Prevalence and Determinants of Ocular Disorders among in-School Children with Physical and Mental Disabilities in Osun State, South West Nigeria.

PURPOSE: This study set out to determine the prevalence and the factors contributing to ocular disorders among children with physical and mental disabilities, who represent a vulnerable group in Osun State. METHODOLOGY: This was a cross-sectional study among children with physical and mental disabilities aged 5-17 years using a multistage sampling technique. Demographics, presence of ocular symptoms and determinants of ocular disorders were noted. Distant visual acuities were measured; refraction and ocular examination were performed. Appropriate drug treatment, prescribed spectacle or low vision aids were dispensed as necessary, at subsidized rates. RESULTS: Of 189 children enrolled, 103(54.5%) were males and 86(45.5%) were females, with male to female ratio of 1.2:1. Mean age was 14.7 ± 0.45 years and 28/189 (14.8%) had ocular disorders in either eye. Some of the participants had multiple pathologies. The commonest identified visual disorder was refractive error (11.1%). There was a statistically significant ocular disorder determinant among most mothers of respondents (82.1%) who had ocular disorders and did not receive antenatal care in the hospital, p<0.05. Only 28.6% of children who had ocular disorders were fully immunized. CONCLUSION: The majority of mothers of children with ocular disorders did not receive antenatal care in the hospital. Health education on the importance of early antenatal care in the hospital is advocated to reduce the occurrence of ocular disorders. Early assessment and correction of ocular problems will prevent unnecessary visual impairment in these vulnerable children.

OBJECTIF: Cette étude visait à déterminer la prévalence et les facteurs contribuant aux troubles oculaires chez les enfants présentant des handicaps physiques et mentaux, qui représentent un groupe vulnérable dans l'État d'Osun. MÉTHODOLOGIE: Il s'agissait d'une étude transversale menée auprès d'enfants atteints de handicaps physiques et mentaux âgés de 5 à 17 ans, utilisant une technique d'échantillonnage à plusieurs niveaux. Les données démographiques, la présence de symptômes oculaires et les déterminants des troubles oculaires ont été notés. Les acuités visuelles à distance ont été mesurées ; la réfraction et l'examen oculaire ont été effectués. Un traitement médicamenteux approprié, des lunettes prescrites ou des aides à la basse vision ont été délivrés au besoin, à des tarifs subventionnés. RÉSULTATS: Sur 189 enfants inscrits, 103 (54,5 %) étaient des garçons et 86 (45,5 %) étaient des filles, avec un ratio garçons/filles de 1,2:1, âge moyen de 14,7 ± 0,45 ans ; tandis que 28/189 (14,8 %) présentaient des troubles oculaires dans l'un ou l'autre des yeux. Certains participants avaient plusieurs pathologies. Le trouble visuel le plus fréquemment identifié était l'erreur réfraction (11,1 %). Il y avait un déterminant de trouble oculaire statistiquement significatif chez la majorité des mères des répondants (82,1 %) qui avaient des troubles oculaires et n'avaient pas reçu de soins prénatals à l'hôpital p<0,05. Seulement 28,6 % des enfants présentant des troubles oculaires étaient entièrement immunisés. CONCLUSION: La plupart des mères d'enfants atteints de troubles oculaires n'ont pas reçu de soins prénatals à l'hôpital. Une éducation sanitaire sur l'importance des soins prénatals précoces à l'hôpital est préconisée afin de réduire l'occurrence des troubles oculaires. L'évaluation précoce et la correction des problèmes oculaires préviendront une atteinte visuelle inutile chez ces enfants vulnérables. MOTS-CLÉS: Trouble oculaire, Prévalence, Enfants en âge scolaire, Handicaps physiques et mentaux.

Screening for eye diseases in a University community in Southwest Nigeria

Background ­ University, a subset of the general population, will expectedly have common ocular problems as prevalent in the population. Knowing these problems as done through screening and health education during WSD activities in 2017 thus raise awareness for their prevention. This study was aimed at determining the types of eye defects in a university community. Methodology ­ A descriptive cross-sectional survey utilizing purposive serial selection to examine inhabitants of a university community. Socio-demographic information and detailed ocular examinations were carried out. Data analysis using SPSS Version 20 and cross tabulations with statistical significance derived using paired sample t-test at p values < 0.05 were done. Results ­ With n=140, 79(56.4 %) were males. Mean age was 26.7 + 11.5years. Majority were staffs (77.1%) with 62.1% having tertiary education. Normal vision was reported in (92.9%), while 5.7% had visual impairment with 1.4% uniocular blindness. Common ocular findings were allergic conjunctivitis (12.9%), glaucoma suspects (10.0%), Pterygium (3.6%), glaucoma/corneal opacity (2.1% respectively), and optic atrophy (1.4%). Conclusion ­Disorders seen were mostly avoidable. Incorporating eye health services into University Healthcare will control their occurrence allowing optimal job performance.

Banger-Related Ocular Injuries During New Year Festivities in Osogbo, SW Nigeria.

BACKGROUND: Different types of ocular injuries could be sustained following banger explosives. This case report could be the first of such reports in West Africa. CASE DETAILS: We report cases of ocular injuries caused by bangers. This was a hospital-based study of 3 consecutive cases that presented during the New Year festival. Injuries were classified according to Birmingham eye trauma terminology system (BETTS). Two of the patients ended up with irreversible loss of vision. Another two of the three were bystanders. CONCLUSION: As banger-related ocular injuries result in significant morbidity, public education regarding the proper use of bangers would help in preventing the incidence of ocular injuries and blindness. Advocacy for a strict legislation to regulate its use is strongly recommended.

Couching techniques for cataract treatment in Osogbo, South west Nigeria.

BACKGROUND: Couching is still being practised in developing countries including Nigeria despite its adverse effects on vision. OBJECTIVES: To find out the different techniques of couching, highlight the unacceptable poor visual sequelae and assess knowledge, attitudes, and practices of subjects. SETTINGS AND DESIGN: Clinic based and prospective observational study. METHODS AND MATERIAL: Structured interview and clinical examination of consecutive patients was used to obtain information. RESULTS: Fifteen subjects and 20 eyes of 9(60%) males and 6(40%) females were studied. Age range 60 -90 years and mean 72.4±8.0. Commonest presenting complaints were "I cannot see properly/clearly" 4(26.7%) and "I want to do my second eye so I can see better" 3(20%). Presenting Versus (vs.) Corrected visual acuity (VA) was75% vs 60% blind, 55% vs 45% low vision, and 0% vs 10% normal vision, p= 0.032. Friends and neighbours mostly introduced subjects to couching (26.7% each). Commonest methods involved using sharp objects/needling 45% and blunt/grooving/rocking methods (30%). Subjects assumed "supine" position 75% of time. Eighty five percent of eyes were done at the coucher's. Procedure was painful in 73.3%. Only 5 eyes (25%) maintained vision for >10years. Thirteen (86.7%) said "no" to a repeat procedure and 93.4% would advice against couching. CONCLUSIONS: Couching methods used were very crude and archaic with attendant poor quality of vision and dissatisfaction. Public education, affordable and accessible cataract surgical services taken to the rural communities could gradually phase out couching.

Ocular status of commercial drivers in Osun State, Nigeria.

AIMS/OBJECTIVES: To determine the ocular status of commercial vehicle drivers in Osun State, Western Nigeria and highlight the effect on safety on the road. DESIGN: A cross-sectional-survey utilizing a multistage-random-sampling-technique done between May and June 2004. PARTICIPANTS: 99 consenting commercial vehicle drivers, registered with NURTW, Osogbo. Motorcyclists and non-registered NURTW drivers were excluded. METHODS: Clearance from LAUTECH Teaching Hospital's (LTH) ethical committee and informed consent obtained. Structured questionnaire and complete eye examination with vision test was done in the clinic. Driving test and ability to read number plates from a distance of 20.5m before and after dilatation were done in the hospital premises. RESULTS: Mean age of the subjects was 45.9 years (SD 7.7). Prevalence of visual impairment was 6.1%.and of failed driving test was 6.1%, while, uniocular blindness was 5.1%. Pupillary dilatation significantly reduced both ability to drive and to read number plate p < 0.05. Road traffic accident was associated with visual impairement, field loss, protan colour deficiency, cup:disc ratio > 0.5, and intraocular pressure > 21 mmHg. RTA was less likely among those who could read number plates (OR = 0.51). Prevalence of cataract was 24.3%, pterygia 20.7%, cornea opacity 6.6% and uncorrected-refractive errors 31.3%, with hypermetropia being most prevalent (19.7%). None had corrective lenses as at time of examination. CONCLUSION: Eye diseases causing uniocular blindness, visual impairment and uncorrected refractive errors were seen to be common among the commercial vehicle drivers. Mandatory, specific-periodic ophthalmological examination for correcting and preventing these are necessary before first issuance and revalidation of driver's license. Health education about eye care is therefore necessary to enhance safety on our roads.

Evaluation of cataract surgery outcome in Western Nigeria.

OBJECTIVE: To evaluate the baseline visual outcome of cataract surgeries and improve on these towards achieving one of the objectives of vision 2020. DESIGN: A retrospective study. SETTING: Hospital-based, utilizing 3 eye centres in Osun State, Nigeria between January 2000 and December 2002. METHODS: Records of 283 hospital-elective-cataract-surgeries only of all ages in 3 centres were evaluated. RESULTS: Mean age was 62.2 years. Fifty-eight 58% were blind before while only 6.3% remained blind post op. With best correction, visual outcome was good in 47.5%, moderate in 37.6% and poor in 15%. The commonest co-morbidity was glaucoma 33 (71.7%). The most common intra operative complications were vitreous loss 61 (27.35%) and posterior capsular rupture (6.28%). Capsular opacity (6.28%) was commonest post operatively with significantly poor visual outcome (χ(2)= 51.46, p-value = <0.05). Causes of poor visual outcome were uncorrected refractive error (59.37%), co-morbidity (24.22%), and surgery related complications (16.41%). Visual outcome was significantly better with IOL or prescribed glasses (χ(2)=19.66, p-value <0.05) and better still with ECCE +IOL (χ(2)=8.46, p-value <0.05). Poor visual outcome was significantly associated with co-morbidity (χ(2) = 23.88, p-value <0.05), surgical complications (χ(2)= 51.46, p-value = <0.05). CONCLUSION: The baseline cataract visual outcome was poor due to delay in correction of refractive error, comorbidities, and surgical complications. Good outcome could be attained by routinely ensuring different methods of adequate postoperative visual rehabilitation. Skills acquisition, availability of adequate equipments, establishment of a good records system to achieve effective evaluation and monitoring of outcome cannot be over emphasized.

Visual standards in commercial driving.

OBJECTIVES: The study was carried out to review the ocular factors involved in road traffic accidents (RTA) in order to reduce associated injuries and possibly suggest a standard for driving. MATERIALS AND METHODS: The study was carried out in the eye clinic of Ladoke Akintola University of Technology Teaching Hospital, Osogbo between May and June 2004. A stratified random sample technique was used to select 99 drivers (198 eyes) from 6 motor park units. Information obtained included age, sex, past history of road traffic accident (RTA), visual acuity and field, colour vision and ability to read number plate tests. RESULTS: Six drivers (6.1%) were visually impaired. There were 5 cases of monocular blindness. Twenty (20.20%) drivers had accidents in the past, 24(24.24%) could not read number plate at 20.5meters, 6 (6.1%) were colour blind while 36 had visual field loss within 120 degrees horizontally. All the six drivers that had visual field loss encroaching within 20 degrees of fixation had accidents in the past. CONCLUSION: This study has shown that there is need to improve on the standard of vision testing before licenses are issued or renewed. Where visual acuity alone is used, it must be done properly by testing one eye at a time. However, a comprehensive eye test using a battery of tests comprising visual acuity, colour vision, visual field and number plate test at 20.5 meters before first issue of driving license and at renewals will be better. Drivers with visual impairment or inability to read number plate test at 20.5 meters should be disqualified from driving commercial vehicles. Drivers with monocular blindness or visual field loss encroaching within 20 degrees of fixation must also not be allowed to drive commercial vehicles. However, further large scale studies will be necessary in order to prove all these propositions scientifically.

Common causes of red eye presenting at an ophthalmic clinic.

BACKGROUND: Redness of the eye is a common ophthalmic symptom. The problem causing redness could arise from within or outside the globe. These range from cases of simple inflammation following itching and minor trauma for example, to severe cases like orbital cellulitis and tumours. Patients may not even be aware of the redness. The aim of this study is to highlight the common causes of red eye as seen in an outpatient department in an ophthalmic set up. This should be of immense help to the general medical practitioners to whom the patients often first present. METHODS: All patients presenting for the first time to Ladoke Akintola University of Technology Teaching Hospital over a four month period were screened. 117 had red eyes and were recruited. 125 eyes were found to be red. The characteristics of the redness were then studied to determine the cause. RESULTS: There was a male preponderance, M : F of 2:1. Persons 45 years and below, were most commonly involved 88 (66.67%). The most frequent cause of red eye was trauma, in 48 (41.03%) patients, followed by allergic conjunctivitis in 29 (24.77%). The main causes of redness differed in different age groups and occupation. There was no case of angle closure glaucoma seen as a cause of redness. CONCLUSION: There are diverse causes of redness of the eye. Persons who are not eye specialists to whom patients with red eyes present first should be conversant with the causes, to know what action to take, especially when to refer to the eye specialist.

Prevalence and causes of blindness and visual impairment among school children in south-western Nigeria.

The aim of the study was to assess the prevalence and identify the causes of blindness and visual impairment in school children of Ilesa-East Local Government Area of Osun State, Nigeria. A total of 1144 school children in primary and secondary schools were selected using a 2-stage random sampling method and examined to determine the prevalence and causes of blindness and visual impairment. A total of 17 (1.48%) children were blind or visually impaired. These comprised of 11 (0.96%) children who were visually impaired and 4 (0.3%) who were severely visually impaired. Only 2 (0.15%) school children were blind. The causes of visual impairment were refractive error 10 (0.87%) and immature cataract 1 (0.08%), causes of severe visual impairment included corneal opacities 2 (0.2%), amblyopia leading to squint 1 (0.08%) and 1 cataract 1 (0.08%). The causes of blindness in school children were corneal scars presumed to be due to vitamin A deficiency 1 (0.08%) and keratoconus 1 (0.08%). Causes of blindness and visual impairment in children attending regular schools in Nigeria were treatable. Prevention, early recognition and prompt treatment of these diseases by regular screening of school children would definitely reduce unnecessary visual handicap in Nigerian school children so that they can attain their full potential in the course of their education. Also, information from this study is relevant for the purpose of planning eye care programmes for the prevention of blindness in Nigerian school children. This will go a long way in the prevention of unnecessary blindness and visual impairment in school children.