Amsler Grid Versus 10-2 Test in Primary Open Angle Glaucoma.

Background: Glaucoma is the leading cause of global irreversible blindness. The goal of management in glaucoma lies in its early detection and treatment to prevent further optic neuropathy. Available equipment for early glaucoma detection is not cost-effective or readily available in resource-scarce settings such as Nigeria. Thus, there is a need for a simple cost-effective tool to detect glaucomatous central visual field (CVF) defects in all the stages of glaucoma within the community in resource scarce-settings. Aims and Objectives: The aim of this article is to determine the validity of the Amsler grid in detecting central glaucomatous visual field defects in primary open angle glaucoma (POAG). Materials and Methods: This was a cross-sectional study of follow-up glaucoma patients at a secondary eye care hospital in Nigeria. All patients had detailed ophthalmic examination in addition to 24-2 and 10-2 CVF tests and Amsler grid test. POAG was classified using the Hodapp-Parrish-Anderson criteria into mild, moderate, and severe on 24-2 CVF. The diagnostic validity of the Amsler grid was calculated using the 10-2 CVF as a reference standard. Regression analyses were performed between the Amsler grid scotoma area and 10-2 CVF parameters [mean deviation (MD), scotoma extent (SE), and scotoma mean depth (SMD)]. Results: A total of 150 eyes of 150 patients were enrolled. The sensitivity, specificity, and positive predictive value and negative predictive value of the Amsler grid compared with the 10-2 CVF was 49.5%, 95.9%, 96.2%, and 47.9%, respectively, with an area under curve of 0.7. Sensitivity increased with increasing severity (P < 0.001) from 20.0%, 31.0%, and 76.6% in mild, moderate, and severe POAG, respectively. The Amsler grid scotoma area had the strongest relationship with the 10-2 MD, followed by 10-2 SE and 10-2 SMD with a quadratic R2 of 0.579, 0.370, and 0.307, respectively. Conclusion: The Amsler grid has a low sensitivity in mild-to-moderate POAG. However, it may serve as an adjunctive tool in resource-scarce settings for detection of severe POAG in the community by primary eye care providers.

Prevalence of congenital colour vision deficiency among secondary school students in Ibadan, South-West Nigeria.

AIM: The aim was to determine the prevalence and pattern of congenital colour vision deficiency among secondary school students in Ibadan, Nigeria. SUBJECTS AND METHODS: A descriptive cross-sectional study was conducted among students from three public secondary schools through a multi-staged sampling method. Ocular examination including visual acuity assessment and colour vision test with the Ishihara plate was performed for all students. Further assessment with the Farnsworth-Munsell D-15 panel was performed for those who failed the Ishihara test. RESULTS: One thousand six hundred and thirty-five students participated in the study. There were 769 (47.0%) males with mean age of 13.9 ± 1.9 years. The overall prevalence of congenital colour vision deficiency was 2.3% with prevalence of 3.8% and 0.9% in males and females, respectively, which was statistically significant (P = 0.00112), and equal proportion of deutans 11 (32.0%) and protans 12 (35.0%) ratio of 1:1.1. CONCLUSION: The prevalence of congenital colour vision deficiency among public secondary school students in Ibadan is comparable to findings in other parts of the country.

Comparison of Peribulbar with Posterior Sub-Tenon's Anesthesia in Cataract Surgery Among Nigerians.

PURPOSE: To compare the akinetic and the analgesic effects of peribulbar and posterior sub-Tenon's anesthesia in patients undergoing cataract surgery. METHODS: In a hospital-based randomized comparative interventional study, patients aged 50 years and above who underwent elective surgery for uncomplicated cataract were randomized to receive either peribulbar block or posterior sub-Tenon block. Pain during injection, surgery, and after surgery was assessed using numerical reporting scale (NRS). Limbal excursion was measured with a transparent meter rule. RESULT: A total of 152 eyes of 152 patients were studied. Peribulbar and sub-Tenon regional blocks provided comparable adequate akinesia (P = 0.06) and similar levels of analgesia (P = 0.10) during cataract surgery. Both techniques also provided similar levels of analgesia to the patient during injection and in the immediate postoperative period. Ninety-two percent of patients who had peribulbar and 97% of those who had sub-Tenon blocks reported either mild pain or no pain at all during surgery (P = 0.49). There was no report of severe pain in all patients during the stages of the surgery. Occurrence of chemosis and subconjunctival hemorrhage was more common in sub-Tenon than peribulbar anesthesia. CONCLUSIONS: This study shows that peribulbar and posterior sub-Tenon routes of administering anesthetic substances is comparable in providing adequate akinesia and analgesia for cataract surgery with minimal complications. Therefore, both techniques are effective and safe for cataract surgery among Nigerians.

Effect of face washing with soap and water and cleaning with antiseptics on upper-lid bacteria of surgical eye patients.

OBJECTIVE: To determine the effect of face washing with soap and water and cleaning with povidone iodine and cetrimide/chlorhexidine gluconate (Savlon) on upper-lid bacteria. DESIGN: Prospective, nonrandomized clinical trial. PARTICIPANTS: Eighty patients attending the Eye Clinic, University College Hospital, Ibadan, Nigeria. METHODS: Eighty patients assigned to 4 groups had swabs of the upper eyelid skin taken before and after face wash with soap and water, and cleansing with Savlon and 5% povidone iodine. Specimens were cultured and Gram stained. Bacterial counts were carried out using standard techniques. RESULTS: Face washing with soap and water increased the proportion of patients with bacterial isolates from 80.0% to 87.5%. The average colony count increased from 187.1 to 318.5 colony units per mL (p = 0.02). Application of 5% povidone iodine without face washing with soap and water reduced the proportion of patients with bacterial isolates from 82.6% (mean count 196.5) to 28.6% (mean count 34.1)(p = 0.001); in comparison, the application of 5% povidone iodine after face washing with soap and water reduced the proportion from 71.4% (mean count 133.9) to 40.0% (mean count 69.0)(p = 0.01). Application of Savlon without face washing with soap and water reduced the proportion of patients with bacterial isolates from 100% (mean count 310.9) to 41.2% (mean count 19.8)(p = 0.004) compared with the application after face washing, which reduced the proportion from 89.5% (mean count 240.3) to 41.2% (mean count 82.9)(p = 0.02). CONCLUSIONS: Both povidone and Savlon are effective in reducing periocular bacteria in an African setting. Prior face washing with soap and water had no added benefit in reducing bacterial colony count.