Presentation of Glaucoma in the Greater Accra Metropolitan Area of Ghana

Background: This study addresses the prevalence and clinical presentation of patients with primary open angle glaucoma (POAG) in the greater Accra metropolitan area. Methods: This is a retrospective case series of 455 patients (813 eyes) at the Emmanuel Eye Clinic. Patients were diagnosed from May 2008 to Nov 2011. The definition of POAG conformed to the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Information collected included basic demographic data; distribution of glaucoma subtypes; measured intraocular pressure (IOP); best corrected visual acuity (BCVA) and optic disc measurements. Results: Nearly 24 presented blind in at least one eye. The average age was 56.7 +/-16.7 years and the average IOP was 33.9 mmHg +/- 12.7 mmHg for right eyes and 33.5 mmHg +/-12.0 mmHg for left eyes. The mean vertical cup to disc ratio (vCDR) was 0.83 for right eyes versus 0.82 for left eyes. A total of 32 patients (53 eyes) were diagnosed with normal tension glaucoma (NTG). Statistically significant differences between the NTG and high tension groups included age (45.3 +/- 16.7 vs. 56.7 +/-16.7; p0.001); mean IOP (19.1 mmHg +/- 4.5 mmHg vs. 33.7 +/- 12.4 mmHg; p0.001) and mean vCDR (0.76 +/- 0.17 vs. 0.83 +/- 0.10; p0.01). Comparing age-matched NTG patients with high tension glaucoma patients showed no significant difference in vCDR. Conclusions: The clinical presentation of POAG at the Emmanuel Eye Center is characterized by elevated IOP and grossly advanced optic neuropathy. Significant differences between high tension glaucoma and NTG were identified

The Effect of Medical Therapy on IOP Control in Ghana

Background: To investigate IOP control following twelve months of continuous medical therapy in Ghana. Methods: This retrospective case series included 163 glaucoma patients diagnosed at a referral eye center between 1996 and 2006. Information collected included age; gender; IOP at presentation; six months and one year post treatment and types of anti-glaucoma medications prescribed. Optimal IOP control was defined according to results from the Advanced Glaucoma Intervention Study (AGIS); which demonstrated arrest of visual field progression in patients with IOP 18 mmHg at all visitations: Level 1 (post-treatment IOP . 21 mmHg); Level 2 (. 18 mmHg) and level 3 (. 16 mmHg). The principal outcome measure was the achievement of IOP 18 mmHg at six months and twelve month visitations. Results: One hundred sixty three patients were analyzed. These included 68 males (41.7) and 95 females (58.3). The mean age was 57}16 (median 59 years; range 7 . 95 years). There was no significant difference in age (p

Barriers to Cataract Surgical Uptake in the Upper East Region of Ghana

Background: The Upper East Region has one of the highest cataract surgical rates in Ghana. Notwithstanding this; cataract blindness is still a major problem. Aim: To determine patient-related barriers to cataract services in the region and their resolution. Methods: Focus Group Discussion (FGD) and Indepth interviews were used to explore the opinions of 66 cataract patients resident in the region between July and August 2003. Purposeful sampling was used in selecting 24 patients in the hospital while a Snowball sampling method was employed on 42 respondents resident in the village communities Results: Average age of the respondents was 67.6 years with equal proportions of males and females (0.9:1). Twelve and fifteen percent of respondents respectively cited fear and lack of escort as barriers to service up-take while 8and 9pointed to sociocultural beliefs and the fact that they were able to cope satisfactorily with their disability. Only 1.5of respondents gave lack of awareness as a barrier with none citing geographical barrier as a problem. Cost of surgery; however; stood out clearly as a very significant barrier with 91of respondents attesting to it. Conclusion: It is concluded that further expansion of outreach services; coupled with a more intensive health education is needed to overcome these barriers

Epidemiology of Hospitalized Ocular Injuries in the Upper East Region of Ghana

Aim of Study: The Upper East is the poorest and most rural region in Ghana and ocular injuries are a major public health problem. This study aims at providing epidemio- logic data on the burden of this problem in order to facilitate the provision of integrated eye care and safety strategies for the prevention of such injuries in the region. Design: A retrospective case series. Methods: Computerized records of all eye injuries admitted to the clinic between January and December 2004 were retrieved and analyzed using the Epi-Info software. Injuries were classified using the Birmingham Eye Trauma Terminology while Snellen visual acuities were classified/ banded using the WHO categories of visual impairments. Results: Ninety six eyes of 96 patients were admitted over the study period. Seventy five percent of the patients were males and 82.3 below the age of 30 years. Half of the patients had to travel beyond 100 km to get ophthalmic assistance. Only one third of the cases reported within 24 hours while 21 reported after one week of their injuries. These delayed periods of reporting showed no statistically significant relationship with the distances travelled to the hospital (p=0.76; chi2 test); nor the eventual visual outcome achieved following treatment. Open-globe injuries were by far the most common (60/96) and were 4.7 times more likely (Chi squared test) to produce poor visual outcome (p=0.02 CL 1.75-12.63). Conclusion: Current eye care strategies do not adequately address the issue of eye injuries in the region. There is the need to provide integrated approach by incorporating primary eye care strategies into the existing primary health care system