Comparing the Use of Smartphone and Vernier Calipers for Corneal Diameter Measurement in Nigerian Term Neonates.

BACKGROUND: Corneal diameter (CD) measurement in newborns is essential for the detection of blinding ocular pathologies. It requires specially trained personnel, contact techniques, and the use of anesthesia. Smartphone use may obviate these challenges. AIM: This study compares CD measurement among newborns using a Smartphone and manual calipers. SUBJECTS AND METHODS: This is a cross-sectional comparative study done at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Consecutively selected stable term neonates whose mothers consented to the study and met the inclusion criteria had their CDs measured with both calipers and smartphones and the values compared. Mean, range, and standard deviation were calculated using Statistical Package for the Social Sciences (SPSS) IBM (version 22), while paired t-test calculated the difference in mean CD measurements between both methods. Pearson's correlation and Bland-Altman's analysis determined the correlation and agreement between both methods, respectively. Inter and intraobserver repeatability were assessed. A P value less than 0.05 was taken as statistically significant. RESULTS: The mean CD measurement using calliper method was 10.01 ± 0.29mm and 10.03 ± 0.24 mm right eye (RE) and left eyes (LE), respectively) for investigator 1 and 10.16 ± 0.25 mm and 10.19 ± 0.21 mm (RE, LE) for investigator 2. Using smartphone measurement, mean CD measurements of 9.98 ± 0.21 mm and 10.00 ± 0.29 mm (RE, LE) were observed for investigator 1 and 10.07 ± 0.19 mm and 10.06 ± 0.21 mm (RE, LE) for investigator 2. The difference in mean CD for both instruments and by both investigators was not statistically significant (P value > 0.05). CONCLUSION: Corneal diameter measurement in neonates using smartphone technology does not deviate significantly from caliper measurement; it is safe, easy to use, and advocated.

Spectacle design preferences among school children in Enugu State, Nigeria.

BACKGROUND: Uncorrected refractive error has profound effects on children's educational and social development and spectacles are cost-effective in correcting this. However, the cosmetic appearance of spectacles may affect compliance to prescribed spectacles. AIMS: This study explored spectacle design preferences of school children in Enugu State, Nigeria and any associated sociodemographic factors. A cross-sectional study among children aged 5-15 years from schools in Enugu state, Nigeria. PATIENTS AND METHODS: The children independently selected from sets of spectacle frames, indicating their preferences on the basis of spectacle frame color, material, shape and size of the lens portion, design of the earpiece portions. Simple descriptive analysis was performed. Frequency tables were generated. Pearson's Chi-square test was used to test associations between categorical variables. Odds ratios were used to measure the strength of the associations where P < 0.05. Tests of significance were set at the 95% level. RESULTS: A total of 1,167 children (45.6% male and 54.4% female) were seen. Majority of the children preferred red colored spectacle frames 467 (40%), plastic frames 723 (62%), rectangular shaped lens-pieces (55.2%), and frames with a straight earpiece 987 (84.6%). There is a strong association between gender and choice of spectacle colour (P < 0.01), gender and lens size preference (P < 0.05), and between school location and shapes of spectacle earpiece (P < 0.01). CONCLUSIONS: Spectacle preferences exist among the study population and some demographic factors are associated with these preferences which should be considered in any childhood refractive error services.

Prevalence of refractive errors and visual impairment in school children in Enugu South-East Nigeria.

AIMS: To determine the prevalence of refractive errors and causes of visual impairment in school children in Enugu State, South-eastern Nigeria. METHODS: A descriptive cross-sectional, school-based survey in children aged 5-15 years from selected primary and junior secondary schools (public and private) in both urban and rural communities of Enugu State was carried out. Ocular examinations were performed on them according to the Refractive Error in School-age Children (RESC) protocol. RESULTS: A total of 1167 children were examined. The mean age (standard deviation) was 10.58 ± 3.0 years. Females were 653 (54.4%) of the study population. The uncorrected, presenting and best-corrected visual acuity of ≤20/40 (6/12) in the better eye of the children in this study were 3.6%. 3.5% and 0.4%. Among the children that had visual impairment, refractive error accounted for 33.3% of reduced vision while the overall prevalence of refractive error was 2.1%. Prevalence of myopia was 1.9% and hyperopia, 0.1%. The most prevalent astigmatism was ≤0.75 dioptre cylinder. CONCLUSION: The prevalence of refractive error in this study is low, with myopia being more common. Despite the low prevalence of refractive error, school vision screening is still important for African children as it serves as an opportunity to identify other ocular morbidities among the children.

Conjunctival bacterial flora and their antibiotic sensitivity among patients scheduled for cataract surgery in a tertiary hospital in south-east Nigeria.

PURPOSE: To determine the pre-operative conjunctival bacteria flora and their antibiotic susceptibility among patients scheduled for cataract surgery. METHODS: A descriptive, cross-sectional, hospital-based study design was adopted. It involved 104 consecutive, consented patients scheduled for cataract surgery at the University of Nigeria Teaching Hospital Enugu, from June to September 2017. The participants' socio-demographic characteristics, medical, and social history were obtained through interviewer-administered questionnaire. Conjunctival swab was obtained from the inferior fornix of the eye scheduled for cataract surgery using sterile swab stick and transported to medical laboratory for analysis. Susceptibility tests were carried out on the representatives of different groups of available antibiotics. Data was analyzed using the SPSS version 23. RESULT: The participants were mainly females (64.4%), married, and farmers, with at least primary school education and a mean age of 64 ± 2SD years. The conjunctival swab bacteria isolation rate was 36.5%. Gram-positive bacteria accounted for 73.7% of the total isolates. Coagulase-negative Staphylococcus (34.2%) was the most frequently isolated bacteria. Gentamicin, ofloxacin, and polymycin B (76%) were the most efficacious antibiotics followed by moxifloxacin and tobramycin (68%) on all the isolates. Ofloxacin (82%) was the most sensitive to Gram positive while gentamicin (90%) was for Gram-negative bacteria. CONCLUSION: In Enugu, the most common pre-operative conjunctival bacteria isolated were Coagulase-negative Staphylococcus with varied antibiotic sensitivity. Routine prophylaxis with gentamicin and ofloxacin is therefore advised to forestall the dreaded post-operative endophthalmitis.

Relationship between corneal biomechanical properties among pregnant women in a tertiary hospital in Nigeria.

OBJECTIVE: In Nigeria, many pregnant women as well as health-care providers are unaware of the effect of pregnancy on the eye. The present study investigated the changes in central corneal thickness (CCT), corneal sensitivity (CS), and intraocular pressure (IOP) among pregnant women in a tertiary hospital in Nigeria and the relationship between them. MATERIALS AND METHODS: A prospective longitudinal study was used. One hundred and thirty-four pregnant women attending the Obstetric Clinic of the University of Nigeria Teaching Hospital, Enugu, were consecutively recruited in their second trimester for the study. Changes in CCT, CS, and IOP were monitored at the second and third trimesters and 6-week postpartum. Data obtained were analyzed using Statistical Package for the Social Sciences version 20. The effect of duration of pregnancy on these variables was determined using simple linear regression and further analysis was done using Bonferroni's post hoc test. RESULTS: The women were aged 18-48 years, with a mean age of 30.81(±5.49) years and majority of them (61.2%) were multigravida. The duration of pregnancy varied inversely and significantly with CS (P < 0.05) and IOP (P < 0.000) with the least values recorded in the third trimester, while it varied directly and also significantly with CCT (P < 0.000) with the highest value obtained in the third trimester. A negative correlation that was significant only in third trimester was found between CCT and IOP (P < 0.02) and CS (P < 0.03). CONCLUSION: There was a progressive increase in CCT with a corresponding decrease in CS and IOP across the trimesters of pregnancy, but these changes reversed 6-week postpartum.

Ectopic arachnoid granulation involving a rare intracranial venous sinus variant.

Arachnoid granulations are hypertrophied arachnoid villi, which extend from the subarachnoid space into the venous system and aid in the passive filtration and reabsorption of cerebrospinal fluid. These macroscopic structures have been described in various locations, with the transverse and sigmoid sinuses seen as normal variants on imaging. Here we present the occurrence of an enlarged arachnoid granulation at the foramen rotundum where a variant intracranial venous sinus was identified during routine dissection. Variations, such as the one described herein, should be recognised by those who operate or interpret images of the skull base.

Prevalence and profile of ophthalmic disorders in oculocutaneous albinism: a field report from South-Eastern Nigeria.

To assess the burden and spectrum of refractive and non-refractive ophthalmic disorders in south-eastern Nigerians with oculocutaneous albinism. In a population-based survey in Enugu state, between August, 2011 and January, 2012, albinos were identified using the database of the Enugu state's Albino Foundation, and mass media-based mobilisation. The participants were enrolled at the Eye Clinics of the University of Nigeria Teaching Hospital and Enugu State University of Science and Technology Teaching Hospital using a defined protocol. Relevant socio-demographic and clinical data were obtained from each participant. Descriptive and comparative statistics were performed. Statistical significance was indicated by p < 0.05. The participants (n = 153; males, 70) were aged 23.5 + 10.4 SD years (range 6-60 years). Both refractive and non-refractive disorders were present in all participants. Non-refractive disorders comprised nystagmus, foveal hypoplasia, hypopigmented fundi and prominent choroidal vessels in 100.0% participants; and strabismus in 16.3% participants. Refractive disorders comprised astigmatism -73.2% eyes, myopia -23.9% and hypermetropia 2.9%. Spherical refractive errors ranged from -14.00 DS to +8.00 DS while astigmatic errors ranged from -6.00 DC to +6 DC. Mixed refractive and non-refractive disorder i.e. presenting visual impairment was present in 100.0% participants. Overall, refractive error was associated with non-possession of tertiary education (OR 0.61; 95% CI 0.38-0.96; p = 0.0374). There is high prevalence of refractive, non-refractive and mixed ophthalmic disorders among albinos in south-eastern Nigeria. This underscores the need for tailored provision of resources to address their eye care needs, and creation of needs awareness amongst them.

Oculocutaneous albinism: identifying and overcoming barriers to vision care in a Nigerian population.

To assess eye care service utilization, and identify access barriers in a south-eastern Nigerian albino population. The study was a population-based, cross-sectional survey conducted in Enugu state between August, 2011 and January, 2012. Using the data base of the state's Albino Foundation and tailored awareness creation, persons living with albinism were identified and recruited at two study centres. Data on participants' socio-demographics, perception of vision, visual needs, previous eye examination and or low vision assessment, use of glasses or low vision devices were collected. Reasons for non-utilisation of available vision care services were also obtained. Descriptive and comparative statistics were performed. A p < 0.05 was considered statistically significant. The participants (n = 153; males 70; females 83; sex ratio: 1:1.1) were aged 23.46 + 10.44 SD years (range 6-60 years). Most--95.4 % of the participants had no previous low vision assessment and none--0.0% had used low vision device. Of the participants, 82.4% reported previous eye examination, 33.3% had not used spectacles previously, despite the existing need. Ignorance--88.9% and poor access--8.5% were the main barriers to uptake of vision care services. In Enugu, Nigeria, there is poor awareness and low utilization of vision care services among people with albinism. The identified barriers to vision care access are amenable to awareness creation and logistic change in the provision of appropriate vision care services.

Prevalence of eye diseases among school children in a rural south-eastern Nigerian community.

INTRODUCTION: Vision has an essential role in a child's development, and visual deficit is a risk factor not only for altered visio-sensory development, but also for overall socioeconomic status throughout life. Early detection provides the best opportunity for effective treatment of eye and vision problems in children. Therefore, timely screening is vital to avoid lifelong visual impairment. There is a paucity of data regarding the causes of eye disease among rural children in Nigeria. The aim of this study was to determine the prevalence and causes of eye disease among children residing in rural communities in Nigeria. METHODS: A cross-sectional survey was conducted to determine the prevalence and common causes of ocular morbidities in primary school children in Abagana, a rural community in Njikoka Local Government Area of Anambra State, South-East Nigeria. Children aged 6-16 years in all 8 primary schools were registered, interviewed and their eyes examined. Data were analyzed according to age, sex, type of ocular disorder and causes of visual impairment. Frequency and percentages were calculated with univariate analysis and parametric method. RESULTS: The census population consisted of 2092 children, 1081 (51.7%) males, with a male to female ratio of 1.07:1. Ocular disorders were found in 127 (6.1%) of the population. The most common ocular disorders in this community were vernal conjunctivitis 61 (2.9%) followed by refractive error 14 (0.7%). Amblyiopia, which is avoidable, was the most common cause of visual impairment. CONCLUSION: Study findings indicated that early detection through early eye screening; health education and access to a quality eye care facility will reduce the burden of eye disease and blindness among rural Nigerian children.

Computerized motion sensitivity screening tests in a multicountry rural onchocercal community survey in Africa.

PURPOSE: To determine whether the Wu-Jones Motion Sensitivity Screening Test (MSST) accurately reflects the burden of optic nerve disease in several onchoendemic communities in Africa. MATERIALS AND METHODS: The MSST was used to evaluate subjects in the communities of Raja in Sudan, Bushenyi in Uganda, Morogoro in Tanzania, and Ikon, Olomboro, and Gembu in Nigeria. Motion sensitivity was expressed as a percentage of motion detected in the individual eye, and this was averaged for the community. A perfectly normal eye would detect all motion and score 100%. RESULTS: In this study, 3858 eyes of 2072 subjects were tested. The test was completed in 76% of respondents. Acceptability was high. Average test time was 120.4 s. The overall mean motion sensitivity of all eyes tested was 88.49%, ±17.49. Using a cutoff level of 50%, 6.4% of all subjects tested were subnormal. The highest proportion of subnormals recorded was in Morogoro at 12.7%. Severe defects in a community best correlated with optic nerve disease prevalence, while the proportion of the defect from a higher cutoff level best correlated with overall ocular morbidity. A repeat examination in the next 5 years following ivermectin treatment will show the influence, if any, on community-wide MSST performance. CONCLUSION: A wide range in community scores reflected disease diversity. The MSST appears to be a useful test in community-wide screening and diagnosis as it reflects the general level of ocular pathology and specifically, optic nerve disease.

Prevalence and distribution of ocular onchocerciasis in three ecological zones in Nigeria.

The African Programme for Onchocerciasis Control (APOC) sponsored a baseline study in Nigeria between 1998 and 1999 on the prevalence and distribution of Onchocerciasis. The randomly selected 1,064 subjects in the baseline study underwent detailed eye examination in Cross River (rain forest), Taraba (savanna) and Kogi (forest-savanna) States. This paper compares and contrasts the public health significance of ocular onchocerciasis in these ecological zones. A blindness prevalence of 2.4% was recorded in the study, onchocerciasis being responsible for 30.2% of the bilaterally blind subjects. Onchocerciasis-induced blindness prevalence was relatively high in the rain forest and forest savanna zones of Cross River and Kogi States, Cross River having the highest site-specific prevalence (50.0%), followed by Kogi (41.7%). Taraba recorded only 27.3%. Other conditions identified included glaucoma, optic nerve disease and cataract rates of which were also found to be high among the population (6.9%, 6.5 % and 8.9% respectively). Anterior segment onchocercal lesions, punctate and sclerosing keratitis were the predominant features of the infection in the savanna zone (14.1% and 6.3% respectively), while posterior segment lesions were much more common in the forest zone. The need to sustain the present efforts to control onchocerciasis through mass ivermectin treatment is recommended.

Utility and effectiveness of computerised motion sensitivity screening tests in rural onchocercal community survey.

BACKGROUND: Non-invasive tool of community diagnosis for onchocercal endemicity needs to be identified and ascertained for their utility and effectivity in order to facilitate the control of onchocerciacis in sub-Saharan Africa OBJECTIVE: To determine the utility and effectiveness of the Wu-Jones Motion Sensitivity Screening Test (MSST) in detecting optic nerve diseases in onchocercal-endemic rural Africa. METHODS: MSST was applied to sampled subjects in the selected communities of Raja in Sudan; Bushenyi in Uganda; Morogoro in Tanzania; and of Ikom, Olamaboro and Gashaka in Nigeria. Basically, six points within the central field of vision were repeatedly tested at 1/3 meter from the screen of a laptop computer in a room darkened. Motion sensitivity was expressed as a percentage of motion detected in the individual eye and this was averaged for the community. RESULTS: A total of 3,858 eyes of 2,072 patients were examined. Seventy-six percent of the subjects completed the test, at an average test time of 120.4 (66.7) seconds. The overall mean motion sensitivity of all eyes tested was 88.49 (17.49%). At a cut-off point of 50%, 6.4% of all subjects tested were subnormal, while at 70% cutoff, 13.3% were subnormal. The highest proportion of 50% cutoff sub-normality was recorded at Morogoro at 12.7%. CONCLUSION: Motion Sensitivity Screening Test was widely accepted and easily administered to the rural and largely illiterate subjects studied. Our data suggest that the proportion of severe field defects by MSST in a community, with cutoff at 33%, best correlates with optic nerve disease prevalence, while proportion of defect from a higher cut-off level at about 50%, best correlates with overall ocular morbidity.

Utility and Effectiveness of Computerised Motion Sensitivity Screening Tests in Rural Onchocercal Community Survey

BACKGROUND: Non-invasive tool of community diagnosis for onchocercal endemicity needs to be identified and ascertained for their utility and effectivity in order to facilitate the control of onchocerciacis in sub-Saharan Africa OBJECTIVE: To determine the utility and effectiveness of the Wu-Jones Motion Sensitivity Screening Test (MSST) in detecting optic nerve diseases in onchocercal-endemic rural Africa. METHODS: MSST was applied to sampled subjects in the selected communities of Raja in Sudan; Bushenyi in Uganda; Morogoro in Tanzania; and of Ikom; Olamaboro and Gashaka in Nigeria. Basically; six points within the central field of vision were repeatedly tested at 1/3 meter from the screen of a laptop computer in a room darkened. Motion sensitivity was expressed as a percentage of motion detected in the individual eye and this was averaged for the community. RESULTS: A total of 3;858 eyes of 2;072 patients were examined. Seventy-six percent of the subjects completed the test; at an average test time of 120.4 (66.7) seconds. The overall mean motion sensitivity of all eyes tested was 88.49 (17.49). At a cut-off point of 50; 6.4of all subjects tested were subnormal; while at 70cutoff; 13.3were subnormal. The highest proportion of 50cutoff sub-normality was recorded at Morogoro at 12.7. CONCLUSION: Motion Sensitivity Screening Test was widely accepted and easily administered to the rural and largely illiterate subjects studied. Our data suggest that the proportion of severe field defects by MSST in a community; with cutoff at 33; best correlates with optic nerve disease prevalence; while proportion of defect from a higher cut-off level at about 50; best correlates with overall ocular morbidity

Pattern of Eye Disorders among Inmates of a Nigerian Prison

Aim:To determine the prevalence of eye disorders among the inmates of a Nigerian prison with a view to providing eye health care for the prisoners. Methods: A cross sectional survey of the ocular health status of the prisoners in a Nigerian prison was carried out using a pretested protocol designed for the study. Data was obtained on bio-data as well as anterior and posterior segment examinations. These were analyzed using EPI-INFO version 6.0. Results: Two hundred and sixty-nine (26.8) out of the 1005 prisoners examined had eye disorders. The commonest ocular problems noted were presbyopia (21.5); pterygium (19.3) refractive error (15.6) and allergic conjunctivitis (12.5). One inmate (0.1) was blind; 12 (1.2) had monocular blindness while 5(0.5) had low vision. Cataract was the commonest cause of monocular blindness and also the only cause of bilateral blindness. Conclusion: The prevalent eye diseases in the prison community are similar to the findings in the general population. There is a need to train the staff of the medical clinics in Nigerian prisons as integrated eye health workers to enable them meet the basic eye health needs of the prisoners

APOC impact assessment studies: baseline ophthalmological findings in Morogoro, Tanzania.

The goal of the African Programme for Onchocerciasis Control (APOC) is to eliminate Onchocerciasis as a disease of public Health significance and an important constraint to socio-economic development in the 19 none OCP (Onchocerciasis Control Project) countries covered through Community-Directed Treatment with Ivermectin, CDTI. In 1998, impact assessment studies were carried out in Morogoro, Tanzania during which baseline ophthalmological parameters were established. The hypothesis being tested is that CDTI will prevent or delay progression of onchocercal eye lesions and blindness. A total of 425 subjects aged 10 years or more from 14 villages within Bwakira district ofMorogoro region in Tanzania were examined for Snellen visual acuity, ocular microfilaria, lens opacities, uveitis and posterior segment disease especially chorioretinitis and optic nerve disease. Motion Sensitivity Screening Test (MSST) was carried out as well. Microfilaria was present in the anterior chamber of nearly half (49.2%) of all subjects examined. Prevalence of blindness was extremely high at 15.2%. Onchocercal lesions were responsible for blindness in 41.5% of these, followed by cataracts (27.7%), glaucoma (10.8%) and trachoma (6.2%). The main pathway to onchocercal blindness in this population was anterior uveitis with or without secondary cataracts. There is an urgent need to get CDTI underway and institute other horizontal primary eye care measures, especially cataract backlog reduction, in order to reduce the excessive burden of avoidable blindness in this community.

The Undergraduate Training in Ophthalmology: The University of Nigeria Nsukka Medical Students

Objective: The study was embarked upon to determine the view of University of Nigeria final year medical students on the adequacy of their undergraduate training in ophthal- mology; vis-a-vis rendering basic eye care as general duty doctors. Methods: One hundred final year medical students; who had finished their ophthalmology clinical postings; completed a self-administered; structured and semi structured questionnaires in August 2004. Data analysis was done manually using an electronic calculator. Result: Majority of the students (60) were of the view that the training was inadequate. This was largely attributed to the low level of clinical exposure and community experience in the programme. Conclusion: The undergraduate training in ophthalmology undergone by these final year medical students may not have equipped them with adequate knowledge and skills to render basic eye care as general duty doctors. There is a need to improve the relevance and quality of the training.) were of the view that the training was inadequate. This was largely attributed to the low level of clinical exposure and community experience in the programme. Conclusion: The undergraduate training in ophthalmology undergone by these final year medical students may not have equipped them with adequate knowledge and skills to render basic eye care as general duty doctors. There is a need to improve the relevance and quality of the training

Pattern of Ocular Diseases among Computer users in Enugu; Nigeria

Objective: To determine the pattern of ocular disorders among computer users in Enugu. Methods: A cross-sectional survey of computer users was conducted in Enugu metropolis between August and December 2000. 560 subjects were selected by simple random sampling method. Examination methods include use of interviewer-administered structured questionnaire; visual acuity tests for distance and near; external eye examination; tonometry; direct ophthalmoscopy; retinoscopy and measurement of the distance between the operator and the computer. Result: A total of 354(63.2) females and 206(36.8) males were recruited for the study. Majority of the subjects (85.6) were under 34 years of age. Two hundred and eleven (37.7) out of five hundred and sixty subjects interviewed and examined had ocular disorders. Common ocular disorders seen include refractive errors (55); presbyopia (16.6); Pterygium (14.7); conjunctivitis (6.6). 7 subjects (1.3) had monocular blindness with VA

Causes of childhood blindness: results from schools for the blind in south eastern Nigeria.

AIM: This cross sectional study was undertaken to identify the major causes of childhood severe visual impairment/blindness (SVI/BL) among students in schools for the blind in south eastern Nigeria with a view to offering treatment to those with remediable blindness. METHODS: 142 students attending three schools for the blind in the study area were interviewed and examined using the World Health Organization programme for prevention of blindness (WHO/PBL) childhood blindness proforma. RESULTS: By anatomical classification, the major causes of SVI/BL identified in the children (aged 15 years or less) were lesions of the lens (30.4%), corneal lesions (21.7%), whole globe lesions (mainly phthisis bulbi) (17.4%), and glaucoma/buphthalmos (10.9%). For the young adults (more than 15 years) these lesions accounted for 31.9%, 21.3%, 23.4%, and 8.5% of SVI/BL, respectively. For all the students, the commonest single diagnoses were cataract (23.5%) and corneal scarring (21.4%), of which 86.7% were caused by measles. By aetiological classification, childhood factors (38.6%) constituted the major cause of blindness: 37.0% in the children and 39.4% in the young adults. In 74.5% of all the students, blindness was considered avoidable. CONCLUSIONS: A high proportion of childhood blindness in schools for the blind in south eastern Nigeria is avoidable. Development of paediatric ophthalmology in Nigeria to manage childhood cataract and glaucoma is advocated.