Effect of repeated ivermectin treatments on ocular onchocerciasis: evaluation after six to eight doses.

In 26 villages (1987 population 12,302), hyperendemic for savanna onchocerciasis in North Cameroon, ivermectin was distributed annually between 1987/89 and 1995. Each year until 1992, ophthalmologic examinations were performed before treatment. A final examination was made in 1995. The effects of ivermectin on ocular onchocerciasis were assessed by following (a) the ophthalmologic indices in three cohorts of males recruited before treatment in 1987, 1988 and 1989, who were treated and examined annually, and (b) the indices recorded yearly in the cross-section of males aged 15-19 years. The indices in 1995 from patients who had received up to eight doses were compared with those calculated before treatment in individuals of similar age. In the cohorts, the prevalences of microfilariae in the anterior chamber (MFAC) and of punctate keratitis (PK) recorded in 1995 were markedly reduced; there was a non-significant decrease in sclerosing keratitis (SK), and a significant worsening in the fundus indices in the cohorts. The cross-sectional analysis showed significant decreases in the prevalences of MFAC, PK and SK, and a significant increase in the mean visual acuity; there was no significant change in any fundus index. The findings suggest that repeated ivermectin treatment does not prevent the appearance of initial retinal lesions or the worsening of existing retinal lesions.

[Activities of the African Institute of Tropical Ophthalmology, 1990-1997]. / Activités de l'Institut d'Ophtalmologie Tropicale de l'Afrique, 1990-1997.

The African Institute of Tropical Ophthalmology (AITO) was founded in Bamako in 1953. It is part of a regional structure, The Organization for Cooperation and Coordination in the Control of Major Endemic Diseases (OCCCMED). AITO is a WHO collaborating center for the prevention of blindness and has four aims: the provision of eye care, training (ophthalmologists, cataract surgeons, specialist nurses, spectacle manufacturers), research (epidemiology, clinical and surgical) and assessment of public eye care as a function of the needs of the member states of OCCCMED. The European Regional Program for the Prevention of Blindness and an International Sight First Program Center are located at AITO. AITO is at the heart of a network dedicated to fighting blindness, and its activities extend beyond the borders of the OCCCMED.

[Training at the African Institute of Tropical Ophthalmology in Bamako]. / Formation à l'Institut d'Ophtalmologie Tropicale de l'Afrique de Bamako.

The African Institute of Tropical Ophthalmology (AITO) is an OCCCMED institute, founded in Bamako in 1953. The OCCCMED itself is based at Bobo Dioulasso (Burkina Faso). AITO is a WHO collaborating center for the prevention of blindness. Training is one of the main activities of the institute, along with eye care, research and assessment. The prevalence of blindness in sub-Saharan countries is about 1.2%, with blindness mostly caused by cataracts, trachoma, glaucoma and onchocercosis. The demand for eye care is high but there are currently too few trained personnel to satisfy that demand. Therefore, AITO's role in training eye-care professionals is particularly important. The institute trains ophthalmologists, specialist nurses, eye surgeons (who remove cataracts) and spectacle manufacturers. Training is carried out within the framework of the community and apprenticeship in the workplace. The student must attain specific targets, listed in a "competency passport" issued at the start of training. Clinical and surgical ophthalmology and general eye care are taught. Training costs and grants are mostly paid by the Lions Club International Sight First Program or by the French Overseas Development Ministry. Since 1991, AITO has trained to graduation: 18 ophthalmologists; 24 eye surgeons; 83 specialist nurses; 16 spectacle manufacturers.

[Future of ophthalmology nurses and physicians trained at the African Institute of Tropical Ophthalmology]. / Devenir des infirmiers et médecins ophtalmologistes formés à l'IOTA.

Six ophthalmologists and 24 specialist ophthalmology nurses from French-speaking African countries graduate from AITO each year. Their training focuses on the skills they will need to participate in the national programs to combat blindness. All the ophthalmologists (10) and specialist ophthalmology nurses (42) from Mali, Niger, Burkina Faso and Senegal, who graduated from AITO within the last ten years were interviewed. Eight of the ten ophthalmologists and all of the specialist nurses are currently working in national programs to combat blindness. The specialist nurses knew more about public eye health issues than about optics. The training given is appropriate for ophthalmology professionals working in these countries. The chief demand of both ophthalmologists and specialist nurses was that they should have continuous training and supervision.

[Synthesis of the blindness situation in the countries of the Organization for Cooperation and Coordination in the Control of Major Endemic Diseases]. / Synthèse de la situation en matière de cécité dans les paysde l'OCCGE.

The major causes of blindness in the OCCCMED states are cataracts, trachoma, glaucoma and oncocercosis. The prevalence of blindness is about 1.2% and there are about 880,000 blind individuals and 2,500,000 people with impaired vision. Cataracts were the cause of blindness in 440,000 people and the cause of visual impairment in 1,320,000 individuals. About 1,500,000 people were found to have oncocercosis, and about 24,000 were blind. The true rate of trachoma is unknown. Thirteen thousand cataracts are surgically removed in the region each year, the CSR (cataract surgery rate) being 210. In the last few years, national programs have been set up to combat blindness and equipment and training have been established. With a ratio of 1 ophthalmologist per 523,000 people, the WHO's objectives are becoming attainable.

[Strategies to control cataracts]. / Stratégies de lutte contre la cataracte.

Cataracts, often associated with aging (80%), are a major cause of blindness (more than 50% of cases of blindness in Africa), and for this reason, up to 80% of cases could be predicted or prevented. The socio-economic costs (care and loss of productivity) are increased by morbidity (blindness, impaired vision, congenital, complicated or infected cataracts). The biological determinants of cataracts account for the difficulties in developing and implementing effective preventive action. These epidemiological determinants (prevalence, incidence, increase in life expectancy) account for the size of the public health problem. The surgical removal of cataracts in Africa currently only deals with about 1% of the prevalence rate or 10% of the incidence. Cataracts are, however, easy to cure, resulting in great benefits to public health. The waiting list for cataract operations is very short because of social and cultural barriers which limit the acceptability and accessibility of treatment. Rather than formalizing the dogmatic choices of surgical techniques and structures (fixed, mobile, advanced?), we should promote all phases of treatment from active screening and the selection of cases for surgery to the follow-up of interventions and their impact. We should also increase public awareness, develop a system for the transfer of information that is effective and improve the cost-effectiveness and capacity of the region to provide high quality services on a large scale. We must promote patient satisfaction at all stages of treatment: its quality, its delivery and its low cost.

Prevalence de la cecite et de la baisse de vision en zone rurale de foret au Cameroun en 1992

Une enquete transversale avec echantillonnage en grappes; a permis d'estimer la prevalence instantanee des deficiences visuelles en zone rurale de foret au Cameroun. Le taux de prevalence standardise de la cecite bilaterale est egal a 1;2 pour cent; celui de la baisse de vision bilaterale a 4 pour cent et celui de la cecite unilaterale a 1;8 pour cent. La cataracte senile est la cause principale de deficience visuelle. Les opacites corneennes totales ou centrales sont la deuxieme cause de deficience et concernent 8 pour cent de l'ensemble des deficients. Au vu de ces estimations il semble opportun d'envisager l'elaboration d'un programme national de lutte adequat

[Ocular damage caused by industrial lasers. Apropos of 3 accidents]. / Les méfaits oculaires des lasers. A propos de trois accidents.

We report three cases of ocular injury caused by industrial lasers when safety precautions are not observed. These three cases concern engineers working in a research institute and using YAG laser alignment procedure. Damages observed are: a) Macular hole; b) Subretinal hemorrhage; c) Intravitreous hemorrhage. An absolute central scotoma occurred in two cases.