Paediatric Refractive Errors in an Eye Clinic in Osogbo, Nigeria

Visual impairments amongst preschool and school attendees: A scoping review of vision school screening in Nigeria and Kenya

Background: The United Nations Convention on the Rights of the Child emphasises the importance of quality education and good health. Vision problems affect the academic performance of schoolchildren in developing and under-resourced countries. The most prevalent vision problem amongst children is uncorrected refractive errors (URE).Aim: To gain knowledge about vision problems and visual impairments (VI) through school vision screening amongst children in Kenya and Nigeria.Method: A scoping review of online databases (Web of Science and PubMed) and one African registry (African Journals Online) for articles from January 2011 until April 2021 was conducted. The authors included 26 articles of the 439 screened.Results: The literature revealed inconsistencies in how VI was defined. The main cause of vision problems is URE. Furthermore, there is a lack of systematic school vision screening tools and programmes.Conclusion: Efficient eye care services to schoolchildren aged 3–18 years in Kenya and Nigeria must involve multiple disciplinary interventions and governmental responsibility. Collaboration models between public and private health sectors, nongovernmental organisations and families are necessary to prevent VI amongst children. Better vision enhances school performance.

Ocular Morbidity-A Critical Analysis to Improve Outpatient Services in an Eye Department in a Sub-Saharan Megacity

The aim of this study was to analyse outpatient services in an ophthalmic clinic of a church-run hospital providing secondary level care in an African megacity, paying special attention to the poorest users of the services. The range of examination was reviewed from 500 patient records of all ages consecutively chosen on random days attending the outpatient department for the first time in order to optimize workflow and to analyse the offered treatment modalities. Mean age was 41.9 ± 21.9 years, and 53.6% of the patients were female. Of the patients, 74.8% presented with visual impairment. The most frequent findings were refractive errors (35.8%), presbyopia (21.2%), allergic conjunctivitis (14.0%), cataract (13.2%) and glaucoma (6.4%). Patient management consisted of optical treatment (49.6%), surgery (11.4%) and medical treatment (39.0%). These results show the importance of the demand in refractive services and the need to train specific service providers. Knowing the frequencies of common conditions enables more appropriate diagnostic and treatment strategies, e.g., the importance of refractive errors, and should lead to improvements in training, staffing, therapeutics and patient outcomes. This approach can be applied to many other outpatient services and should be evaluated in light of the city’s impoverished health outreach and educational situation.

REFRACTIVE ERRORS AMONG CHILDREN ATTENDING A TERTIARY EYE FACILITY IN IBADAN, NIGERIA: HIGHLIGHTING THE NEED FOR SCHOOL EYE HEALTH PROGRAMS

BACKGROUND

It is estimated that 19 million children aged below 15 years are visually impaired globally. Twelve million of these are due to uncorrected refractive errors. The aim of this study was to describe the pattern of refractive errors seen in children attending the eye clinic of the University College Hospital, Ibadan, Nigeria.

METHODS

A descriptive retrospective study of children with refractive errors seen between January 2011 and December 2012 was conducted. Information on the age, sex, type of refractive error, degree of error (spherical equivalent), presenting complaint, previous spectacle use and return for follow-up visit were retrieved and analyzed using SPSS version 20.

RESULTS

Three hundred and sixty-six children diagnosed with refractive errors accounted for 34.6% of all children seen. Of these, 267 (73%) records were successfully retrieved. The mean age was 10.58 (± 3.14) years, with 156 (58.5%) aged between 11 and 15 years. The male to female ratio was 1:2. The commonest refractive error was myopia, found in 124 (23.2%) of 534 eyes followed by simple myopic astigmatism and compound myopic astigmatism found in 117 (21.9%) and 111 (20.8%) eyes respectively. Majority, 229 (85.8%) had never worn spectacles previously and only 80(30%) children returned for a follow up visit.

CONCLUSION

Refractive errors constitute a common diagnosis among children seen in our tertiary eye facility. Late presentation and poor follow up among our patients are a cause for concern. Public enlightenment, health education and school eye programs are recommended to reverse this trend.

Refractive errors among patients attending the ophthalmology department of a medical college in North-East India

Purpose:

To determine the magnitude and pattern of refractive errors among patients attending the ophthalmology department of a new medical college in North-East India.

Materials and Methods:

A prospective study of the new patients (age ≥5 years), who were phakic and whose unaided visual acuities were worse than 20/20 but improved with pinhole, was done. Complete ophthalmic examination and refraction with appropriate cycloplegia for age were done for the 4582 eligible patients. Spherical equivalents (SE) of refractive errors of the right eyes were used for analysis.

Results:

Of the 4582 eligible patients, 2546 patients had refractive errors (55.56%). The proportion of emmetropia (SE − 0.50–+0.50 diopter sphere [DS]), myopia (SE <−0.50 DS), high myopia (SE >−5.0 DS), and hypermetropia (>+0.50 DS for adults and >+2.0 DS for children) were 53.1%, 27.4%, 2.6%, and 16.9%, respectively. The proportion of hyperopia increased till 59 years and then decreased with age (P = 0.000). The proportion of myopia and high myopia decreased significantly with age after 39 years (P = 0.000 and P = 0.004, respectively). Of the 1510 patients with astigmatism, 17% had with-the-rule (WTR), 23.4% had against-the-rule (ATR), and 19% had oblique astigmatisms. The proportion of WTR and ATR astigmatisms significantly decreased (P = 0.000) and increased (P = 0.000) with age, respectively.

Conclusions:

This study has provided the magnitude and pattern of refractive errors in the study population. It will serve as the initial step for conducting community-based studies on the prevalence of refractive errors in this part of the country since such data are lacking from this region. Moreover, this study will help the primary care physicians to have an overview of the magnitude and pattern of refractive errors presenting to a health-care center as refractive error is an established and significant public health problem worldwide.

The prevalence and causes of decreased visual acuity - a study based on vision screening conducted at Enukweni and Mzuzu Foundation Primary Schools, Malawi

AIM

To determine the prevalence and causes of decreased visual acuity (VA) among pupils recruited in two primary schools in Mzimba district, northern region of Malawi.

MATERIALS AND METHODS

The study was based on the vision screening which was conducted by optometrists at Enukweni and Mzuzu Foundation Primary Schools. The measurements during the screening included unaided distance monocular VA by using Low Vision Resource Center and Snellen chart, pinhole VA on any subject with VA of less than 6/6, refraction, pupil evaluations, ocular movements, ocular health, and shadow test.

RESULTS

The prevalence of decreased VA was found to be low in school-going population (4%, n=594). Even though Enukweni Primary School had few participants than Mzuzu Foundation Primary School, it had high prevalence of decreased VA (5.8%, n=275) than Mzuzu Foundation Primary School (1.8%, n=319). The principal causes of decreased VA in this study were found to be amblyopia and uncorrected refractive errors, with myopia being the main cause than hyperopia.

CONCLUSION

Based on the low prevalence of decreased VA due to myopia or hyperopia, it should not be concluded that refractive errors are an insignificant contributor to visual disability in Malawi. More vision screenings are required at a large scale on school-aged population to reflect the real situation on the ground. Cost-effective strategies are needed to address this easily treatable cause of vision impairment.