided diagnosis and management recommendation through virtual consultation. Glaucoma diagnosis and staging were based on at least 1 eye meeting the optic nerve criteria as specified by the Canadian glaucoma guidelines. RESULTS In all, 1206 participants were seen and 19 of these could not complete the examination. Of 1187 patients, 56% were women and the mean age was 56.60±12.36 years. Of the patients, 11.8% had images that were ungradable in at least 1 eye. The prevalence of glaucoma and glaucoma suspects was 3.46% (n=42) and 4.12% (n=50), respectively. The proportion of patients with early, moderate, advanced, and absolute glaucoma was 2.4%, 33.3%, 52.4%, and 2.4%, respectively. Other diagnoses (pathology in at least 1 eye) included cataract in 13.2%, diabetic retinopathy in 1.48%, and optic atrophy in 1.98%. Of the patients, 28.2% were referred to the Innovation Eye Centre, Kisii, for further assessment. CONCLUSION A structured TG program detected glaucoma in 3.46% of a rural Kenyan population. Timely patient referral was also initiated.
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Affiliation(s)
- Sheila A Marco
- Department of Ophthalmology, University of Nairobi
- Ophthalmology Unit, Aga Khan University Hospital, Nairobi, Kenya
| | - Samreen Amin
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB
| | - Aleena Virani
- Faculty of Arts and Sciences, Queen's University, Kingston, ON, Canada
| | | | | | - Dan Kiage
- Innovation Eye Centre Kisii, Kisii, Kenya
| | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB
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Dean WH, Buchan J, Gichuhi S, Philippin H, Arunga S, Mukome A, Admassu F, Lewis K, Makupa W, Otiti J, Kim MJ, Macleod D, Cook C, Burton MJ. Simulation-based surgical education for glaucoma versus conventional training alone: the GLAucoma Simulated Surgery (GLASS) trial. A multicentre, multicountry, randomised controlled, investigator-masked educational intervention efficacy trial in Kenya, South Africa, Tanzania, Uganda and Zimbabwe. Br J Ophthalmol 2021; 106:863-869. [PMID: 33495158 PMCID: PMC9132848 DOI: 10.1136/bjophthalmol-2020-318049] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/05/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022]
Abstract
Background/Aim Glaucoma accounts for 8% of global blindness and surgery remains an important treatment. We aimed to determine the impact of adding simulation-based surgical education for glaucoma. Methods We designed a randomised controlled, parallel-group trial. Those assessing outcomes were masked to group assignment. Fifty-one trainee ophthalmologists from six university training institutions in sub-Saharan Africa were enrolled by inclusion criteria of having performed no surgical trabeculectomies and were randomised. Those randomised to the control group received no placebo intervention, but received the training intervention after the initial 12-month follow-up period. The intervention was an intense simulation-based surgical training course over 1 week. The primary outcome measure was overall simulation surgical competency at 3 months. Results Twenty-five were assigned to the intervention group and 26 to the control group, with 2 dropouts from the intervention group. Forty-nine were included in the final intention-to-treat analysis. Surgical competence at baseline was comparable between the arms. This increased to 30.4 (76.1%) and 9.8 (24.4%) for the intervention and the control group, respectively, 3 months after the training intervention for the intervention group, a difference of 20.6 points (95% CI 18.3 to 22.9, p<0.001). At 1 year, the mean surgical competency score of the intervention arm participants was 28.6 (71.5%), compared with 11.6 (29.0%) for the control (difference 17.0, 95% CI 14.8 to 19.4, p<0.001). Conclusion These results support the pursuit of financial, advocacy and research investments to establish simulation surgery training units and courses including instruction, feedback, deliberate practice and reflection with outcome measurement to enable trainee glaucoma surgeons to engage in intense simulation training for glaucoma surgery. Trial registration number PACTR201803002159198.
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Affiliation(s)
- William H Dean
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK .,Ophthalmology, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - John Buchan
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Gichuhi
- Ophthalmology, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Heiko Philippin
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Eye Centre, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany
| | - Simon Arunga
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Agrippa Mukome
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Fisseha Admassu
- Department of Ophthalmology, University of Gondar, Gondar, Ethiopia
| | - Karinya Lewis
- Ophthalmology, Salisbury Hospital NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - William Makupa
- Ophthalmology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
| | - Juliet Otiti
- Ophthalmology, Makerere University Faculty of Medicine, Kampala, Uganda
| | - Min J Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - David Macleod
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Colin Cook
- Ophthalmology, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Matthew J Burton
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Ophthalmology training in sub-Saharan Africa: a scoping review. Eye (Lond) 2020; 35:1066-1083. [PMID: 33323984 DOI: 10.1038/s41433-020-01335-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 11/08/2022] Open
Abstract
Sub-Saharan Africa is home to 12% of the global population, and 4.3 million are blind and over 15 million are visually impaired. There are only 2.5 ophthalmologists per million people in SSA. Training of ophthalmologists is critical. We designed a systematic literature review protocol, searched MEDLINE Ovid and Embase OVID on 1 August 2019 and limited these searches to the year 2000 onwards. We also searched Google Scholar and websites of ophthalmic institutions for additional information. We include a total of 49 references in this review and used a narrative approach to synthesise the results. There are 56 training institutions for ophthalmologists in eleven Anglophone, eleven Francophone, and two Lusophone SSA countries. The median duration of ophthalmology training programmes was 4 years. Most curricula have been regionally standardised. National, regional and international collaborations are a key feature to ophthalmology training in more than half of ophthalmology training programmes. There is a drive, although perhaps not always evidence-based, for sub-specialisation in the region. Available published scientific data on ophthalmic medical and surgical training in SSA is sparse, especially for Francophone and Lusophone countries. However, through a broad scoping review strategy it has been possible to obtain a valuable and detailed view of ophthalmology training in SSA. Training of ophthalmologists is a complex and multi-faceted task. There are challenges in appropriate selection, capacity, and funding of available training institutions. Numerous learning outcomes demand curriculum, time, faculty, support, and appropriate assessment. There are opportunities provided by modern training approaches. Partnership is key.
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Kyei S, Aberor J, Assiamah F, Kwarteng MA. Optical coherence tomography indices in the diagnosis and discrimination of stages of primary open-angle glaucoma in an African population. Int Ophthalmol 2020; 41:981-990. [PMID: 33185821 DOI: 10.1007/s10792-020-01652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/31/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this study was to determine the structure-function association of the optical coherence tomography (OCT) indices (retinal nerve fibre layer (RNFL), ganglion cell complex (GCC) and optic nerve head (ONH) parameters) with the visual field sensitivity and their diagnostic ability at different stages of primary open-angle glaucoma (POAG) among a population West-African descent. METHODS The study was a clinic-based prospective study which employed purposive sampling in the recruitment of clinically diagnosed POAG and non-glaucoma patients. OCT and visual field test (VFT) results were collated. Classification of the POAG cases was done using the Hodapp-Parrish-Anderson criteria. ROC was used for assessing the diagnostic ability of OCT indices. Pearson's correlation was used to assess the structure-function association. P value < 0.05 was considered statistically significant. CONCLUSIONS Of the 497 subjects (497 eyes), 301 (60.6%) were males and 196 (39.4%) were females. The average, superior and inferior RNFL and GCC showed a strong positive correlation with the visual field sensitivity, but the average RNFL had the highest correlation (r = 0.673, p < 0.001). The parameters of the ONH showed a moderate-to-weak correlation with the visual field sensitivity. However, there was no significant correlation between structure and function in early POAG (p > 0.05). Superior GCC showed the highest diagnostic ability for POAG (AUC = 0.655; p < 0.001) comparable to the RNFL. Macula (GCC) and (RNFL) have a comparable ability to diagnose POAG at all the stages of POAG and can be used complimentarily for glaucoma assessment and diagnosis.
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Affiliation(s)
- Samuel Kyei
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Justice Aberor
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Frank Assiamah
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Michael Agyemang Kwarteng
- Department of Optometry, Faculty of Science and Engineering, Bindura University of Science Education, Bindura, Zimbabwe
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Dean W, Gichuhi S, Buchan J, Matende I, Graham R, Kim M, Arunga S, Makupa W, Cook C, Visser L, Burton M. Survey of ophthalmologists-in-training in Eastern, Central and Southern Africa: A regional focus on ophthalmic surgical education. Wellcome Open Res 2019; 4:187. [PMID: 31886411 PMCID: PMC6913214 DOI: 10.12688/wellcomeopenres.15580.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 11/20/2022] Open
Abstract
Background: There are 2.7 ophthalmologists per million population in sub-Saharan Africa, and a need to train more. We sought to analyse current surgical training practice and experience of ophthalmologists to inform planning of training in Eastern, Central and Southern Africa. Methods: This was a cross-sectional survey. Potential participants included all current trainee and recent graduate ophthalmologists in the Eastern, Central and Southern African region. A link to a web-based questionnaire was sent to all heads of eye departments and training programme directors of ophthalmology training institutions in Eastern, Central and Southern Africa, who forwarded to all their trainees and recent graduates. Main outcome measures were quantitative and qualitative survey responses. Results: Responses were obtained from 124 (52%) trainees in the region. Overall level of satisfaction with ophthalmology training programmes was rated as 'somewhat satisfied' or 'very satisfied' by 72%. Most frequent intended career choice was general ophthalmology, with >75% planning to work in their home country post-graduation. A quarter stated a desire to mainly work in private practice. Only 28% of junior (first and second year) trainees felt surgically confident in manual small incision cataract surgery (SICS); this increased to 84% among senior trainees and recent graduates. The median number of cataract surgeries performed by junior trainees was zero. 57% of senior trainees were confident in performing an anterior vitrectomy. Only 29% of senior trainees and 64% of recent graduates were confident in trabeculectomy. The mean number of cataract procedures performed by senior trainees was 84 SICS (median 58) and 101 phacoemulsification (median 0). Conclusion: Satisfaction with post-graduate ophthalmology training in the region was fair. Most junior trainees experience limited cataract surgical training in the first two years. Focused efforts on certain aspects of surgical education should be made to ensure adequate opportunities are offered earlier on in ophthalmology training.
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Affiliation(s)
- William Dean
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
- Department of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - John Buchan
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
| | - Ibrahim Matende
- College of Ophthalmology of Eastern Central & Southern Africa, Nairobi, Kenya
| | - Ronnie Graham
- International Agency for the Prevention of Blindness, Durban, South Africa
| | - Min Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Arunga
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
| | | | - Colin Cook
- Department of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Linda Visser
- Department of Ophthalmology, University of KwaZulu-Natal, Durban, South Africa
| | - Matthew Burton
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Mwanza JC, Tulenko SE, Barton K, Herndon LW, Mathenge E, Hall A, Kim HY, Hay-Smith G, Budenz DL. Eight-Year Incidence of Open-Angle Glaucoma in the Tema Eye Survey. Ophthalmology 2018; 126:372-380. [PMID: 30316889 DOI: 10.1016/j.ophtha.2018.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine the incidence of open-angle glaucoma (OAG) and its risk factors in the Tema Eye Survey in Ghana, West Africa. DESIGN Longitudinal, observational population-based study. PARTICIPANTS One thousand two hundred five of 1500 participants 40 years of age or older selected randomly from 5603 participants originally drawn from the population and who had undergone a baseline examination. METHODS All participants underwent baseline and follow-up ophthalmologic examinations 8 years apart. Glaucoma diagnosis was determined based on the International Society for Geographical and Epidemiologic Ophthalmology criteria. MAIN OUTCOME MEASURES Incidence and odds ratio (OR). RESULTS The response rate was 80.3%. Of 1101 nonglaucomatous participants at baseline who had complete follow-up data, 4.6% (95% confidence interval [CI], 3.7%-5.2%) demonstrated OAG over the 8-year period, or 0.58% (95% CI, 0.4%-0.8%) per year. The 8-year incidence increased with age from 3.1% in those 40 to 49 years old to 7.0% in those 60 to 69 years old. Baseline risk factors for incident OAG were male gender (OR, 2.1; 95% CI, 1.1-4.0; P = 0.025), older age relative to those 40 to 49 years old (those 50-50 years old: OR, 2.6; 95% CI, 1.2-5.7; those 60-69 years old: OR, 4.3; 95% CI, 2.0-8.8; and for those 70 years of age and older: OR, 6.3; 95% CI, 2.6-15.4; all P < 0.001), higher intraocular pressure (IOP; OR, 1.4; 95% CI, 1.1-1.8; P < 0.001), larger vertical cup-to-disc ratio (OR, 5.8; 95% CI, 5.2-6.6; P < 0.001), and thinner central cornea (OR, 1.2; 95% CI, 1.03-1.5; P = 0.013). A separate analysis performed with central corneal thickness-based IOP correction did not change the outcome of the associative model of incident glaucoma. CONCLUSIONS The incidence of OAG is higher in this population than reported in nonblack populations outside Africa. This is important not only in Ghana and probably other West African countries but also wherever people of the West African diaspora reside. These data enhance our understanding of the epidemiologic factors of OAG in this setting and may serve as reference for public health policy and planning.
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Affiliation(s)
- Jean-Claude Mwanza
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Samantha E Tulenko
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Keith Barton
- Moorfields Eye Hospital and Department of Epidemiology and Genetics, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Leon W Herndon
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | | | - Hanna Y Kim
- Department of Ophthalmology, Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, California
| | | | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Okoye RS, Bell L, Papadopoulos I. Investigating the level of glaucoma awareness and perception of its risk factors in Anambra State, Nigeria. Public Health 2018; 160:100-107. [PMID: 29800791 DOI: 10.1016/j.puhe.2018.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the level of awareness of glaucoma and perception of its risk factors in Anambra State, and to examine and evaluate the health seeking behaviour of this target population and its relationship with the development glaucoma. STUDY DESIGN This is a qualitative study that utilised face-to-face semi-structured interviews to investigate the level of glaucoma awareness in the state. METHODS Purposive, non-random sampling technique was used to recruit the participants, and data were collected from 28 participants [aged 21-73 years] using semi-structured interview. The resulting data were analysed using Nvivo 10 software and Interpretative phenomenological analysis framework. RESULTS Of the 28 interviewees, 15 (53.6%) live in urban areas, and 13 (46.4%) live in the rural areas; 11 (39.3%) of the participants were male and 17 (60.7%) were females. In this study, people with more education, and people that live in the urban areas tend to have heard about glaucoma compared with people with less education, and who live in the rural areas; although this sample was too small to make substantive claims. Glaucoma was perceived as 'a dangerous eye disease that can cause blindness if not treated early; serious eye problem; an incurable eye problem that can eventually result to blindness, and a dangerous eye problem that can easily render a person blind'. Four a priori themes and ten emergent themes were identified. CONCLUSIONS There is low awareness of glaucoma in this population, and this encourages people to indulge in certain risk behaviours that could predispose them to glaucoma. Therefore, providing sustained health promotion programmes and improved eye care services could help this population immensely in the current struggle against glaucoma blindness.
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Affiliation(s)
- R S Okoye
- School of Health and Education, Middlesex University, The Burroughs, London NW4 4BT, UK; St Patricks International College, School of Health and Social Care, 40 Tower Hill, London EC3N 4DX, UK.
| | - L Bell
- School of Health and Education, Middlesex University, The Burroughs, London NW4 4BT, UK.
| | - I Papadopoulos
- Research Centre for Transcultural Studies in Health, Middlesex University, The Burroughs, London NW4 4BT, UK.
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Baboolal SO, Smit DP. South African Eye Study (SAES): ethnic differences in central corneal thickness and intraocular pressure. Eye (Lond) 2018; 32:749-756. [PMID: 29328064 DOI: 10.1038/eye.2017.291] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/26/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeGlaucoma is the leading cause of irreversible blindness worldwide. South Africa has a diverse population but there is a lack of published ethnic specific normative data. The purpose of the study is to determine the distribution of intraocular pressure (IOP) and central corneal thickness (CCT) values in a multi-ethnic South African population and to determine additional systemic and ocular factors that influence IOP and CCT.Patients and methodsThis cross-sectional study included a total of 402 participants with 706 eyes aged 18-94 years. Participants underwent a standardized interviewer-administered questionnaire for risk factor assessment followed by a full ophthalmic examination. The averages of six IOP readings were measured with an Icare PRO tonometer and CCT was measured with a Pentacam.ResultsThe mean CCT readings in the African, Mixed ethnicity, and Caucasian participants were 514.77±31.86, 531.77±35.17, and 549.97±30.51 μm (P<0.001). The mean IOP in the African, Mixed ethnicity, and Caucasian participants were 15.51±2.49, 15.09±2.12, and 15.13±2.53 mm Hg (P=0.07). Africans had significantly higher IOP than Mixed ethnicity (P=0.034) and Caucasians (P=0.011). Hypertensives had a higher IOP (P=0.03). Age and pseudophakia were associated with a lower IOP (P<0.001) and higher CCT (P<0.001). There was a strongly positive correlation between CCT and IOP (β=0.021; P<0.001).ConclusionsIn the South African Eye Study (SAES), Africans had the thinnest corneas and highest IOP followed by Mixed ethnicity and Caucasians. Including systemic and ocular factors that influence IOP specific to each population and ethnic group, will lead to a more accurate clinical risk stratification in glaucoma management.
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Affiliation(s)
- S O Baboolal
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - D P Smit
- Division of Ophthalmology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Goosen E, Coleman K, Visser L, Sponsel WE. Racial Differences in Selective Laser Trabeculoplasty Efficacy. J Curr Glaucoma Pract 2017; 11:22-27. [PMID: 28138214 PMCID: PMC5263882 DOI: 10.5005/jp-journals-10008-1216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/28/2016] [Indexed: 01/04/2023] Open
Abstract
AIM Sub-Saharan Africa has a population of 1 billion, with one ophthalmologist per million people. Basic ophthalmic support services are virtually absent for all but a few urban populations. Minimally invasive laser treatment may help. This study reports our initial experience using selective laser trabeculoplasty (SLT) in a mixed-racial population of adult glaucoma patients in Durban, South Africa. STUDY DESIGN Institution Review Board approved the 5-year chart review. MATERIALS AND METHODS Consecutive glaucomatous adults underwent SLT (Lumenis Selecta) on one or both eyes applying 360° treatment of 120 to 140 closely spaced burns (400 urn spot size for 3 ns; range 1.1-1.4 mJ). Significance of change in intraocuar pressure (IOP) from baseline at 1, 3, 6, and 12 months was assessed by two-tailed paired t-test. RESULTS Among 148 eyes of 84 patients (60 African, 21 Indian, 3 Caucasian), 69 had already undergone glaucoma therapy, and 15 untreated (de novo). Among all eyes, mean IOP was reduced by >32% with mean IOP < 15 mm Hg from baseline at all four study intervals (p < 0.0001). A 20% reduction in IOP was sustained at 12 months in 90% of African eyes but in only 50% of Indian eyes. CONCLUSION Selective laser trabeculoplasty was effective in producing clinically significant IOP reduction among South African adults with or without prior medical or surgical anti-glaucoma therapy. Socioeconomically comparable individuals of Indian ancestry showed good therapeutic responses, but significantly less efficacious than those observed among Black subjects. Programs to provide first-line SLT management of glaucoma in Africa, where 90% of patients are unable to sustain prescribed medical therapy, appear to be a very appropriate option. HOW TO CITE THIS ARTICLE Goosen E, Coleman K, Visser L, Sponsel WE. Racial Differences in Selective Laser Trabeculoplasty Efficacy. J Curr Glaucoma Pract 2017;11(1):22-27.
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Affiliation(s)
- Emil Goosen
- Surgeon, Department of Ophthalmology, Port Elizabeth, Eastern Cape South Africa
| | - Kate Coleman
- Consultant, Department of Ophthalmology, Blackrock Clinic, Dublin, Ireland
| | - Linda Visser
- Head, Department of Ophthalmology, Nelson Mandela Medical School, Durban, South Africa
| | - William E Sponsel
- Professor, Department of Vision Sciences, University of the Incarnate Word, San Antonio, Texas, USA; Department of Biomedical Engineering, University of Texas, San Antonio, Texas, USA
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De-Gaulle VF, Dako-Gyeke P. Glaucoma awareness, knowledge, perception of risk and eye screening behaviour among residents of Abokobi, Ghana. BMC Ophthalmol 2016; 16:204. [PMID: 27855682 PMCID: PMC5114832 DOI: 10.1186/s12886-016-0376-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Virtue Fiawokome De-Gaulle
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
| | - Phyllis Dako-Gyeke
- Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
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Kyari F, Nolan W, Gilbert C. Ophthalmologists' practice patterns and challenges in achieving optimal management for glaucoma in Nigeria: results from a nationwide survey. BMJ Open 2016; 6:e012230. [PMID: 27729348 PMCID: PMC5073544 DOI: 10.1136/bmjopen-2016-012230] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/20/2016] [Accepted: 08/25/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE OF THE STUDY Glaucoma, a chronic non-communicable disease, and leading cause of irreversible blindness worldwide is a public health problem in Nigeria, with a prevalence of 5.02% in people aged ≥40 years. The purpose of this nationwide survey was to assess Nigerian ophthalmologists' practice patterns and their constraints in managing glaucoma. STUDY DESIGN Ophthalmologists were sent a semistructured questionnaire on how they manage glaucoma, their training in glaucoma care, where they practice, their access to equipment for diagnosis and treatment, whether they use protocols and the challenges they face in managing patients with glaucoma. RESULTS 153/250 ophthalmologists in 80 centres completed questionnaires. Although 79% felt their training was excellent or good, 46% needed more training in glaucoma diagnosis and surgery. All had ophthalmoscopes, 93% had access to applanation tonometers, 81% to visual field analysers and 29% to laser machines (in 19 centres). 3 ophthalmologists had only ophthalmoscopes and schiøtz tonometers. For 85%, a glaucomatous optic disc was the most important feature that would prompt glaucoma work-up. Only 56% routinely performed gonioscopy and 61% used slit-lamp stereoscopic biomicroscopy for disc assessment. Trabeculectomy (with/without antimetabolites) was the only glaucoma surgery performed with one mention of canaloplasty. Poor compliance with medical treatment (78%) and low acceptance of surgery (71%) were their greatest challenges. CONCLUSIONS This study indicates that a systems-oriented approach is required to enhance ophthalmologist's capability for glaucoma care. Strategies to improve glaucoma management include strengthening poorly equipped centres including provision of lasers and training, and improving patients' awareness and education on glaucoma.
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Affiliation(s)
- Fatima Kyari
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
- Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | | | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
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Ocansey S, Kyei S, Diafo A, Darfor KN, Boadi-Kusi SB, Aglobitse PB. Cost of the medical management and prescription pattern for primary open angle glaucoma (POAG) in Ghana-a retrospective cross-sectional study from three referral facilities. BMC Health Serv Res 2016; 16:282. [PMID: 27430262 PMCID: PMC4950601 DOI: 10.1186/s12913-016-1528-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/07/2016] [Indexed: 06/13/2024] Open
Abstract
Background Glaucoma is the leading cause of irreversible blindness globally, and treatment involves considerable cost to stakeholders in healthcare. However, there is infrequent availability of cost information and patterns of management, especially in developing countries. This study determined the cost of the medical management of POAG, adherence, and pattern of medication prescription in Ghana. Methods A retrospective cross-sectional study involving 891 Primary Open Angle Glaucoma (POAG) cases seen in the year 2012 at three referral facilities. Demographics, ocular history, resource consumption, medication, test, surgery and other related cost were extracted from 84 patients who had fully complied with their treatment to calculate total cost (TC) based on 2012 estimates. Glaucoma drugs prescribed to patients who had adhered to all their review visits within the period evident from case folders were recorded and analysed for the prescription pattern. Results Out of 891 POAG cases seen in 2012, 351(39.4 %) attended all the required review visits, but only 84 (9.4) had fully and continually adhered to all their treatment regimes. They comprised 41(48.8 %) males and 43(51.2 %) females with a mean age of 65 ± 14.8. Majority of the respondents were elderly above 60 year of age (65.5 %). The total estimated cost for the 84 cases in the year was GH¢ 81,237 ($40,619), comprising GH¢ 72,193 ($36,097) direct medication cost and GH¢9,045 ($4,523) direct non-medication cost (surgery and test cost), and an average of GH¢ 967 ($484) for a mean visit of 5.6 ± 1.1 in the year. A total of 673 glaucoma medications had been prescribed for 351 patients for the year, with timolol being the most prescribed (64.19 %) and monotherapy as the most adopted form of therapy (61.06 %). Age and income showed concurrent increase with cost (P ≤ 0.05). Conclusions Cost of managing glaucoma constitutes a substantial financial burden and influenced the pattern of medication prescription.
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Affiliation(s)
- Stephen Ocansey
- Department of Vision and Hearing Sciences, Faculty of Science and Technology, Anglia Ruskin University, Cambridge, UK. .,Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Samuel Kyei
- Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Ama Diafo
- Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Kwabena Nkansah Darfor
- Department of Economics, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Bert Boadi-Kusi
- Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Peter B Aglobitse
- Department of Economics, Faculty of Social Sciences, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
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Kyari F, Entekume G, Rabiu M, Spry P, Wormald R, Nolan W, Murthy GVS, Gilbert CE. A Population-based survey of the prevalence and types of glaucoma in Nigeria: results from the Nigeria National Blindness and Visual Impairment Survey. BMC Ophthalmol 2015; 15:176. [PMID: 26653326 PMCID: PMC4676891 DOI: 10.1186/s12886-015-0160-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/24/2015] [Indexed: 12/13/2022] Open
Abstract
Background Glaucoma is the leading cause of irreversible blindness worldwide. There tends to be a lower reporting of glaucoma in Africa compared to other blinding conditions in global burden data. Research findings of glaucoma in Nigeria will significantly increase our understanding of glaucoma in Nigeria, in people of the West African diaspora and similar population groups. We determined the prevalence and types of glaucoma in Nigeria from the Nigeria National Blindness and Visual Impairment cross-sectional Survey of adults aged ≥40 years. Methods Multistage stratified cluster random sampling with probability-proportional-to-size procedures were used to select a nationally representative sample of 15,027 persons aged ≥40 years. Participants had logMAR visual acuity measurement, FDT visual function testing, autorefraction, A-scan biometry and optic disc assessment. Participants with visual acuity of worse than 6/12 or suspicious optic discs had detailed examination including Goldmann applanation tonometry, gonioscopy and fundus photography. Disc images were graded by Moorfields Eye Hospital Reading Centre. Glaucoma was defined using International Society of Geographical and Epidemiological Ophthalmology criteria; and classified into primary open-angle or primary angle-closure or secondary glaucoma. Diagnosis of glaucoma was based on ISGEO classification. The type of glaucoma was determined by gonioscopy. Results A total of 13,591 participants in 305 clusters were examined (response rate 90.4 %). Optic disc grading was available for 25,289 (93 %) eyes of 13,081 (96 %) participants. There were 682 participants with glaucoma; a prevalence of 5.02 % (95 % CI 4.60–5.47). Among those with definite primary glaucoma that had gonioscopy (n = 243), open-angle glaucoma was more common (86 %) than angle-closure glaucoma (14 %). 8 % of glaucoma was secondary with the commonest causes being couching (38 %), trauma (21 %) and uveitis (19 %). Only 5.6 % (38/682) of participants with glaucoma knew they had the condition. One in every 5 persons with glaucoma (136;20 %) was blind i.e., visual acuity worse than 3/60. Conclusion Nigeria has a high prevalence of glaucoma which is largely open-angle glaucoma. A high proportion of those affected are blind. Secondary glaucoma was mostly as a consequence of procedures for cataract. Public health control strategies and high quality glaucoma care service will be required to reduce morbidity and blindness from glaucoma.
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Affiliation(s)
- Fatima Kyari
- International Centre for Eye Health (ICEH), Clinical Research Department, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK. .,Department of Ophthalmology, College of Health Sciences (CHS), University of Abuja, Abuja, Nigeria.
| | | | - Mansur Rabiu
- Prevention of Blindness Union, Riyadh, Saudi Arabia.
| | - Paul Spry
- Bristol Eye Hospital, University Hospitals, Bristol NHS Foundation Trust, Bristol, UK.
| | - Richard Wormald
- International Centre for Eye Health (ICEH), Clinical Research Department, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK. .,Moorfields Eye Hospital, London, United Kingdom.
| | | | - Gudlavalleti V S Murthy
- International Centre for Eye Health (ICEH), Clinical Research Department, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK. .,Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Andhra Pradesh, India.
| | - Clare E Gilbert
- International Centre for Eye Health (ICEH), Clinical Research Department, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK.
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Jackson DJ, Razai MS, Falama R, Mongwa M, Mutapanduwa M, Baemisi C, Josiah E, Nkomazana O, Lehasa A, Brealey E, White AJ, Jankowski D, Kerr-Muir MG, Martin KR, Ngondi JM. The clinical characteristics of patients with glaucoma presenting to Botswana healthcare facilities: an observational study. BMJ Open 2014; 4:e005965. [PMID: 25472657 PMCID: PMC4256541 DOI: 10.1136/bmjopen-2014-005965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to establish the clinical characteristics of patients with glaucoma attending eye care facilities in Botswana, and management of glaucoma among patients who received care in these facilities. The study also aimed to calculate the number of new diagnoses of glaucoma within the glaucoma service. DESIGN A prospective, hospital-based, observational study. SETTING A multicentre study was undertaken in government-run eye departments in Botswana from June to August 2012. PARTICIPANTS All patients with a diagnosis of glaucoma attending clinics at seven study sites were invited to participate. OUTCOME MEASURES Examination findings, diagnosis and management were extracted from individual patient-held medical charts. Sociodemographic characteristics, patient knowledge and understanding of glaucoma were assessed through face-to-face interviews. In addition, details of outpatient attendances for 2011 were collected from 21 government-run hospitals. RESULTS The majority of the 366 patients interviewed had a diagnosis of primary glaucoma (86.6%). The diagnoses were mainly made by ophthalmologists (48.6%) and ophthalmic nurses (44.0%). Many patients (38.5%) had been symptomatic for over 6 months before visiting an eye clinic. The mean presenting intraocular pressure was 28.2 mm Hg (SD 11.9 mm Hg). Most follow-up patients (79.2%) had not received surgery, however, many (89.5%) would accept surgery. Only 11.5% of participants had heard of glaucoma prior to diagnosis. Many participants (35.9%) did not understand glaucoma after being diagnosed. The majority (94.9%) of living first-degree relatives had never been examined. The number of newly diagnosed glaucoma cases for 2011 in the south of the country was 14.1/100,000; 95% CI (12.0 to 16.5), in the north it was 16.2/100,000; 95% CI (13.8 to 19.0). CONCLUSIONS Glaucoma is a significant burden that presents challenges to ophthalmic services in Botswana. Many patients have limited understanding of the condition and poor access to services. There is a need to develop a treatment infrastructure to include safe surgery and a reliable supply of effective medication.
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Affiliation(s)
- Daniel J Jackson
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Mohammad S Razai
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Rosemary Falama
- University of Botswana School of Medicine, Gaborone, Botswana
| | | | | | - Chao Baemisi
- University of Botswana School of Medicine, Gaborone, Botswana
| | | | | | | | - Evelyn Brealey
- Addenbrooke's Abroad, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew J White
- Cambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | | | | | - Keith R Martin
- Cambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
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Kyari F, Abdull MM, Bastawrous A, Gilbert CE, Faal H. Epidemiology of glaucoma in sub-saharan Africa: prevalence, incidence and risk factors. Middle East Afr J Ophthalmol 2013; 20:111-25. [PMID: 23741130 PMCID: PMC3669488 DOI: 10.4103/0974-9233.110605] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of this study is to review the epidemiology of different types of glaucoma relevant to Sub-Saharan Africa (SSA) and to discuss the evidence regarding the risk factors for onset and progression of glaucoma, including risk factors for glaucoma blindness. METHODS Electronic databases (PubMed, MedLine, African Journals Online- AJOL) were searched using the full text, Medical Subject Headings (MeSH) terms, author(s) and title to identify publications since 1982 in the following areas: population-based glaucoma prevalence and incidence studies in SSA and in African-derived black populations outside Africa; population-based prevalence and incidence of blindness and visual impairment studies in SSA including rapid assessment methods, which elucidate the glaucoma-specific blindness prevalence; studies of risk factors for glaucoma; and publications that discussed public health approaches for the control of glaucoma in Africa. RESULTS Studies highlighted that glaucoma in SSA is a public health problem and predominantly open-angle glaucoma. It is the second-leading cause of blindness, has a high prevalence, an early onset and progresses more rapidly than in Caucasians. These factors are further compounded by poor awareness and low knowledge about glaucoma even by persons affected by the condition. CONCLUSION Glaucoma care needs to be given high priority in Vision 2020 programs in Africa. Many questions remain unanswered and there is a need for further research in glaucoma in SSA in all aspects especially epidemiology and clinical care and outcomes involving randomized controlled trials. Genetic and genome-wide association studies may aid identification of high-risk groups. Social sciences and qualitative studies, health economics and health systems research will also enhance public health approaches for the prevention of blindness due to glaucoma.
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Affiliation(s)
- Fatima Kyari
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mohammed M. Abdull
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Andrew Bastawrous
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare E. Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah Faal
- Africa Vision Research Institute, Durban, South Africa
- Calabar Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Nigeria
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Soatiana JE, Kpoghoumou MA, Kalembo FW, Huyi Zhen H. Outcomes of Trabeculectomy in Africa. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojoph.2013.33019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE To estimate the outpatient clinic burden and surgical workload related to glaucoma in Lagos, Nigeria. METHODS A multicentre study involving the 2 tertiary eye institutions, 7 secondary eye centers with eye care facilities, and the largest private eye hospital in Lagos state, Nigeria. Data on outpatient department (OPD) visits were collected over a 4-week period, using a specially designed tally sheet. Theater records were examined in each hospital over a 1-year period (2009) for the number and types of glaucoma surgeries performed. RESULTS A total of 6240 patients visited the OPD over the 4-week period, out of which 1577 (25.3%) were glaucoma patients. OPD visit per ophthalmologist were 274, 323, and 61, whereas glaucoma visits per ophthalmologist were 75, 70, and 23 in the tertiary, secondary, and private centers, respectively. Glaucoma surgeries constituted 8.6% of total surgeries (n=4050). Trabeculectomy with intraoperative 5-fluorouracil was the most common procedure (81.0%). Number of glaucoma surgeries per ophthalmologist per month in the tertiary, secondary, and private centers were 0.5, 0.9, and 1.4, respectively. Overall number of glaucoma surgery per ophthalmologist per month was 1. CONCLUSIONS Glaucoma visits constitute a significant proportion of eye clinic visits in Lagos state, Nigeria, and therefore, necessary manpower, infrastructure, and equipments should be mobilized for its optimal management. Also, there is a relatively low output of glaucoma surgeries that needs to be further investigated and appropriate measures taken to manage it.
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Guzek JP, Anyomi FK, Fiadoyor S, Nyonator F. Prevalence of blindness in people over 40 years in the volta region of ghana. Ghana Med J 2011; 39:55-62. [PMID: 17299544 PMCID: PMC1790811 DOI: 10.4314/gmj.v39i2.35983] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
SummaryIn 2001, we conducted a population-based cluster survey of the prevalence of blindness and glaucoma in three districts of the Volta region of Ghana, West Africa. A secondary purpose was to assess the presenting visual acuities of individuals who had undergone extracapsular cataract extraction with an intraocular lens implant (ECCE/IOL) and intracapsular cataract extraction (ICCE). The target population consisted of 2400 adults, aged 40 years and older, of whom, 2298 (95.7%) were examined. The prevalence of moderate to severe bilateral blindness was found to be 4.4 %. The main causes of blindness were cataract and glaucoma (53.9% and 20.6%, respectively). Eighty-one percent of the blind had preventable or treatable causes. Nine percent of the population >/=40 years needed cataract surgery in one or both eyes for vision </=6/18. The corrected prevalence of glaucoma in one or both eyes was 7.5%. There were 51 individuals who had undergone cataract surgery, all of whom had been operated in Ghana. Those who had ECCE/IOL surgery had a presenting visual acuity of 20/60 or better in 65% of eyes while those who had ICCE surgery achieved this level in only 30% of eyes [p=0.02].
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Affiliation(s)
- J P Guzek
- Loma Linda University School of Medicine, Department of Ophthalmology, Loma Linda, CA, USA 92350
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25
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Abstract
PURPOSE More than 90% of blindness worldwide exists in the developing world, but information on the social and economic burden and the cost-effectiveness of treatment in these settings is often limited or nonexistent. We demonstrate the use of computer modeling to simulate the current and future epidemiology, outcomes, and treatment of primary open-angle glaucoma in high-incidence populations of the developing world. METHODS A previously validated vision model was modified to simulate the incidence progression and social and economic outcomes of glaucoma in Barbados, which was the source of epidemiology data, and Ghana, which has similar propensity for glaucoma but lower socioeconomic development. We then assessed the cost-effectiveness of hypothetical case-finding and treatment scenarios, including U.S. guideline-level care and one-time laser surgery. RESULTS Barbados incurs relatively greater social and economic burden from glaucoma than Ghana. In Barbados, population screening followed by U.S. guideline levels of care appears to be highly cost-effective. Because of a younger population with higher mortality at younger ages, glaucoma appears to cause less visual impairment and blindness in Ghana than in Barbados, resulting in lower per capita disability and productivity losses. Population screening or guideline-level treatment scenarios were generally not cost-effective in Ghana, but treating self-referring patients with a hypothetical one-time laser surgery was highly cost-effective relative to World Health Organization willingness to pay thresholds. CONCLUSIONS The social and economic burden of glaucoma is higher in developed nations because of increased life expectancy, an older population age profile, and higher per capita gross domestic product. Similarly, lower mortality rates and higher per capita gross domestic product increase the relative cost-effectiveness of screening and treatment interventions intended to mitigate glaucoma burden.
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Essuman VA, Braimah IZ, Ndanu TA, Ntim-Amponsah CT. Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population. Eye (Lond) 2010; 25:77-83. [PMID: 21057523 DOI: 10.1038/eye.2010.156] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the surgical outcome of combined trabeculotomy-trabeculectomy in Ghanaian children with primary congenital glaucoma. MATERIALS AND METHODS A retrospective case series involving 19 eyes of 12 consecutive children with primary congenital glaucoma who had primary trabeculotomy-trabeculectomy from 12 August 2004 to 30 June 2008, at the Korle-Bu Teaching Hospital, Ghana. Main outcome measures were preoperative and postoperative intraocular pressures, corneal diameter, corneal clarity, bleb characteristics, duration of follow-up, surgical success, and complications. RESULTS A total of 19 eyes of 12 patients met the inclusion criteria. Six of the patients were males. Mean age at diagnosis was 4.4 (range 2-8) months. Mean age at surgery was 5.9 months (range 3-16). Eight (67%) infants had bilateral disease. Mean duration of follow-up was 13.1 (range 5-38) months. The preoperative mean horizontal corneal diameter was 13.4 ± 1.1(range 12-16) mm. Complete success (intraocular pressure <21 mm Hg) was obtained in 15 (79%) eyes. The probability of success was 94.4, 83.3, 66.7, 44.4, 38.9, 33.3, and 13.3% at 3, 6, 9, 12, 15, 18, and 21 months, respectively (Kaplan-Meier analysis). All eyes had corneal oedema preoperatively. Seventeen eyes (90%) had clear cornea at their last follow-up. Mean preoperative and postoperative intraocular pressures were 30.3 ± 8.8 and 18.1 ± 6.8 mm Hg respectively (P<0.001, t-test). Twelve (63%) eyes had well-functioning blebs at the last follow-up. One eye (5%) developed seclusio pupillae and cataract postoperatively. CONCLUSION The overall success for combined trabeculotomy-trabeculectomy in Ghanaian children with primary congenital glaucoma was 79%. The probability of success reduced from more than 66% in the first 9 months postoperatively to below 45% after that.
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Affiliation(s)
- V A Essuman
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.
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Ayena K, Agbo A, Attaya A, Djagnikpo A, Kondi G, Dzidzinyo K, Amedome K, Nononsaa K, Banla M, Balo K. Caractéristiques de l’excavation papillaire dans une population jeune de 20 à 40 ans du Nord Togo. J Fr Ophtalmol 2010; 33:408-13. [DOI: 10.1016/j.jfo.2010.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 03/25/2010] [Indexed: 11/16/2022]
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Gyasi M, Amoako W, Adjuik M. Presentation patterns of primary open angle glaucomas in north eastern ghana. Ghana Med J 2010; 44:25-30. [PMID: 21326988 PMCID: PMC2956317 DOI: 10.4314/gmj.v44i1.68853] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Previous reports have indicated that open angle glaucoma is a major problem in the Upper East region of Ghana. Such reports have shown high prevalence among young patients under the age of 40 years. None has given enough details on the burden, pattern of distribution and extent of changes in the optic nerve head and intraocular pressures. This study aims at addressing these issues in order to highlight the situation. METHODS Retrospective case series involving review of clinical records of all first-time attendants diagnosed with glaucoma at the Bawku Hospital between October 2003 and December 2005. Case definitions and diagnostic criteria were made to conform as much as possible to the ISGEO and EGS recommendations. Data analysis was done using the Epi-Info software. RESULTS Records of 891 eyes of 446 patients were reviewed. Median age was 56 years with 23.6% below 40 years. POAG was diagnosed in 98.4% with 8.3% manifesting the NTG variant. One third (34.1%) of all the patients reported bilaterally blind while half were uniocularly blind. Nearly a third (70.2%) had CDRs>0.8 while more than half (54.9%) had CDRs measured at unity. Males were twice as many as females (65.5% and 34.5% respectively) but blindness sequelae among the latter was twice as much and this was statistically significant (p=0.0008;chi2 test) CONCLUSION late presentation of open angle glaucoma cases is a major problem in this part of Ghana. We recommend a more aggressive approach to tackle the disease and reduce its blindness sequelae.
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Affiliation(s)
- M Gyasi
- Bawku Hospital - Eye Department, P.O.Box 45, Bawku, Upper East Region, Ghana
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29
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Omoti AE, Enock ME, Iyasele ET. Surgical management of primary open-angle glaucoma in Africans. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.09.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mielke C, Dawda VK, Anand N. Deep sclerectomy and low dose mitomycin C: a randomised prospective trial in west Africa. Br J Ophthalmol 2006; 90:310-3. [PMID: 16488952 PMCID: PMC1856941 DOI: 10.1136/bjo.2005.079483] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To study the efficacy and safety of deep sclerectomy (DS) augmented with intraoperative low dose mitomycin C (MMC) in a west African population. METHODS Prospective, randomised, controlled trial. Trial participants were Nigerian patients with medically uncontrolled primary open angle glaucoma undergoing primary surgery at Maja Hospital, Lagos, Nigeria. 39 eyes of 39 patients undergoing DS were randomised into receiving intraoperative MMC 0.25 mg/ml for 2 minutes at the end of procedure (DS-MMC) and a control group (DS-noMMC). RESULTS There were 21 patients in the DS-noMMC and 18 in the DS-MMC group with no difference in the preoperative characteristics of the groups. Mean follow up was 16.4 (SD 11.3) months. The probability of maintaining an intraocular pressure less than 18 mm Hg with or without additional medications (95% confidence intervals) at 1 year was 70% (47-92%, 95%) and 79% (57-100%), and at 18 months was 35% (8-62%) and 38% (7-69%) for the DS-noMMC and DS-MMC groups, respectively, with no difference in success rates (p = 0.6). An IOP of less than 18 mm Hg without additional medication was maintained in 65% (41-89%) and 73% (49-96%) at 1 year and 24% (8-48%) and 13% (13-46%) at 18 months for the DS-noMMC and DS-MMC groups, respectively (p = 0.5). There were no serious complications related to the procedure. CONCLUSIONS The success rates of DS in black west African glaucoma patients, as performed in this study, were low. The study did not achieve sufficient power to detect whether low dose intraoperative MMC application can increase success rates of DS.
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Affiliation(s)
- C Mielke
- Sankt-Gertraude Kraukenhaus Hospital, Berlin, Germany
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Egbert PR, Jacobson DW, Fiadoyor S, Dadzie P, Ellingson KD. Onchocerciasis: a potential risk factor for glaucoma. Br J Ophthalmol 2005; 89:796-8. [PMID: 15965151 PMCID: PMC1772729 DOI: 10.1136/bjo.2004.061895] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2005] [Indexed: 11/04/2022]
Abstract
BACKGROUND Onchocerciasis is a microfilarial disease that causes ocular disease and blindness. Previous evidence of an association between onchocerciasis and glaucoma has been mixed. This study aims to further investigate the association between onchocerciasis and glaucoma. METHODS All subjects were patients at the Bishop John Ackon Christian Eye Centre in Ghana, west Africa, undergoing either trabeculectomy for advanced glaucoma or extracapsular extraction for cataracts, who also had a skin snip biopsy for onchocerciasis. A cross sectional case-control study was performed to assess the difference in onchocerciasis prevalence between the two study groups. RESULTS The prevalence of onchocerciasis was 10.6% in those with glaucoma compared with 2.6% in those with cataracts (OR, 4.45 (95% CI 1.48 to 13.43)). The mean age in the glaucoma group was significantly younger than in the cataract group (59 and 65, respectively). The groups were not significantly different with respect to sex or region of residence. In models adjusted for age, region, and sex, subjects with glaucoma had over three times the odds of testing positive for onchocerciasis (OR, 3.50 (95% CI 1.10 to 11.18)). CONCLUSIONS This study has shown a positive association between subclinical onchocerciasis and glaucoma. This finding emphasises the importance of eradication of onchocerciasis from west Africa.
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Affiliation(s)
- P R Egbert
- Stanford University School of Medicine, Department of Ophthalmology, Palo Alto, CA 94305, USA.
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Balo KP, Anika A, Banla M, Agla K, Djagnikpo PA, Koffi Gue KB. Distribution de l’excavation papillaire dans une population générale de 685 personnes âgées de plus de 40 ans et habitant le Sud Togo. J Fr Ophtalmol 2004; 27:250-5. [PMID: 15039626 DOI: 10.1016/s0181-5512(04)96126-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Clinical reports and epidemiological surveys have raised the key issues of both the burden of glaucoma blindness and the high prevalence of the disease among the populations of Togo. This population survey aimed to collect data on the distribution of cup disc ratios. PATIENTS AND METHODS The study population of 685 persons was selected in a remote rural area. All participants aged over 40 years were included. Eye assessment was conducted in the local health facilities using a visual acuity chart, an ophthalmoscope and light magnification for exploration of the anterior segment. RESULTS The mean age of participants was 49.70 years (range, 40-99 years); men accounted for 61.8% and women 38.2%. Mean cup disc ratios were not different in both eyes, with 0.38 in the right eye and 0.37 in the left. Cup disc ratios over 0.5 represented 29.3% in the right eye and 29.8% in the left one; a cut-off point over 0.7 gave an abnormal cup ratio prevalence of 9.2% in the right eye and 9.3% in the left eye. In 92% of cases, the appearance of the cupping was round, and was elliptic in 7.6% of patients. We found that 75% of discs had a central round cupping. The temporal location was noted in 22% of cases while nasal locations were recorded in 2.4%. CONCLUSION This survey has noted the various patterns of cup discs, with the mean cup disc ratio similar to what is usually described in similar studies. Further population-based surveys using the cut-off ratios found here are needed to determine the prevalence of glaucoma in this rural area.
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Affiliation(s)
- K P Balo
- Service d'Ophtalmologie, CHU Tokoin, Lomé, Togo.
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Mbulaiteye SM, Reeves BC, Mulwanyi F, Whitworth JAG, Johnson G. Incidence of visual loss in rural southwest Uganda. Br J Ophthalmol 2003; 87:829-33. [PMID: 12812876 PMCID: PMC1771764 DOI: 10.1136/bjo.87.7.829] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Surveys have been conducted to measure prevalence of eye disease in Africa, but not of incidence, which is needed to forecast trends. The incidence of visual loss is reported in southwest Uganda. METHODS A rural population residing in 15 neighbouring villages was followed between 1994-5 (R1) and 1997-8 (R2). Survey staff screened adult residents (13 years or older) for visual acuity using laminated Snellen's E optotype cards at each survey. Those who failed (VA >6/18) were evaluated by an ophthalmic clinical officer and an ophthalmologist. Incidence of visual loss (per 1000 person years (PY)) was calculated among those who had normal vision at R1. RESULTS 2124 people were studied at both survey rounds (60.9% of those screened at R1); 48% were male. Participants in R1 were older (34.7 versus 31.5 years at R2, p<0.001). Visual loss in R2 occurred in 56 (2.8%) of 1997, yielding a crude incidence rate of 9.9, and an age standardised incidence rate of 13.2, per 1000 PY. Incidence of visual loss increased with age from 1.21 per 1000 PY among people aged 13-34 to 64.2 per 1000 PY in those aged 65 years or older (p for trend >0.001). The six commonest causes of visual loss were: cataract, refractive error, macular degeneration, chorioretinitis, glaucoma, and corneal opacity. If similar rates are assumed for the whole of Uganda, it is estimated that 30 348 people would develop bilateral blindness or bilateral visual impairment, per year. CONCLUSIONS Cataract and refractive error were the major causes of incident visual loss in south west Uganda. These data are valuable for forecasting and planning eye services.
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Affiliation(s)
- S M Mbulaiteye
- Medical Research Council/ Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda.
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Racette L, Wilson MR, Zangwill LM, Weinreb RN, Sample PA. Primary open-angle glaucoma in blacks: a review. Surv Ophthalmol 2003; 48:295-313. [PMID: 12745004 DOI: 10.1016/s0039-6257(03)00028-6] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Glaucoma is one of the leading causes of blindness worldwide. Primary open-angle glaucoma (POAG) is the most prevalent form of glaucoma and has a particularly devastating impact in blacks. In the black American population, POAG prevalence is estimated to be six times as high in certain age groups compared to whites. POAG is more likely to result in irreversible blindness, appears approximately 10 years earlier and progresses more rapidly in blacks than in whites. Racial differences in optic disk parameters have been reported and show that blacks have larger optic disks than whites. This finding is robust and may account for the reported differences in other optic disk parameters. The existence of racial differences in intraocular pressure remains to be demonstrated, as conflicting findings are reported in the literature. Intraocular pressure may actually be underestimated in blacks, perhaps because they have thinner corneas. The prevalence of diabetes and hypertension is higher in blacks than in whites, and although no causal relationship has been established between POAG and each of these systemic diseases, some reports suggest that they often occur together, perhaps through an indirect relationship with intraocular pressure. Compounding the problem, there is evidence that blacks are less responsive to both drug and surgical treatment for POAG. Finally, they often have reduced accessibility to treatment and are less aware of the risks of having POAG. This article provides a comprehensive review of the current knowledge pertaining to POAG in blacks.
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Affiliation(s)
- Lyne Racette
- Glaucoma Center and Visual Function Laboratory, Department of Ophthalmology, University of California at San Diego, La Jolla 92093-0946, USA
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