Visual impairment and perceptual visual disorders in children with cerebral palsy in Nigeria.

Cerebral palsy (CP) is the most common cause of childhood physical disability globally. This study describes the spectrum of ocular morbidity and visual impairment in a community-based (recruited by key informants) sample of children with CP in Cross River State, Nigeria. METHODS: A paediatric neurologist clinically confirmed CP and assessed systemic comorbidity. Ophthalmological assessment included developmental age appropriate acuity tests, objective refraction and objective and subjective tests of perceptual visual dysfunction (PVD). RESULTS: 388 children aged 4-15 years with CP were identified. Visual problems were reported by carers in only 55 (14%) cases. Binocular visual acuity impairment was seen in 20/201 by Lea symbols test (10%) and 213/388 (55%) by the mirror test. Abnormal visual fields were seen in 58/388 (14.9%); strabismus in 183 (47%) abnormal contrast sensitivity in 178 (46%) and abnormal saccades in 84 (22%), spherical refractive errors in 223 (58%), significant astigmatism in 36 (12%), accommodative dysfunction in 41 (10.6%), optic atrophy in 198 (51%). Perceptual visual disorders were present in 22 (6%) subjectively and 177 (46%) objectively. The estimated frequency of cerebral visual impairment (CVI) in children ranged from 61 (16%) to 191 (49%) if children with optic atrophy were included. CONCLUSION: Children with CP have a wide spectrum of ocular morbidity and visual impairment, underestimated by carers. Children with CP require visual acuity assessments with a range of tests which account for associated comorbidities and oculomotor dysfunction. Functional vision assessments for PVD is important. CVI is common.

Cross-Sectional Study on the Coping Strategies Among Glaucoma Patients Attending a Secondary Eye Clinic in Calabar, Nigeria.

PURPOSE: The major objective of this cross-sectional study was to examine the coping strategies of glaucoma patients at a secondary eye care unit with a view to deciding whether an intervention programme would be justified. PATIENTS AND METHODS: The coping styles of 130 consenting adult glaucoma patients aged 18 years and above who were being treated for glaucoma in the Cross River State Eye Care Programme clinic in Calabar, Nigeria, were investigated by means of the 28-item Brief-COPE inventory in this descriptive cross-sectional study. RESULTS: The mean age of the participants was 54.2 years (±14.3) while almost three quarters (73.8%) of them were married. About four out of every five persons examined (81.5%) had a minimum of primary education. "Substance (alcohol and other drug) use", "self-blame" and "behavioural disengagement" are coping styles that were reported by 33%, 42% and 42% of the participants, respectively. This group of patients should be identified in the clinic for appropriate psychological intervention. CONCLUSION: The present study confirms previous findings and contributes additional evidence that suggests that coping strategies should be considered in the holistic management of glaucoma patients. The information from the current study can be used to develop targeted interventions aimed at improving the coping styles of glaucoma patients.

Visual status of special needs children in special education schools in Calabar, Cross River State, Nigeria.

OBJECTIVE: The objective of this study was to determine visual status of children with special needs attending special schools in Calabar, Cross River State, Nigeria. SUBJECTS AND METHODS: A cross-sectional study of all children with special needs attending special education schools in Calabar Municipal Local Government Area, Cross River State, was performed. Data were obtained using interviewer-administered questionnaires on the caregivers and ocular examination of the children which included visual acuity, refraction, ocular alignment and motility tests and funduscopy. Data analysis was performed using the Statistical Package for the Social Sciences version 20. RESULTS: A total of 161 children with special needs out of the 176 enrolled were examined yielding a 91.5% response rate. The male-to-female ratio was 1.2:1. Their age range was 5-17 years with the mean age of 12.9 ± 3.3 years and a modal age group of ≥13 years. Twenty (12.4%) had visual impairment (VI). Uncorrected refractive error accounted for 12 (60%) of the VI. Children with learning disability (odds ratio [OR]: 3.28 and 95% confidence interval [CI]: 1.73-6.36) and developmental disability (OR: 1.90 and 95% CI: 1.10-3.20), respectively, had significantly higher occurrence of VI. Of the 161 children examined, only 11 (6.8%) have had their visual status assessed in the past. CONCLUSION: Children with special needs had higher prevalence of VI; however, only a few have had an assessment of their visual status in the past.