Assessment of four validated questionnaires for screening of dry eye disease in an African cohort

PURPOSE

To evaluate the 5-item dry eye questionnaire (DEQ-5) for measurement precision and unidimensionality, and assess the ability of Ocular Surface Disease Index (OSDI), McMonnies Dry Eye Questionnaire (MQ), Ocular Comfort Index questionnaires (OCI), and DEQ to predict clinical measures of DED in an African population.

METHOD

Participants (n = 113; mean age 24.7 ± 5.4 years) completed all four questionnaires administered in a randomized order. Internal consistency and test-retest reliability of the instruments were assessed. A masked examiner performed clinical dry eye tests in both eyes of participants and the results used to classify into either "dry" or "non-dry" groups. The diagnostic criteria for dry eye disease were tear break up time (TBUT) < 10 s plus at least one of Schirmer <15 mm in 5 min., > 5 corneal staining spot, or > 9 conjunctival staining spots. Rasch analysis was performed to assess the DEQ for unidimensionality and measurement precision, and receiver operating characteristic curve (AUC) analysis was used to assess the ability of the four questionnaires to predict clinical measures of DED.

RESULTS

The responses from the DEQ-5 met the Rasch analysis criterion of unidimensionality with infit and outfit values of between 0.74-1.43 mean-square and 0.69-1.49 mean-square, respectively, and measurement precision of 2.33. Internal consistency and test-retest reliability of each test was high, with Cronbach alpha >0.70 for the questionnaire and their respective subscales but internal consistency reliability of the MQ was poor (Cronbach's alpha = 0 .29-0 0.52). Each test segregated the "dry" and "non-dry" groups with moderate (all AUC 0.70-0.80) and similar accuracy (P > .05).

CONCLUSION

The DEQ -5 demonstrated adequate measurement precision and unidimensionality. Each of the four questionnaires showed psychometric validity for clinical use in the African population, and modest and similar accuracy when screening for dry eye signs but the performance of the McMonnies questionnaire was limited in terms of internal consistency reliability.

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

Purpose:

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

Method:

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

Results:

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

Conclusion:

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

Inter-regional trends in causes of childhood blindness and low vision in Ghana

BACKGROUND

Inter-regional trends of visual loss in most developing countries remain largely unknown. We compared the causes of childhood blindness among children attending blind schools in the northern (one school) and southern (two schools) regions of Ghana and assessed their need for spectacles and low-vision devices.

METHODS

Using a standardised methodology, children were examined by an ophthalmologist and optometrists in each location. Causes of visual loss were classified anatomically and by time of onset, and avoidable causes identified. Children identified with functional low vision were assessed and provided with low-vision devices.

RESULTS

A total of 252 children under 16 years of age were examined in the schools. The overall prevalence of total blindness was 73 (29.0 per cent), with similar proportions (p = 0.87) in the north (29 [28.4 per cent]) and south (44 [29.3 per cent]); 92 (36.5 per cent) had functional low vision. Two children improved with spectacles and 35 benefited from low-vision devices. Corneal scarring was significantly (p = 0.045) more prevalent in southern Ghana (n = 150) than in the north (n = 102), responsible for visual loss in 36 (24.0 per cent, 95% CI 17.2-30.8 per cent) and 14 (13.7 per cent, 95% CI 7.0-20.4 per cent) cases, respectively. No significant difference (p = 0.321) was observed in the prevalence of cataract between northern (28: 27.5 per cent, 95% CI 18.3-36.2 per cent) and southern Ghana (33: 22.0 per cent, 95% CI 15.4-28.6 per cent). Over 87 per cent of children had 'avoidable' causes of visual loss, with a higher proportion being treatable (124: 49.2 per cent) than preventable (96: 38 per cent).

CONCLUSION

Cataract was the major cause of visual loss in the overall population. The south had a higher proportion of corneal scarring and late-onset blindness compared with the north. More than one-third of blindness in blind schools in Ghana could have been prevented by primary care interventions and nearly half could have been treated surgically to prevent visual loss. Two in five children in blind schools in Ghana could benefit from optical intervention.

Knowledge, usage and barriers associated with contact lens wear in Ghana

BACKGROUND

Despite findings that contact lens wear for vision correction provides better quality of life than spectacles, contact lens use in developing countries is low. This study evaluated knowledge, usage and barriers associated with contact lens wear among spectacle wearers in Cape Coast, Ghana.

METHOD

A cross-sectional survey using a structured questionnaire was conducted on an adult population of spectacle wearers to assess their knowledge of contact lens wear for vision correction. The participants were proportionately sampled from three eye clinics in the Cape Coast Metropolis, Ghana. Questionnaires were either self-administered or completed with the help of a research assistant.

RESULTS

Of the 422 participants, only 147 (34.8%) knew of contact lens wear for vision correction. The proportion of spectacle wearers reporting history of contact lens wear was 14 (3.3%). Barriers to contact lens wear reported were satisfaction with vision through spectacles 102 (25.0%), lack of adequate information 111 (27.2%), fear of side effects 94 (23.0%) and cost 78 (19.1%). The younger adults and those with higher number of changes of spectacles were more likely to know of contact lenses.

CONCLUSION

Knowledge and usage of contact lenses among spectacle wearers was low. Contact lens education and demonstration of visual performance through fitting of trial contact lenses on potential candidates may help overcome barriers to contact lens wear.

Effect of preserved and preservative-free timolol eye drops on tear film stability in healthy Africans

Background:

Preserved versus nonpreserved formulations for ophthalmic use have been well described in the literature although not specifically in the African population where beta blockers are frequently used as the first-line therapy due to economic and availability issues. This study sought to determine the effect of preserved and preservative-free Timolol eye drops on tear film stability in healthy black Africans.

Materials and Methods:

Sixty healthy nondry eye subjects aged 19–25 years were randomly assigned into four groups (n = 15) and differently treated with eye drops of phosphate buffered saline (PBS), preservative-free timolol (PFT), benzalkonium chloride (BAK) only, and BAK-preserved timolol (BPT). Noninvasive tear break-up time (NITBUT) was measured using the keratometer at baseline and 30, 60, and 90 min after drop application.

Results:

No significant decline in NITBUT was observed following treatment with PFT and PBS. However, BAK treatment showed a positive time-dependent significant decline in NITBUT (P < 0.001) while a significant decline in the BPT-treated group was only found at 90 min (−3.52 s; P < 0.001). In comparison to the PFT-treated group, treatment with BAK and BPT showed significantly lower NITBUT (P < 0.001).

Conclusion:

BPT is associated with a significant decline in tear film stability in black Africans. This finding has implications in the management of glaucoma in patients with high-risk of dry eyes in this population.

Evaluation of Blood Transfusions in Anemic Children in Effia Nkwanta Regional Hospital, Sekondi-Takoradi, Ghana

Blood transfusion is a common practice in sub-Saharan Africa as a way of correcting anemia in children with mild and severe sicknesses. This study evaluated this practice in a secondary health-care institution in Ghana. A retrospective study was done over a 3-year period from January 2010 to December 2012. Medical records of children admitted, successfully treated, and discharged from the hospital were collected and analyzed. Data were analyzed using Epi Info version 7. Transfusions were more among male children (89, 63.1%) than female children (52, 36.9%). The highest number of blood transfusions were carried out on children in the age range 0-1 year (66, 46.8%). The majority of the blood transfusions were done on children with hemoglobin concentration level of 5 g/dL and below. Children with malaria parasitemia (83, 58.9%) had more transfusions than children without malaria parasitemia (58, 41.1%). Fever alone (43, 30.5%) and fever with gastrointestinal symptoms (33, 23.4%) were the predominant symptoms among children who had blood transfusions. In conclusion, younger children received more transfusions than older children. Also, male children received more blood transfusions than female children. Malaria was observed as a major contributory factor to the requirement for blood transfusions among the children.

Visual impairment attributable to uncorrected refractive error and other causes in the Ghanaian youth: The University of Cape Coast Survey

PURPOSE

To determine the prevalence of visual impairment attributable to refractive error and other causes in a youthful Ghanaian population.

METHODS

A prospective survey of all consecutive visits by first-year tertiary students to the Optometry clinic between August, 2013 and April, 2014. Of the 4378 first-year students aged 16-39 years enumerated, 3437 (78.5%) underwent the eye examination. The examination protocol included presenting visual acuity (PVA), ocular motility, and slit-lamp examination of the external eye, anterior segment and media, and non-dilated fundus examination. Pinhole acuity and fundus examination were performed when the PVA≤6/12 in one or both eyes to determine the principal cause of the vision loss.

RESULTS

The mean age of participants was 21.86 years (95% CI: 21.72-21.99). The prevalence of bilateral visual impairment (BVI; PVA in the better eye ≤6/12) and unilateral visual impairment UVI; PVA in the worse eye ≤6/12) were 3.08% (95% CI: 2.56-3.72) and 0.79% (95% CI: 0.54-1.14), respectively. Among 106 participants with BVI, refractive error (96.2%) and corneal opacity (3.8%) were the causes. Of the 27 participants with UVI, refractive error (44.4%), maculopathy (18.5%) and retinal disease (14.8%) were the major causes. There was unequal distribution of BVI in the different age groups, with those above 20 years having a lesser burden.

CONCLUSION

Eye screening and provision of affordable spectacle correction to the youth could be timely to eliminate visual impairment.