Neurophthalmic manifestations of giant sellar tumors in adults: Relationship between endocrine status and visual acuity profile pre and postsurgical treatment: A prospective cohort study.

OBJECTIVE: To evaluate the relationship between visual acuity (VA) and endocrine status among patients with giant sellar tumors pre and postsurgical treatment. METHODS: A 7-year single institution prospective cohort study of patients with giant sellar tumors treated by pterional transylvian microsurgical resection. Patients were evaluated and followed-up by a collaborative team of ophthalmologists and neurosurgeons. RESULTS: Sellar tumors represent 25% of our brain tumors cases (n = 257). Giant sellar tumors were 61 (23.7%) cases. Pituitary adenomas occurred in 40 patients and in 24 of these, the tumor was a functional adenoma. The age range was 16 to 75 years with a mean of 43.7 ± 3.3 years. Visual impairment (n = 60), headache (n = 55), and endocrinopathy (24) were among the common manifestations. VA and visual field defects were experienced by 59 and 39 patients, respectively. For both eyes, endocrine active tumors presented with poorer preoperative VA profile using mean logMAR VA [(χ2 = 10.3, P = 0.002 OD) and (χ2 = 8.9, P = 0.003 OS)]. Postoperatively, the mean logMAR VA profiles of endocrine active tumors showed a significantly better response when compared to endocrine inactive tumors in both eyes [(χ2 = 5.53, P = 0.029 OD) and (χ2 = 6.77, P = 0.037 OS)]. CONCLUSION: Visual acuity defects are almost invariable in patients with giant sellar tumor and may be associated with an endocrine profile. Surgical resection with normalization of hormone status is rewarded with VA improvement.

Correlates of Stone Quarry Workers' Awareness of Work-related Ocular Health Hazards and Utilization of Protective Eye Devices: Findings in Southeastern Nigeria.

OBJECTIVE: To assess the awareness of work-related ocular health hazards and utilization of personal protective eye devices (PPEDs) among stone quarry workers in Abakaliki, southeastern Nigeria. MATERIALS AND METHODS: In a cross-sectional survey of stone quarry industry workers in Abakiliki, conducted between March and April, 2012, data on participants' socio-demographics, job characteristics, PPED awareness, and utilization were collected. Descriptive and analytical statistics were performed. For intergroup comparisons, P < 0.05 was considered statistically significant. RESULTS: All workers were aware of the need for utilization of eye protective devices; however, 98.7% declined its use for various reasons. About 74.6% attributed nonutilization to nonavailability while 10.4% attributed it to high cost and 10.2% declined its utilization due to discomfort associated with its use. DISCUSSION: Usage of PPEDs was associated with job specification, educational level, duration of work experience, awareness of work hazards, and knowledge about the purpose of PPEDs. Nonusage was associated with unavailability, high cost of procurement, and ocular discomfort from poor fitting and misty/cloudy vision with use. Users were more numerous among blasters and crushers whose jobs were most predisposed to work related accidents and workers with formal education. CONCLUSIONS: Findings from the study reveal high level of awareness yet nonutilization of eye protection. Barriers to the utilization of these eye protective devices should be addressed to ensure greater compliance of its use.

Determinants of Eye Care Utilization in Rural South-eastern Nigeria.

To determine the barriers and incentives to eye care utilization (ECU) in Abagana, a rural south-eastern Nigerian community. The study was a population-based cross-sectional mixed method (quantitative and qualitative) survey of adult inhabitants of Abagana, in July-August, 2011. Data on respondents' socio-demographics, barriers and incentives to ECU were collected, and analysed using descriptive and comparative statistics. A p < 0.05 was considered statistically significant. Qualitative data were obtained from focus group discussions and in-depth interviews and analyzed using ATLAS.ti software. The 549 respondents (males 224) were aged 49.8 ± 15.9 SD years (range 18-93 years). Overall, orthodox eye care had ever been sought by 42.4%, and 46.4% of those who reported change in vision. Lack of awareness-31.8%, cost-18.0%, and fatalistic attitudes-15.9% were the main ECU barriers. Possession of health insurance (OR 11.49; 95% CI 4.21-31.34; p = 0.001), family history of eye disorder (OR 3.27, 95% CI 2.03-5.26; p = 0.001), noticed change in vision (OR 11.30; 95% CI 1.42-90.09; p = 0.022), current eye disease (OR 4.06; 95% CI 2.29-7.19; p = 0.001) and systemic co-morbidity (OR 4.33; 95% CI 2.67-7.02; p = 0.001) were the incentives to ECU. To enhance the low ECU in Abagana community, educational interventions on eye health maintenance and eye health seeking behaviours, and measures to reduce eye care cost are recommended.

Eliminating the barriers to uptake of cataract surgery in a resource-poor setting: a focus on direct surgical cost.

BACKGROUND: Cataract remains a leading cause of blindness worldwide. Despite the high therapeutic efficacy of cataract surgical interventions, surgical uptake has been sub-optimal, especially in low- and middle-income countries. OBJECTIVE: The objective was to investigate the effect of surgical fee reduction on the uptake of cataract surgical services at the University of Nigeria Teaching Hospital (UNTH) Enugu. METHODS: In a retrospective comparative study, all patients who underwent cataract surgery at UNTH between January 2008 and December 2011 were identified from the eye theatre's surgical logbook. Their clinical charts were recalled and relevant demographic and clinical data were abstracted, categorized into pre (January 2008 to December 2009, Group A), and post (January 2010 to December 2011, Group B) surgical fee reduction groups. Descriptive and comparative statistical analyses were performed. RESULTS: A total of 376 cataract surgeries (Group A, 164 [43.6%]; Group B, 212 [56.4%]) was performed during the 4-year study period. The surgeries were performed on 217 males, and 159 females aged 55.4 ΁ 23.4 standard deviation years (range, 7 months to 89 years). The average annual uptake of cataract surgery was 94 overall, 82 pre and 106 postsurgical fee reductions. The two groups did not differ significantly by age (P = 0.8750) or gender (P = 0.8337). CONCLUSION: There is low uptake of cataract surgery at UNTH Enugu. Direct surgical fee reduction alone caused only a modest increase in uptake without alteration in age and gender balance. Further fee reduction and exploration of other uptake barriers are warranted.

Knowledge and attitudes towards eye diseases in a rural south-eastern Nigerian population.

BACKGROUND: Knowledge and attitudes concerning eye disorders are important socio-demographic parameters critical for eye care uptake and outcomes, especially in underserved populations. OBJECTIVES: To assess knowledge and attitudes concerning common eye disorders in a rural south-eastern Nigerian population. METHODS: The study was a population-based survey of knowledge and attitudes concerning common eye diseases conducted in Abagana community in September 2011. RESULTS: The participants comprised 263 males and 238 females. Their profile of good knowledge was eye infections: 38.9%; refractive error: 28.9%; cataracts: 18.0%; diabetic retinopathy: 8.0%; glaucoma: 5.8%; and overall good knowledge: 4.0%. Prevention and treatment of eye disorders were rated as first priorities over other major disabilities by 91.4% participants. Older age and formal education were the significant predictors of good knowledge. CONCLUSION: In Abagana, there is poor overall and disorder-specific knowledge of eye disorders. Socio-demographic factors are important determinants of knowledge. Community-based preventive eye health education is underscored.

Demographic, socio-economic and clinical characteristics: implications for time to presentation at a Nigerian tertiary ophthalmic outpatient population.

OBJECTIVE: To investigate the associations between time to presentation, and sociodemographic and clinical characteristics of new adult ophthalmic outpatients at the University of Nigeria Teaching Hospital (UNTH), Enugu, between March and August 2010. STUDY DESIGN: Hospital-based case-control study. METHODS: Consecutive new ophthalmic outpatients at UNTH were categorized into controls (early presenters, i.e. <3 months after onset of current eye disease) and cases (late presenters, i.e. >3 months after onset of current eye disease). Relevant data were obtained from the participants' case notes and interviews. Descriptive statistics yielded frequency distributions; bivariate and multivariate comparisons were used to test the significance of associations. P < 0.05 was considered to indicate significance. RESULTS: Eight hundred and twenty-four subjects [454 males and 370 females, mean age 39.2 (standard deviation 1.2) years, range 19-82 years] participated in this study. There were 370 early presenters and 454 late presenters. Multivariate analysis found that late presentation was significantly associated with age >50 years [odds ratio (OR) 1.34, 95% confidence interval (CI) 1.28-2.22; P < 0.01], female gender (OR 1.63, 95% CI 1.52-2.11; P < 0.01), residence >20 km from UNTH (OR 0.65, 95% CI 0.38-0.89; P = 0.0212), individual-level deprivation (OR 0.69, 95% CI 0.55-0.92; P = 0.0324) and subnormal visual acuity at presentation (OR 1.32, 95% CI 1.05-1.76; P = 0.0353). CONCLUSIONS: At UNTH, most new adult ophthalmic outpatients present >3 months after onset of their current eye disease. Measures to overcome age-, gender- and distance-related causes of late presentation, grassroots economic empowerment of the feeder population and public education about eye health are required.

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.

Population-based screening of ophthalmic disorders in a cohort of Nigerian Army personnel.

OBJECTIVES: To assess the burden and spectrum of ophthalmic disorders among army personnel at the 82 Division of the Nigerian Army, Enugu, South Eastern Nigeria. METHODS: A population-based screening survey in July 2010 in the 82nd Division, Nigerian Army. Data on participants' sociodemographics, past medical and ophthalmic history, and findings on ophthalmic examination and refraction were noted according to a defined protocol and analysed statistically using p < 0.05 as the level of significance. RESULTS: There were 254 participants (223 males, p < 0.05) with a mean age of 36.2 + 9.7 SD years (range 19 -63 years). The prevalence of ophthalmic disorders in the study cohort was 34.6%. These were mainly refractive abnormalities (22.0%) and anterior segment disorders (13.8%). The refractive abnormalities comprised myopia (51.8%), hypermetropia (28.6%) and astigmatism (16.1%). CONCLUSIONS: The prevalence of ophthalmic disorder among army personnel at the 82nd Division, Enugu, is comparatively high. Spherical refractive error and anterior segment disorders are the commonest ophthalmic disorders. These have implications for needs-based and cost-effective provision of eye care services to this military formation and probably to the rest of the Nigerian Army as well. To generate broad-based comparative data, future multi-centre surveys are warranted.

Pterygium: A review of clinical features and surgical treatment.

BACKGROUND: Ptergium is a frequently encountered clinical entity in ophthalmic practice. Although commoner in the tropics compared with the temperate region, all Ophthalmologists worldwide should be conversant with the clinical features and outcome of various approaches to surgical management. A review of the efficacy of the currently available surgical procedures for pterygium excision using postoperative recurrences as the main outcome measure is presented. METHOD: Manual and electronic (PUBMED, MEDLINE, AJOL AND HINARI) search for medical literature relevant to clinical features and surgical treatment of pterygium was conducted. Previous reviews, large case series reports, randomized controlled trials and one meta-analysis were selected and critically reviewed. RESULTS: Postoperative recurrence is a dominant complication of pterygium excision irrespective of the adopted surgical procedure. Pterygium excision with adjunctive therapy and ocular surface reconstruction is the current procedure of choice in view of its comparatively higher efficacy in preventing recurrence. CONCLUSION: Recurrence is the commonest postoperative complication of pterygium excision. There is need for further research into the aetiopathogenesis and risk factors for recurrence of human pterygia.

What does the medical student know about eye donation/corneal transplant? The University of Nigeria scenario.

OBJECTIVE: The study was designed to determine the knowledge of eye donation and corneal transplant among final year medical students of The University of Nigeria, Enugu Campus (UNEC). METHODS: Self-administered structured questionnaires were distributed to the members of the final year (graduating) class of the Medical College of UNEC in June 2007. Responses were obtained to questions bordering on eye donation and corneal transplant. RESULTS: One hundred and thirty-one students out of 183 eligible students participated in the study (response rate = 71.6%). One hundred and four students (79.4%) were aware of eye donation/corneal transplant. However 95 students (72.5%) were not aware that the eyes can only be removed from a dead donor. Eighty-four students (64.1%) were not aware that eyes with cataract could be donated. Eighty-seven (66.4%) students were not willing to pledge their eyes for donation. CONCLUSION: Medical students lack adequate knowledge about some aspects of eye donation and corneal transplantation. This may be a predictor of the level of awareness among the general public. Concerted innovative education and information dissemination strategies are required at this stage of national development to address the misconceptions surrounding eye donation and corneal transplant. There is a need to target medical students as future motivators, counsellors and eye donors. This should help advance the eye donation rates in Nigeria whenever the plans for the establishment of an eye-bank are finalized.

Myopia: a review of literature.

INTRODUCTION: Among the refractive errors, myopia is a leading cause of visual impairment throughout the world and its prevalence is on the increase. Pathological myopia is a genetically determined refractive error and a growing body of evidence shows that visual experiences early in life may affect ocular growth and eventual refractive error. In addition to the human cost of visual debility, there is a profound economic cost to the society. The current review highlights recent advances in the management of myopia. METHODS: Information was obtained by searching Medline for citations of articles in English using the Keyword "Myopia" in addition to current literature review. RESULT: Myopia can be classified into two groups, low to moderate degree of myopia (refered to as simple myopia-0.5 to -6.0 dioptres) and high or pathological myopia (greater than 6.0 dioptres). Simple myopia can be corrected with spectacles or contact lenses whereas high myopia may be complicated by potentially blinding conditions such as vitreous and macular degeneration and retinal detachment. CONCLUSION: Recent advances in the management of myopia have made it possible to restore vision to a reasonable degree.