A Survey of the Management of Diabetic Macular Oedema in Sub-Saharan Africa.

Background: There is minimal information about the availability of treatment for Diabetic macular oedema (DMO) in sub-Saharan Africa (SSA). The principal aim of this survey was to determine the 'real world' management of DMO amongst ophthalmologists working in SSA. Methodology: Questionnaires were distributed to members of retinal and ophthalmological societies in SSA. Results: Ninety-Three ophthalmologists from 24 countries participated with the majority working in Nigeria (51, 55%). Most were retina specialists (50, 54%) and consultants (67, 62%). Clinically significant macular oedema prompted treatment for 62 (67%) ophthalmologists, whilst visual acuity (81, 87%) and OCT changes (76, 82%) were more common reasons to treat DMO. Treatment included intravitreal anti-VEGF (91, 98%), laser (70, 75%), intravitreal steroid (57, 61%), topical drops (52, 56%), oral tablets (32, 34%) and surgery (20, 22%). The commonest intravitreal anti-VEGF agents used were bevacizumab (89, 96%) and ranibizumab (71, 76%). Intravitreal triamcinolone was used by 69 (74%), topical NSAIDs by 51 (55%), and acetazolamide tablets by 22 (24%) ophthalmologists as a treatment for DMO. Conclusion: Sub-Saharan African ophthalmologists commonly use intravitreal anti-VEGF, laser, intravitreal steroid, and topical NSAIDs to treat DMO. Economic constraints and/or the inability to maintain the intensive regimen required for successful intravitreal anti-VEGF therapy probably influence some treatment choices.

A Study of the Prevalence and Pattern of Sickle Cell Retinopathy among Eye Clinic Attendees in a Nigerian Tertiary Hospital.

Background: Sickle Cell Disease (SCD) is the first and the most common group of haemoglobinopathies in the world. It affects virtually all body systems including the eyes. Proliferative Sickle cell Retinopathy (PSR) is a cause of visual loss in the working age group which has an impact on the economy and quality of life. This study aimed to describe the pattern of presentation of Sickle Cell Retinopathy (SCR)to improve understanding of the disease presentation. Methodology: The ophthalmic surgical records of patients diagnosed with sickle cell disease at the retinal unit, department of Ophthalmology at the Lagos University Teaching Hospital between the year 2011-2020 were reviewed retrospectively. Results: A total of 64 patients (108 eyes) records were reviewed in this study. The Prevalenceof sickle cell retinopathy was 5.4% of all retina cases within the study period. Age ranged from 10-70 years; the mean age was 36.28 years ± 13.66. There were 25 females and 39 males (F:M= 1:1.6). SCR was most common in patients with HbSC 40 (62.5%). Common presenting symptoms were loss of vision34 (53.1%) and floaters 34 (53.1%). Goldberg stage III 26 (20.3%) and stage IV 27 (21.1%) were the most common stages of proliferative disease at presentation. A significant association was seen between Haemoglobin genotype SC and the occurrence of sickle cell retinopathy with 90% of the patients with Haemoglobin genotype SC having had PSR. The majority of the patients25 (39.1%) had no treatment, and 13 (20.3%) had laser photocoagulation only. Conclusion: Sickle cell retinopathy is not uncommon in Nigeria and many patients only present in tertiary health facilities when they have severe symptoms such as loss of vision. This may be attributed to the late diagnosis and referral. Routine screening is recommended to ensure early detection and treatment to prevent avoidable blindness.

Risk factors for COVID-19 infection and disease severity in Nigeria: a case-control study.

Introduction: identifying risk factors for SARS-CoV-2 infection and disease severity is critical to developing measures to protect vulnerable groups. We aimed to identify risk factors for SARS-CoV-2 infection and severe disease. Methods: this was an unmatched case-control study that recruited participants in the country from April to July 2020. Cases tested positive on Reverse-Transcription Polymerase Chain Reaction (RT-PCR), while controls tested negative on RT-PCR. Data were collected by trained research assistants using an interviewer-administered questionnaire. Cases were categorized into severe and non-severe to identify risk factors for severe disease. Results: there were 497 cases and 997 controls recruited. Contact with a symptomatic confirmed case adjusted odds ratio (aOR) 1.91 (95% CI: 1.30-2.80) and attendance of mass gatherings aOR 1.74 (95% CI: 1.10-2.74) were associated with SARS-CoV-2 infection, while the use of private transportation aOR 0.56 (95% CI: 0.37-0.85) and use of a face mask aOR 0.43 (95% CI: 0.19-0.95) were associated with lower odds of infection. We identified 38 (7.7%) severe cases and 459 (92.3%) non-severe cases. Multivariate analysis identified age ≥ 50 years aOR 4.54 (95% CI: 1.86-11.08), male sex aOR 2.95 (95% CI: 1.07-8.11), hypertension aOR 3.52 (95% CI: 1.46-8.50), and diabetes aOR 5.76 (95% CI: 2.01-16.50) as risk factors for severe disease, while Hausa ethnicity aOR 0.15 (95% CI: 0.04-0.62) lowered the odds of severe disease. Conclusion: our findings highlight the importance of exposure history, mass gatherings, private transportation, and the use of face masks. Being over 50 years, male and having comorbidities indicate a worse prognosis.

Assessment of eye drop instillation techniques among patients with primary open angle glaucoma in a Nigerian tertiary hospital.

PURPOSE: To assess the technique of eye drop instillation and its determinants among patients with primary open angle glaucoma (POAG) attending a Nigerian tertiary hospital. METHODS: This study was a cross-sectional observational study conducted among 130 participants. Systematic sampling technique was used. Inclusion criteria were the presence of POAG, in individuals ≥ 18 years, and self-instilling their ocular hypotensive medications for at least 6 months. Demographic data and clinical characteristics were obtained using an interviewer-administered questionnaire and clinical examination. All participants underwent eye drop instillation of sterile water. Administration techniques were observed and graded using a comprehensive grading scheme. Patients with poor techniques were educated. Determinants of poor eye drop administration technique were also explored. RESULTS: One hundred and thirty patients with POAG were studied. The mean age was 57.13 ± 13.20 years, and 63% percent of the participants had poor eye drop administration technique. On multivariate analysis, previous eye drop instillation education significantly influenced eye drop instillation technique (p = 0.02; OR = 3.230; 95% CI = 1.173-8.896). Among the participants, 47 (36%) touched the globe, 128 (98.5%) did not wash their hands, and 126 (97%) did not occlude the punctum. Sequel to the training, mean score of subjects improved from 2.8 ± 1.1 to 4.1 ± 1.3 (p value < 0.001). CONCLUSION: This study demonstrated that a high proportion of POAG patients had poor eye drop instillation technique despite long-term self-use of topical medication. Thus, this aspect of therapy deserves periodic scrutiny by the clinician.

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.

Coronavirus Disease 2019 Virus among ophthalmologists in Nigeria: Knowledge, attitude, and perceptions

Background: Globally, there is still much to learn about the evolving coronavirus disease 2019 (COVID-19) virus, its transmission, prevention, and treatment. Therefore, this study investigates the knowledge, perception, and screening practices of COVID-19 infection in the ophthalmology practice in Nigeria. Materials and Methods: This survey was a descriptive, cross-sectional survey conducted among practising ophthalmologists and ophthalmologists in training in Nigeria in an online survey. Data compiled were then analyzed using the IBM SPSS software version 22.0 with two-tailed P < 0.05 considered to indicate statistical significance. Results: A total of 206 ophthalmologists/ophthalmologists in training were recruited for this study. Most of the respondents, 97 (47.1%), practiced in centres in South-West Nigeria and were board-certified ophthalmologists 96 (46.6%). In general, the majority of the respondents, 182 (88.3%), had good knowledge regarding the COVID-19 virus, its transmission, prevention as it regards the ophthalmic practice, 134 (74.8%) either agreed or strongly agreed that the ophthalmologist is at a higher risk of contracting the virus from infected patients even if the patient is asymptomatic. COVID-19 infection was perceived as very serious by the majority of the respondents, 135 (65.5%), although 128 (62.1%) felt that all routine cases should be seen only following a low-risk assessment. Conclusion: As the world races toward complete vaccination of the population against this fatal infection, continued training is required to ensure the best practices among ophthalmologists to bridge the present knowledge gaps, corrects myths, misconceptions, and ensure the safety of both the patient and the ophthalmologist.

Ocular manifestations of leukaemia: A teaching hospital experience.

BACKGROUND: Knowledge of the ophthalmic manifestations of leukaemia is important not only because of the frequency with which changes are seen but because the eye often reflects the disease state of the illness, and once identified, prompt referral, early treatment can be instigated, blindness can be averted and a life may be saved. These manifestations are often overlooked because of the underestimation of the magnitude of the ocular sequelae which may be blinding. AIM: This study aims to describe the ophthalmic findings in adult leukaemic patients at two teaching hospitals in Lagos, Nigeria. PATIENTS AND METHODS: This was a clinic-based, comparison multicentre study conducted at Lagos University Teaching Hospital and Lagos State University Teaching Hospital over a 9-month period of May 2012-January 2013. The cases were newly diagnosed leukaemic patients (acute and chronic) from the haematology clinics. Controls were escorts of apparently normal patients. Detailed ocular examination was carried out after written informed consent was obtained. Analysis was done using SPSS 17. RESULTS: A total of 160 eyes in 80 individuals examined comprised forty cases and forty controls. The results of the cases were compared with the age- and sex-matched controls. Leukaemic-related ophthalmic manifestations were present in 56 eyes (70.0%) of the cases studied. Findings in cases were periorbital oedema in 8 eyes (10%), subconjunctival haemorrhage in four eyes (5%), intraretinal haemorrhage as found in 25 eyes (31.3%), retinal venous tortuosity in 21 eyes (26.3%), Roth spots in 19 eyes (23.8%) and retinal infiltrates in 17 eyes (21.3%). CONCLUSION: Ophthalmic disorders occur in adult patients living with leukaemia. Prompt initial and periodic ophthalmic evaluation is recommended in all leukaemic patients.

Two cases of Vogt-Koyanagi-Harada's disease in sub-Saharan Africa.

Vogt-Koyanagi-Harada's (VKH) disease has been reported to be rare in sub-Saharan Africa. Two Nigerians with the disease are presented in this report. The first patient, a 32-year-old pregnant Nigerian woman presented with a 1-month history of bilateral blurring of vision, persistent headache, and alopecia. Presenting visual acuity was 1 m counting fingers in both eyes. Examination revealed vitiligo and poliosis with bilateral panuveitis as well as bilateral exudative retinal detachment. A clinical assessment of complete VKH disease was made. The patient commenced systemic and topical steroids that resulted in remarkable recovery of vision and control of inflammation. The second patient, a 56-year-old Nigerian woman presented with severe headache, tinnitus, and visual loss in both eyes of 2 weeks duration. There was associated redness of both eyes and photophobia. Examination showed visual acuity of Hand motion (HM) and counting fingers at 1 meter (CF). in the right and left eye, respectively, with bilateral panuveitis and bilateral exudative retinal detachment. Subsequent follow-up showed poliosis, vitiligo, and sunsetting fundus appearance. The patient improved with systemic and topical corticosteroids. Developing a high index of suspicion is necessary in diagnosing VKH disease, even in sub-Saharan Africa. Prompt institution of appropriate treatment prevents blindness.

Mobile phones for retinopathy of prematurity screening in Lagos, Nigeria, sub-Saharan Africa.

PURPOSE: Retinopathy of prematurity (ROP), thought to be rare in Nigeria, sub-Saharan Africa, has been reported in recent studies. Developing cost-effective screening is crucial for detecting retinal changes amenable to treatment. This study describes the use of an iPhone combined with a 20-D lens in screening for ROP in Lagos, Nigeria. METHODS: The ROP screening program was approved by the Lagos University Teaching Hospital Ethical Committee. Preterm infants with birthweight of less than 1.5 kg or gestational age of less than 32 weeks were screened. In conjunction with the neonatologist, topical tropicamide (0.5%) and phenylephrine (2.5%) was used to dilate the pupils. A pediatric lid speculum was used. Indirect ophthalmoscopy was used to examine the fundus to ensure there were no missed diagnoses. An iPhone 5 with 20-D lens was used to examine the fundus. The App Filmic Pro was launched in the video mode. The camera flash served as the source of illumination. Its intensity was controlled by the app. The 20-D lens was used to capture the image of the retina, which was picked up by the camera system of the mobile phone. Another app, Aviary, was used to edit the picture. RESULTS: The images captured by the system were satisfactory for staging and determining the need for treatment. CONCLUSIONS: An iPhone combined with a 20-D lens appear to be useful in screening for ROP in resource-poor settings. More studies are needed in this area.