Impact of COVID-19 on ophthalmic surgical procedures in sub-Saharan Africa: a multicentre study.

BACKGROUND: The COVID-19 pandemic had a profound impact on healthcare and ophthalmology services globally. Numerous studies amongst various medical and surgical specialties showed a reduction in patient attendance and surgical procedures performed. Prior published ophthalmic literature focused on specific types of procedures and were usually single centre. The current study attempts to quantify the impact on a larger scale, namely that of sub-Saharan Africa, and to include all ophthalmic subspecialties. METHODS: This is a retrospective analysis of the surgical records from 17 ophthalmology centres in seven countries located in East, Central, West and Southern Africa. The date of declaration of the first lockdown was used as the beginning of the pandemic and the pivot point to compare theatre records one year prior to the pandemic and the first year of the pandemic. We examined the total number of surgical procedures over the two year period and categorized them according to ophthalmic subspecialty and type of procedure performed. We then compared the pre-pandemic and pandemic surgical numbers over the two year period. RESULTS: There were 26,357 ophthalmic surgical procedures performed with a significant decrease in the first year of the pandemic (n = 8942) compared to the year prior to the pandemic (n = 17,415). The number of surgical procedures performed was lower in the first year of the pandemic compared to the year prior to the pandemic by 49% [Incidence rate ratio (IRR) 0.51, 95% CI 0.41-0.64), 27% (0.73, 0.55-0.99), 46% (0.54, 0.30-0.99), 40% (0.60, 0.39-0.92) and 59% (0.41, 0.29-0.57) in sub-Saharan Africa (4 regions combined), West, Central, East and Southern Africa, respectively]. The number of surgical procedures in the different sub-specialty categories in sub-Saharan Africa (4 regions combined) was significantly lower in the first year of the pandemic compared to the year prior to the pandemic, except for glaucoma (IRR 0.72, 95% CI 0.52-1.01), oncology (0.71, 0.48-1.05), trauma (0.90, 0.63-1.28) and vitreoretinal (0.67, 0.42-1.08) categories. CONCLUSION: This study provides insight into the impact of the COVID-19 pandemic in multiple regions and countries on the African continent. The identification of which surgical subspecialty was most affected by the COVID-19 pandemic in each region allows for better planning and resource allocation to address these backlogs.

Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system.

AIM: To determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS. METHODS: A prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome. RESULTS: There were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005). CONCLUSION: Reliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.

How useful is visual field testing in an African glaucoma clinic?

PURPOSE: To investigate the usefulness of visual field testing in the diagnosis and subsequent management of glaucoma in a specialist glaucoma clinic at Groote Schuur Hospital, Cape Town, South Africa. METHODS: A retrospective case note review of 344 patients who attended the glaucoma clinic between January and June 2010. RESULTS: The study population consisted of 201 (58%) females and 143 (42%) males. The diagnoses included 207 (60%) cases with primary open-angle glaucoma, 58 (17%) cases with chronic angle closure glaucoma, 46 (13%) cases with secondary glaucoma, 17 (5%) cases with normal pressure glaucoma, ten (3%) cases with ocular hypertension, and six (2%) glaucoma suspects. Visual field testing contributed to the diagnosis of glaucoma in only 34 (10%) cases. A total number of 2,604 fields were performed. Of these fields, 1,931 (74%) were reliable. A baseline was reached in only 141 (53%) patients. There was evidence of field progression in only 24 (9%) cases. Changes to glaucoma treatment were based on inadequate control of intraocular pressure alone in 309 (90%) patients. Visual field progression contributed to changes in treatment in only 15 (4%) cases. CONCLUSION: Visual fields are not used in the diagnosis and management of glaucoma in the majority of patients in our clinic. Patients present with advanced disease, which is easily diagnosed without the use of visual fields. Progression of fields seldom contributes to monitoring and intraocular pressure is mainly used to monitor the adequacy of treatment.

Open globe injuries in patients seen at Groote Schuur Hospital, Cape Town, South Africa.

BACKGROUND: Ocular trauma accounts for a significant proportion of admissions to the eye ward at Groote Schuur Hospital (GSH), Cape Town, South Africa. There are few published studies on ocular trauma in South Africa. Some studies elsewhere have shown an association between open globe injuries and recent alcohol use, but no such study has been conducted in this country. OBJECTIVES: To identify causes of and outcomes after open globe injuries at GSH, with emphasis on the association between assault and alcohol use as well as the relationship, if any, between victim and assailant. METHODS: This was a prospective case series of all adult patients admitted to GSH with open globe injuries over a 2-year period. Ocular findings were recorded with a minimum 3-month follow-up period. RESULTS: There were 249 open globe injuries. Assault had occurred in 183 (73.5%), and 66 (26.5%) were accidental. In the assault-related cases, 95 (51.9%) of the assailants were reported to have used alcohol and 121 (66.1%) of the victims admitted to alcohol use prior to the assault. There was a statistically significant relationship between ethanol use and type of injury, 71.4% of assault cases overall being associated with ethanol use. In assault-related cases, the assailant was known to the victim in 113 cases (61.7%). Of the patients, 78.7% had a final acuity of <3/60 in the traumatised eye. CONCLUSION: A significant number of open globe injuries due to assault are related to ethanol abuse and occur when the victim and assailant are known to each other. Such injuries are likely to have a poor prognosis.

Herpetic ulcer of the eyelids in an immunocompromised patient.

A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ulcerative lesion of the right upper and lower eyelids. She was on treatment for pulmonary tuberculosis and had been admitted to a secondary level hospital. She had no other ocular symptoms or signs. A tissue biopsy of the lesion revealed multinucleate squamous cells with ground glass viral nuclear inclusion bodies, indicative of herpes simplex virus (HSV) infection. The ulcer healed with oral and topical acyclovir therapy, confirming a herpetic origin. There is only one other reported case of this type of ulcerative eyelid lesion caused by HSV; the patient in this case was also immunocompromised.

Primary health eye care knowledge among general practitioners working in the Cape Town metropole

Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly; and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general. Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions; including a self-assessment section; was sent to each of 140 randomly chosen GPs in Cape Town. Results: A response rate of 79.2 was obtained. Respondents included graduates from all eight medical schools in South Africa. Most of the responding GPs were practising for more than 10 years (78.2). The mean test score was 52.5 (standard deviation [SD]: 22.2). The mean self-rating was 51.9(SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9 of them would attend such courses. Also; 82 of GPs felt that primary care doctors; not optometrists; should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems; presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology

Primary Health Eye Care Knowledge among General Practitioners Working in the Cape Town Metropole

The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly; and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general.Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions; including a self-assessment section; was sent to each of 140 randomly chosen GPs in Cape Town.Results: A response rate of 79.2). The mean test score was 52.5 (standard deviation [SD]: 22.2). The mean self-rating was 51.9 (SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9 of them would attend such courses. Also; 82 of GPs felt that primary care doctors; not optometrists; should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems; presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology