Clinical presentation and visual status of retinitis pigmentosa patients: a multicenter study in southwestern Nigeria.

BACKGROUND: To review the visual status and clinical presentation of patients with retinitis pigmentosa (RP). METHODOLOGY: Multicenter, retrospective, and analytical review was conducted of the visual status and clinical characteristics of patients with RP at first presentation from January 2007 to December 2011. Main outcome measure was the World Health Organization's visual status classification in relation to sex and age at presentation. Data analysis by SPSS (version 15) and statistical significance was assumed at P<0.05. RESULTS: One hundred and ninety-two eyes of 96 patients with mean age of 39.08±18.5 years and mode of 25 years constituted the study population; 55 (57.3%) were males and 41 (42.7%) females. Loss of vision 67 (69.8%) and night blindness 56 (58.3%) were the leading symptoms. Twenty-one (21.9%) patients had a positive family history, with RP present in their siblings 15 (71.4%), grandparents 11 (52.3%), and parents 4 (19.4%). Forty (41.7%) were blind at presentation and 23 (24%) were visually impaired. Blindness in six (15%) patients was secondary to glaucoma. Retinal vascular narrowing and retinal pigmentary changes of varying severity were present in all patients. Thirty-five (36.5%) had maculopathy, 36 (37.5%) refractive error, 19 (20%) lenticular opacities, and eleven (11.5%) had glaucoma. RP was typical in 85 patients (88.5%). Older patients had higher rates of blindness at presentation (P=0.005); blindness and visual impairment rate at presentation were higher in males than females (P=0.029). CONCLUSION: Clinical presentation with advanced diseases, higher blindness rate in older patients, sex-related difference in blindness/visual impairment rates, as well as high glaucoma blindness in RP patients requires urgent attention in southwestern Nigeria.

Prevalence and types of glaucoma among an indigenous African population in southwestern Nigeria.

PURPOSE: To determine the prevalence and identify the types of glaucoma in the Akinyele district of Oyo State in southwestern Nigeria. METHODS: Residents of Akinyele district of Oyo State in southwestern Nigeria aged 40 years and older were randomly selected in a stratified manner. All participants underwent comprehensive ophthalmic examination, including visual acuity assessment, anterior segment biomicroscopy, IOP measurement, gonioscopy, optic nerve head and disc evaluation, and central visual field assessment. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) classification scheme. RESULTS: A sample of 811 subjects (90% response rate) was examined. The crude prevalence of all forms of glaucoma was 7.3% (95% confidence interval [CI] 5.5%-9.1%) with an age and sex standardized rate of 6.9% (95% CI 6.88%-6.92%). Primary open angle glaucoma was found in 6.2% (95% CI 4.5%-7.8%) and primary angle closure glaucoma in 0.2% (95% CI 0.0%-0.6%). Secondary glaucoma accounted for 0.9% of the cases, with couching and neovascular process being the main causes (0.2% each). Prevalence of glaucoma increased significantly with increasing age (P for trend < 0.05). CONCLUSIONS: The high prevalence of glaucoma (7.3%) in the Akinyele district in southwestern Nigeria is comparable with those in predominantly black populations in the Akwapim-South district of Ghana and Barbados. Primary open angle glaucoma remains the most prevalent form of glaucoma.

Cataract blindness in Osun state, Nigeria: results of a survey.

PURPOSE: To estimate the burden of blindness and visual impairment due to cataract in Egbedore Local Government Area of Osun State, Nigeria. MATERIALS AND METHODS: Twenty clusters of 60 individuals who were 50 years or older were selected by systematic random sampling from the entire community. A total of 1,183 persons were examined. RESULTS: The age- and sex-adjusted prevalence of bilateral cataract-related blindness (visual acuity (VA) < 3/60) in people of 50 years and older was 2.0% (95% confidence interval (CI): 1.6-2.4%). The Cataract Surgical Coverage (CSC) (persons) was 12.1% and Couching Coverage (persons) was 11.8%. The age- and sex-adjusted prevalence of bilateral operable cataract (VA < 6/60) in people of 50 years and older was 2.7% (95% CI: 2.3-3.1%). In this last group, the cataract intervention (surgery + couching) coverage was 22.2%. The proportion of patients who could not attain 6/60 vision after surgery were 12.5, 87.5, and 92.9%, respectively, for patients who underwent intraocular lens (IOL) implantation, cataract surgery without IOL implantation and those who underwent couching. "Lack of awareness" (30.4%), "no need for surgery" (17.6%), cost (14.6%), fear (10.2%), "waiting for cataract to mature" (8.8%), AND "surgical services not available" (5.8%) were reasons why individuals with operable cataract did not undergo cataract surgery. CONCLUSIONS: Over 600 operable cataracts exist in this region of Nigeria. There is an urgent need for an effective, affordable, and accessible cataract outreach program. Sustained efforts have to be made to increase the number of IOL surgeries, by making IOL surgery available locally at an affordable cost, if not completely free.

Bilateral sporadic aniridia: review of management.

PURPOSE: To report a rare case of bilateral sporadic aniridia in an African child and review the management modalities. PRESENTATION: We report a case of bilateral sporadic aniridia with horizontal nystagmus, axial cataract optic disc, and fovea hypoplasia in a 5-year-old female patient. She was managed conservatively. Various modalities of treatment are reviewed.

Epidemiology of ocular trauma among the elderly in a developing country.

PURPOSE: To study the epidemiology of ocular trauma among the elderly in a developing country. METHOD: This is a multi-center retrospective clinical study of patients aged 65 years and above managed for ocular trauma between 2001 and 2007 at 4 hospitals in southwestern Nigeria. Age, sex, occupation, residential address, location at time of injury, activity preceding injury, agent of injury, treatment modalities offered and presenting visual acuity were recorded in a predesigned form. Type of injury was classified according to Birmingham Eye Trauma Terminology. Data were recorded and analyzed with descriptive statistics and Chi square using SPSS 11 (SPSS Inc., Chicago, IL) and statistical significance accepted at P < 0.05. RESULTS: 78 patients with overall mean age of 70.1 ± 5.5 years and male to female ratio of 1.9: 1 (P=0.007) were studied. Mean age for males was 70.0 ± 5.4 years and 70.1 ± 5.7 years for females. Eye injury occurred most commonly on the farm (37.2%), during farm related activities (35.9%) with sticks/twigs (41.1%) being commonest agent of ocular trauma among the elderly. However, injury occurred most frequently at home (51.9%) and during a fight/dispute (25.9%) with inciting agents being most frequently (33.3%) home related in elderly females. Eye injury was mainly of closed globe variety (85.9%); open globe injury was associated with higher incidence of hospitalization (P < 0.0001) and visual impairment (P=0.004) at presentation. CONCLUSION: Although eye injury in elderly occurred more commonly on the farm during farm related activities, gender related differences are present with injury occurring more commonly in the home and during assaults/disputes.

Non-surgical management of congenital eversion of the eyelids.

PURPOSE: To report the effectiveness of non-invasive management of congenital eversion of the eyelids, a rare condition associated with serious socio-psychological consequences. CASE REPORT: Three neonates with congenital eversion of the eyelids and secondary conjunctival chemosis and prolapse were managed with 5% hypertonic normal saline, lubricants, antibiotics, and padding. Complete eye opening was achieved by the 10th day of presentation and the condition resolved. CONCLUSION: Non-invasive management of congenital eyelid eversion was found to be effective with no need for surgical management. All health care workers should be informed that this condition is amenable to conservative treatment if started early, so that prompt referral for expert management can be offered.

Congenital bilateral eversion of the eyelids.

The authors report a case of congenital bilateral eversion of the eyelids with secondary conjunctival prolapse in a 4-hour-old neonate. Conservative treatment with hypertonic normal saline, lubricants, antibiotics, and padding was instituted. No surgery was performed. Complete eye opening was achieved by the 10th day after birth. Medical management is advantageous in that it is inexpensive, noninvasive, and can be performed even in a center with poor surgical facilities, as is commonly encountered in developing countries. The sociopsychological aspect of the disease, possible pathophysiology, and treatment are discussed.

Perception of blindness and blinding eye conditions in rural communities.

PURPOSE: The purpose of this qualitative study was to explore the causes and management of blindness and blinding eye conditions as perceived by rural dwellers of two Yoruba communities in Oyo State, Nigeria. METHODS: Four focus group discussions were conducted among residents of Iddo and Isale Oyo, two rural Yoruba communities in Oyo State, Nigeria. Participants consisted of sighted, those who were partially or totally blind and community leaders. Ten patent medicine sellers and 12 traditional healers were also interviewed on their perception of the causes and management of blindness in their communities. FINDINGS: Blindness was perceived as an increasing problem among the communities. Multiple factors were perceived to cause blindness, including germs, onchocerciasis and supernatural forces. Traditional healers believed that blindness could be cured, with many claiming that they had previously cured blindness in the past. However, all agreed that patience was an important requirement for the cure of blindness. The patent medicine sellers' reports were similar to those of the traditional healers. The barriers to use of orthodox medicine were mainly fear, misconception and perceived high costs of care. There was a consensus of opinion among group discussants and informants that there are severe social and economic consequences of blindness, including not been able to see and assess the quality of what the sufferer eats, perpetual sadness, loss of sleep and dependence on other persons for daily activities. CONCLUSION: Local beliefs associated with causation, symptoms and management of blindness and blinding eye conditions among rural Yoruba communities identified have provided a bridge for understanding local perspectives and basis for implementing appropriate primary eye care programs.

Prevalence and causes of blindness in a tropical African population.

UNLABELLED: A population based survey of Egbedore Local Government area (LGA), a tropical African population in Osun State, Nigeria was conducted to determine the prevalence and causes of blindness in the community, Osun State, one of the new states created on 27th August, 1991 is situated in the southwest region of Nigeria. It has a population of about 2, 654,244 using the population growth rate of 3.0 percent per year. Egbedore LGA has a population of 49,555 being the projected estimate of the local census done in 1991. STUDY DESIGN: The study was in accordance with World Health Organisation recommendations. 3204 rural dwellers were examined. The survey team was divided into: 1. Registration team 2. Retrieval team 3. Visual acuity team 4. Ocular examination team. The survey candidates, once registered were asked to go to a nearby school or health center where visual acuity and ocular examination teams completed the assignment. The retrieval team consisted of an ophthalmic nurse and a local escort who persuaded and brought to examination site registered individuals who failed to appear voluntarily. Ocular examination team performed the eye examination. Analysis of data was done using personal computer AT model and systat package for analysis. RESULT: It is found that 1.18% of the population was blind by WHO standard. Cataract alone accounted for 47.4% of the blind, uncorrected aphakia 18.4%, glaucoma 15.8%, phthisis bulbi 5.3%, uveitis, optic atrophy, macular degeneration, retinitis pigmentosa and refractive error all accounted for 2.6% each. CONCLUSION: More than half of the burden of blindness is potentially curable. About a third is preventable through health education, early diagnosis and prompt treatment. A cataract outreach programme with provision of low cost aphakic glasses will go a long way in reducing blindness in this community and Osun State in general.