The burden and spectrum of vitreo-retinal diseases among ophthalmic outpatients in a resource-deficient tertiary eye care setting in South-eastern Nigeria

Prevalence and systemic associations of retinal vascular occlusions in Sub-Saharan Africa

Background

Retinal vascular occlusions are a common cause of visual impairment. Studies on retinal vascular occlusions in sub-Saharan Africa (SSA) have primarily been retrospective and on retinal vein occlusion (RVO) only. The aim of this study, therefore, was to determine the prevalence and pattern of retinal vascular occlusions and their systemic associations in SSA.

Materials and Methods

This was a hospital-based, cross-sectional study involving all new patients presenting at the general ophthalmic and specialty retina clinics in four hospitals in Nigeria over a 1 year period. All the patients underwent a comprehensive eye examination. The demographic and clinical data of patients with retinal vascular occlusions were entered into an excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 22.0. Statistical significance was indicated by P < 0.05.

Results

A total of 8614 new patients were seen, and a diagnosis of retinal vascular occlusion was made in 90 eyes of 81 patients giving a disease prevalence of 0.9%. Eighty-one eyes of 72 (88.9%) patients had RVO, while 9 eyes of 9 (11.1%) patients had retinal artery occlusion (RAO). The mean age of patients with RVO and RAO was 59.5 years and 52.4 years, respectively. Increasing age, hypertension, and diabetes were the significant associations with retinal vascular occlusion with P < 0.0001.

Conclusion

Retinal vascular occlusions are an increasing cause of retinal disease in SSA and tend to occur at an earlier age. They are associated with hypertension, diabetes, and increasing age. Further studies will, however, be required to establish the demographic and clinical profile of patients with RAO in the region.

Pattern of vitreo-retinal diseases at University of Gondar tertiary eye care and training center, North-West Ethiopia

Objective

Vitreoretinal diseases are common causes of ocular morbidities and blindness. Data on the spectrum of vitreoretinal diseases needs to be studied and known in order to establish appropriate vitreoretinal care setups. The aim of this study was to determine the patterns of vitreoretinal diseases among patients who visited the vitreoretina clinic of University of Gondar Tertiary Eye Care and Training Center, NW Ethiopia (UoG-TECTC).

Methodology

A hospital based cross sectional study was conducted from October/2017-September/2018. All patients who visited the vitreoretinal clinic for the first time during the study period were studied. Data were collected with standardized data extraction format entered into SPSS statistical package Version 20 and analyzed.

Result

A total of 739 new patients who visited the vitreoretinal clinic were included in the study. The mean age was 50.26 +/- 19 years. The age group between 21–60 years accounted for 59.7% of study patients. Male’s accounted for 63.1% and 58.7% of the participants were from urban areas. Bilateral disease was diagnosed in 504 (68.2%) of patients and 220 (29.7%) were bilaterally blind at presentation. Three hundred eighty nine (52.6%) of them had duration of illness six months and above.

Diabetic Retinopathy (DR), Age Related Macular Degeneration (AMD) and Rhegmatoginous Retinal Detachment (RRD) were the top three retinal diseases accounting for 21.3%(196), 17.3% (128) and 12.4% (92) of diagnoses respectively. Systemic comorbidities were found in 44% (325) of the patients with diabetes mellitus, hypertension and hyperlipidemia being the commonest, occurring in 27.8%, 6.3% and 2.8% of study patients respectively. Cataract was the commonest ocular comorbidity seen in 33.5% of study participants.

Conclusion

Vitreoretinal diseases affected a significant number of patients presented to our center and most of the study patients presented late with significant vision loss and blindness. Males were affected more than females and the age group between 21–60 years accounted nearly two-third of study patients. This is the working age group suffering from vision loss from vitreoretinal diseases. DR, AMD and RRD were the commonest retinal pathologies accounting for nearly half of the vitreoretinal diseases and these conditions are treatable either surgically or medically. However, available facilities for the management of these diseases are not adequate at the center. Strengthening the vitreoretinal services of UoG-TECTC with relevant equipment is recommended.

Profile of retinal diseases in adult patients attending two major eye clinics in Kinshasa, the Democratic Republic of Congo

AIM

To determine the frequency and types of retinal diseases and the extend of the related visual loss in adult patients attending two public eye clinics of Kinshasa, Democratic Republic of Congo.

METHODS

Review of medical records of patients with retinal diseases seen in the major eye clinics in Kinshasa, the University Hospital of Kinshasa (UHK) and Saint Joseph Hospital (SJH), from January 2012 to December 2014. Demographics and diagnoses were retrieved and analyzed. Outcome measures were frequency and prevalence of retinal diseases, blindness and low vision.

RESULTS

A total of 40 965 patients aged 40y or older were examined during this period in both clinics. Of these, 1208 had retinal disease, giving a 3-year and an annual prevalence of 3% and 1%, respectively. Mean age was 61.7±10.7y, and 55.8% of the patients were males. Arterial hypertension (68.1%) and diabetes (43.3%) were the most common systemic comorbidities. Hypertensive retinopathy (41.8%), diabetic retinopathy (37.9%), age-related macular degeneration (AMD; 14.6%), and chorioretinitis and retinal vein occlusion (7.3% each) were the most common retinal diseases, with 3-year prevalence rates of 1.3%, 1.0%, 0.43%, and 0.21% respectively. Bilateral low vision and blindness were present in 26.8% and 8.4% of the patients at presentation. Major causes of low vision and blindness were diabetic retinopathy (14.8%), AMD (4.9%), retinal detachment (2.8%), and retinal vein occlusion (2.5%). The prevalence was significantly higher among males than females, and at the UHK than SJH.

CONCLUSION

Retinal diseases are common among Congolese adult patients attending eye clinics in Kinshasa. They cause a significant proportion of low vision and blindness.

The Burden of Visual Impairment and Blindness from Vitreoretinal Diseases: A Nigerian Tertiary Hospital Retina Unit Experience

Objective:

The objective of this study is to determine the burden of visual impairment and blindness from vitreoretinal diseases in the retina unit of a Nigerian tertiary hospital.

Methodology:

A prospective, cross-sectional study on all consecutive new patients presenting with vitreoretinal diseases (VRD) at the vitreoretinal (VR) clinic at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife from May 2011 to April 2014. Patient's bio-data, presenting complains, Snellen's or tumbling E-chart visual acuity unaided, slit-lamp examination of the vitreous and fundus with +90/+78D, binocular indirect ophthalmoscopy as well as slit-lamp examination of anterior segment, and applanation tonometry findings were recorded in predesigned pro forma. Visual acuity was categorized using WHO/ICD. The data were analyzed using the SPSS software version 16 for simple frequencies and presented.

Results:

Of 2025 eyes reviewed, 112 (49.8%) eyes were visually impaired and 67 (29.8%) were blind. Eight (5.2%) patients were bilaterally blind. Diabetic retinopathy was the most common cause of bilateral blindness (25%), and concurrently, the most common VRD (29.8%). All categories of visual loss were more prevalent among the aged ≥65 years. More males (62.2%) were blind from VRD. Cataract was the most common ocular comorbidity seen (43.6%).

Conclusion:

The burden of visual impairment and blindness from VRD is large; eye health education for early presentation for eye care as well as the development of VR care with infrastructure upscale to include optical coherence tomography, laser, and surgical care for prompt diagnosis and treatment will be of benefit in reducing the burden.

Assessment of single nucleotide polymorphisms associated with steroid-induced ocular hypertension

AIM

To access the association of forty-eight single nucleotide polymorphisms (SNPs) identified from Caucasian population with steroid-induced ocular hypertension (OHT) in India population.

METHODS

Fifty-four triamcinolone-acetonide (TA) and forty-seven dexamethasone (Dex) administered subjects were enrolled in the study after a written consent. Intraocular pressure (IOP) values were recorded for a period of 6-month post steroid injections and patients were grouped as steroid-responders (SR: IOP≥21 mm Hg) and non-responders (NR: IOP≤20 mm Hg). Genomic DNA was isolated from peripheral venous blood. Forty-eight SNPs identified in TA treated Caucasian patients by genome wide association study (GWAS) were genotyped using iPLEX™ MassARRAY among TA as well as Dex administered Indian patients. Genotyping data of 48 general subjects from a previous study were considered as reference controls for statistical analysis. Genotypic frequencies were calculated and P-value, Chi-square and odds ratio at 95% confidence-interval of group A (steroid treated vs controls), group B (SR vs NR), group C (phenotype correlation: influence of time, severity and gender on IOP rise), were calculated. P<0.05 was considered to be statistically significant.

RESULTS

OHT was observed in 50% of TA and 26% of Dex administered patients, respectively. IOP rise was mostly severe (>30 mm Hg) and immediate (<1wk) among TA-SR patients while it was noticed to be mild (<30 mm Hg) and between 1-2mo among Dex-SR patients. Logistic regression for risk factor correlation with OHT remained non-significant, hence these factors were not considered as confounding parameters for further analysis. rs133, rs34016742, rs274554, rs10936746, rs274547, rs804854, rs7751500, rs359498, and rs7547448 SNPs significantly varied even after Bonferroni corrections (P<0.0025; group A). rs1879370 (TA) and rs6559662 (Dex) were significantly (P<0.05) associated with OHT (group B). rs133 (severe IOP rise), rs11047639 and rs1879370 (male gender), and rs11171569 (immediate IOP rise) significantly (P<0.05) influenced the phenotype correlation only among TA-OHT patients. However, the significance of these SNPs in group B and phenotype analysis (group C) was lost upon Bonferroni corrections (P<0.0025).

CONCLUSION

Prevalence of OHT in study population is observed to be similar to other studies both in TA and Dex treated patients. We can correlate rs34016742 involved in diabetes signaling pathway to the occurrence of ocular edematous and inflammatory conditions. Except rs133 that is involved in neuro-degeneration and myopia occurrence, none of the other SNPs identified in Caucasian population possess any correlation with OHT incidence in TA and Dex administered Indian subjects.

Profile, Visual Presentation and Burden of Retinal Diseases Seen in Ophthalmic Clinics in Sub-Saharan Africa

Purpose

To determine the burden of retinal diseases and the degree of visual impairment associated with each disease, amongst Nigerians.

Patients and Methods

This was a hospital-based multicenter, prospective, cross-sectional, non-comparative study conducted from January to December 2018. Data was obtained from consecutive patients with a retinal diagnosis presenting at the general ophthalmic and specialty retina clinics in four hospitals (three public, and one private teaching eye department) in Nigeria. Biodata, visual acuity and refraction, intraocular pressure, findings on dilated retinal examination, diagnosis and systemic diseases were noted. Degree of monocular and bilateral visual loss associated with each diagnosed retinal disease was summarized and p value was calculated using chi-square test. P < 0.05 was considered significant.

Results

Eight hundred seventy-six of 8614 patients had a retinal diagnosis; establishing a hospital-based retinal disease prevalence of 9.8%. Male:female ratio was 1.1:1. The mean age of study patients was 49.97 (standard deviation 17.64 years). Mean symptom duration was 21.63 months (standard deviation 41.94). The mean intraocular pressure was 13.87 mmHg. Forty-three different retinal diseases were diagnosed. The most common was retinal complications of diabetes, i.e., diabetic retinopathy (DR) alone, diabetic macular edema (DME) alone and a combination of DR and DME, which accounted for 13.7%, 5.6% and 9.3%, respectively (contributed 28.6% of the entire diagnosis). This was followed by retinal detachment (RD), in 219 eyes (15.4%), dry age-related macular degeneration (AMD) in 124 eyes (8.7%). Nearly half of the eyes were blind or severely visually impaired. Blindness occurred in 34.1% of eyes; severe visual impairment in 8.2% of eyes and 29.7% had normal vision. There were 469 patients who had systemic diseases. The common systemic diseases were hypertension in 169 patients (19.3% of the total number of patients), hypertension and diabetes in 156 patients (18%), and diabetes alone in 98 patients (11.1%). Sickle cell disease was present in 1.5%.

Conclusion

There is need to invest in infrastructure, local training and development of systems for early detection and treatment of several retinal diseases in sub-Saharan Africa; DR and DME having the largest burden. Collaborative physician care and management of hypertension and diabetes could significantly reduce the burden of DR and DME.

Pattern of vitreo-retinal diseases at the national referral hospital in Bhutan: a retrospective, hospital-based study

BACKGROUND

Knowing the pattern and presentation of the diseases is critical for management strategies. To inform eye-care policy we quantified the pattern of vitreo-retinal (VR) diseases presenting at the national referral hospital in Bhutan.

METHODS

We reviewed all new patients over three years from the retinal clinic of the Jigme Dorji Wangchuck National Referral Hospital. Demographic data, presenting complaints and duration, treatment history, associated systemic diseases, diagnostic procedures performed, and final diagnoses were quantified. Comparisons of the expected and observed frequency of gender used Chi-squared tests. We applied a sampling with replacement based bootstrap analysis (10,000 cycles) to estimate the population means and the standard errors of the means and standard error of the 10th, 25th, 50th, 75th and 90th percentiles of the ages of the males and females within 20-year cohorts. We then applied t-tests employing the estimated means and standard errors. The 2913 subjects insured that the bootstrap estimates were statistically conservative.

RESULTS

The 2913 new cases were aged 47.2 ± 21.8 years. 1544 (53.0%) were males. Housewives (953, 32.7%) and farmers (648, 22.2%) were the commonest occupations. Poor vision (41.9%), screening for diabetic and hypertensive retinopathy (13.1%), referral (9.7%), sudden vision loss (9.3%), and trauma (8.0%) were the commonest presenting symptoms. Coexistent diabetes and hypertension were the most common associated systemic diseases. Haematological tests (blood sugar, HbA1c and lipid profile, 31.8%), OCT (27.4%), refraction (9.9%), B-scan (8.7%), fundus photography (8.0%) were the most commonly performed diagnostic tests. Hypertensive retinopathy (18.9%) was the commonest VR disease, followed by refractive errors referred for retinal evaluation (16.7%), diabetic retinopathy with macular oedema (15.8%), and AMD (11.0%). Retinal detachment was more prevalent in females (83 vs. 41, p = 0.007). Rare vision-threatening diseases like seasonal hyper-acute pan-uveitis also presented.

CONCLUSIONS

The developing VR service in Bhutan is challenged by the spectrum of diseases, limited human resources (e.g. one retinal surgeon during the study), and accessibility to tertiary eye-care services, all amidst difficult terrain. Sustained effort and robust coordination among the eye-care professionals, government and non-governmental organisations are critical for optimising VR services, especially as rates of diseases such as diabetes and hypertension grow.

Pattern and Presentation of Vitreo-Retinal Diseases: An Analysis of Retrospective Data at a Tertiary Eye Care Center in Nepal

PURPOSE

We examined patients presenting in a tertiary eye hospital in Nepal, focusing on information relevant to screening and management programs for vitreo-retinal (VR) disease.

DESIGN

Retrospective, cross-sectional study.

METHODS

We reviewed all patients presenting for the first time to the VR-clinic over 1 year. We quantified patient demography, symptoms and duration, systemic diseases, ophthalmological examinations, diagnostic investigations, and final diagnoses.

RESULTS

Of the 1905 cases, 1148 were male (60.3%). The 25th percentile of ages was 29 and 38 years for male and female, respectively; thus, female presented later (P < 0.0001). Hypertension was the commonest systemic disease (40.8%), followed by diabetes (32.5%). Age-related macular degeneration (AMD) and diabetic retinopathy (DR) affected 447 eyes (11.8%) and 416 eyes (10.9%), respectively. Male and female AMD and DR patients did not differ in age or disease duration. Similarly, age or disease duration for DR did not correlate with severity. Asymmetry of disease severity between eyes with AMD and DR was largest in patients with 1 normal eye. Presenting acuity was asymmetric between eyes (P < 0.0001) with people more often reporting once their right eyes had acuity of 6/18 or worse.

CONCLUSIONS

The screening of blood pressure and glucose levels combined with fundus photography could prevent many from progressing to life-changing visual impairment and blindness. Later reporting by females began at childbearing age; therefore, education and ocular screening could be usefully coupled in reproductive health programs. Clubbing VR disease screening with other established health programs like diabetes control program, hypertension clinics, school health program, and so on, would provide economical and sustainable approach.

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.

The importance of keeping a broad differential in retina clinic: the spectrum of ophthalmic disease seen by retina specialists in a tertiary outpatient clinic setting

BACKGROUND AND OBJECTIVE

To describe the new patient population referred to retina specialists at tertiary ophthalmic academic centers in the United States.

STUDY DESIGN AND METHODS

Retrospective chart review of all new patients seen by retina specialists at Stanford University from 2008 to 2011.

RESULTS

Retina specialists saw 7,197 new patients during the study period, with a mean age of 52.2 ± 25.6 years (range: 0 to 108 years). Younger patients (0 to 10 years) were more likely male (P < .001) while older patients were more likely female (P < .01 for 61 to 70, 81+ years). The most common diagnoses were diabetic eye disease (17.0%), retinopathy of prematurity (9.9%) and age-related macular degeneration (9.5%).

CONCLUSION

Retina specialists treat patients of all ages, and the most common diagnoses vary with age and gender. Patients present to retinal clinic with a vast spectrum of disease from various ophthalmic and systemic etiologies; therefore, it is important to maintain a broad differential diagnosis.

Epidemiology of diabetic retinopathy and maculopathy in Africa: a systematic review

AIM

To summarize findings from studies reporting the prevalence and incidence of diabetic retinopathy and diabetic maculopathy in African countries in light of the rising prevalence of diabetes mellitus.

METHODS

Using a predefined search strategy, we systematically searched MEDLINE, EMBASE, Science Citation index and Conference Proceedings Citation index, African Index Medicus and the grey literature database 'OpenSIGLE' for studies published between January 1990 and February 2011. Included studies reported prevalence or incidence of diabetic retinopathy or diabetic maculopathy of subjects with diabetes resident in African countries.

RESULTS

Sixty-two studies from 21 countries were included: three population-based surveys; two cohort studies; five case-control studies; 32 diabetes clinic-based, nine eye clinic-based and 11 other hospital-based surveys. Included studies varied considerably in terms of patient selection, method of assessing the eye and retinopathy classification. In population-based studies, the reported prevalence range in patients with diabetes for diabetic retinopathy was 30.2 to 31.6%, proliferative diabetic retinopathy 0.9 to 1.3%, and any maculopathy 1.2 to 4.5%. In diabetes clinic-based surveys, the reported prevalence range for diabetic retinopathy was 7.0 to 62.4%, proliferative diabetic retinopathy 0 to 6.9%, and any maculopathy 1.2 to 31.1%. No obvious association between prevalence and income level of the country was detected.

CONCLUSIONS

Large, community-based cross-sectional and cohort studies are needed to investigate rates and determinants of prevalence of diabetic retinopathy, incidence and progression in Africa. Consensus is needed on the most appropriate methods of identification and classification of retinopathy for research and clinical practice. Estimates of prevalence of diabetic retinopathy, proliferative diabetic retinopathy and maculopathy are comparable with recent European and American studies.

Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review

To review studies on hypertension in Nigeria over the past five decades in terms of prevalence, awareness and treatment and complications. Following our search on Pubmed, African Journals Online and the World Health Organization Global cardiovascular infobase, 1060 related references were identified out of which 43 were found to be relevant for this review. The overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population, type of measurement and cut-off value used for defining hypertension. The prevalence is similar in men and women (7.9%-50.2% vs 3.5%-68.8%, respectively) and in the urban (8.1%-42.0%) and rural setting (13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5% (2000-2011). Awareness, treatment and control of hypertension were generally low with attendant high burden of hypertension related complications. In order to improve outcomes of cardiovascular disease in Africans, public health education to improve awareness of hypertension is required. Further epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society.