A Non-Inferiority Study of Combination of Latanoprost and Timolol Formulation to Their Separate Use in Drug-Naive Primary Open Angle Glaucoma and Ocular Hypertension Nigerian Patients. {RCT 93803536 (Nigeria Clinical Trial Registry)}.

BACKGROUND: Control of intraocular pressure continues to be the mainstay of the management of primary open-angle glaucoma. It is also one of the key factors to consider in the diagnosis and risk of conversion of ocular hypertension to glaucoma (POAG). Medical management of IOP control is central to the treatment of POAG especially in resource-poor countries. AIM: This study aimed to demonstrate the non-inferiority of a fixed combination of front-line drugs in the medical management of glaucoma (latanoprost and timolol) compared to concomitant use of the same drugs. METHODOLOGY: It was a double-blind, randomized clinical trial (RCT) in which 116 sequentially consenting participants 40 years and above were recruited and randomized to receive either a fixed combination (group A) or a concomitant combination of latanoprost and timolol (group B). The study was carried out across two tertiary centers in southwest Nigeria. RESULTS: One hundred and fifteen (115) patients were analysed, 58 in group A and 57 in group B. The mean age of participants was 57.9 (± 11.5) years. There were 51 (44.3%) females. Primary open-angle glaucoma (POAG) was the diagnosis in 88 (76.5%) of the participants. No statistically significant difference between the two groups at recruitment. Mean IOP reduction from baseline to day 28 was -17.30 ± 7.8 (95% CI: -15.37 to -19.15), and -14.59 ± 6.1 (95% CI: -12.98 to -16.19) for groups A and B. Group A thus had a 54.97% IOP reduction from baseline values while group B had 51.81% (p = 0.770). The mean intergroup difference (MeD) in IOP reduction (µA - µB) between the two groups on day 28 was 2.05 ± 5.74 (95% CI: 0.6 - 1.61) p=0.04. CONCLUSION: The study was able to demonstrate a noninferiority relationship between the fixed combination dosage form of latanoprost and timolol as compared to the concomitant dosage forms.

CONTEXTE: Le contrôle de la pression intraoculaire reste le pilier de la prise en charge du glaucome à angle ouvert primaire. C'est également l'un des principaux facteurs à considérer dans le diagnostic et le risque de conversion de l'hypertension oculaire en glaucome (POAG). La gestion médicale du contrôle de la pression intraoculaire est essentielle dans le traitement du POAG, surtout dans les pays à ressources limitées. OBJECTIF: Cette étude visait à démontrer la non-infériorité d'une combinaison fixe de médicaments de première ligne dans la gestion médicale du glaucome (latanoprost et timolol) par rapport à l'utilisation concomitante des mêmes médicaments. MÉTHODOLOGIE: Il s'agissait d'un essai clinique randomisé en double aveugle dans lequel 116 participants consécutifs âgés de 40 ans et plus ont été recrutés et répartis de manière aléatoire pour recevoir soit une combinaison fixe (groupe A) soit une combinaison concomitante de latanoprost et de timolol (groupe B). L'étude a été menée dans deux centres tertiaires du sud-ouest du Nigeria. RÉSULTATS: Cent quinze (115) patients ont été analysés, 58 dans le groupe A et 57 dans le groupe B. L'âge moyen des participants était de 57,9 (± 11,5) ans. Il y avait 51 (44,3%) femmes. Le glaucome à angle ouvert primaire (POAG) a été diagnostiqué chez 88 (76,5%) des participants. Aucune différence statistiquement significative entre les deux groupes au moment du recrutement. La réduction moyenne de la pression intraoculaire entre le début et le jour 28 était de -17,30 ± 7,8 (IC à 95% : -15,37 à ­19,15) et de -14,59 ± 6,1 (IC à 95% : -12,98 à -16,19) pour les groupes A et B. Le groupe A a ainsi présenté une réduction de 54,97 % de la PIO par rapport aux valeurs initiales tandis que le groupe B a enregistré 51,81 % (p = 0,770). La différence moyenne intergroupes (DMI) dans la réduction de la PIO (µA ­ µB) entre les deux groupes au jour 28 était de 2,05 ± 5,74 (IC à 95% : 0,6 ­ 1,61) p = 0,04. CONCLUSION: L'étude a pu démontrer une relation de noninfériorité entre la forme posologique fixe de latanoprost et de timolol par rapport aux formes posologiques concomitantes. MOTS-CLÉS: Glaucoma, Hypertension oculaire, Contrôle de la PIO, Nigérians, Latanoprost, Timolol, Hypotenseurs oculaires, Combinaison fixe, Patients naïfs aux médicaments.

Perception of red eye among senior secondary students in Sagamu, Southwest Nigeria.

BACKGROUND: Red eye is a very common presenting complaint in clinical practice among all age groups, including adolescents. Health habits formed during adolescence is carried to adulthood and is often a consequence of their perception. This study, therefore, determined the perception of students toward the red eye. AIM: To determine the perception of red eye and its associated factors among secondary school students in Sagamu. METHODS: A cross-sectional descriptive study was carried out among 1082 senior secondary school students in Sagamu local government area, using a semi-structured self-administered questionnaire. Data were analyzed using SPSS Version 20. Relevant descriptive and inferential statistics were calculated. RESULTS: The mean age of respondents was 15.27 ± 1.48 years. There were more females (54.8%) than males. Majority (81%) had heard of red eye, and this was mainly from neighbors; 58.4% felt they could not contact red eye from an infected person. About 35% would instill onion if they had a red eye. About 50.2% felt red eye could lead to blindness. Awareness of red eye was associated with age (P = 0.005), but not with sex and religion. Among respondents, 95.5% and 96.2% had a poor perception as well as a poor attitude toward red eye, respectively. CONCLUSION: The perception and attitude of senior secondary school students in Sagamu to red eye is poor. Appropriate eye health education and promotional services, including periodic eye examination of students, should be carried out in school health services. Early presentation to eye care centers for its treatment should be encouraged.

A COMMUNITY-BASED PREVALENCE OF PRESBYOPIA AND SPECTACLE COVERAGE IN SOUTHWEST NIGERIA.

BACKGROUND: The use of population-based method to assess the prevalence of presbyopia and spectacle use is few even though it is more reliable compared to the commoner hospital based studies. This study was carried out to determine the need for spectacle services in our coverage area. AIM: To determine the prevalence of presbyopia among adults of 30 years old and above in Sagamu local government area of Ogun state, South-West, Nigeria. DESIGN: The study was a population based descriptive and cross-sectional design. SETTING: The study was carried out using a multistage cluster random sampling with probability proportional to size of regular adult residents of Sagamu Local Government area, Sagamu, Ogun state, Nigeria. MATERIALS AND METHODS: Examination of respondents included administration of semi-structured interviewer assisted questionnaire and distance visual acuity measurement with or without pinhole at 6 meters using the Snellen's charts. Automated refraction with subjective refraction was carried out in all participants with presenting visual acuity (PVA) worse than 6/9 but with an improvement with pinhole. Near assessment was done at 40cm with the distance correction in place if required. Ocular examination was also carried out in all participants that had refraction including pupillary dilatation when indicated. RESULTS: The prevalence of presbyopia was 80.9%. There was an increasing prevalence with age (p<0.001) with a 100% prevalence in the ≥80 years age group. The mean add requirement was +2.24DS. The met presbyopic need was 22.9% and the unmet need 58%. The presbyopic spectacle coverage was 28.4% which was positively associated with younger age (p=0.034), attaining at least secondary school education (p<0.001), and living in an urban area (p<0.001). CONCLUSION: The prevalence of presbyopia is high in this community and found in persons younger than 40 years and the spectacle coverage for the population is low with a high unmet spectacle need. There is a need to provide near vision spectacles to a large proportion of residents in the community.

Normative Ocular Biometric Dimensions and its Variation in a Nigerian Population.

BACKGROUND: The increasing need for high precision in different aspects of clinical and diagnostic ophthalmology calls for a knowledge of the normative ocular biometric parameters. Since this may be affected by race, it is thus important to obtain more information in an effort to determine the African values.The main objective of this study is to determine the normal ocular biometric dimensions and their variation with age in a south western Nigerian population. STUDY DESIGN: A population-based descriptive cross-sectional study carried out in Sagamu Local Area of Ogun State, Nigeria. MATERIALS AND METHOD: A multi-staged cluster random sampling technique was used to select eligible participants who underwent ocular biometry between July and October 2010. RESULTS: Three hundred and two respondents aged 18 years and above underwent A-scanography and keratometry. The mean axial length, anterior chamber depth, lens thickness, vitreous chamber depth and cornea power were 23.31±0.91mm, 3.13±0.40mm, 4.15±0.46mm, 16.01±0.91mm and 43.77±1.33D respectively. Axial length, lens thickness and vitreous chamber depth demonstrated a significant positive increase with age while anterior chamber depth and cornea power decreased with age. CONCLUSION: Ocular biometric values in adults of South Western Nigeria were comparable to previous documentations and had significant variation with age.

The spectrum of eye injuries in Sagamu, Nigeria.

BACKGROUND: Eye injuries are major causes of visual morbidity and monocular blindness worldwide. The common causes of eye injuries needs to be well defined in each community so as to plan for prevention of high morbidity and blindness as part of blindness prevention programme. OBJECTIVE: It is necessary to compare the trend in causes of ocular injuries in Ogun State after a similar study over 15 years before. The part played by road traffic accidents [RTA] compared to other causes is also to be analysed. METHODOLOGY: This prospective study was carried out between July 2004 and June 2005. All cases presenting to the Accident and Emergency Unit and Eye Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, and the 2 private eye clinics in Sagamu town, presenting with any form of eye injuries during the study period were included. The biodata, cause and type of eye injury, time of injury, time of presentation and treatment offered were obtained using a questionnaire. The results were analysed with Epi-Info 2002. RESULTS: One hundred and twelve patients were studied. Eighty-one [72.3%] of the victims were males; most of them, 36[33.0%] were students and 32 [29.4%] artisans. The common causes of eye injuries were RTA 35[31.3%], assault 22[19.6%], vegetative agents 18 [16.1%] and machine tools 11[9.8%]. Most patients presented either within 24 hours, 56[50.0%] or within a week, 34[30.4%] of injury, and mostly during the day 86[97.6%]. Most injuries were found in the anterior segment 95[84.8%] and most commonly, victims 65[58%] required only medications as treatment. CONCLUSION: Majority of eye injuries found in Sagamu are treatable and can be handled by an experienced non-ophthalmologist successfully and most are now accounted for by RTAs and assault which indicate some changes in common causes compared to previous studies in Nigeria.

Visual acuity of commercial motor drivers in Ogun State of Nigeria.

AIMS AND OBJECTIVES: To objectively assess the visual acuity of commercial motor drivers (CMD) in 3 Local Government Areas (LGA) of Ogun State of Nigeria in order to determine their eligibility to drive. SUBJECTS AND METHODS: The visual acuities of CMDs in 3 LGAS of Ogun state in Nigeria (selected using a multistage sampling technique) were tested with Snellens acuity charts and the eyes examined with bright pen torches and ophthamoscopes. Visual acuity 6/12 or better in the worse eye was taken as adequate to obtain a driving license. The drivers with worse visual acuities were further examined to find the cause of decreased vision. RESULTS: The visual acuities of 524 drivers were determined and analyzed. Their ages ranged from 19-66 years with a mean of 46.8 ±7.2 years. Two hundred and twenty (41.9%) of the drivers were between 40 and 49 years old. Four hundred and four (77.1%) did not have any form of eye test prior to this study. Four hundred and sixty three drivers (88.4%) were eligible to drive while 61 drivers (11.6%) were not eligible. Decreased visual acuity was caused by refractive error in 22(36.1%), cataract in 19(31.2%), glaucoma in 12(19.7%), corneal scar in 5(8.2%) and posterior segment lesions in 3(4.9%). CONCLUSION: Objective assessment of vision should be an essential component of licensure. Middle aged and elderly drivers are prone to age related ocular diseases and require reassessment of visual status every 3 years when licenses are renewed.

Squamous cell carcinoma of the conjunctiva in Sagamu, Nigeria--a review and 2 case reports.

AIM: To review the current literature on squamous cell carcinoma [SCC] of the conjunctiva and report 2 presentations in Sagamu, Nigeria since the availability of histopathological services. METHODS: The available literature using e-medicine and pubmed internet websites were summarized. The 2 cases seen by the first author since histopathological services started at Olabisi Onabanjo University Teaching Hospital [O.O.U.T.H.], Sagamu were summarized using the case note records and the pathological reports of their surgical specimens. RESULTS: The 2 cases showed the variable ways SCC of the conjunctiva can present in an equatorial African country like Nigeria. DISCUSSION: Limbal interpalpebral conjunctival lesions should arouse the possibility of this rare neoplasia even in patients with no evidence of predisposing factors. CONCLUSION: Even though SCC of the conjunctiva is commoner in Caucasians, its possible presentations should be kept in mind in equatorial non-Caucasian populations like Nigeria.

Congenital eye diseases at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.

BACKGROUND: Congenital eye disorders, though rare are important causes of childhood blindness. It can occur in isolation or in combination, or as part of a syndrome. This retrospective study was aimed at documenting the causes of congenital eye diseases at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria. METHOD: A review of the case notes of patients presenting at the eye clinic with congenital eye diseases between January 1994 and December 2004 was carried out. RESULT: The most common congenital disorders are cataract 50 (47.6%), congenital glaucoma 15 (14.3%), Dacryostenosis 11 (10.5%), and corneal opacity 6 (5.7%) which are causes of preventable blindness. Less common congenital disorders are microcornea (1%), aniridia (1%), retinal atrophy (1%), and congenital anomaly of the optic disc (1%), which are congenital causes of irreversible childhood blindness. CONCLUSION: We conclude that screening programmes should be instituted at the maternity centers before babies are discharged for early detection of congenital eye diseases and treatment of those that can cause preventable blindness. Also we recommend that Government should strengthen our welfare system by providing adequate measures for rehabilitation and care of those with irreversible blindness.

Ocular morbidity survey in an opthalmically underserved rural area of Nigeria.

This paper describes in some detail a prevalence of blindness study conducted in a rural area of South-Western Nigeria, which is served by a peripheral eye clinic. By a stratified random cluster-sampling procedure, 1975 people in ten villages were selected for ocular examination. Community prevalence rate of ocular morbidity was 3.3% with the highest prevalence in the 51-60 years age group. There was a male-female ratio of 4:3 and the prevalence of ocular morbidity in the 31-50 years age group was most significant, but people in this age group seldom reported at the peripheral eye clinic serving the survey areas. Age-related macular degeneration was found to be prevalent in the community, while few cases were reported at the peripheral eye centre. The information gathered in the survey is being used to plan and improve eye care services from the peripheral eye clinic. Case finding in persons aged 31-50 years and those at risk for age-related macular degeneration has been recommended as part of the programme of the peripheral eye clinic.

Prevalence of obesity among Nigerian school children.

The prevalence of obesity among 457 school children in the age group 6-19 years is 3.2% for males and 5.1% for females based on weight for age. 3.7% males and 3.3% females were classified as obese when triceps skinfold thickness was used as the basis of obesity. Preventable socio-economic factors are responsible for the high prevalence of obesity among, Nigerian school children. This the first study of prevalence of obesity among Nigerian school children.