Pattern of Ametropia, Presbyopia, and Barriers to the Uptake of Spectacles in Adult Patients Attending a General Hospital in Kaduna State.

Aim: The aim of the study was to assess the pattern of ametropia, presbyopia, and the barriers to the uptake of spectacles among adult patients attending Hajiya Gambo Sawaba General Hospital (HGSGH), Zaria, Nigeria. Materials and Methods: This study was a descriptive hospital-based study. The study population was selected by systematic sampling over a 3-month period (July-September, 2016). A questionnaire was administered for sociodemographic data, patients' history, and refraction. Patients with visual acuity less than 6/12 or who required at least +1.00DS to read N8 were given spectacle prescriptions and assessed after 2 months to confirm if they purchased the spectacles. Results: Two hundred and nine patients were assessed: 124 (59.3%) females and 85 (40.7%) males. The age ranged from 18 to 75 years with a mean of 45.5. One hundred and seventy-five (83.7%) had ametropia, 100 (47.8%) had presbyopia, and patients having both were 66 (31.6%). Astigmatism was the most common ametropia, 118 (67.4%), followed by hypermetropic astigmatism 33 (18.9%) and myopia 24 (13.7%). Only 97 (46.6%) patients purchased their spectacles, and 92 of them were using their spectacles. One hundred and twelve (52.2%) patients did not buy their spectacles, with cost being most common barrier to the uptake of spectacles. Conclusion: There is a high burden of ametropia and presbyopia among patients attending HGSGH, Zaria. Cost of spectacles and 'no felt need' were found to affect spectacle uptake. Health information and availability of low-cost spectacles are important strategies in reducing the burden of uncorrected ametropia and presbyopia in Kaduna State.

Ocular Morbidity Among Children With Protein Energy Malnutrition in Northwest Nigeria.

Background: Protein energy malnutrition (PEM) remains a major health challenge in Nigeria, especially Northern Nigeria. Its association with ocular morbidity and irreversible blindness has been previously documented. There are however limited recent literature on these ocular manifestations, which may have evolved over the years. This study is thus relevant to establish a current baseline for the ocular manifestations associated with PEM in Northern Nigeria. Materials and Methods: This was a comparative, cross-sectional study. The sample size was 400 children; 200 with PEM, and 200 without PEM. Consenting parents with children between 6 - 59 months of age diagnosed with PEM, and those without PEM were recruited. Sociodemographic characteristics, general and ocular history were documented. A detailed ocular examination which included visual acuity assessment, examination of ocular adnexae, as well as the anterior and posterior segment of the eyes were done. Data was collected in a structured proforma, and analysed with the SPSS version 21, and Windows WinPepi softwares. Results: Abnormal ocular findings were significantly higher in the PEM group compared to the non-malnourished group [46.5% vs 24%, OR = 2.910 (1.891, 4.477), p = < 0.001]. The predominant ocular examination findings in the PEM and non-malnourished groups were infective conjunctivitis (35.5% vs 17%), lid oedema (11% vs 0%), signs of xerophthalmia (6% vs 0%) and visual impairment (3% vs 0%). Conclusion: PEM is still complicated by varying severity of ocular morbidity, with the potential of progression to irreversible blindness.

Prevalence and Spectrum of Eye Disorders Among Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus in a Tertiary Hospital in Northern Nigeria.

Purpose: The aim of this study was to determine the spectrum of eye disorders in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Materials and Methods: A cross-sectional hospital-based study was conducted among 100 consecutive patients with RA and SLE. A semi-structured questionnaire was used to obtain details of patients' sociodemographics, type of rheumatic disease, and prescribed medications. Each patient had a detailed examination of the anterior and posterior segments of the eye. Refraction, intraocular pressure measurement, Schirmer's test, tear breakup time, gonioscopy, and dilated fundoscopy were also done. Fundus photograph, central visual field assessment, and optical coherence tomography were done as necessary. Analysis was done with the Statistical Package for Social Sciences (SPSS) version 25. Statistical significance was set at P < 0.05. Results: A total of 100 patients consisting of 74 RA and 26 SLE patients were evaluated. The female: male ratio was 4.3: 1 for RA, and all SLE patients were females. The prevalence of eye disorders was 42% in all patients; it was 41.9% and 42.3% among RA and SLE patients, respectively. The most common eye disorders were dry eye (38), refractive errors (18), and cataract (16). The mean age of RA patients with eye disorders (52.19 ± 16.17 years) was significantly higher than those without eye disorders (42.30 ± 13.14 years) (P = 0.005). Conclusion: Eye disorders are common in RA and SLE. Comprehensive eye examination should be done on all RA and SLE patients at diagnosis and before commencement of medications, and patients should be referred promptly for evaluation when they have eye complaints.

Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020.

OBJECTIVES: Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria. DESIGN: Descriptive case study. SETTING: Neonatal intensive care units in Nigeria. PARTICIPANTS: Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria). METHODS AND ANALYSIS: A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. RESULTS: In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems. CONCLUSION: ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential.

Congenital Orbital Teratoma: A Case Report.

Teratomas are germ cell tumors that may contain several tissues derived from one or more of the three germ layers. Congenital orbital teratomas are rare. We report a case of congenital orbital teratoma in a 7-h-old male neonate who was noticed to have periocular swelling and progressive proptosis of the left eye at birth. Orbital teratoma was suspected based on the clinical presentation and imaging findings. Treatment was conducted by modified exenteration, and the diagnosis was confirmed histologically as mature teratoma.

Ease and Willingness to Use Smartphone Applications for Visual Acuity Assessment Among Patients in Ahmadu Bello University Teaching Hospital, Zaria.

Background: Smartphone applications (apps) are increasingly becoming more popular for medical use. Aim: The aim of this article is to determine the willingness and ease of using smartphone apps for visual assessment among adult patients attending the general outpatient ophthalmology clinic of Ahmadu Bello University Teaching Hospital, Zaria in Nigeria. Design: The study was a hospital-based descriptive cross-sectional design. Materials and Methods: New and old adult patients who presented at the clinic and consented to the study were selected. Visual acuity assessment was done using a 6-m Snellen chart and three selected Smartphone visual acuity applications sequentially. A semi-structured questionnaire was used for data collection and then analysed using SPSS version 23. Results: A total of 287 patients were studied. Majority (96%) of the patients found the Smartphone apps to be easy to use. A good proportion (76%) of the patients also believed that Smartphone charts were easier to use than the conventional Snellen chart and expressed willingness to use the app again. Conclusion: Smartphone visual acuity apps could offer a convenient, easy-to-learn, and easy-to-use means of visual acuity assessment. This coupled with the demonstrated patient's willingness to embrace this technology could be used to encourage the use of clinically validated apps for the early detection as well as monitoring of any impairment of vision, especially in out-of-clinic situations.

Prevalence of Diabetes Mellitus and Diabetic Retinopathy in Persons 50 Years and Above in Katsina State Nigeria: A Population-based Cross-sectional Survey.

PURPOSE: To estimate the prevalence and magnitude of diabetes mellitus and diabetic retinopathy among people with diabetes mellitus in Katsina State. METHODS: A population-based cross-sectional study of persons aged 50 years and over in Katsina State Nigeria based on the rapid assessment of avoidable blindness survey plus diabetic retinopathy methodology. The study was conducted in November and December 2018. RESULTS: A total of 2,653 of the 2,807 (94.5%) enrolled persons were examined. The unadjusted prevalence of diabetes was 3.3% (95% CI: 2.7-4.1) with females having higher risk of having diabetes than males (OR 1.04; (95% CI 1.00-1.07; P = .03). The age-sex adjusted magnitude of diabetes mellitus is 15,492 persons in the study population, but 60% of the people are unaware of their disease status. The proportion of people with diabetes mellitus and any retinopathy is 26.2% (95%CI: 14.4-31.6); 15.8% in males and 35.7% in females. The proportion of people with diabetes mellitus with any maculopathy is 12.5% (95% CI: 6.9 - 21.5). The proportion of people with diabetes mellitus having any retinopathy and/or maculopathy is 26.2% while that of a sight-threatening lesion is 7.5%. CONCLUSION: The burden of diabetes and diabetic retinopathy in the population is lower than national average and elsewhere. However, there is still need to establish a simple cost-effective diabetic retinopathy service for the population as the burden of the problem will only increase with time.

Prevalence and causes of blindness and visual impairment; and cataract surgical services in Katsina state of Nigeria.

AIM: To generate data on blindness and visual impairment for planning and monitoring a comprehensive eye care programme in Katsina state of Nigeria. METHOD: A rapid assessment of avoidable blindness (RAAB) survey methodology was used to select 3120 persons aged 50 years and over. The sample was selected using a multistage cluster randomised sampling. Each participant had visual acuity and lens assessment. Persons with vision less than 6/12 in any eye were assessed for the cause of visual impairment. Persons with cataract were asked why they had not had surgery. Data were captured electronically with the mRAAB Android-based software and analysed with STATA V.14 software. RESULTS: A response rate of 90.1% was achieved. The age-sex adjusted blindness prevalence was 5.3% (95% CI 5.2% to 5.3%). Women were 30% more likely to be blind (OR 1.3, 95% CI 1.2 to 1.3). The principal causes of blindness were cataract (70%), other posterior segment (12%) and glaucoma (7%); 86.7% of blindness was avoidable. The prevalence of cataract blindness is 2.6% (95% CI 2.5% to 2.6%) with higher odds in women (OR 1.2, 95% CI 1.2 to 1.3, p<0.005). The cataract surgical coverage <6/60 for persons was 28.2% and women were 45% less likely to have had cataract surgery (OR 0.55, 95% CI 0.34 to 0.78, p<0.005). The major barriers to cataract surgery are lack of felt need and the cost of services. CONCLUSION: Katsina state of Nigeria has high burden of avoidable blindness affecting more women. The state eye care programme should have cataract services that are more accessible, affordable and gender sensitive.

Outcome of cataract surgery in rural areas of Kaduna State, Nigeria.

AIM: To evaluate the visual outcome of all patients who had cataract surgery with intraocular lens implant in five Local Government Areas (LGAs) of Kaduna State and to identify reasons for poor outcome and to proffer suggestions to improve outcome. MATERIALS AND METHODS: A prospective study using the WHO cataract surgery record form to collect data from consecutively screened and operated cataract patients over a period of 18 months (January 2006-June 2007). Data was analysed using Monitoring Catarct Surgery Outcome V2.3 software by the WHO. RESULTS: A total of 690 eyes of 644 patients were operated, ECCE+PCIOL implantation was achieved in 664 (96.2%) while 26(3.8%) had anterior chamber lens implant. The age range was 40 - 99 years and male to female ratio was 1: 0.9. Good outcome was obtained in 239 (34.6%) and 370(53.6%) of patients at 2 and 8 weeks respectively in the postoperative period. Surgical complications like striate keratopathy/corneal oedema (18.3%), cortical reminant (4.2%) and posterior capsular rupture (2.9%), and uncorrected refractive error were identified as reasons for poor outcome. CONCLUSION: A good outcome of greater than 80% at 8 weeks postoperative period was not achieved. Provision of postoperative correction of residual ametropia in the rural community, as well as improved surgical techniques of surgeons, will go a long way to improve the visual outcome and cataract surgery uptake.

Corneal ulcers in a tertiary hospital in Northern Nigeria.

BACKGROUND/OBJECTIVE: To highlight the pattern of corneal ulcers at the Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. MATERIALS AND METHODS: A retrospective review of case notes of patients who presented with corneal ulcer at the Guinness Ophthalmic Unit, Ahmadu Bello University Teaching Hospital between January 1995 and December 2005. Information obtained include demographic data, presenting complaints, predisposing factors, microbiological diagnosis, use of orthodox or traditional medications before presentation, duration before presentation and, presenting and final visual acuity. RESULTS: A total of 228 cases presented within the 10 years study period. There were 129 (56.6%) males and 99 (43.4%) females. The age range was 15 months to 66 years. The commonest presenting complaints was poor vision 109 (47.8%) followed by lacrimation 97 (42.5%) and ocular pains 96 (42.1%). The common predisposing factors were trauma 117 (51.3%), use of traditional eye medications 39 (17.1%), self medication with topical steroids 13 (5.7%) and measles 9 (4.0%). The presenting visual acuity was <6/60 in 49.8% of the patients, <6/18-6/60 in 23.4%, and 6/6-6/18 in 25.5% of the patients. At discharge, 45.6% had a visual acuity of 6/6-6/18, 27.2% had borderline vision (<6/18-6/60), 18.0% had severe visual impairment (<6/60), while 6.6% had no light perception. The commonest organisms isolated were Staphylococcus aureus in 19.7%, fungal hyphae in 15.8% and Streptococcus pneumoniae in 4.8%. CONCLUSION: In this study most patients with corneal ulcer presented with poor vision and excessive lacrimation. Trauma was the commonest predisposing factor with bacterial organisms as the commonest isolate.

Corneal Ulcers in a Tertiary Hospital in Northern Nigeria

Background/Objective: To highlight the pattern of corneal ulcers at the Guinness Ophthalmic Unit; Ahmadu Bello University Teaching Hospital; Kaduna; Nigeria.Materials and Methods: A retrospective review of case notes of patients who presented with corneal ulcer at the Guinness Ophthalmic Unit; Ahmadu Bello University Teaching Hospital between January 1995 and December 2005. Information obtained include demographic data; presenting complaints; predisposing factors; microbiological diagnosis; use of orthodox or traditional medications before presentation; duration before presentation and; presenting and final visual acuity.Results: A total of 228 cases presented within the 10 years study period. There were 129 (56.6) males and 99 (43.4) females. The age range was 15 months to 66 years. The commonest presenting complaints was poor vision 109 (47.8) followed by lacrimation 97 (42.5) and ocular pains 96 (42.1). The common predisposing factors were trauma 117 (51.3); use of traditional eye medications 39 (17.1); self medication with topical steroids 13 (5.7) and measles 9 (4.0). The presenting visual acuity was 6/60 in 49.8 of the patients; 6/18-6/60 in 23.4; and 6/6-6/18 in 25.5 of the patients. At discharge; 45.6 had a visual acuity of 6/6-6/18; 27.2 had borderline vision (6/18-6/60); 18.0 had severe visual impairment (6/60); while 6.6 had no light perception. The commonest organisms isolated were Staphylococcus aureus in 19.7; fungal hyphae in 15.8and Streptococcus pneumoniae in 4.8.Conclusion: In this study most patients with corneal ulcer presented with poor vision and excessive lacrimation. Trauma was the commonest predisposing factor with bacterial organisms as the commonest isolate

An appraisal of common otologic disorders as seen in a deaf population in North-Western Nigeria.

BACKGROUND/OBJECTIVE: Deaf persons are equally susceptible to other otologic diseases as the rest of the population; however, there may be increased morbidity among the deaf population. The aim of the study is to determine common otologic problems and their prevalence among the deaf and to offer treatment where appropriate. MATERIALS AND METHODS: Six hundred and twenty students aged between 5 and 38 years with profound hearing loss were recruited from a special school for the deaf. Hearing level was assessed and full ENT examination including otoscopy was done. RESULTS: 22.4% [139] of the deaf students had otologic diseases, with 69.1% of them having wax impaction and chronic suppurative otitis media and otitis media with effusion accounting for 21.6 and 7.2% respectively. CONCLUSION: The study showed that wax impaction is a common problem and this can be quite uncomfortable for some of the students. A routine general and otologic screening program targeted at the deaf and deaf-blind is recommended.

Efficacy of Garcinia kola 0.5% Aqueous Eye Drops in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension.

PURPOSE: To evaluate the intraocular pressure (IOP) lowering efficacy of Garcinia kola 0.5% aqueous solution eye drops in patients with newly diagnosed primary open-angle glaucoma or ocular hypertension (POAG/OH). MATERIALS AND METHODS: A randomized, double-masked, multicenter, active-controlled prospective study. Patients who met the inclusion criteria were randomly assigned in equal numbers to receive Timolol 0.5% eye drops as a control medication (A = Group 1 eyes) or Garcinia kola 0.5% eye drops as the study medication (B = Group 2 eyes). All drops were instilled at 6 am and 6 pm daily. Goldman applanation tonometry was performed at 9 am, 12 pm and 3 pm at baseline, week-6, week-12 and week-24 visits. Voluntary and actively elicited reports of adverse events were documented. The mean change in IOP over 24 weeks was the primary outcome measure. Both groups were compared for statistically significant differences at all visits. A P < 0.05 was considered statistically significant. RESULTS: A total of 178 patients were randomly assigned to G. kola and Timolol groups. At baseline there were no differences in mean IOP between groups, based on age, sex, or diagnosis. At the end of the study period (24(th) week), the mean (+/- SD) reduction in IOP was 12.93 +/- 2.3 mmHg (47.8% +/- 0.8% reduction) in G. Kola group and 13.09 +/- 2.8 mm Hg (48.2% +/- 1.03% reduction) in the Timolol group (P > 0.05). Adverse events were mild in nature with no statistically significant differences between groups (P > 0.05). CONCLUSIONS: Garcinia kola ophthalmic solution significantly reduces IOP as compared to baseline. The IOP lowering effect of both treatments was equivalent.