An investigation on the status of resilience amongst adults with blindness in Addis Ababa

Background: Living with blindness for anyone, whether educated or uneducated, rich or poor, with adequate support or without it is seriously limiting. The quality of life of people with blindness is significantly influenced by the level of resilience they possess. The status of resilience of adults with blindness living in Addis Ababa is not known. Objectives: Against this backdrop, this study was designed to explore the level of resilience of Adults living with blindness. The influence of some demographics on resilience was also examined. Method: Survey design was employed to carry out the intended objectives of this stud. Data was collected from a random sample of 220 adults with blindness living in Addis Ababa using Connor-Davidson Resilience Scale. Descriptive statistics, t-test and one way ANOVA followed by Scheffe post hoc comparisons were used to analyse the data. Results: The results revealed that the level of resilience of adults with blindness was found below the average score with a mean score of 46.11. Participants' gender, time of onset of blindness, marital status and education seemed to influence resilience of blind adults. Conclusion: Adults having blindness currently living in Addis Ababa are less resilient than needed. Resilience of adults with blindness is differentiated by their demographic characteristics. These people need an integrated effort to enhance their resilience capacity by reducing the barriers and challenges they encounter and promoting protective resources through the different wings of disability related services

Prevalence and causes of visual impairment among older persons living in low-income old age homes in Durban, South Africa

Background: Visual impairment (VI) increases with age and has been reported to be more prevalent among older adults living in old age homes than in the general population. Aim: To determine the prevalence and causes of VI among older adults living in low-income old age homes in Durban, South Africa. Setting: This study was conducted at low-income old age homes in Durban. Methods: This cross-sectional study of 118 residents aged 60 years and older, collected socio-demographic data, presenting visual acuities (VAs) for each eye, and binocularly. Anterior segment eye examinations were conducted with a penlight torch and a portable slit-lamp, while posterior segment evaluation was conducted with direct and indirect ophthalmoscopy. Objective and subjective refractions were performed, and the best-corrected distance and near VAs were measured in each eye. VI was defined as presenting VA < 6/18 and included moderate VI (< 6/18−6/60), severe VI (< 6/60 ­3/60) and blindness (< 6/120). Results: The mean age of the participants was 73.3 years and included 80.5% females and 19.5% males. The prevalence of VI and blindness was 63.6%. Optical correction significantly reduced the prevalence of VI and blindness by 19.5% (p < 0.05). The main causes of non-refractive VI and blindness were cataract (54.5%), posterior segment disorders (25.5%) and corneal opacities (20%). Conclusion: The prevalence of VI and blindness is high among residents in low-income old age homes living in Durban. Refractive correction and surgical cataract intervention can significantly reduce the burden of VI and blindness among the elderly residents

Visual outcome of patients with pituitary adenomas following surgery and its contributory factors at a tertiary hospital in Ghana

BACKGROUND: Craniotomy and transphenoidal microsurgery are surgical options for treatment of pituitary adenoma at Korle Bu Teaching Hospital(KBTH). Despite major advances and reported success rates of transphenoidal resection globally, paucity of local data regarding visual outcome of either procedure exists. We evaluated the visual outcome of patient with pituitary adenoma following surgery in a tertiary hospital in Ghana. METHODS: This is a prospective study of 18 of 45 consecutive new patients with pituitary adenoma seen from November 2010 to July 2013 at Korle-Bu Teaching Hospital(KBTH), Accra, Ghana. Sixteen (88.9%) of the 18 had surgery by transphenoidal route and 2(11.1%) by craniotomy. All patients had macroadenoma (tumour size >1cm) and histological confirmation of diagnosis. Pre-operative and post-operative visual acuity and its relationship to tumour size and duration of symptoms before diagnosis were evaluated. RESULTS: Data on 18 patients aged 33-60 years, mean (SD) 45.9±8.5, was analysed. Eleven (61.1%) were females.Visual blur, 15(83.3%), and headache,13(72.2%), were predominant presenting complaints.Common neuro-ophthalmic signs included unilateral or bilateral optic atrophy, 17(94.4%), Relative Afferent Pupillary Defect (RAPD) in 8(44.4%) and impaired colour vision in 32 of 36(88.9%) eyes. Preoperatively, 8(22.2%) and 13(36.1%) of 36 eyes were visually impaired or blind respectively. Postoperatively, 6(16.7%) eyes were visually impaired and 17(47.2%) eyes blind. Blindness was associated with late presentation (p<0.005) and larger tumour width (p<0.036). CONCLUSIONS: More than a third of eyes of patients with pituitary adenoma were blind before and after surgery. Blindness was associated with late presentation and larger tumours. Transphenoidal surgery may be beneficial following early diagnosis to avoid irreversible blindness/visual impairment

Eye diseases in Akon payam, South Sudan

Objectives: To determine the prevalence and causes of blindness and visual impairment among patients in Akon payam, Warrap State, South Sudan.Methods and materials: This was a cross-sectional study of 862 patients conducted at Akon in the period 18 ­ 31 September 2015. The Snellen E chart was used to measure visual acuity, and all patients had a basic eye examination. Their vision status was categorized according to the World Health Organization classification. Data were entered and analyzed using SPSS version 22(IBM).Results: The age range of the study population was 3 - 86 years; 81.9% were aged 41-80 years. 50.8% were males and 49.2% were females. There were 1483 bilaterally blind eyes giving a prevalence of blindness of 86% (95% CI: 3.2497-3.3531) with prevalence of visual impairment of 3.9 %( 95% CI: 2.5001-3.0944.Cataract (59.7%) was the commonest eye disease, followed by glaucoma (15.1%), corneal dystrophy (9.3%), allergic conjunctivitis (5.5%), corneal scar (1.9%), refractive errors(1.8%) and others(6.7%). Among those who are blind cataract (66%) was the major agent with females affected more than males .It was followed by glaucoma (16.7%), corneal dystrophy (10%), corneal scar(1.8%) and the rest of agents(5.4%). The main age group affected by blindness was the 41- 80 years age group (87%) and the least was below 20 years (1.1%). There was a strong association between age and sex with the causes of blindness.Conclusion: There was equal sex preponderance with more blindness in those aged 41 years or above. Cataract and glaucoma still remained major cause of blindness in this payam. More effort is needed by the government to reduce the burden of these diseases

The prevalence of self-reported vision difficulty in economically disadvantaged regions of South Africa

Background: Vision impairment, resulting in vision difficulties, is a leading cause of disability, and hence one of the key barriers for people to access education and employment, which may force them into poverty. Objectives: The objective of this study was to determine the prevalence of self reported vision difficulties as an indicator of vision impairment in economically disadvantaged regions in South Africa, and to examine the relationship between self-reported vision difficulties and socio-economic markers of poverty, namely, income, education and health service needs. Methods: A cross-sectional study was conducted in economically disadvantaged districts to collect data from households on poverty and health, including vision difficulty. As visual acuity measurements were not conducted, the researchers used the term vision difficulty as an indicator of vision impairment. Data were collected from 27 districts (74 901 respondents). Logistic regression analysis and chi-square tests were used to determine bivariate relationships between variables and self-reported vision difficulty. Kernel density estimators were used for age, categorised by self-reported and not reported vision difficulty.Results: Prevalence of self-reported vision difficulty was 11.2% (95% CI; 8.7% - 13.7%). More women (12.7%) compared to men (9.5%) self-reported vision difficulty (p 0.01). Self-reported vision difficulty was higher (14.2%) for respondents that do not spend any money. A statistically significant relationship was found between the highest level of education and self-reporting of vision difficulty; as completed highest level of education increased, self-reporting of vision difficulty became lower (p 0.01). A significantly higher prevalence of self-reported vision difficulty was found in respondents who are employed (p 0.01), 17% (95% CI: 12.8% - 21.1%). Conclusion: The evidence from this study suggests associations between socio-economic factors and vision difficulties that have a two-fold relationship (some factors such as education; and access to eye health services are associated with vision difficulty whilst vision difficulty may trap people in their current poverty or deepen their poverty status). The results are thus indicative of the need for further research in South Africa

Making a Difference with Vision 2020: The Right to Sight? Lessons from two States of North Western Nigeria

Settings and Aim: The World Health Organization launched in 1999 an initiative to eliminate the global avoidable blindness and prevent the projected doubling of avoidable visual impairment between 1990 and 2020 (Vision 2020: The Right to Sight). The World Health Assembly (WHA) adopted resolutions WHA 59.25; WHA 56.26 urging member states to adopt the Vision 2020 principles. More than 90 nongovernmental development organizations; agencies; and institutions; together with a number of major corporations; are now working together in this global partnership. Two neighboring states in North Western Nigeria provide eye care services using different approaches; one state uses the principles of Vision 2020; the other uses a different strategy. The aim of the study was to assess awareness and utilization of eye care services in two Nigerian states. Design: A population-based cross-sectional interview of households was conducted in two neighboring states using a structured questionnaire. Data analysis was performed using SPSS version 21 and a P 0.05 was considered as significant. Findings: Participation rate was 97 in the two states. The population in the Vision 2020-compliant state were significantly more aware about general eye care services (80 vs. 44; P 0.0005); had less proportion of households unaware of any eye care service (55 vs. 69; P 0.0005); and have a significantly higher felt the need to utilize eye care services (47 vs. 5.9; P 0.0005). The service utilization rate was however low in the two states. Conclusion: The principles of Vision 2020: The Right to Sight is adaptable to different cultures/societies and has demonstrated a potential to increase awareness and a felt need for eye care in poor resource settings

Contribution of Corneal Blindness to Visual Disability among Street Blind beggars in a Local Government Area of a State in Northern Nigeria

Aim: To determine the contribution of corneal blindness to visual disability among Blind Street Beggars (bsb) with a view to draw the implications to blindness prevention programme in Sokoto North Local government area (LGA) . Materials and Methods: The cross sectional study was conducted in Sokoto North Local LGA in Sokoto State. The study was conducted over a period of six weeks between May and June; 2009. Ethical clearance was obtained from the Ethical Committee of University of Ilorin Teaching Hospital. The list of blind persons in these areas was obtained from the traditional head of the blind (Sarkin Makafi) who assisted in mobilizing the subjects. Blind subjects who consented were included in the study. Data obtained were entered and analyzed in form of frequency tables using Epi-info 2000 statistical software package . Results: A total of 202 of the registered persons were found to be blind on ophthalmic examination and were therefore included in the analysis. There were 107 (53) males and 95 (47) females with a mean age of 49 years. One hundred and sixty four (81.2) blind beggars became blind during childhood period while 38 subjects (18.8) became blind during adulthood. Trachoma corneal opacity was responsible for 12.8 of the blindness while other corneal opacity accounted for 60.8. Conclusion: Majority of the subjects had preventable blindness. We recommend a comprehensive eye care programme with a strong emphasis on health education and prompt treatment of these causes as a means of reducing the population of street blind beggars in Sokoto North LGA

Causes of Blindness and Career Choice among Pupils in a Blind School; South Western Nigeria

Background: The causes of Blindness vary from place to place with about 80 of it been avoidable. Furthermore Blind people face a lot of challenges in career choice thus limiting their economic potential and full integration into the society. This study aims at identifying the causes of blindness and career choice among pupils in a school for the blind in South -Western Nigeria. Materials and Methods: This is a descriptive study of causes of blindness and career choice among 38 pupils residing in a school for the blind at Ikere -Ekiti; South Western Nigeria. Results: Thirty eight pupils comprising of 25 males (65.8) and 13 females (34.2) with age range from 6-39 years were seen for the study; The commonest cause of blindness was cataract with 14 cases (36.84) while congenital glaucoma and infection had an equal proportion of 5 cases each (13.16). Avoidable causes constituted the greatest proportion of the causes 27 (71.05) while unavoidable causes accounted for 11 (28.9). The law career was the most desired profession by the pupils 11 (33.3) followed by Teaching 9 (27.3); other desired profession includes engineering; journalism and farming. Conclusion: The greatest proportion of causes of blindness identified in this study is avoidable. There is the need to create public awareness on some of the notable causes particularly cataract and motivate the community to utilize available eye care services Furthermore there is need for career talk in schools for the blind to enable them choose career where their potential can be fully maximized

Leber plus disease

Introduction: Leber's neuropathy is a rare disease. The ''Leber Plus' is exceptional; is associated with a severe neurological disorder. This presentation was intended to describe a case of Leber Plus. Methods: A 45-year-old man consulted our department for bilateral blindness since 15 years Results: On both sides there was no light perception; optic atrophy with serious peripapillary vessels sclerosis. There was a flccid paraplegia. The 11 778 mitochondrial DNA mutation was identifid. Conclusion: The prevalence of the Leber's neuropathy is probably underestimated in black Africa because of lack of molecular biology laboratory

The state of peadiatric eye care in Nigeria: a situational review and call for action

The fight against childhood blindness is being given top priority by the World Health Organization especially in regions of the world; like Nigeria where the gross income per capita is relatively low with up to 60.9 of them living in absolute poverty as at 2010. Avoidable causes of blindness in children needs to be eliminated through the development of sustainable and equitably distributed high quality children eye care services as part of our national health care system. However enough attention has not been given to achieve this yet. The purpose of this editorial is to highlight the challenges in childhood eye care in this country as well as discuss ways the current negative trend can be reversed

Prevalence of Cataract Blindness in Rural Ethiopia

Background: Over three-quarter of all blindness worldwide are preventable and usually caused by cataract and trachoma. Objective: To assess the prevalence of cataract blindness in rural Ethiopia in order to facilitate further health care planning. Methods: A Cross-sectional; community-based study of inhabitants over 40 years of age from villages in the Abeshge and Kebena Districts; south of Addis Ababa. A total of 1100 eligible participants were identified in the study. Visual acuity (VA) was measured using a Snellen's E chart at 6 metres and eye examinations were performed using torch light; 2.5 X magnifying glasses and an ophthalmoscope. Cataract was defined as lens opacity identified as the cause of blindness and low vision after ruling out other causes. Unfortunately; there was no access to a refraction set and slit lamp to conduct thorough examinations. Results: The adjusted prevalence of bilateral cataract blindness (VA3/60) was 2.4; 95confidence interval [CI]; 1.8-3.0. Cataract is the major cause of bilateral blindness (66.7) among the participants. The cataract surgical coverage was 28.9for men and 18.1for women. The adjusted prevalence of bilateral cataract and VA6/60 was 3.6(95CI; 1.4-5.8). In this last group; the surgical coverage was 41.2(persons) and 38.5(eyes). Of all operated eyes; 30could not see at 6/60. Inability to afford the procedure (64.5) and poor knowledge of cataract (29.8) were the reasons why surgery had not been performed. Conclusions: Cataract blindness is a major health problem in the study area with low surgical uptake. There is backlog of cataract blindness in the study area that will increase with ageing. This backlog was also reflected in other developing countries. Awareness campaigns; reducing cost; and expansion of surgical services may help to increase the cataract surgical rate; and women should be offered more cataract surgery. These results will enable health managers to plan effective interventions in line with Vision 2020

Psychological and Social Adjustment to Blindness: Understanding from two groups of Blind People in Ilorin; Nigeria

Background: Blindness can cause psychosocial distress leading to maladjustment if not mitigated. Maladjustment is a secondary burden that further reduces quality of life of the blind. Adjustment is often personalized and depends on nature and quality of prevailing psychosocial support and rehabilitation opportunities. This study was aimed at identifying the pattern of psychosocial adjustment in a group of relatively secluded and under-reached totally blind people in Ilorin; thus sensitizing eye doctors to psychosocial morbidity and care in the blind. Materials and Methods: A cross-sectional descriptive study using 20-item Self-Reporting Questionnaire (SRQ) and a pro forma designed by the authors to assess the psychosocial problems and risk factors in some blind people in Ilorin metropolis. Result: The study revealed that most of the blind people were reasonably adjusted in key areas of social interaction; marriage; and family. Majority were considered to be poorly adjusted in the areas of education; vocational training; employment; and mobility. Many were also considered to be psychologically maladjusted based on the high rate of probable sychological disorder of 51; as determined by SRQ. Factors identified as risk factors of probable psychological disorder were poor educational background and the presence of another medical disorder. Conclusion: Most of the blind had no access to formal education or rehabilitation system; which may have contributed to their maladjustment in the domains identified. Although their prevailing psychosocial situation would have been better prevented yet; real opportunity still exists to help this group of people in the area of social and physical rehabilitation; meeting medical needs; preventive psychiatry; preventive ophthalmology; and community health. This will require the joint efforts of medical community; government and nongovernment organizations to provide the framework for delivery of these services directly to the communities

Experience with Extra-capsular Cataract Exraction and Intra-ocular Lens Implant in Children

BACKGROUND: In developing countries congenital cataract has become an important cause of treatable blindness in childhood. However; difficulty in correcting aphakia is one of the reasons for poor visual outcome. OBJECTIVE: To determine the visual outcome after extra capsular cataract extraction and intra ocular lens implant and factors militating against good visual outcome in children. METHODS: A prospective interventional study of cataract extraction in children with intra ocular lens implant. Extra capsular cataract extraction with intra ocular lens implant was performed using the superior limbal approach. Polymethyl Methacrylate lenses were inserted. Posterior capsulotomy was done with a 25G needle bent at the tip in 26 eyes. RESULTS: Thirty two eyes of twenty five children aged between 4 months and 16 years were operated. Extra capsular cataract extraction with posterior chamber intraocular lens implant was done in 27 (83.4) eyes; plain extra capsular cataract extraction in 3 (9.4) eyes; extra capsular cataract extraction with anterior chamber intraocular lens implant in 1 (3.1) eye and vectis extraction in 1 (3.1) eye. Twenty six eyes had primary posterior capsulotomy. Thirty-two (100) eyes and 15 (60) children were blind before surgery. Result of post operative visual acuity in 18 children after refraction was 6/18 or better in 4 (22.2) children 6/24-6/60 in 11 (61.1) and 3/60 in 3 (16.7) children. CONCLUSION: Visual rehabilitation following extra capsular cataract extraction with Intra Ocular Lens Implant is encouraging in children