Ocular injuries and eye care seeking patterns following injuries among cocoa farmers in Ghana

Seeing the unseen: The low treatment rate of eye emergencies in Africa

BACKGROUND

Emergency medical care is essential in preventing morbidity and mortality, especially when interventions are time-sensitive and require immediate access to supplies and trained personnel.

AIM

To assess the treatment rates of eye emergencies in Africa. Ocular emergencies are particularly delicate due to the eye’s intricate structure and the necessity for its refractive components to remain transparent.

METHODS

This review examines the low treatment rates of eye emergencies in Africa, drawing on 96 records extracted from the PubMed database using predetermined search criteria.

RESULTS

The epidemiology of ocular injuries, as detailed in the studies, reveals significant relationships between the incidence and prevalence of eye injuries and factors such as age, gender, and occupation. The causes of eye emergencies range from accidents to gender-based violence and insect or animal attacks. Management approaches reported in the review include both surgical and non-surgical interventions, from medication to evisceration or enucleation of the eye. Preventive measures emphasize eye health education and the use of protective eyewear and facial protection. However, inadequate healthcare infrastructure and personnel, cultural and geographical barriers, and socioeconomic and behavioral factors hinder the effective prevention, service uptake, and management of eye emergencies.

CONCLUSION

The authors recommend developing eye health policies, enhancing community engagement, improving healthcare personnel training and retention, and increasing funding for eye care programs as solutions to address the low treatment rate of eye emergencies in Africa.

Facilitators and barriers to protective eyewear acceptance among Indian farmers: a qualitative studyf Judith

BACKGROUND

Agriculture, one of the most hazardous occupations globally, accounts for a significant proportion of work-related injuries, particularly in developing countries like India. However, lack of awareness and possibly low education levels make farmers in the unorganized sector vulnerable to eye injuries. This study aimed to identify the barriers to and facilitators of protective eyewear among farmers.

METHODS

A multicentric study was conducted to assess occupational ocular hazards and preventive strategies among farmers in southern India. The facilitating factors and barriers to spectacles or protective eyewear among the study population were explored using a snapshot qualitative study conducted from two centres in Tamil Nadu and one in Karnataka. Thematic analysis was used to analyse the facilitators of and barriers to protective eyewear among farmers.

RESULTS

Five focus group discussions were conducted with 31 farmers (mean age 55.8 ± 9.2 years) from three centers. Six themes were identified: occupational hazards while farming, practice patterns for managing occupational hazards, uses of protective eyewear while farming, benefits and challenges of protective eyewear, perceptions about protective eyewear and suggestions for improvement. Eye injuries from dust, branches, and chemicals were common, and farmers relied on home remedies for minor issues. Protective eyewear was appreciated for preventing injuries and improving safety but faced challenges such as discomfort, poor fit, and aesthetic concerns, particularly among women.

CONCLUSIONS

Although there is awareness regarding the need for protective eyewear, it is often not used due to discomfort during work or concerns about possible breakage of the spectacles. It is imperative for primary eye care professionals to raise awareness regarding the importance of ocular protection in the workplace.

Chemical eye injuries: a 10 year retrospective review of acute presentations and clinical outcomes in Auckland, New Zealand

To assess the aetiologies, clinical characteristics, treatment regimens, and outcomes of acute chemical injuries treated at an emergency eye clinic. Retrospective, observational study of all cases of chemical eye injury that presented acutely to the Greenlane Clinical Centre in Auckland, New Zealand from 1 January 2012 through 31 December 2021. Patient demographics, activity at the time of injury, causative chemical, clinical characteristics of injury at presentation, severity (Dua) classification, admission and discharge best corrected visual acuity (BCVA), treatment regimen, time to epithelisation and number of follow-up appointments were recorded. In total, 1522 cases involving 1919 eyes were studied. The mean age was 40.6 ± 18.8 years and 65% were male. The majority of cases occurred at home (62%) and cleaning was the most common activity (38%). There were 1490 Grade I (98%), 22 Grade II (1.5%), 5 Grade III (0.3%), 1 Grade IV (0.07%), 0 Grade V, and 4 Grade VI (0.3%) cases. An epithelial defect was noted in 409 cases (26.9%), of which re-epithelialisation occurred within one week for 378 cases (92%) and within 30 days for 384 cases (94%). Moderate vision loss (BCVA ≤ 6/12) attributed to the injury occurred in 152 (10%), while severe vision loss (BCVA ≤ 6/60) occurred in 30 (2%). Lack of irrigation at the scene was associated with an increased risk of severe injury and longstanding visual impairment (p = 0.0001). Most acute chemical injuries are mild with good clinical outcomes. Although rare, severe injuries are associated with a lack of irrigation at the scene and worse visual outcomes.

The implications of governance factors for economic and social upgrading in Ghana’s cocoa value chain

This paper identifies several governance factors that enable economic upgrading and the link between economic and social upgrading /downgrading of smallholders and Abusa sharecroppers in Ghana's cocoa value chain (GCVC). The findings are based on qualitative interviews and focus group discussions with various actors in GCVC. Our findings suggest two types of economic upgrading: process and product upgrading, achieved by smallholder producers and Abusa Sharecroppers in GCVC. While process upgrading is enabled by governance factors such as price stabilization and controlling opportunistic behavior, transparency in the sale of certified beans and premium management is key for product upgrading. Regarding the link between economic and social upgrading, we reveal that process upgrading leads to the same outcome of social upgrading and downgrading for smallholders and Abusa sharecroppers due to governance factors such as production and purchasing policies and lack of resources and capabilities. However, product upgrading links to social upgrading and downgrading for smallholders and Abusa sharecroppers respectively owing to governance factors such as controlling resources and bargaining power. We provide insights into key actors and their interests, drivers of change and effects of incentives that play crucial roles in shaping governance factors that influence economic and social upgrading of smallholders and Abusa sharecroppers in GCVC. In our conclusion, we identify how regulations, institutional support and conflicts of interest are key for enabling upgrading of developing countries’ agricultural value chains.

Characteristics of Grape Shelf Eye Injuries at Vineyards in Japan

We aimed to investigate the characteristics and visual outcomes of farm work-associated eye injuries at vineyards. We retrospectively reviewed medical charts of patients with farm work-associated eye injuries. The eyes were divided into two groups according to the type of farming that contributed to the eye injury: the vineyard and other farming groups. Injury types, surgical procedures, and changes in visual acuity were statistically evaluated. After initial treatment, patients were followed up at different periods. We examined 30 eyes, including 14 eye injuries in the vineyard group and 16 eye injuries in the other farming group. The mean age of the patients was 58.8 ± 16.7 years, and 83.3% were male. None of the patients wore any safety eyewear at the time of injury. After initial treatment, the mean best-corrected visual acuity significantly improved from 0.83 ± 0.94 at baseline to 0.30 ± 0.57 at the final follow-up (p = 5.8 × 10^-4). Eye injuries in the vineyard group were mostly caused by the penetration of wires of grape shelves and were frequent from winter to spring. We concluded that farm work-associated eye injuries at vineyards have characteristic properties compared with those during other farm work. The use of safety eyewear is strongly recommended to prevent eye injuries during farm work.

Delay in accessing definitive care for patients with microbial keratitis in Nepal

Background

The aim of this study was to describe the health-seeking journey for patients with microbial keratitis (MK) in Nepal and identify factors associated with delay.

Methods

Prospective cohort study where MK patients attending a large, tertiary-referral eye hospital in south-eastern Nepal between June 2019 and November 2020 were recruited. We collected demographic details, clinical history, and examination findings. Care-seeking journey details were captured including places attended, number of journeys, time from symptom onset, and costs. We compared "direct" with "indirect" presenters, analyzing for predictors of delay.

Results

We enrolled 643 patients with MK. The majority (96%) self-referred. "Direct" attenders accounted for only 23.6% (152/643) of patients, the majority of "indirect" patients initially presented to a pharmacy (255/491). Over half (328/643) of all cases presented after at least 7 days. The total cost of care increased with increasing numbers of facilities visited (p < 0.001). Those living furthest away were least likely to present directly (p < 0.001). Factors independently associated with delayed presentation included distance >50 km from the eye hospital [aOR 5.760 (95% CI 1.829-18.14, p = 0.003)], previous antifungal use [aOR 4.706 (95% CI 3.139-5.360)], and two or more previous journeys [aOR 1.442 (95% CI 1.111-3.255)].

Conclusions

Most patients visited at least one facility prior to our institution, with time to presentation and costs increasing with the number of prior journeys. Distance to the eye hospital is a significant barrier to prompt, direct presentation. Based on these findings, improving access to eye care services, strengthening referral networks and encouraging early appropriate treatment are recommended to reduce delay, ultimately improving clinical outcomes.

Occupational Ocular Injuries and Utilization of Eye Protective Devices among Sawmill Workers in the Ojo Local Government Area of Lagos State, Nigeria

In this work, we carried out a cross-sectional study to assess occupational ocular injuries and utilization of eye protective devices among sawmill workers in the Ojo local government area of Lagos State, Nigeria A structured questionnaire was used to conduct face-to-face interviews among the sawmill workers. Pearson’s chi-squared test and t-test were used to test associations between variables. A p-value of less than 0.05 was considered statistically significant. A total of 215 sawmill workers with a mean age of 37.08 ± 12.07 years participated in the study. A majority (55.8%) of the participants were male (93.7%), and a majority were 21–40 years old (55.8%). Of the participants, 78.6% were aware of occupational ocular injuries and 17.7% used ocular safety devices. The major barrier to the use of eye protective devices was unavailability (43%). Workers who were ≥20 years old (p < 0.001), who received a monthly salary of less than USD 100 (p < 0.043), who had work experience of ≥10 years (p < 0.04), who were aware of ocular hazards (p < 0.03), and who did not use protective eye devices (p < 0.02) were significantly associated with occupational ocular injuries compared to others. The prevalence of occupational ocular injuries and the utilization of eye safety devices among the sawmill workers in the current study were comparable to findings from other studies. Based on the results of our study, we advise the provision of ocular protective devices for sawmill workers and policies to enforce regular utilization.

Epidemiology, economic and humanistic burdens of Ocular Surface Chemical Injury: A narrative review

Ocular surface chemical injury (OSCI) is a common type of ocular emergency that can potentially cause significant and permanent visual impairment. However, the global prevalence, demographic factors, socioeconomic burden, and psychological impact of OSCI have not been well investigated or reported. This review aims to provide a comprehensive overview of these aspects, highlight gaps in the literature, and advocate key strategies in reducing the incidence of OSCI. OSCI was responsible for 0.1-15% of all ocular emergency presentations, with an estimated incidence of 5.1-50 per 100,000 population-year. Young working adult men were the most at-risk group, though high rates of OSCI were also observed in young children in developed countries, especially from detergent pods. Low- and middle-income countries were noted to have higher proportions of assault-related and pediatric OSCI cases, often with more severe presentations. Direct and indirect costs for some hospitalized patients led to loss of all personal and household income after the injury. Emergency department costs in the United States were estimated at $106.7 million over four years and costs of treating long term complications such as glaucoma were estimated to be as high as $93,003 over five years. Significant negative impacts on visual and health-related quality of life and psychological well-being have been reported after injury, with higher rates of anxiety, depression, and psychological distress compared to the general population.

Eye injuries caused by date palm thorns and leaves

PURPOSE:

To describe the clinical presentation, management, and outcome of hospitalized patients having date palm tree eye injuries.

METHODS:

This is a retrospective study of consecutive patients who were admitted to Al-Ain hospital following date palm tree eye injuries between 2012 and 2017. Patients' demography, symptoms and signs at presentation, surgical intervention, visual acuity (VA) before and after treatment, hospital stay, and causes for VA limitation were studied.

RESULTS:

Sixteen patients were studied. Their median (range) age was 38.5 (7–58) years, all were males. Majority (87.5%) were from the Indian subcontinent and had their injuries at farms. Eye pain (94 %) was the most common presenting symptom while keratitis (62.5%) and corneal perforation (43.8%) were the most common physical findings. Vision showed a statistical trend for improvement after treatment (P = 0.1, Wilcoxon singed rank test). Five patients (31%) were blind in the injured eye.

CONCLUSION:

Palm date tree eye injuries which mainly occur at farms are a significant cause for visual loss at United Arab Emirates (UAE). Use of eyes protective goggles combined with legislative eye safety regulations will reduce palm tree eye injuries.

Types of ocular injury and their antecedent factors: A systematic review and meta-analysis

BACKGROUND

Ocular injuries are an important workplace hazard that can lead to vision loss, decreased functioning, and socioeconomic costs. The aim of this systematic review is to identify types of occupational ocular injuries and examine factors associated with these injuries.

METHODS

Four health sciences databases (Ovid Medline, Embase, PsycINFO, and CINAHL) were reviewed to identify evidence pertaining to occupational ocular injuries. This systematic review was registered with PROSPERO (registration number: CRD42018089876) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PICO (Population/Intervention/Comparison/Outcome) tool was used to support, structure, and improve our search strategy.

RESULTS

Overall, 12 studies with quantitative Critical Appraisal Skills Programme grading scores were assessed in a systematic review and meta-analysis of ocular injuries in the workplace. The systematic review identified four main factors associated with occupational ocular injury: (a) use of eye protection at the time of the ocular injury, (b) being male, (c) exposure to biological or chemical occupational hazards, and (d) risk-taking behavior.

CONCLUSIONS

Differences in risk between countries of origin, occupational sectors, and dates of publication, suggest likely differences or changes in safety procedures. We recommend that employers ensure that safety equipment is tailored to the protection of their specific occupational hazards, and that employees are adhering to safety protocols.

Demographic and clinical characteristics of patients with glaucoma in a tertiary eye facility in Ghana

Background: Ghana has been reported to have the second highest prevalence of glaucoma worldwide.Aim: Because of glaucoma causing numerous cases of irreversible blindness, there is the need for baseline data for glaucoma characteristics among Ghanaians. This study was conducted to determine the demographic and clinical characteristics of glaucoma patients in a tertiary eye centre.Setting: The setting for this study is the eye clinic of the Agogo Presbyterian Hospital, which is situated in the Ashanti Region of Ghana.Methods: The medical records of patients who attended the eye centre from January 2013 to December 2017 were reviewed. The data collected included the demographic variables and clinical characteristics of patients diagnosed with glaucoma.Results: Of the 1100 medical records reviewed, 311 were diagnosed with glaucoma. Of the 311 patients, 159 (51.1%) were males and 152 (48.9%) were females, with their ages ranging from 11 to 104 years (mean = 60 ± 18.1 years). Primary open-angle, secondary, juvenile and primary angle-closure glaucomas accounted for 81.6%, 11%, 3.8% and 3.6%, respectively, of all cases of glaucoma. The average intra-ocular pressure was 28.2 ± 11 mmHg. The cup-to-disc ratio and visual acuity varied significantly among the various ethnic groups (p 0.05), while the average intra-ocular pressure did not (p 0.05). Timolol was the first line of treatment for 91.4% cases of glaucoma.Conclusion: Primary open-angle glaucoma is the predominant type in this population, with the clinical characteristics of visual acuity and cup-to-disc ratio varying among the different Ghanaian ethnic groups. There is a need for population-based epidemiologic studies to validate the data collected in this hospital-based study.