Prevalence and risk factors of Vernal Keratoconjunctivitis among a Ghanaian clinical cohort: A case-control study

Background

Vernal Keratoconjunctivitis (VKC) has been determined to be highly prevalent in countries within the tropical climate region. However, little evidence from studies conducted within this region has been put forward to support this claim.

Aim

To determine the prevalence and risk factors of VKC among a Ghanaian clinical cohort.

Methods

A 3-year case-control study was conducted in a tertiary eye care institution, and medical records of patients who had been diagnosed of VKC between 2018 and 2021 were reviewed.

Results

Medical records of 3800 patients were reviewed. Some 359 cases of VKC were identified, with a population prevalence rate of 9.45 % . Males comprised 57.1 % of the population with VKC, with a male-to-female ratio of 1.33 : 1 . The disease was more prevalent (40.8%) in children (≤ 17 years), and the overall odds of incidence decreased by 10% for a unit increase in age. Age and sex-adjusted models revealed significant positive associations between Keratoconus [aOR = 40.760, 95% CI -5.948 to 339.937], Rhinitis [cOR = 5.183, 95% CI -2.074 to 12.022] and VKC. However, the incidence of VKC was relatively less expressive among pterygium cases [cOR = 0.315, 95% CI -0.077 to 0.846].

Conclusion

VKC is highly prevalent among children and is often associated with comorbidities of atopic origin that exacerbate the impact of the disease among this vulnerable population. It is imperative that clinicians provide holistic care for children with VKC.

Risk of major myopia-associated non-communicable ocular health disorders in Ghana

OBJECTIVE

To assess the differential association of myopia with major non-communicable ocular diseases in an African clinical cohort.

METHODS

A five-year hospital-based retrospective study of myopia cases. Patients' folders, Optical Coherence Tomography scans, and fundus photographs were reviewed for the abstraction of relevant data. Only records that employed recognized standards and classification systems for diagnosing and staging the various ocular conditions were included. Demographic characteristics, non-cycloplegic objective refractive findings, and non-communicable eye diseases were retrieved from the records. Myopia-associated risk factors were then determined using logistic regression and correlation.

RESULTS

Some 16018 patients (32027 eyes) met the inclusion criteria for at least one eye comprising 50.8% males (n = 8137) and 49.2% females (n = 7881). The mean age of the patients was 43.14 ± 17.88 years (range: 2-98 years). The mean spherical equivalent± Standard deviation for myopia was -2.30±3.23 DS (range: -0.50 to -25DS). Binary logistic regression analysis showed that myopic eyes had a higher odd of AC (OR, 0.53; 95% CI, 0.50-0.57), POAG (OR, 6.0; 95% CI, 5.26-6.82), DR (OR, 10.70; 95% CI, 3.91-29.27) and cataracts (OR, 20; 95% CI, 15.32-26.20) but not dry eye (OR, 0.74, 95% CI, 0.68-0.81), macular degeneration and pterygium (OR, 0.36; 95% CI, 0.32-0.40).

CONCLUSION

Africans with myopia are more at risk of developing allergic conjunctivitis, cataracts, POAG, and DR but not for dry eye, macular degeneration, and pterygium.

Scheimpflug-Derived Keratometric, Pachymetric and Pachymetric Progression Indices in the Diagnosis of Keratoconus: A Systematic Review and Meta-Analysis

Scheimpflug Pentacam Tomography is becoming crucial in the diagnosis and monitoring of keratoconus, as well as in pre- and post-corneal refractive care, but there are still some inconsistencies surrounding its evidence base diagnostic outcome. Therefore, this study aimed at employing meta-analysis to systematically evaluate the keratometric, pachymetric, and pachymetric progression indices used in the diagnosis of Keratoconus. The review protocol was registered with PROSPERO (Identifier: CRD4202310058) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, MEDLINE, Web of Science, and EMBASE were used for data search, followed by a quality appraisal of the included studies using the revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2). Meta-analysis was conducted using the meta (6.5.0) and metafor (4.2.0) packages in R version 4.3.0, as well as Stata. A total of 32 studies were included in the analysis. All keratometry (K) readings (flattest meridian, K1; steepest meridian, K2, maximum, Kmax) were significantly steeper in keratoconic compared to normal eyes: [MD (95% CI)], K1 [2.67 (1.81; 3.52)], K1-back [-0.71 (-1.03; -0.39)], K1-front [4.06 (2.48; 5.63)], K2 [4.32 (2.89; 5.75)], K2-back [-1.25 (-1.68; -0.82)], K2-front [4.82 (1.88; 7.76)], Kmax [7.57 (4.80; 10.34)], and Kmean [2.80 (1.13; 4.47)]. Additionally, corneal thickness at the center, CCT [-61.19 (-73.79; -48.60)] and apex, pachy-apex [-41.86 (-72.64; -11.08)] were significantly thinner in keratoconic eyes compared to normal eyes. The pooled estimates for pachymetric progression index (PPI): PPImin [0.66 (0.43; 0.90)], PPImax [1.26 (0.87; 1.64)], PPIavg [0.90 (0.68; 1.12)], and Ambrosio relational thickness (ART): ARTmax [-242.77 (-288.86; -196.69)], and ARTavg [-251.08 (-308.76; -195.39)] revealed significantly more rapid pachymetric progression in keratoconic eyes than in normal eyes. The Pentacam Scheimpflug-derived keratometric, pachymetric, and pachymetric progression indices are good predictors in discriminating KC from normal eyes.

Efficacy of intravitreal bevacizumab on diabetic macular oedema in an African population

PURPOSE

To evaluate the short-term effect of intravitreal bevacizumab (avastin) injection on visual outcomes of patients with diabetic macular oedema.

METHODS

A retrospective cross-sectional study was conducted to evaluate 39 eyes of thirty-nine patients (mean age ± SD: 61.4 ± 15.0 years) that received intravitreal bevacizumab injection (1.25 mg in 0.05 ml) as treatment for diabetic macular oedema between January 2014 and July 2019 in Ghana. Data on visual acuity and central macular thickness before treatment and 6 weeks post-treatment were collected and analysed using paired t-test. Ordinary least squares linear regression analysis was also conducted to determine the relationship between improvement in visual acuity and central macular thickness after treatment and other predictor variables.

RESULTS

The mean ± SD visual acuity (LogMAR-equivalent of Snellen) of patients with diabetic macular oedema significantly improved from 0.84 ± 0.58 LogMAR before treatment to 0.69 ± 0.58 LogMAR at 6 weeks post-treatment (mean difference: 0.15 ± 0.32 LogMAR; 95% CI: 0.04 to 0.25; p = 0.01). Mean macular thickness ± SD on the other hand, reduced significantly (p < 0.001) from 316.54 ± 75.35 μm before treatment to 275.54 ± 57.43 μm after treatment. While age and worse pre-treatment visual acuity predicted improvement in visual acuity after treatment, a higher central macular thickness before treatment predicted an improvement in central macular thickness after intravitreal bevacizumab injection.

CONCLUSION

Treatment with intravitreal bevacizumab injection produces short-term improvement in vision and reduction in central macular thickness in African patients with diabetic macular oedema.

Epidemiology and trends in the uptake of refractive error services in Harare, Zimbabwe: a hospital-based retrospective study

Aim

The study aimed to determine the epidemiology and evaluate the trends in the uptake of refractive error services in Harare.

Methods

A clinic-based retrospective study at the Greenwood Park Eye Centre and its three subsidiaries was conducted from January 1, 2015 to December 31, 2020.

Results

12,216 patients' records were retrieved, out of which 1074 (8.79%) had refractive error cases. The prevalence of visual impairment at presentation was 5.80% [95% CI: 5.39 - 6.23]. Among those with refractive error, the sample prevalence of visual impairment before correction was 41.30% [CI: 38.3 - 44.3, 95%], and 2.20% [95% CI: 1.4 - 3.3] after correction. There was inconsistency in the percentage utilization of refractive error services, with the highest being 42.60% in 2015. Refractive error types were related to age, employment position, and type of visual impairment prior to refractive error treatment.

Conclusion

There was a low percentage of refractive error services uptake in urban Zimbabwe.

Ocular trauma among patients attending a tertiary teaching hospital in Zimbabwe

PURPOSE

To investigate the trends, prevalence and distribution of ocular trauma in a Zimbabwean Tertiary Teaching Hospital (Parirenyatwa).

METHOD

A hospital-based retrospective cross-sectional study was conducted at the Parirenyatwa Group of Hospitals, Sekuru Kaguvi Eye Department in Harare, Zimbabwe, to review medical records of patients with ocular trauma visiting for treatment at the outpatient department between January 2017 and December 2021. Information on patients' demographics, presenting visual acuity, type of ocular trauma, and the number of eyes affected were collected and analysed using descriptive and inferential statistics.

RESULTS

A total of 863 patients (1007 eyes) were identified to have experienced ocular trauma of one kind or another, with the youth (18-35 years) reporting with most cases (331, 38.4%). About 71.2% of patients were classified as having open-globe injuries and of that number, 90% were caused by blunt trauma, while the rest were caused by penetrating, intraocular, and perforating injuries. Patients with open-globe injuries were about 10 times more likely to develop blindness than those with closed-globe injuries after adjusting for age and gender, and this was statistically significant (ARR = 9.65, 95% CI: 5.53-16.84, p < 0.001). The prevalence of distance vision impairment due to ocular trauma was 60.1% (95% CI: 56.8%-63.4%), with majority resulting in blindness (22.0%, 95% CI: 19.4%-24.9%).

CONCLUSION

There is a high prevalence of open-globe injuries in Zimbabwe with blunt trauma being the most significant cause. This suggests the need to promote and intensify public eye health awareness and sensitisation on safety strategies for the prevention of ocular trauma throughout the country.

Adherence to Ocular Hypotensive Medication in Patients With Primary Open Angle Glaucoma in Ghana

PRCIS

There is a high rate of nonadherence to ocular hypotensive medications in a highly prevalent glaucoma setting, which warrants the attention of caregivers so as to inform their discussion of the possible barriers to adherence with their patients.

PURPOSE

To assess adherence to ocular hypotensive medication objectively among glaucoma patients in Ghana and to identify factors associated with adherence.

MATERIALS AND METHODS

The prospective, observational cohort study included consecutive patients with primary open angle glaucoma treated with Timolol at the Christian Eye Centre, Cape Coast, Ghana. Adherence was assessed using Medication Event Monitoring System (MEMS) for a period of 3 months. MEMS adherence was defined as the number of doses taken divided by the number of doses prescribed, expressed in percent. Patients with adherence of 75% or less were classified as nonadherent. Associations with glaucoma medication self-efficacy, eyedrop-taking behaviors, and health beliefs were also assessed.

RESULTS

Of the 139 patients (mean age, 65 y [SD, 13 y]) included in the study, 107 (77.0%) were nonadherent when assessed with MEMS, compared with only 47 (33.8%) who self-reported being nonadherent. Overall, mean adherence was 48.5%±29.7. In univariate analysis, MEMS adherence was significantly associated with educational level ( χ2 =9.18, P =0.01) and the number of systemic comorbidities ( χ2 =6.03, P =0.049).

CONCLUSION

Overall, mean adherence was low, and adherence was associated with educational level and number of systemic comorbidities in univariate analysis.

The Aqueous Stem Bark Extract of Alstonia boonei Exhibits Anticataract Activity in Sprague Dawley Rat

In Africa, Alstonia boonei is used folklorically for the management of the multitude of conditions including cataract, which accounts for 50% of cases of blindness in the region. The current study set out to probe the traditional use of the aqueous extract of Alstonia boonei stem bark (ABE) as an anticataract remedy using Sprague Dawley rat models. We investigated the probable phytochemical constituents in the extract, in vitro antioxidant potential, and its in vitro aldose reductase inhibition. For the anticataract investigations, diabetic cataract was induced using galactose in 3-week-old Sprague Dawley rats, and age-related cataract was induced by the administration of sodium selenite to 10-day-old rat pups. Cataract scores in both models were determined after treatment with 30, 100, and 300 mgkg-1 doses of ABE and 10 mlkg-1 of distilled water. Lens glutathione, total lens protein, soluble lens proteins (alpha-A) crystallin, and aquaporin 0 levels in the enucleated lens homogenates were determined. Changes in lens to body weight were also determined with histopathological analysis done on the lenses in the selenite-induced cataract model. The presence of alkaloids, tannins, flavonoids, glycosides, and triterpenoids was identified in the extract. The extract inhibited aldose reductase activity with IC50 of 92.30 μgml-1. The 30, 100, and 300 mgkg-1ABE-treated rats recorded significantly (p < 0.05) reduced cataract scores indicating a delay in cataractogenesis in galactose-induced cataract and in selenite-induced cataractogenesis as well. Markers of lens transparency such as AQP0, alpha-A crystallin, and total lens proteins and lens glutathione levels were significantly (p < 0.05) preserved. In conclusion, this study establishes the anticataract potential of the aqueous stem bark extract of Alstonia boonei in Sprague Dawley rat models.

Trends in myopia management attitudes and strategies in clinical practice: Survey of eye care practitioners in Africa

PURPOSE

There remains a lack of information on the perception and adoption of myopia control strategies among African eye care practitioners (ECPs). This study provides an African perspective to similar previous studies conducted in other parts of the world.

METHODS

A self-administered survey in English and French was distributed to ECPs across Africa. The items on the questionnaire assessed their level of concern about the increasing prevalence of paediatric myopia, perceived efficacy, opinions on, and adoption of various myopia management modalities.

RESULTS

Responses were obtained from 330 ECPs working in 23 African countries. Respondents were highly concerned about the increasing prevalence of paediatric myopia in their clinic (median 8/10) and perceived approved myopia control soft contact lenses as the most effective at slowing myopia progression (mean perceived reduction in myopia progression ± SD; 53.9 ± 27.1%), followed by single vision spectacles (53.1 ± 30.9%), and orthokeratology (52.8 ± 28.0%). Multifocal soft contact lenses (40.4 ± 25.8%) and pharmaceutical agents such as topical atropine drops (39.5 ± 27.1%) were perceived as least effective in slowing myopia progression. Although ECPs reported being aware of various myopia control strategies, they still mainly prescribed single vision spectacles to a large proportion (64.3 ± 29.9%) of young progressing myopes. Nearly one-third (27%) of ECPs who prescribed single vision lenses stated they were concerned about the cost implications to patients. Other reported concerns included safety of, and inadequate information about myopia control options.

CONCLUSIONS

African ECPs continue to prescribe single vision lenses for progressing myopes despite being aware of the various myopia control options. Practitioners' perceptions of the efficacy of several modalities to slow myopia progression do not align with the current best evidence. Clear practice guidelines and continuing education on myopia control are warranted to inform and guide the management of myopic patients in Africa.

Facial dermatosis papulosa nigra, a risk for the development of pterygium and myopia: a descriptive cross-sectional study in Ghana

Background. Dermatosis papulosa nigra (DPN) affects sun-exposed areas such as the face, neck, and trunk. The prevalence of pterygium and myopia in DPN patients in Ghana has not been studied. In this study, we examined the risk and protective factors for pterygium and myopia in DPN patients. Materials and Methods. The study involved 100 participants with facial DPN. A standard ophthalmic exam was performed using a portable slit lamp and a 3.5X magnified loop. Participants completed a closed- ended questionnaire. Logistic regression was used to summarize the level of association between DPN, myopia, and pterygium, as well as demographic factors (gender, age, occupation, family history of lesion and skin complexion). Results. 70% and 84% of participants had pterygium and myopia. Age, gender, complexion, and sun exposure were associated with pterygium and myopia (p < 0.05). Higher grade of pterygium and myopia were prevalent in the aged population. Both univariate and multivariable models highlighted that increasing age and sun exposure (outdoor) were risk factors for developing higher grade of pterygium and myopia in the DPN participants, while light skin color and male gender were respectively identified as protective factors. Conclusions. Our study is the first to examine pterygium and myopia in facial DPN patients. Most Ghanaians with facial DPN are at risk for developing pterygium and myopia.

Anticataract Effect of the Aqueous Extract of the Flowers of Aspilia africana in Murine Model of Diabetic and Age-Related Cataracts

Background

The use of Aspilia africana in traditional medicine for the management of ocular diseases has been reported in India and some indigenous communities of Africa. The aim of this study was to investigate the aqueous extract of the flowers of A. africana (AAE) as an anticataract remedy using murine models of diabetic and senile cataracts.

Methods

Preliminary phytochemical screening of the extract, in vitro antioxidant assays, and in vitro aldose reductase inhibitory activity were performed. For anticataract investigations of the extracts, diabetic cataract was induced by galactose administration in 3-week-old Sprague Dawley rats. The evaluation of experimentally induced age-related cataract was performed by administering sodium selenite to 10-day-old rat pups.

Results

The phytochemical analysis revealed the presence of alkaloids, tannins, flavonoids, glycosides, and saponins. In vitro aldose reductase inhibitory property of the extract on rat lenses revealed that the AAE inhibited the enzyme activity with IC₅₀ of 12.12 µg/ml. For the anticataract investigations, 30, 100, and 300 mg·kg^-1AAE-treated rats recorded significantly low (p ≤ 0.0001) cataract scores compared to the negative control rats, indicating a delay in cataractogenesis from the second week of treatment in the galactose-induced cataractogenesis. Similarly, the treatment with AAE caused a significant reduction (p ≤ 0.0001) in cataract scores compared to the negative control rats in the selenite-induced cataractogenesis. Markers of lens transparency, such as aquaporin 0, alpha-A crystallin, and total lens proteins and lens glutathione levels, were significantly preserved (p ≤ 0.05-0.0001) in each cataract model after AAE treatment.

Conclusion

The study established the anticataract potential of the aqueous extract of flowers of A. africana in murine models, hence giving scientific credence to its folkloric use in the management of cataract.

Prevalence and causes of visual impairment amongst hearing impaired school-going children in sub-Saharan Africa: a scoping review

Background: Learners living with hearing impairment are at a higher risk of visual impairment. Purpose: To summarise relevant literature investigating the prevalence and causes of visual impairment amongst learners living with hearing impairment in sub-Saharan Africa. Methods: A search of nine databases and the reference lists of retrieved studies were conducted using the standard methodology for scoping reviews as described in the PRISMA statement. The databases were MEDLINE, PubMed, EMBASE, the Cochrane Library, Global Health, OVID, Google Scholar, Web of Science, and Science Direct. A scoping review of articles published in the English language from 2000 to 2020 was conducted while considering the study design, sub-Saharan Africa, and school for the deaf. Descriptive statistics was used to analyse the data. Results: The initial search retrieved eight studies, seven of which met the set inclusion criteria. All seven studies included employed a cross-sectional design. The prevalence of visual impairment ranged from 2.2-34.6% with the major cause being uncorrected refractive error (7.9-73.26%). The most common type of refractive error was myopia (42.2%) followed by hyperopia (28.6%) and astigmatism (28.6%). Conclusion: This review has demonstrated that there is a paucity of high-quality and well-designed studies that have investigated the prevalence and causes of visual impairment amongst hearing-impaired children in sub-Saharan Africa suggesting the need for further research in this area. Keywords: Visual impairment; prevalence; Africa; hearing impairment; ocular morbidity.

Toward Universal Eye Health Coverage-Key Outcomes of the World Health Organization Package of Eye Care Interventions: A Systematic Review

Importance

Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed.

Objective

To describe the key outcomes of the PECI development.

Evidence Review

A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review.

Findings

Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI.

Conclusions and Relevance

This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.

Prevalence and risk factors for Falls among older adults in a primary care facility in Ghana

Background

Falls are a serious problem and are among the leading causes of morbidity, functional dependency, and death in older adults. Falls have become a social and global public health concern due to the current aging population in Africa and across the globe. However, their prevalence and risk factors have received little attention in Africa.

Purpose

Thus, this study aimed to provide a baseline survey to determine the prevalence and associated risk factors for falls among older adults attending a primary care facility in Cape Coast, Ghana.

Results

Participants (n = 244) were patients aged 60 years and older who visited the University of Cape Coast Hospital. The prevalence of falls identified in this hospital-based study was 40.2%. The following independent variables were found to be statistically significant predictors of risk of falls among the participants when compared with their respective reference categories; age 80 years and above [OR = 3.707, 95% CI = 1.738 - 7.907, p = 0.001], participants who had a history of falls [OR = 2.234, 95% CI = 1.326 - 3.765, p = 0.003], participants with three or more co-morbidities [OR = 16.456, 95% CI = 2.099 - 129.020, p = 0.008] and obesity [OR = 2.211, 95% CI = 1.151 - 4.250, p = 0.017].

Conclusion

The prevalence of falls among older adults is high. Thus, clinicians in the primary care setting should screen for, give fall prevention education, and prescribe appropriate interventions to at-risk patients.

Impact of meibomian gland dysfunction on quality of life and mental health in a clinical sample in Ghana: a cross-sectional study

OBJECTIVES

This study aimed to determine the impact of meibomian gland dysfunction (MGD) on quality of life and psychosomatic conditions.

DESIGN

This was a clinic-based cross-sectional study.

SETTING

This study was conducted at the eye clinic of the University of Cape Coast, Ghana.

PARTICIPANTS

215 clinical subjects visiting the clinic for a comprehensive eye examination.

PRIMARY AND SECONDARY OUTCOME MEASURES

Symptomatic MGD, asymptomatic MGD, quality of life scores, depression, anxiety and stress.

RESULTS

215 clinical subjects consented to participate in the study, but 212 were included in the analysis. The mean age was 21.9 (± 3.8) years, 54 had MGD and 158 did not have MGD served as controls. There was no statistically significant difference in the mean quality of life scores between subjects with MGD and subjects without MGD (t=1.57, p=0.12). The quality of life scores (DEQS) (p=0.022) were significantly higher in the symptomatic MGD group compared with the asymptomatic MGD group. There was no significant difference in quality of life scores (DEQS) (p=0.251) in the asymptomatic MGD group compared with healthy controls. Using Pillai's trace in the MANOVA, there was a significant effect of MGD on depression, anxiety and stress (V=0.05, F(3,208)=3.76, p=0.012). Furthermore, Pillai's trace in the MANOVA showed a significant difference between asymptomatic and symptomatic MGDs for depression, anxiety and stress scores stress (V=0.24, F(3, 51)=5.24, p=0.003).

CONCLUSION

The study revealed no difference in the quality of life scores between MGD and non-MGD groups. However, the symptomatic MGD group had worse quality of life and psychosomatic symptoms than the asymptomatic MGD group and non-MGD group.

Childhood Vision Impairment and Refractive Error in Zimbabwe: A Hospital-based Retrospective Study

Background

The objective of this study was to determine the causes and distribution of vision impairment and refractive error among children in Zimbabwe.

Methods

A hospital-based retrospective cross-sectional study was conducted among children (3–16) who attended the Eye Institute, Harare, Zimbabwe, from January 2010 to December 2020. Patients' records were collated, and variables such as visual acuity, ocular morbidities, and vision impairment were analysed.

Results

During this time, 1038 children with mean age of 10.63 ± 3.54 years visited the facility. The majority of them were males (53.2%). Prior to treatment, 9.9% of the children had vision impairment which reduced to 3.5% after intervention. Uncorrected refractive error accounted for the majority of vision impairment (67.0%), followed by keratoconus (7.8%), corneal opacity/ulceration (6.8%), and amblyopia (6.8%), among other conditions. Astigmatism (60.6%) was the most prevalent type of refractive error followed by myopia (37.5%).

Conclusion

The prevalence of childhood vision impairment is higher than that found in similar hospital-based studies conducted in Africa. The most common reason for childhood vision impairment was uncorrected refractive error.

Dry eye disease and meibomian gland dysfunction among a clinical sample of type 2 diabetes patients in Ghana

Objective

To evaluate dry eye disease and meibomian gland dysfunction among type 2 diabetes patients

Methods

A hospital-based cross-sectional study was conducted. Parameters assessed included meibum expressibility and quality, Schirmer test 1, tear breakup time (TBUT), ocular surface staining, blink rates and Ocular Surface Disease Index (OSDI) scores. Dry eye was diagnosed based on a combination of subjective symptoms, tear function and ocular surface staining.

Results

Prevalence of DED and MGD were 72.3% and 55.3% respectively. Symptomatic dry eye (OSDI scores) was significantly associated with duration of diabetes (rs = 0.11, P = 0.028) and the presence of conjunctival disorders (OR = 2.09, P = 0.002). MGD was a risk factor for DED (OR = 1.99, P = 0.008); ocular surface damage, the presence of eye lid lesions, abnormal Schirmer test and reduced TBUT were significantly associated with MGD, the strongest predictor being ocular surface damage (OR = 3.21, P = 0.001). OSDI scores had no association with the presence of corneal lesions possibly due to reduced corneal sensitivity.

Conclusion

DED and MGD were prevalent among the patients and therefore there is the need for dry eye assessment as a routine clinical management protocol for patients with type 2 diabetes.

Age- and sex-related differences in the measures of anterior segment parameters in a myopic clinical sample using Pentacam Scheimpflug tomography

PURPOSE

To assess age-and sex-related differences of anterior segment parameters in a myopic clinical sample.

METHODS

This clinic-based retrospective study involved eligible subjects grouped into myopia (i.e., low-to-moderate) and high myopia. Demographics and anterior segment parameters measures were recorded and analyzed.

RESULTS

Some 153 eligible eyes were analyzed-98 myopia and 55 high myopia-comprising 87 males and 66 females. The mean ages and ranges were 28.47 years (SD = 9.59 years), 8-50 years, and 27.82 years (SD = 9.69 years), 10-51 years, for the myopia and the high myopia groups, respectively. The means of the spherical equivalents were - 3.02 D (SD = 1.46 D, range: - 0.50 to - 5.85 D), for the myopia group and - 10.42 D (SD = 5.50 D, range: - 6.00 to - 21.86 D) for the high myopia group. No significant difference was found between degree of myopia and anterior segment measures. Males had larger anterior chamber volume (mean 175.71 ± 26.27, range: 124-225 mm³); (P = 0.007) and deeper anterior chamber depth (3.73 ± 0.27, range: 3.06-4.41 mm) (P = 0.017) than females in the myopia group. Females also had significantly steeper anterior corneal curvature, Km (ant.) but flatter posterior corneal curvature, Km (post.), (- 6.31 ± 0.25, range - 7.00 to - 5.90 D) in both the myopia group [Km (ant.): 44.06 D ± 1.33 D, range: 41.30-47.10; Km (post.): - 6.31 D ± 0.25 D, range: - 7.00 to - 5.90; P = 0.008, P = 0.002, respectively] and the high myopia group [Km (ant.): 43.79 D ± 0.33 D, range: 41.00-47.10; Km (post.): - 6.22 D ± 0.30 D, range: - 6.80 to - 5.60; P = 0.034, P = 0.049, respectively]. Age was not correlated with the anterior segment parameters in both degrees of myopia.

CONCLUSION

Sex has significant influence on the corneal curvature, anterior chamber volume and anterior chamber depth regardless of the degree of myopia.

The utility of measures of anterior segment parameters of a Pentacam Scheimpflug tomographer in discriminating high myopic astigmatism from keratoconus

The study aimed to evaluate and compare anterior segment parameters between keratoconic eyes and eyes with high myopic astigmatism using Pentacam Scheimpflug tomography. This was a retrospective cross-sectional study that included sixty keratoconic eyes (thirty-two persons) and seventy-three eyes (forty-six persons) with high myopic astigmatism with mean ages 24.72 ± 11.65years and 26.60 ± 10.69years, respectively. Twenty-three parameters from the topographic map and fifteen parameters from the Belin-Ambrosió enhanced ectasia display map of the printouts of a Scheimpflug principle-based Pentacam tomographer were evaluated for their diagnostic accuracy using Receiver Operating Characteristic (ROC) curve. All parameters except cornea volume, anterior chamber volume, and anterior chamber angle indicated a significant difference between high myopic astigmatism and keratoconic eyes. The area under the receiver operating characteristic (AUROC) of eighteen Pentacam parameters was excellent (0.9–1.0) in discriminating keratoconus from high myopic astigmatism, out of which four {anterior minimum sagittal curvature (ant. Rmin), posterior minimum sagittal curvature (post. Rmin), maximum Ambrosió relational thickness (ART max) and total deviation value (D)} indicated excellent (>90%) sensitivity and specificity in addition to the excellent AUROC values. Topographic and Belin-Ambrosió enhanced ectasia display (BAD) maps of a Scheimpflug principle-based Pentacam tomographer are useful in enhancing the diagnosis of keratoconus and may also provide valuable information in effectively screening for keratoconus cases among refractive surgery candidates with high myopic astigmatism.

Meibomian Gland Dysfunction and Lipid Profile: A Study Among Pregnant Women

PURPOSE

This study aimed to estimate the frequency of meibomian gland dysfunction (MGD) and its associated factors among pregnant women.

METHODS

This was a hospital-based cross-sectional study of consecutive pregnant women visiting the University of Cape Coast hospital's antenatal clinic. Meibomian gland assessment and tear function test were performed along with the administration of a symptom questionnaire. Correlation, analysis of variance, and logistic regression analyses were used to examine predictors of MGD.

RESULTS

All 201 pregnant women who met the inclusion criteria and gave informed consent were included in the study. The mean age of the entire sample was 29.96 (±4.74) years. The frequency of MGD among the cohort of pregnant women was 22.9% (95% confidence interval, 17.4%-28.9%). Univariate logistic regression revealed that the following factors were significantly associated with MGD: high-density lipoprotein (HDL) (odds ratio [OR] 1.017; 95% confidence interval [CI], 1.001-1.034; P=0.042), total cholesterol (TC) (OR 1.009; 95% CI, 1.003-1.016; P=0.006), and low-density lipoprotein (LDL) (OR 1.008; 95% CI, 1.00-1.016; P=0.049). In multivariate analysis, the model confirmed that MGD was not significantly associated with TC, LDL, and HDL.

CONCLUSIONS

In summary, this study showed a high frequency of MGD in pregnant women but comparable with that reported in the normal population. Clinicians examining pregnant women for dry eye disease may need to pay attention to other causative instigators aside MGD to enable the clinicians to make an appropriate etiology-based diagnosis.

Clinical and sociodemographic characteristics of glaucoma patients at a tertiary referral facility in Zimbabwe

Purpose

To evaluate the clinical and socio-demographic profile of patients living with glaucoma and receiving care in a tertiary eye center in Zimbabwe.

Method

A hospital-based retrospective study of clinical records of glaucoma patients from January 2014 to December 2018. The study involved collating demographic information of patients, visual acuities, (VA) intraocular pressure, (IOP), cup-to-disc ratios, (CDRs), average retinal nerve fibers thickness, (RNFL), cup volume, cup-to-disc area, vertical cup-to-disc ratio, (VCDR), rim area, disc area, glaucoma hemifield test, visual field indices and the management of glaucoma.

Results

Nine thousand one hundred and eighty-five (9,185) folders were retrieved. Out of these, 432 (4.7%) qualified for the study and were analyzed. There were 267 (61.8%) males and 165 (38.2%) females. The mean age (± Standard deviation, SD) of the patients was 62.66 ± 15.94 years, (range 10 - 110 years). The means visual acuity (VA): OD =1.30 ± 1.06 Logarithm of the Minimum Angle of Resolution, (logMAR), OS = 1.33 ± 1.06 logMAR; IOP: OD = 29.51 ± 12.89 mmHg, OS: 29.17 ± 12.59 mmHg; CDRs: OD = 0.91 ± 0.14 D, OS = 0.92 ± 0.14 D; and the average RNFL thickness was 72.76 ± 18.26 µm and 71.24 ± 23.17 µm in the right and left eye respectively. The mainstay of treatment was medication only.

Conclusion

There were more males than females receiving glaucoma care at the tertiary level. Glaucoma cases included juveniles but the mean age was mostly the elderly. It was characterized by high IOPs, large CDRs, and thin RNFL suggestive of late presentation.

Knowledge, Attitudes and Practices of Postnatal Mothers on Ophthalmia Neonatorum in the Central Region, Ghana

Health education is key in the prevention of Ophthalmia Neonatorum (ON). However, health education in relation to eye care in Ghana is very low. To determine the knowledge, attitudes and practices (KAPs) of mothers on Ophthalmia Neonatorum (eye infection in newborns), a descriptive cross-sectional design was adopted, using a standardised interviewer-administered questionnaire to collect data. Using a consecutive sampling technique, we enrolled 407 mothers to participate in the study. The overall KAPs of the study participants were assessed using the sum score of each outcome based on Bloom’s cut-off point. Completed data was then analysed using descriptive statistics with SPSS version 22.0 at the level of P < .05. Out of the 407 participants, 321 (78.9%) had not heard about Ophthalmia Neonatorum with nearly 93% having low levels of knowledge on the neonatal infection. We found a significant association between formal education (P = .001), skilled occupation (P = .008) and a high level of knowledge on Ophthalmia Neonatorum. The study highlights the need to find improved and alternative methods of educating mothers on Ophthalmia Neonatorum in the bid to reduce blindness attributed to the condition.

The Association of Central Corneal Thickness and Intraocular Pressure Measures by Non-Contact Tonometry and Goldmann Applanation Tonometry among Glaucoma Patients

Background

The aim of this study was to determine whether Central Corneal Thickness (CCT) is associated with intraocular pressure measurement (IOP) with a Non-contact tonometer and the Goldmann applanation tonometer in glaucoma patients.

Materials and Methods

The study involved two hundred and thirty-two eyes of clinically diagnosed glaucoma patients receiving care at a referral facility. IOP measurements were obtained using both the Non-Contact Tonometer (NCT) and Goldmann Applanation Tonometer (GAT). The association between age, ethnicity, and CCT, as well as CCT on the measures of NCT and GAT, were analyzed.

Results

There were 64(55.2%) males and 52 (44.8%) females and their ages ranged from 18 to 85 years (mean age = 47.72; SD ± 15.75 years). There was a weak positive correlation between the CCT and NCT findings in the right eye (r = 0.19, n = 116, p < 0.05) and in the left eye (r = 0.25, n = 116, p < 0.05). However, there was no correlation between CCT and GAT measurements. Age had a significant correlation with CCT while gender and ethnicity had no significant correlation.

Conclusion

The study found a significant association between CCT and NCT. However, there was no significant association between CCT and GAT. CCT had an association with age but independent of gender and ethnicity since there was no significant relationship between these variables.

Age and Sex Variation in the Duration of Action and Corneal Touch Threshold (CTT) following Instillation of 0.5% Topical Ophthalmic Proparacaine and Tetracaine Hydrochlorides

PURPOSE

We investigated the effect of age and sex on corneal touch threshold (CTT) and duration of action following administration of 0.5% topical ophthalmic proparacaine and tetracaine hydrochlorides.

METHODS

A prospective, randomized, subject-masked, crossover study design was used. Two hundred and forty human volunteers were enrolled in the study. Corneal touch threshold (CTT) was determined using a Cochet-Bonnet esthesiometer. CTT was measured every 15 seconds for the first 1-minute and at 5-minute intervals subsequently for a period of 40 minutes after the application of each anesthetic. CTT and duration of action of the ophthalmic solutions were tested for statistical significance using repeated measures ANOVA.

RESULTS

The total duration of effect was 20 minutes for females and 25 minutes for males for both anesthetics. The total duration of the effect of both solutions decreased with increasing age; however, elderly participants had the longest duration (5 minutes) of the maximal effect (minimum CTT) of the two ophthalmic preparations. There was a significant influence of sex, F (2.39, 569.65) = 2.86, p=0.04; F (3.48, 828.19) = 4.41, p=0.003, and age, F (4.78, 566.18) = 8.97, p < 0.001; F (7.19, 852.56) = 20.55, p < 0.001 on CTT following application of proparacaine hydrochloride and tetracaine hydrochloride, respectively.

CONCLUSION

CTT and duration of anesthetic effect after instillation of 1 drop of 0.5% proparacaine hydrochloride and 0.5% tetracaine hydrochloride vary based on sex and age.

A study of Ophthalmia Neonatorum in the Central Reion of Ghana: Causative Agents and Antibiotic Susceptibility Patterns

In developing countries such as Ghana, ophthalmia neonatorum (ON) remains a public health concern. This is because of its unknown etiology patterns, the growing concerns of antibiotic resistance strains and the contribution of ON to childhood blindness. This study was therefore conducted to determine the causative agents, risk factors and the antibiotic sensitivity patterns of micro-organisms associated with ON. A clinic-based prospective study was conducted in the Maternal and Child Health units of 6 health care facilities in the Central region of Ghana over a period of 17 months. Conjunctival swabs were taken from all neonates with clinical signs of ON. Isolation and characterization of bacteria were done using standard microbiological methods. Additionally, data were collected and analyzed on neonate's demographics and clinical features of ON. Microbial growth was recorded in 86 cases (52.4%) out of the 110 neonates assessed. Staphylococcus spp. (39.2% of all positive cultures) was the most common causative organism. No case of gonococcus was isolated. Delivery method, vaginal discharge, administration of prophylaxis and weight of neonate were the risk factors associated with the development of ON (P < .05). The level of resistance to Tetracycline was found to be 73%. Neonatal conjunctivitis is more likely to be acquired postnatal. Culture and sensitivity testing are required as an important guide for treatment. The commonest causative organism, Staphylococcus spp., were found to be resistant to Teteracyline, therefore is the need to consider alternatives measures in the prevention and control of ON.

Assessment of infection prevention and control measures adopted by eye care practitioners in Ghana and South Africa against COVID-19

This study investigated the infection prevention and control measures adopted by eye care practitioners in Ghana and South Africa during the lockdown phase of the COVID-19 pandemic.

A descriptive, cross-sectional study was used to investigate infection prevention and control measures by eye care practitioners in Ghana (n = 189) and South Africa (n = 92) during the extended lockdown phase (01 April-30 June 2020) by both countries, immediately following the WHO declaration of COVI9–19 as a pandemic. Participants from both countries included Ophthalmologists, Optometrists, Ophthalmic nurses, and Opticians who were invited via email and social media platforms to complete an online questionnaire. The questionnaire assessed practitioners’ general knowledge on the COVID-19, viral exposure, infection prevention and control measures adopted during eye examinations.

The majority of the practitioners from Ghana 140 (74%) and 43 (47%) South Africa reported COVID-19 screening at their facilities before the commencement of eye examinations. Few practitioners 77 (41%) and 9 (10)% from Ghana and South Africa, respectively had received any form of training (seminars and workshops) in COVID-19 infection prevention and control measures. Practitioners frequently practiced hand washing - Ghana (125, 66%), South Africa (70, 76%) -, wearing of nose masks - Ghana 126 (67%), South Africa 51 (55%), alcohol-rub on equipment - Ghana 115 (61%), South Africa 45(49%) as a means of sterilizing the hand and equipment against COVID-19 during close contact examinations.

The majority of practitioners from the two countries adhered to basic safety protocols despite receiving no additional training on COVID-19 infection prevention. Maintenance of universal safety precautions in eye care facilities is key to preventing nosocomial infections.

Posterior Blepharitis and Associated Potential Factors: A Study among Pregnant Women

Purpose: This study evaluates in a cross-section of pregnant women the frequency of posterior blepharitis, its predisposing factors and how lipid profile impacts the occurrence of posterior blepharitis in pregnancy.Methods: This was a hospital-based cross-sectional study of pregnant women.Results: In this study, 201 pregnant women were recruited and included in the study's analysis. The participants' mean age was 29.96 (±4.74) years, with a median age of 30 and a range of 17 to 40 years. The frequency of posterior blepharitis among this cohort was 13.4% (95% confidence interval, 9.0% to 18.4%). The frequencies of MGD-associated posterior blepharitis and non-MGD associated posterior blepharitis were 6.0% and 7.4%, respectively. There was no statistically significant difference in the mean fluorescein tear breakup time and SPEED scores between non-MGD associated posterior blepharitis and MGD-associated posterior blepharitis, however, the mean tear breakup time(t = 3.999, p < .001) and SPEED scores (t = 6.76, p < .0001) showed a statistically significant difference in posterior blepharitis pregnant women compared to non-posterior blepharitis pregnant women. There was a statistically significant difference in the mean corneal staining scores between non-MGD-associated posterior blepharitis and MGD-associated posterior blepharitis (t = 3.99, p = .001). There was no association between lipid profile and posterior blepharitis in binary logistic regression analysisConclusion: The study showed that posterior blepharitis occurs in pregnancy, but it is not associated with cholesterol levels.

Visual function, spectacle independence, and patients' satisfaction after cataract surgery- a study in the Central Region of Ghana

Background

Reduced visual function is associated with diminished quality of life as well as decreased physical and mental health. Poor visual function related to cataracts is also a risk factor for falls and traffic accidents, which may lead to hospital admissions and limit independence.

Objective

To evaluate patients' satisfaction, visual functions and spectacle independence among patients in the Central Region of Ghana who had cataract surgery in one eye.

Methods

A hospital-based prospective cohort study was carried out on 146 patients booked for cataract surgery: 16 were lost through follow-ups whilst 130 completed the study. Visual functions including visual acuity, contrast sensitivity, stereopsis and colour vision were assessed before and after a month of cataract surgery. Objective and subjective refractions were performed to determine the post-surgery refractive status of the participants. Participants completed the NEI-VFQ 25 questionnaire and the scores obtained were used as a construct of their satisfaction.

Results

The NEI-VFQ 25 questionnaire scores indicated patients' satisfaction was high with an average quality of life score of 77.46. Patients satisfaction was strongly correlated with contrast sensitivity (r=0.653, p<0.001) but moderately correlated with visual acuity (r=-0.554, p<0.001), stereopsis (r=0.490, p<0.001) and colour vision (r=0.466, p<0.001). Contrast sensitivity was a better predictor of patients' satisfaction than visual acuity and stereopsis. Spectacle independence at distance was achieved in only 44.6% of the participants and 5.4% at near. There was a significant (p>0.001) association between spectacle independence and the two types of cataract surgery performed which included Small Incision Cataract Surgery (SICS) and Extracapsular Cataract Extraction (ECCE). Among those who were spectacle independent, 53.4% of them were low vision patients.

Conclusion

Satisfaction of patients after cataract surgery was high but was greatly influenced by visual functions with contrast sensitivity being a better predictor of satisfaction than visual acuity and stereopsis. Spectacle independence after cataract surgery was low at distance and extremely low at near. The type of cataract surgery performed influenced thespectacle independence.

Epidemiology and clinical presentation of glaucoma in a referral facility in Ghana: Any lessons for public health intervention?

The purpose of this study was to evaluate the epidemiological and clinical profile of patients living with glaucoma and receiving care in a tertiary eye center in Ghana. This was a hospital-based retrospective study of clinical records of glaucoma patients from January 2010 to December 2019. The study involved collating demographic information of patients, clinical presentation, and the management of glaucoma. A total of nineteen thousand (19,000) charts were retrieved from the eye center's archives. Out of these, 660 (3.5%) records of patients qualified for the study and were analyzed. There were 398 (60.3%) males and 262 (39.7%) females. Their ages ranged from 9 to 86 years (mean age = 47.30; SD ± 16.86 years). The averages of ocular parameters of 1,320 eyes (660 patients) were visual acuity = 0.26 ± 0.55 logMAR; intraocular pressure: 17.31 ± 6.11 mmHg; cup-to-disc ratios: 0.67 ± 0.17 D; and the average retinal nerve fibers thickness was 95.03 ± 21.74 μm. The mainstay of treatment was the sole use of medication. Males were the major group receiving glaucoma care at the tertiary level. Glaucoma cases included juveniles but the mean age suggests most were of adult-onset. Socio-demographic characteristics affected the diagnosis and management of glaucoma among patients receiving care at a referral center. Public health, stakeholders, and policymakers' interventions can help identify individuals with glaucoma.

Comparative Assessment of The Goldmann Applanation and Noncontact Tonometers in Intraocular Pressure Measurements in a Sample of Glaucoma Patients in the Cape Coast Metropolis, Ghana

Objectives:

The objective of the study was to explore the usage of the Goldmann applanation tonometry and noncontact tonometry interchangeably in the measurement of intraocular pressure (IOP) in glaucoma patients.

Materials and Methods:

The study involved 441 clinically diagnosed glaucoma patients receiving care at a referral facility. IOP measurements were obtained using both the Noncontact tonometer and Goldmann applanation tonometer The repeatability of the measures was analyzed by comparing the repeated measures of the devices using paired t-test and calculating the correlation coefficient. A Bland–Altman analysis was used to determine the limits of agreement between the two procedures.

Results:

There were 271 (61.5%) males and 170 (38.5%) females and their age ranged from 18 to 73 years (mean age = 49.37; standard deviation ± 14.81 years). The findings of the study showed significantly lower readings (P < 0.001) of the GAT (right eye = 17.40 ± 7.48 mmHg; left eye = 16.80 ± 7.49 mmHg) compared to the NCT (right eye = 20.15 ± 8.30 mmHg; left eye = 19.74 ± 8.31 mmHg). There was a strong positive correlation between the GAT and NCT findings in the right eye (r = 0.871, n = 441, P < 0.001) and in the left eye (r = 0.887, n = 441, P < 0.001). There was a wide limit of agreement between NCT and GAT measurements.

Conclusion:

There was statistically significant higher measures obtained with NCT than the GAT but did not exceed the allowable inter-device difference. There was a strong positive correlation between GAT and NCT measurements. However, it is strongly recommended that these devices are not used interchangeably in the monitoring of IOP in glaucoma due to the wide range of limits of agreement.

Prevalence of Refractive Error and Visual Impairment among Rural Dwellers in Mashonaland Central Province, Zimbabwe

Purpose

To determine the prevalence of refractive error and visual impairment in a rural population of Zimbabwe.

Methods

This community-based, cross-sectional study used a multi-stage sampling to select the participants from households in four communities within three rural districts in Mashonaland Central Province. Participants' demographic data were collated, and their presenting visual acuity (VA) was measured using the logMAR E chart. Clinical refraction was preceded by an anterior segment and posterior segment eye examinations. Visual impairment was defined as presenting VA worse than 6/12 (0.3 logMAR) in the better eye. Descriptive statistics were presented as frequencies.

Results

A total of 519 participants were involved in this study. Their ages ranged from 5 to 100 years (mean age = 50.94; standard deviation ± 21.12 years). Out of the 519 participants, 233 (44.9%) were male, and 286 (55.1%) were female. The prevalence of visual impairment was 56.8% (95% confidence interval [CI]: 55.7-67.2), and blindness was 13.1% (95% CI: 11.2-17.6). The prevalence of near visual impairment based on presenting near VA (N = 408) was 78.6% (95% CI: 78.1-85.4). The two most common causes of visual impairment were uncorrected refractive errors (UREs) (54.2%) and cataract (24.8%). The most common cause of blindness was cataract (41.2%). Hypermetropia (56.9%) was the most common refractive error.

Conclusions

A high burden of visual impairment due to UREs and cataracts was observed among the rural dwellers of Zimbabwe. Public health education, access to refractive error services, and cataract surgery are necessary to mitigate this high burden of visual impairment.

Optical coherence tomography indices in the diagnosis and discrimination of stages of primary open-angle glaucoma in an African population

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.

Laser-induced autofluorescence assisted by multivariate techniques discriminates a cataractous lens from healthy lens tissues of Sprague-Dawley rats

Laser-induced autofluorescence (LIAF), combined with multivariate techniques, has been used to discriminate a cataractous lens from healthy lens tissues. In this study, 405 nm and 445 nm were used as excitation sources to induce the autofluorescence. Results show higher autofluorescence intensity in cataractous lens tissues than in healthy ones. Cataractous lens tissues show a red shift of 0.9 nm and 1.2 nm at 405 nm and 445 nm excitations, respectively. Using principal component analysis (PCA), three principal components (PCs) gave more than 99% variability for both 405 nm and 445 nm excitation sources. Based on the three PCs, Fisher's linear discriminant model was developed. An accuracy of 100% was obtained in classifying the lens tissues using Fisher's linear discriminant analysis (FLDA). The LIAF technique assisted by PCA and FLDA may be used for objective discrimination of cataractous lens from healthy lens tissues of Sprague-Dawley rats.

Unorthodox ophthalmic preparations on the Ghanaian market: a potential risk for ocular and enteric infections

PURPOSE

Microbial contamination of orthodox ophthalmic preparations poses a serious threat to the user by causing ocular infections. There is no such information about unorthodox ophthalmic preparations in a medical pluralistic system such as Ghana. The aim of this study was to assess unorthodox ophthalmic medications on the Ghanaian market for possible microbial contaminations.

METHODS

Unorthodox ophthalmic preparations were collected across different herbal and homeopathic outlets in Ghana. A total of 27 samples were collected from the ten (10) regions in Ghana. The samples were inoculated in different culture media (Plate count Agar, Blood Agar, MacConkey Agar, Saboraud Dextrose Agar). The microorganisms isolated were identified using standard microbiological procedures and antimicrobial susceptibility was done to determine whether they were resistant or susceptible strains.

RESULTS

All the samples were contaminated with bacteria and the majority were contaminated with fungus. A total of forty-eight bacteria spp. was isolated thus seven different types namely: Staphylococcus aureus, Bacilli spp., Serrati spp., Escherichia coli, Pseudomonas spp., Klebsiella spp. and Shigella spp. with Staphylococcus aureus being the predominant bacteria. For fungi, a total of eleven fungi species thus four different types namely: Cephalosporium spp., Penicillium spp., Cercosporium spp. and Clasdosporium spp. with the predominant fungi being Penicillium spp. Per the class of preparations, 15 contaminants were isolated from ten (10) anti-inflammatory preparations. The fungi were all susceptible to both Ketoconazole and Fluconazole but the bacteria were resistant to all the conventional antibiotics except Ciprofloxacin and Gentamycin.

CONCLUSION

Unorthodox ophthalmic preparations found on the Ghanaian market are contaminated with bacteria and fungi of clinical importance.

Microbial safety implications of in-use topical diagnostic ophthalmic medications in eye clinics in Ghana

PURPOSE

To determine the microbial contaminants and its clinical importance in topical diagnostic ophthalmic medications (cycloplegics/mydriatics and miotics) in eye clinics in Ghana.

METHOD

A cross-section of eye clinics was sampled for the diagnostic agents (Atropine, Phenylephrine, Tropicamide and Cyclopentolate, Pilocarpine). Standard laboratory procedures and protocols were observed in culturing the samples on different Agars. Microscopy and various biochemical tests were performed to identify microbial species. Antimicrobial susceptibility testing was also performed to ascertain the clinical importance of the isolated microbes.

RESULTS

A total of 113 samples were obtained, from which 334 bacteria were isolated which included Bacilli spp. 91(27.25%), Coagulase Negative Staphylococci spp. 59(17.66%), Moraxella spp. 47(14.07%), Staphylococcus aureus 41(12.27%), Streptococcus spp. 21(6.29%), Klebsiella spp. 20(5.99%), Pseudomonas spp. 13(3.89%), Proteus spp. 12(3.59%), Escherichia coli. 12 (3.59%), Serratia spp. 10(2.99%), Shigella spp. 7(2.09%), Salmonella spp. 1(0.3%). There were 96 isolated fungal contaminants mainly Penicillium spp. 41(42.71%), Cephalosporium spp. 19(19.79%), Cladosporium spp. 15(15.63%), Aspergillus spp. 13(13.54%), Cercospora spp. 8(8.33%). The diagnostic agent with the most bacteria contamination was Phenylephrine 90 (26.95%) and the least being Pilocarpine 49 (14.67%). Also, the diagnostic agent with the most fungal contamination was Cyclopentolate 29 (30.2%) and the least was Tropicamide and Pilocarpine with 15 (15.63%) each. Gentamicin and Ciprofloxacin were the only antibiotics that showed 100% activity against all the bacterial isolates. Fungal contaminants were more susceptible to Ketoconazole as compared to Fluconazole.

CONCLUSION

Topical diagnostic ophthalmic preparations used in clinical settings in Ghana are contaminated with clinically important bacteria and fungi.

Clinical subtypes of dry eye in youthful clinical sample in Ghana

PURPOSE

To evaluate in a cohort of patients with dry eye disease (DED) the distribution of patients with asymptomatic and symptomatic dry eye involving aqueous deficient or the evaporative subtype of DED.

METHODS

This was a clinic-based cross-sectional study of consecutive patients visiting the University of Cape Coast eye clinic for a comprehensive eye examination. Eligible participants completed the Ocular Surface Disease Index (OSDI), ocular surface staining and tear break up time. Subjects with dry eye (symptomatic or asymptomatic) underwent clinical examination comprising lid margin assessments, meibomian gland expressibility and quality assessments, and Schirmer 1 test.

RESULTS

A total of 172 patients were included in the study. The mean age of the eligible participants was 22.7 (±3.7) years, with a range of 17-35 years. There were 83 males and 89 females in the sample. There was an association between the form of the dry eye whether symptomatic or asymptomatic and sex, (X² = 6.51 df = 1 p = 0.011). The frequency of symptomatic aqueous-deficient dry eye was 9(5.2%) whiles that of the symptomatic evaporative dry eye was 20(11.6%). The frequencies of the asymptomatic aqueous-deficient dry eye and asymptomatic evaporative dry eye were 9(5.2%) and 12(7.0%) respectively. The frequency of symptomatic mixed dry eye was 30(17.4%) and the asymptomatic mixed dry eye was 8(4.7%). The distribution of unclassifiable dry eye among the symptomatic dry eye group was 41(23.8%) and 43(25%) among the asymptomatic dry eye group.

CONCLUSION

The number of patients exhibiting signs of the evaporative dry eye resulting from meibomian gland dysfunction far outnumbers those of aqueous deficient dry eye but there remains a high unclassifiable group with an unknown etiology. Further, studies are needed to explore the other etiology or etiologies of dry eye apart from meibomian gland dysfunction and reduced aqueous production.

Factors influencing the decision of GHANAIAN optometry students to practice in rural areas after graduation

BACKGROUND

Human resources for eye health are inequitably distributed in most developing countries including Ghana. In spite of this, most eye care workers are concentrated in urban areas to the disadvantage of rural dwellers who need the services of these workers the most. The aim of the study was to investigate factors that will influence Ghanaian Optometry students' decision to work in rural areas after completion of their training.

METHOD

A cross-sectional survey was conducted among Ghanaian optometry undergraduate students. All undergraduate optometry students (first to sixth year) who agreed to take part in the research completed a 37 item questionnaire that explored; demographic characteristics, views about practice choice and possible attractions and incentives to practice in the rural area.

RESULTS

A total of 333 (87.4%) participants out of 381 Ghanaian optometry students who were registered for the 2015/2016 academic year completed the questionnaire. Rural origin students had the greatest desire to practice in the rural setting when employed by the Government (78.9%) or by NGO (80.3%). Financial incentives (76.6%), scholarship for further studies (76.0%), better living conditions (71.2%) and career ladder jump for rural health workers (71.2%) were the main incentives that influenced the intention of graduate optometrists to practice in the rural areas.

CONCLUSION

Rural origin students are more inclined to work in rural areas than urban origin students, a finding which is informative for optometry training schools when managing their admission policies. Financial incentives among other factors will encourage more students to engage in rural optometric practice irrespective of their place of origin.

Microbial contamination of multiple-use bottles of fluorescein ophthalmic solution

BACKGROUND

The contamination of ophthalmic solutions in ophthalmic practices remains an important cause of a myriad of secondary eye infections and a source of aggravation of ocular disorders such as corneal ulcers and keratitis. The aim of this study was to investigate the possible microbial contamination of fluorescein sodium dye solutions used in eye clinics in Ghana.

METHODS

Fluorescein sodium solutions were collected from various eye clinics in Ghana. Twenty-one samples of multiple-use fluorescein ophthalmic solutions were collected from various regions in Ghana. Eighteen unopened bottles yet to be used were also collected to serve as controls from the same facilities. The solutions were inoculated in different culture plates (blood agar, MacConkey agar, Sabouraud dextrose agar and plate count agar). The resulting microbial growth was identified using standard microbial identification techniques. Susceptibility tests were performed to ascertain the clinical importance of the organisms identified.

RESULTS

Positive cultures were recorded for all 21 multiple-use bottles (in-use) collected, but there were no positive cultures for the unopened bottles (yet to be used). Six different genera of bacteria were identified from fluorescein solutions, including resistant strains of Staphylococci spp., Bacillus spp., Klebsiella spp., Pseudomonas spp., Haemophilus spp. and Bordetella spp. Pseudomonas spp. were the most common bacterial contaminants. For fungi contaminations, Aspergillus spp., Penicillium spp. and Cladosporium spp. were isolated. The most common fungal contaminants were Aspergillus spp.

CONCLUSIONS

Multiple-use bottles of fluorescein solution used in eye clinics in Ghana were contaminated with clinically important strains of bacteria and fungi.

Association between dry eye symptoms and signs

Purpose

To evaluate the association between subjective dry eye symptoms and the results of the clinical examinations.

Methods

The study was a clinical-based survey involving 215 first-year students selected consecutively during a regular ocular health examination at the University of Cape Coast Optometry Clinic. The data collection process spanned for a period of four months. Out of the 215 students, 212 returned their completed questionnaires and were subsequently included in the study. Dry eye tests including meibomian gland assessment, tear break up time, fluorescein staining, Schirmer test, and blink rate assessment, were performed on each subject after completion of the Ocular Surface Disease Index (OSDI) questionnaire. Shapiro–Wilk test was used to determine the normality of the clinical tests, and Spearman's correlations co-efficient was used to determine the correlations between the clinical test results and dry eye symptoms.

Results

Statistically significant associations were found between OSDI scores and blink rate (r_s = 0.140; P < 0.042), and associations between OSDI scores and contrast sensitivity scores (r_s = 0.263; P < 0001). However, the results of corneal staining (r_s = −0.006; P < 0.926), Schirmer test (r_s = −0.033; P = 0.628), tear break up time (r_s = −0.121; P < 0.078), meibomian gland expressibility (r_s = 0.093; P < 0.180), and meibomian gland quality (r_s = 0.080; P < 0.244) showed no significant association with OSDI. The correlation coefficients range from −0.006 to 0.263 showed low to moderate correlation between dry eye symptoms and the results of clinical test.

Conclusion

Associations between dry eye symptoms and clinical examinations are low and inconsistent, which may have implications for the diagnoses and treatment of dry eye disease.

Efficacy and safety of extemporaneously prepared miconazole eye drops in Candida albicans-induced keratomycosis

PURPOSE

Extemporaneously prepared miconazole eye drops (EPMD) are used by some eye care practitioners to manage keratomycosis in Ghana. This study therefore aimed to determine the efficacy and safety of EPMD using in vitro and in vivo experimental models.

METHODS

The minimum inhibitory concentration (MIC) of EPMD was determined by the agar-well diffusion method. In vivo, the activity of EPMD on corneal ulcer, neovascularization, clouding, edema, carring and on keratomycotic conjunctivitis and corneal scarring (clinical features) associated with Candida albicans-induced keratomycosis in rabbits was determined by treating them with 0.034-1.08% (weight-in-volume) EPMD for a period of 30 days. The safety of EPMD on the healthy eye was determined by instilling various concentrations into the intact eye of the rabbits.

RESULTS

The MIC of EPMD on Candida albicans was 1.08% (zone of inhibition of 13 mm ± 0.578), which resulted in significantly better improvements (p ≤ 0.001) in clinical findings than eyes treated with sterile water (p > 0.05), and showed no significant difference (p > 0.05) compared to eyes treated with 0.3% fluconazole. There were no visible signs of ocular toxicity on instilling it into healthy eyes of rabbits.

CONCLUSION

The extemporaneously prepared miconazole eye drops are effective and safe to use in keratomycosis.

Onset and duration of cycloplegic action of 1% cyclopentolate - 1% tropicamide combination

PURPOSE

To study the time course (onset, time and duration of maximal cycloplegia, and the full duration) of cycloplegic action of 1% Cyclopentolate - 1% Tropicamide.

METHODS

Seventy-seven students, aged 15-24 years were purposively sampled from the University of Cape Coast and Cape Coast Technical Institute. Subjective near addition (ADD) determination and pupil diameter measurement before and after a drop of the test agent (1% Cyclopentolate - 1% Tropicamide combination in the right eye) and the control (1% Cyclopentolate in the left eye) were performed. Measurements of subjective near ADD and pupil diameter were made after the initial reading at 5 minutes interval for the first hour and every 30 minutes for the next 7 hours for each participant. Time of onset, time of peak cycloplegia, duration of peak cycloplegia and duration of total cycloplegic effect was indirectly determined.

RESULTS

1% Cyclopentolate - 1% Tropicamide combination had rapid onset of cycloplegia (5-10 minutes), shorter time of maximal cycloplegia (55 versus 90 minutes), and recovery (7 versus ≥ 8hours) in the majority (79.2%) of subjects.

CONCLUSION

Cyclopentolate -Tropicamide combination was comparable to Cyclopentolate in depth of cycloplegia produced, and clinically superior to 1% Cyclopentolate in rapidity of cycloplegic onset, time of maximal cycloplegia and recovery from cycloplegia.

Near vision spectacle coverage and barriers to near vision correction among adults in the Cape Coast Metropolis of Ghana

PURPOSE

To determine the near vision spectacle coverage and barriers to obtaining near vision correction among adults aged 35 years and older in the Cape Coast Metropolis of Ghana.

METHODS

A population-based cross-sectional study design was adopted and 500 out of 576 participants aged 35 years and older were examined from 12 randomly selected clusters in Cape Coast, Ghana. All participants underwent a comprehensive eye examination which included: distance and near visual acuities measurements and external and internal ocular health assessments. Distance and near refractions were performed using subjective refraction technique. Information on participants' demographics, near vision correction status, near visual needs and barriers to acquiring near vision correction were obtained through a questionnaire administered as part of the study.

RESULTS

The mean age of participants was 52.3±10.3 years of whom 280 (56%) were females and 220 (44%) were males. The near vision spectacle coverage was 25%, 33% "met need" for near vision correction in the presbyopic population, and 64% unmet need in the entire study population. After controlling for other variables, age (5^th and 6^th decades) and educational level were associated with "met need" for near vision correction (OR=2.7 (1.55-4.68), p =0.00, and OR=2.36 (1.18-4.72), p=0.02 respectively). Among those who needed but did not have near vision correction, 64 (26%) did not feel the need for correction, 55 (22%) stated that they were unaware of available interventions, and 53 (21%) found the cost of near vision correction prohibitive.

CONCLUSION

There was a low near vision spectacle coverage in this population which suggests the need for strategies on health education and promotion to address the lack of awareness of spectacle need and cost of services.

Occupational hazards correlates of ocular disorders in Ghanaian fisheries

The study examined the ocular health of agricultural workers in the fisheries sub sector with the aim of establishing a possible correlation between the work place hazards and their ocular health. A multi-stage random sampling (involving 683 subjects, 358 fishmongers and 325 fishers) was employed. Ocular hazards encountered at the work place included seawater, sand or dust, heat, sunrays and smoke. Exposure to these hazards were found to be associated with ocular irritation (P&lt;0.001), tearing (P&lt;0.001), red eye (P&lt;0.001), gritty sensation (P&lt;0.001), blurred distant vision (P=0.001) and blurred near vision (P=0.001). The development of pterygium was associated with the exposure to sunrays (P=0.042) and heat (P=0.001) among fishmongers. Further analysis using multivariate logistic regression indicated exposure to heat as the most important predictive factor for pterygium (OR=1.951, P=0.003). Exposure to seawater was found to be associated with the development of cataract (P=0.022) among fishermen/fishers. Cataract among fishmongers was rather associated with exposure to heat (P=0.005), sunrays (P=0.035) and sand/dust (P=0.002). Exposure to work place hazards is associated with ocular disorders in the fishing industry of Ghana.

Analgesic properties of aqueous leaf extract of Haematostaphis barteri: involvement of ATP-sensitive potassium channels, adrenergic, opioidergic, muscarinic, adenosinergic and serotoninergic pathways

BACKGROUND

Pain is the most common cause of patients seeking medical advice as a result of its association with different pathologies. This study evaluated the antinociceptive property of Haematostaphis barteri as well as the possible mechanism(s) associated with its antinociceptive property.

METHODS

Mice were administered H. barteri (30-300 mg kg-1; p.o.), followed by intraplantar injection of 10 μL of 5% formalin into the hind paws. The pain score was determined for 1 h in the formalin test. The possible nociceptive pathways involved in the antinociceptive action of H. barteri were determined by pre-treating mice with theophylline (5 mg kg-1, a non-selective adenosine receptor antagonist), naloxone (2 mg kg-1, a non-selective opioid receptor antagonist), glibenclamide (8 mg kg-1; an ATP-sensitive K+ channel inhibitor), and atropine (3 mg kg-1; non-selective muscarinic antagonist).

RESULTS

H. barteri (30-300 mg kg-1) significantly and dose dependently precluded both first and second phases of nociception. Pre-treatment with naloxone had no effect on the analgesic activities of H. barteri in the first phase. Again, pre-treatment with atropine and glibenclamide did not significantly reverse the neurogenic antinociception of the extract in phase 1. However, theophylline reversed the analgesic effect of the extract in the first phase. In phase 2, theophylline had no effect on the analgesic activities of the extract. Naloxone, atropine, and glibenclamide significantly blocked the antinociception of H. barteri in the inflammatory phase of the formalin test.

CONCLUSIONS

H. barteri possesses antinociceptive property mediated via the opioidergic, adrenergic, muscarinic, ATP-sensitive K+ channels, and adenosinergic nociceptive pathways.

Knowledge and awareness of ocular allergy among undergraduate students of public universities in Ghana

BACKGROUND

Ocular allergy is a growing public health problem that greatly impacts the day-to-day life of sufferers and their families. Other aspects of their activities of daily living such as schooling, professional, and social life are affected hence an increased awareness and knowledge of ocular allergies, their detection and treatment is paramount. This study was to assess the level of knowledge and awareness of ocular allergy among undergraduate students of public universities in Ghana.

METHODS

A descriptive cross sectional survey was conducted among 1000 students from three selected public universities in Ghana. Each respondent completed a questionnaire that had questions concerning awareness and knowledge of ocular allergy.

RESULTS

Out of the 1000 students, 347 (34.7 %) were aware of ocular allergy. Of these 347 students, the level of knowledge of ocular allergy was generally low. Majority of the students had their source of information about ocular allergy from the media and the internet. There was statistical significant association among awareness of ocular allergy, sources of information and programme of study (p < 0.001).

CONCLUSION

Level of awareness among university students is generally low. Students' programmes of study influenced their knowledge of ocular allergy. Public health measures are recommended to help educate students on the prevention and control of ocular allergy as well as the complications associated with this condition.

Anti-asthmatic property and possible mode of activity of an ethanol leaf extract of Polyscias fruticosa

CONTEXT

Polyscias fruticosa (L.) Harms (Araliaceae) is used as a traditional remedy for asthma in Ghana.

OBJECTIVE

The objective of this study is to establish the anti-asthmatic property and a possible mode of activity of an ethanol leaf extract of P. fruticosa (PFE).

MATERIALS AND METHODS

The time (min) for pre-convulsive dyspnea, and time for recovery, after sensitization with 150 μg OVA and induction of bronchospasm with 1% acetylcholine or histamine in normal, and 100, 250, and 500 mg/kg PFE-treated Dunkin Hartley guinea pigs, were recorded. Atropine (0.1 mg), mepyramine (0.1 mg), and PFE (1 mg) effect on a contractile response of 2.0 × 10(-2) μg/ml acetylcholine and 5.8 × 10(-2) μg/ml histamine on the isolated guinea pig ileum was investigated. Cytological and histological studies were conducted using guinea pig peritoneal mast cells and mesenteric cells, respectively, to establish PFE effect on compound 48/80-induced mast cell degranulation.

RESULTS

PFE (100-500 mg/kg) prolonged the onset of pre-convulsive dyspnea by 76.1-180.2% (p ≤ 0.01-0.001), and decreased recovery time by 71.9-78.5% (p ≤ 0.01-0.001). It also enhanced percentage protection against histamine-induced bronchospasm by 15.8-80.1-fold (p ≤ 0.05-0.01), and decreased percentage recovery time 2.5-3.3-fold (p ≤ 0.05-0.01). PFE significantly inhibited (60.4 ± 8.3%) contractile responses of histamine and produced significant inhibition (56-79%: p ≤ 0.001) of mast cell degranulation.

CONCLUSION

PFE has anti-asthmatic, antihistaminic, and mast cell stabilization effect making it useful in traditional asthma management.

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

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.