Pachydermoperiostosis with bilateral ptosis and its associated systemic comorbidities: a rare case report.

Pachydermoperiostosis is a rare genetic disease known as primary or idiopathic hypertrophic osteoarthropathy (HOA)/Touraine-Solente-Gole syndrome. It is an autosomal dominant or recessive disorder comprising digital clubbing, periostosis, hyperhidrosis, and pachydermia (thickening of facial skin). Ocular manifestations are uncommon; however, blepharoptosis may occur. This case presented with severe bilateral ptosis due to the disease progression. A large 20 mm upper lid resection with levator advancement was performed to improve his ability to see. This is the first reported case of pachydermoperiostosis (PDP) in Jamaica. We present a rare case of pachydermoperiostosis with severe blepharoptosis, who attained a good result with surgical intervention.

Vision-related quality-of-life in Jamaican glaucoma patients at Kingston Public Hospital.

AIM: To determine the vision-related quality-of-life of glaucoma patients and the association between clinical and socioeconomic factors, and vision-related quality-of-life. METHODS: This was a cross-sectional study. Consecutive patients with glaucoma were interviewed using a modified 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) by a single interviewer. Statistical analysis was done to find associations between patient variables and vision-related quality-of-life scores. Confidentiality and anonymity were maintained. RESULTS: Ninety-six participants were recruited in the study. There were 44 males and the mean age for males and females was 65.7 and 69.5y, respectively. The mean composite score was 71.2 (with a maximum possible score of 100), with the highest mean score in the colour vision subscale (89.8) and the lowest mean score in the driving subscale (34.0). Worse visual acuity (P<0.001), longer duration of glaucoma (P<0.001) and higher number of glaucoma medications (P<0.001) were associated with a worse composite score. Female participants and those who lived in urban areas had significantly better scores than male participants (P=0.002) and those who lived in rural areas (P=0.017), respectively. CONCLUSION: The vision-related quality-of-life in Jamaican glaucoma patients is comparable to that of glaucoma patients in the Barbados Eye Study and other international studies using the VFQ-25 questionnaire. Worse quality-of-life scores are associated with poorer visual acuity, longer duration of glaucoma, more glaucoma medications, and sociodemographic factors such as male gender and rural residence.

An unusual cause of visual loss: Subfoveal, motile angiostrongyliasis.

This is a short report describing the clinical presentation, investigations, treatment and outcome of a patient living in the Jamaican countryside who was diagnosed with a live, motile subfoveal helminth identified as Angiostrongylus cantonensis on optical coherence tomography at the University Hospital of the West Indies Eye Clinic. This is the second documented case in Jamaica. Early recognition of angiostrongyliasis is important as it may manifest as eosinophilic meningitis which can be fatal without prompt treatment.

Knowledge, beliefs and practices regarding sickle cell eye disease of patients at the sickle cell unit, Jamaica.

INTRODUCTION: Sickle cell disease can result in visually threatening eye disease (proliferative sickle cell retinopathy). This can be prevented with timely eye screening. It is important for patients to understand their role. Our research is to determine the knowledge, beliefs and practices (KBP) regarding eye disease of Sickle Cell patients and the impact of genotype, demographic and socio-economic status. METHODS: Cross-sectional study at the Sickle Cell Unit, Jamaica during May 2016. Consecutive non-pregnant adults (>18 years of age) attendees, who were not acutely unwell, were invited to participate. A 26-item single interviewer administered questionnaire was used to obtain socio-demographic data, highest level of education completed, employment status, sickle cell genotype, if known, frequency of clinic attendance and patients' knowledge, beliefs and practices. Ten of these were yes/no questions, whereas eight required that they choose correct answers from four choices. RESULTS: One hundred subjects were recruited, 72% had homozygous SS disease. Their ages ranged from 18-63 years (mean 34.1 years, SD11.3). Fifty six percent were female. Most (75%) had achieved at least secondary education. The majority (62%) were unemployed. The mean belief score was 3.6/6(60%) and the mean knowledge and practice scores were 3.3/7(47%) and 2.2/5(44%) respectively. Milder genotypes had higher knowledge scores vs the more severe genotypes (4.0 vs 3.2, P=0.013). Only 28% had regular eye examinations; less than 50% had seen an ophthalmologist in the past year. Practice scores were higher in employed than in unemployed patients (2.6 vs 1.9, (P=0.04)). Employed patients were more likely than the unemployed to see their eye doctor for regular eye "examinations" (42.1% vs 19.4%, χ2=6.0, P=0.02). The practice and knowledge scores correlated (r2=0.363, P<0.001) and belief score (r2=0.304, P =0.002), except where 98% believed they should see an ophthalmologist annually, but only 42% did, and 21% had never. CONCLUSION: Knowledge scores were fair, however, the practice was not always in keeping with knowledge.

Ophthalmomyiasis externa due to sheep nasal botfly in rural Jamaica.

We present the case of a young male patient who presented with pain, redness and foreign body sensation in his left eye. There was no associated decrease in vision. Three live larvae were removed from his left conjunctival sac and sent to the laboratory for identification. The patient was treated symptomatically and his symptoms were mostly resolved by the following day. The larvae were later identified as the first instar of the sheep nasal botfly. Poor sanitation and exposure to livestock were among the identified risk factors in this case. Physicians must have this as a differential diagnosis for conjunctivitis in patients with risk factors. This is the first reported case of ophthalmomyiasis from Jamaica.

Computer vision syndrome and ergonomic practices among undergraduate university students.

AIM: To determine the prevalence of computer vision syndrome (CVS) and ergonomic practices among students in the Faculty of Medical Sciences at The University of the West Indies (UWI), Jamaica. METHOD: A cross-sectional study was done with a self-administered questionnaire. RESULTS: Four hundred and nine students participated; 78% were females. The mean age was 21.6 years. Neck pain (75.1%), eye strain (67%), shoulder pain (65.5%) and eye burn (61.9%) were the most common CVS symptoms. Dry eyes (26.2%), double vision (28.9%) and blurred vision (51.6%) were the least commonly experienced symptoms. Eye burning (P = .001), eye strain (P = .041) and neck pain (P = .023) were significantly related to level of viewing. Moderate eye burning (55.1%) and double vision (56%) occurred in those who used handheld devices (P = .001 and .007, respectively). Moderate blurred vision was reported in 52% who looked down at the device compared with 14.8% who held it at an angle. Severe eye strain occurred in 63% of those who looked down at a device compared with 21% who kept the device at eye level. Shoulder pain was not related to pattern of use. CONCLUSION: Ocular symptoms and neck pain were less likely if the device was held just below eye level. There is a high prevalence of Symptoms of CVS amongst university students which could be reduced, in particular neck pain and eye strain and burning, with improved ergonomic practices.

Knowledge, Beliefs and Practices of Patients with Diabetic Retinopathy at the University Hospital of the West Indies, Jamaica.

To determine the knowledge, beliefs and practices of patients with diabetic retinopathy attending the Retina Eye Clinic at the University Hospital of the West Indies. A prospective study was done using a questionnaire with a sample population of 150 patients. The questions included their knowledge about the frequency of their eye examination, the relevance of exercise and a healthy diet, the role of the ophthalmologist and their views on the importance of compliance with medications for diabetes and hypertension. One hundred and fifty patients were recruited. Sixty six percent (99/150) were females and 34 % (51/150) males. The ages ranged from 29 to 83 years (mean ± SD, 56.1 ± 10.3) years. Type II diabetes was more common; 63 and 79 % of females and males respectively. A minority (19.8 %) obtained tertiary education. The mean % knowledge scores were 86 ± 14 for males and 82.8 ± 16.4 for females (p = 0.260). Prior to attending the retina clinic, 50 % were unaware of the need for annual eye examinations. Compliance with medication, exercise and a special diet was seen in 73, 40.3 and 49.7 % respectively. Current knowledge scores were good. However, knowledge about the timing and frequency of eye examinations prior to attending the retina clinic was inadequate. Correct knowledge and beliefs did not correspond to a high level of compliant practices.

Chikungunya in the Caribbean: An Epidemic in the Making.

Chikungunya is a mosquito-borne virus that has shown increased prevalence in the Caribbean since October 2013. There have been several outbreaks throughout Asian and African countries over the past few decades with global travel and tourism having a major impact on the further spread of this disease. Improved policies and practices for preventative measures and epidemiological surveillance must be implemented to prevent the continued transmission of chikungunya.

Diabetic retinopathy and its risk factors at the university hospital in Jamaica.

PURPOSE: To determine the frequency of diabetic retinopathy and its risk factors in diabetic patients attending the eye clinic at the University Hospital of the West Indies (UHWI). MATERIALS AND METHODS: This was a prospective cohort study of diabetic outpatients attending the Eye Clinic at the UHWI. Data were collected on age, gender, type of diabetes mellitus (DM), type of diabetic retinopathy, other ocular diseases, visual acuity, blood glucose and blood pressure. RESULTS: There were 104 patients (208 eyes) recruited for this study. There were 58.6% (61/104) females (mean age 53.6 ± 11.9 years) and 41.4% (43/104) males (mean age 61.7 ± 12.1 years). Type II DM was present in 68.3% (56% were females) of the patients and Type I DM was present in 31.7% (69.7% were females). Most patients (66%) were compliant with their diabetic medications. The mean blood glucose was 11.4 ± 5.3 mmol/L. Elevated blood pressure (<130/80) was present in 82.7% of patients. The mean visual acuity was 20/160 (logMAR 0.95 ± 1.1). The frequency of diabetic retinopathy was 78%; 29.5% had background retinopathy, and 50.5% of eyes had proliferative diabetic retinopathy (PDR) of which 34% had tractional retinal detachments. The odds ratio of developing PDR was 1.88 (95% confidence intervals (CI): 1.02-3.3) for Type I DM compared to 0.74 (95% CI: 0.55-0.99) for Type II DM. PDR was more prevalent in females (χ(2), P = 0.009) in both Type I and II DM. CONCLUSIONS: Jamaica has a high frequency of PDR which is more common in Type I diabetics and females. This was associated with poor glucose and blood pressure control.

Sphenoidal sinus mucocele presenting with acute visual loss in a scuba diver.

A 43-year-old male scuba diver presented with an acute history of painful unilateral visual loss after scuba diving. He had right-sided retrobulbar pain and headache. He was known to have sinusitis and had transient visual loss in two previous episodes after scuba diving. His visual acuity was hand motions and 20/20 in the right and left eye, respectively. There was no proptosis. He had a right relative afferent pupillary defect. Colour vision was normal in the left eye and absent in the right eye. Fundal examination revealed healthy discs and macula bilaterally. He was assessed as a right optic neuropathy, possibly secondary to compression. An MRI of the brain revealed a large sphenoidal mucocele extending into the right optic foramen. He was treated with oral steroids, antibiotics and nasal decongestants. He underwent endoscopic intranasal sphenoidectomy and marsupialisation with return of his visual acuity to 20/25 in that eye.

Anaesthesia for phacosemulsification surgery: is it as comfortable as we think?

We report an observational prospective study to determine which local anaesthetic technique gave the most comfort during phacoemulsification (cataract) surgery. 1835 patients were recruited. 61.8% were female. Peribulbar (18.2%), subtenons (28.6%), and topical (53.2%) anaesthesia was used. The pain score was assessed by the visual analogue pain scale (VAPS) which ranged from 0 (no pain) to 10 (worse possible pain). The lowest mean pain score occurred in the subtenons group, mean VAPS 0.2 (95% CI 0.1-0.3). The mean pain scores for topical and peribulbar anaesthesia were 0.6 (95% CI 0.5-0.7) and 0.59 (95% CI 0.41-0.76) respectively. Subtenons anaesthesia gave the most comfort during phacoemulsification. Patients experienced more discomfort with 2nd eye surgery. Older patients and males had a higher pain threshold in all three anaesthetic groups.

Ocular morbidity of traumatic hyphema in a Jamaican hospital.

PURPOSE: To determine the outcome of patients with hyphema secondary to ocular contusion. METHOD: A retrospective review of the ophthalmic records of 44 consecutive patients with traumatic hyphema secondary to ocular trauma presenting to the Eye Clinic of the University Hospital of the West Indies between May 2004 and November 2007. RESULTS: The mean age was 21 years (95% confidence interval [CI] 16.4-25.5 years). Follow-up ranged from 2 weeks to 22 months. The most common mechanism of injury was impact by a missile and 41% occurred at home. The mean visual acuity at presentation was logMAR 1.85 (95% CI 1.4-2.3) and at 3 months improved to logMAR 0.63 (95% CI 0.3-1.0). The presenting intraocular pressure (IOP) ranged from 7-64 mmHg with 45.4% (20/44) having IOP of greater than 21 mmHg; 18% had the sickle cell trait. A total of 72.7% of patients presented with a grade I hyphema. Surgical intervention was indicated in 20.5% (9/44), which included anterior chamber paracentesis/washout and trabeculectomy. The most frequent complications were secondary glaucoma (32.4%), angle recession (23.5%), cataract (20.6%), and commotio retinae (20.6%). In the sickle cell group, 80% presented with elevated IOP (29-64 mmHg) and 70% had complications. A total of 94.7% of patients had an IOP <21 mmHg at 3 months. CONCLUSIONS: Traumatic hyphema is a recognized cause of significant visual disability. Improved visual acuity was attained after 3 months. The presenting visual acuity correlated with the visual prognosis. Patients with posterior segment complications tended to have poorer visual outcomes. The presence of the sickle cell gene increased the risk of secondary glaucoma.

Sustained visual recovery after treatment with intrathecal methotrexate in a case of optic neuropathy caused by chronic lymphocytic leukemia.

A 68-year-old woman with chronic lymphocytic leukemia (CLL) had acute optic neuropathy associated with cerebrospinal fluid evidence of meningeal spread of CLL. There was no evidence of a hematologic relapse. After undergoing four weekly doses of intrathecal methotrexate, vision improved dramatically and spinal fluid became normal. Four years later, she has near normal vision in the affected eye and remains in hematologic remission. This is the first reported case of successful treatment of optic neuropathy in CLL with intrathecal methotrexate alone.