Causes of low vision and their management at Korle Bu Teaching Hospital, Accra, GHANA.

BACKGROUND: Provision of low vision services to the visually impaired is vital in blindness intervention programs. Such services are avenues for low vision patients to utilize their residual vision in carrying out daily tasks. AIM: To review the causes of low vision and services provided to low vision patients at Korle Bu Teaching Hospital. STUDY DESIGN: A retrospective cross-sectional study. METHODOLOGY: Study subjects were low vision patients who had been referred by ophthalmologists and optometrists from all over Ghana for low vision services. At the Low Vision Centre, patients were re-examined to confirm that they had low vision and were suitable for low vision devices. The visual acuities of all patients was determined using a Snellen chart (with letters and tumbling E chart) followed by anterior and posterior segment examination using a Haagstreit slit lamp biomicroscope and direct and/or indirect ophthalmoscope (Keeler). All patients were refracted for near and distance and best corrected visual acuities were recorded. Patients with best corrected visual acuities of less than 6/18 but better than light 3/60 in the better were considered for low vision devices. Clinical records of low vision patients managed at the Korle Bu Teaching Hospital between March 2005 and December 2014 were examined to determine the main causes of low vision and interventions given. Their demographics, clinical features, services offered and annual trend in low vision uptake were analyzed. RESULTS: A total of 604 patients managed between March 2005 and December 2014 at the low vision centre of the Korle Bu Teaching Hospital were included in the study. The mean age was 40.55+6.95 years. There was statistically no significant difference between the mean age in either sex; p-value = 1.000. Glaucoma was the leading cause of low vision in 135 (22.35%) of cases, followed by non-glaucomatous optic atrophy 62(10.26 %), retinitis pigmentosa 54(8.94 %), maculopathy 52(8.61 %) and ARMD 48(7.95 %) respectively. Uptake of the low vision services was highest in the second year of commencing the services. Interventions were mainly magnifiers, telescopes, closed circuit television (CCTV), counselling and referral to the School for the Blind. CONCLUSION: Glaucoma and non-glaucomatous optic atrophy were the predominant causes of low vision, and magnifiers and telescopes were the most commonly prescribed devices.

Cataract Surgical Uptake Among Older Adults in Ghana.

OBJECTIVES: In sub-Saharan Africa, cataract surgical services are highly inadequate and surgical uptake for cataract is low. This paper describes cataract surgical uptake among older adults in Ghana. METHODS: This work was based on World Health Organization's multi-country Study on global Ageing and adult health (SAGE), conducted in six countries including Ghana. Wave one of SAGE in Ghana was conducted in 2007-2008 as collaboration between WHO and Department of Community Health, University of Ghana Medical School. A nationally representative sample of 5571 older adults (≥50 years) and a small sample of persons 18-49 years were interviewed. Data was obtained on uptake of cataract surgery in older adults and analyzed using descriptive measures and chi square for associations in categorical outcome measures. RESULTS: Overall surgical uptake was 48.9% among older adults and was slightly higher among older men (49.1%) than women (48%). Cataract surgical uptake was relatively higher in the 60-69 years group (55%), urban residents (52.6%) and those living without partners (50%). Educational and income levels of older persons did not affect cataract surgical uptake. Regional differences in cataract surgical uptake existed; was less than 60% in all ten regions (except one), and the two regions with most self-reported cataracts (Ashanti and Greater Accra) had less than 50% uptake. CONCLUSIONS: Intensive public education, engagement of community groups and increased access to cataract surgery at health facilities and outreach services need consideration at national/sub-national levels. Further investigations to garner equity in national eye care efforts are recommended.

Eye Donation:Awareness and Willingness among Patients Attending a Tertiary Eye Center in Ghana.

BACKGROUND: Eye donation for corneal transplant holds the key for visual restoration from corneal diseases. Consequently, knowing the level of awareness of eye donation and willingness among potential donors to donate their eyes after death to ensure availability of donated cornea for transplantation is very crucial. This baseline information is essential for planning towards the establishment of an eye bank. AIM: To determine the level of awareness of eye donation and willingness to donate among patients attending the Eye Clinic at the Korle Bu Teaching Hospital. STUDY DESIGN: Cross-sectional study. MATERIALS AND METHODS: This cross-sectional study was done among 536 eye patients selected by convenient sampling and interviewed using a semi-structured administered questionnaire at the Eye Clinic at the Korle Bu Teaching Hospital. Univariate and multivariate logistic regression were performed at 5% level of significance. RESULTS: Awareness of eye donation and willingness to donate eyes after death were observed in 45 (8.40%) and 321(59.90%) of respondents respectively. Age group 60 and above [AOR = 2.62; CI (0.94-7.31); P=0.04] and education at the professional and tertiary levels [AOR = 4.00 (1.08-14.81); P= 0.03] were possible predictors of awareness of eye donation whilst education was the only predictor of willingness to donate an eye. The main source of awareness of eye donation was through healthcare personals and the media (46.70 %), while the optimal time for eye donation was known by 17.80 % of those who were aware of eye donation. CONCLUSION: Even though few respondents were aware of eye donation, majority of the respondents were ready to pledge their eyes for donation after death. There is the need for public education on the benefits of eye donation.

Breakfast eating habits among medical students.

BACKGROUND: Breakfast is often thought to be the most important meal of the day as it is known to provide energy for the brain and improve learning. It is also known to contribute significantly to the total daily energy and nutrient intake. Skipping breakfast may affect performance during the rest of the day. AIM: To determine the level of breakfast skipping among medical students and its effect on their attention span and level of fatigue during clinical sessions. DESIGN: A descriptive cross-sectional study of breakfast eating habits among medical students at the University of Ghana Medical School, Korle Bu-Accra. SETTING: The University of Ghana Medical School, Korle Bu-Accra. METHOD: Questionnaires were distributed to second year (pre-clinical) medical students studying the basic sciences and clinical students in ophthalmology to be self-administered. Interview data was captured and analyzed using SPSS version 17.0. RESULTS: The total number of pre-clinical students recruited was 154 and clinical students 163 bringing to a total of 317 students made up of 203 males and 114 females (M: F=1.8:1). The overall breakfast skipping among the students was 71.92%. The prevalence among the pre-clinical students was 76.62% and clinical students 67.48%. Generally, breakfast skipping was significantly related to fatigue and poor attention during clinical sessions. CONCLUSION: This study suggests that the medical students, both pre-clinical and clinical, skip breakfast and this may affect their studies adversely.

Necrotic melanocytoma associated with polycystic liver disease and cutaneous neurofribomata.

Melanocytoma, a specific variant of melanocytic naevus may occur anywhere along the uveal tract but most commonly it is on the optic disk and adjacent choroid. We report a case of necrotic melanocytoma with associated polycystic liver disease and peripheral neurofibromatosis in a 70-year old man who was referred to the eye unit of the Korle bu Teaching hospital, Accra, Ghana with a CT scan suggestive of choroidal melanoma. Histopathological features of the enucleated eye revealed necrotic melanocytoma. He also had other systemic conditions. The case is presented and the literature reviewed.

PSYCHO-SOCIAL CHALLENGES OF PATIENTS FOLLOWING ORBITAL EXENTERATION.

OBJECTIVE: Orbital exenteration results in devastating functional, aesthetic and psychological losses. We studied the psycho-social challenges of patients following orbital exenteration. DESIGN: Retrospective descriptive study. SETTING: Korle-Bu Teaching Hospital, eye clinic, Accra. SUBJECTS: Ten surviving patients, at least six months post orbital exenteration. RESULTS: Though all the patients were satisfied with the medical results of the surgery, 50% felt strongly uncomfortable or dissatisfied with the cosmetic effect of the surgery. Sixty percent of the patients suffered unwelcome comments and 50% uncomfortable stare from close friends and relations. Sixty percent were not uncomfortable in the company of friends and close relations. CONCLUSION: Our findings call for a counseling plan for our patients while it is also necessary to find ways of improving their cosmesis.