Macular diseases in Ibadan, Nigeria.

BACKGROUND: Retina diseases including the diseases of the macular are underreported in developing countries of sub-Sahara Africa including Nigeria. METHOD: A retrospective review of retinal register of cases presenting to the retinal clinic of the University College Hospital, Ibadan within 4 years (December 2015, to November 2019). Demographics and clinical data of all patients with macula diseases were retrieved. Data were analysed using the Statistical Package for Social Sciences IBM (SPSS-IBM), version 22 (SPSS Inc., Chicago, Illinois, USA), and reported as frequency distributions and percentages. RESULTS: A total of 1291 retinal cases were seen during the period under review, out of which 322 cases were diseases of the macula, representing 24.9% of retinal cases seen. The top 3 common causes of macular disease found in the study were dry Age-related Macular Degeneration (AMD) 63 (19.6%); Macula oedema 53 (16.5%) and Non-AMD atrophic maculopathy (from Retinitis Pigmentosa, chloroquine maculopathy and hereditary causes) 51 (15.9%) representing more than 50% of cases. Macular holes 48 (14.9%); Non-AMD macular scar (Toxoplasmosis, Trauma) 37 (11.5%) and choroidal neovascular membrane (CNVM) 26 (8.1%) are other important causes. Idiopathic Polypoidal Choroidal Vasculopathy (IPCV) 17 (5.3%) is an emerging cause of macular disease in the retina unit of the University College Hospital Ibadan. CONCLUSION: Age-related macular degeneration (AMD), Macular oedema and Non-AMD atrophic maculopathy are major causes of macular disease presentation in the retinal clinic of the University College Hospital Ibadan, Nigeria. CNVM and IPCV are emerging causes.

UTILIZATION OF EYE CARE SERVICES AMONG STUDENTS ATTENDING SCHOOLS FOR THE HEARING IMPAIRED IN OYO STATE, SOUTH-WEST NIGERIA.

BACKGROUND: Vision screening and detection of ophthalmic disorders in hearingimpaired individuals is important to optimise their visual function and therefore, their quality of life. OBJECTIVE: To determine the utilisation of eye care services among students attending schools for the hearing impaired in Oyo State, Nigeria. METHODS: This was a descriptive cross-sectional study conducted among hearingimpaired students aged 11 years and above. Using systematic random sampling, participants were selected from four schools. An interviewer administered semistructured questionnaire was used to collect socio-demographic data and information on history of eye symptoms and utilisation of eye care services. Data analysis was performed using the IBM SPSS software version 22 and test of association done using chi-square test with level of statistical significance set at p-value <0.05. RESULTS: A total of 335 students were recruited into the study. Mean age was 17 ± 2.9 years (range 11 - 39 years). Only 147 (43.9%) respondents had utilised eye care services in the past. Some of the reasons given for non-utilisation include financial constraints and lack of an escort to the hospital. CONCLUSION: This study has demonstrated that the rate of utilisation of eye care services among the studied population is suboptimal. Therefore, it is essential for government, eye care providers and other stakeholders to design and implement policies and eye care programmes that would improve the uptake of eye care services among hearing-impaired individuals. This will reduce the compounding effect of visual impairment in such individuals.

Comparison between focometer and autorefractor in the measurement of refractive error among students in underserved community of sub-Saharan Africa.

PurposeTo compare focometer and autorefractor in the measurement of refractive errors among students in an underserved community of sub-Saharan Africa.MethodsThe study was a descriptive comparative cross-sectional study conducted in October/November 2014 among secondary school students of Ijaiye-Orile, Oyo State, Nigeria. Students were selected using systematic random sampling method. Ocular examination and measurement of refractive error was carried out on each student using a focometer and an autorefractor.ResultsA total of 230 students were studied. Mean age of the students was 15.1±1.9 years with a range of 13-21 years. Refractive error was detected in 95 (41.3%) of the students using autorefractor and in 81 (35.2%) with focometer. Among those found to have refractive error using autorefractor, 75 (78.9%) students had a difference of ≤±0.75 DS between the autorefractor and focometer readings. The sensitivity and specificity of the focometer relative to the autorefractor was 73.7% and 91.9%, respectively.ConclusionThe focometer is comparable to the autorefractor in the measurement of refractive error because of its high sensitivity and specificity. The high positive and negative predictive values makes the focometer an effective tool for both screening and diagnosis of refractive error in rural areas among secondary schools students. Its use would make refractive service available and affordable to individuals living in the resource poor rural communities thereby reducing the burden of refractive error in such areas. The focometer should also be a useful tool in school eye health programs.

Chloroquine retinopathy: pattern of presentation in Ibadan, Sub-Sahara Africa.

BackgroundSelf-medication with chloroquine is common in Ibadan, Sub-Sahara Africa. Retinopathy from chloroquine is not uncommon. The aim was to determine the pattern of presentation.MethodologyCases of Chloroquine retinopathy seen at the Retina and Vitreous Unit of the University College Hospital, Ibadan between 2008 and 2014 were reviewed. Information on age, sex, duration of chloroquine use, and visual loss were retrieved. Visual acuity at presentation, anterior, and posterior segment findings were documented. The results were analyzed using proportions and percentages.ResultsFourteen cases were seen during the study period. Mean age was 50.7 years. Male to female ratio was 3.5 : 1. Average duration of visual loss before presentation was 2.7 years. Average duration of self-medication with chloroquine was 5.3 years. Presenting visual acuity showed 2(14%) cases of bilateral blindness(VA<3/60 in both eyes); 5(35.7%) cases of uniocular blindness; three cases of bilateral low vision(VA worse than 6/18 but better than 3/60). Anterior segment examination showed abnormal sluggish pupillary reaction in those with severe affectation. Dilated fundoscopy showed features ranging from mild macular pigmentary changes and bulls eye maculopathy to overt extensive retinal degeneration involving the posterior pole, attenuation of retinal vessels, optic atrophy, and beaten bronze appearance of atrophic maculopathy.ConclusionChloroquine retinopathy is not uncommon in Ibadan, Sub-Sahara Africa. Bulls eye maculopathy, extensive retinal, and macular degeneration with optic atrophy are the main presentations. Public health education is imperative.

BARRIERS TO AN EFFECTIVE DIABETIC RETINOPATHY SERVICE IN IBADAN, NIGERIA (SUB -SAHARAN AFRICA) - A PILOT QUALITATIVE STUDY.

BACKGROUND: Diabetic retinopathy is an increasing cause of blindness. The prevalence of retinopathy in hospital attending diabetics in Ibadan is reported to be 42 %. This study assessed the barriers identified by patients and service providers to delivering good services for diabetic retinopathy in Ibadan, Nigeria, Sub-Saharan Africa. METHODS: A qualitative survey using non-participatory observation, in-depth interviews (patients and healthcare providers), and focus group discussion for diabetic patients in the eye clinic in University College Hospital, Ibadan was done. Semistructured interview and topic guides were used to evaluate the barriers to effective service. The participants were selected using a non-probability, purposive sampling strategy. Twenty participants were involved in the pilot study. There were ten in-depth interviews of patients and two focus group discussions of patients (3 in each group). Four healthcare providers were interviewed (a retinal surgeon, a senior registrar, an endocrinologist and a public health nurse). RESULTS: Lack of awareness that diabetes causes irreversible blindness was identified as a major barrier by both patients and providers. Cost of treatment of diabetes and treatment of retinopathy was also an important barrier. The long waiting time before consultation, staff attitudes to patients and appointment scheduling problems deterred patients from using the service. CONCLUSIONS: More diabetic patients can be encouraged to use eye service by providing more detailed information/counselling and making clinic attendance less costly and more convenient.

Diabetic retinopathy: current developments in pathogenesis and management.

Diabetic retinopathy is now an important cause of visual impairment in the developing countries due to changing lifestyles. This review includes recent developments on the pathogenesis of diabetic retinopathy emphasizing the role of Protein Kinase C and Vascular Endothelial Growth Factor. It also bring to the fore the atypical presentations, recent use of pharmacological agents and the importance of screening in the management of diabetic retinopathy. These developments are relevant in Nigeria, and Ophthalmic and Medical practitioners need to be aware.

Pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft.

BACKGROUND: The use of conjunctiva autograft, adjunct antimetabolite therapy has been shown to be effective in preventing pterygium recurrence. OBJECTIVE: To compare 5 fluorouracil (5-FU) to conjunctival autograft in the treatment of large, fleshy pterygium. METHODS: A randomised controlled prospective study of outcome of pterygium treatment using 5-FU as adjuvant treatment compared to conjunctiva autograft. Thirty-five eyes with large pterygium treated with bare sclera conjunctival excision plus 5-FU were compared with 33 eyes treated with excision and conjunctival autograft alone. RESULTS: Post-operative pterygium recurrence was observed in four (11.4%) eyes treated with 5-FU and 4 (12.1%) eyes treated with conjunctiva autograft (P>0.05). The post-operative complications included, granuloma formation 11.4% for 5-FU and 3.0% for autograft and conjunctival discharge 5.7% for 5-FU group only. CONCLUSION: 5-FU is marginally superior to conjunctival autograft in the prevention of pterygium recurrence but neither gives a more desirable single digit recurrence rate. Randomised studies combining both conjunctival autograft and 5-FU in pterygium treatment is advocated to further explore their effect.

Ocular abnormalities in children with cerebral palsy.

This prospective study was undertaken to evaluate the prevalence of ocular abnormalities, as well as describe the various eye defects seen among cases of cerebral palsy presenting at the Paediatric Neurology Clinic, University College Hospital, Ibadan, Nigeria. All cases of cerebral palsy seen at the Paediatric Neurology Clinic, University College Hospital, Ibadan, over a period of 18 months were carefully evaluated by the Paediatric Neurologist for signs of ocular abnormalities. Those in whom such abnormalities were found were referred to the Consultant Ophthalmologist for detailed eye examination and accurate description of the ocular abnormalities. One hundred and forty nine children with cerebral palsy were seen during the period of study, forty two had associated ocular abnormalities, giving a prevalence rate of 28.2%. More than half (61.9%) of the cases were completely blind. The major ocular abnormalities identified in the affected cases were strabismus (50%), optic atrophy (50%) and cortical visual impairment (47.7%). Other eye defects less frequently seen were nystagmus (9.5%) and refractive errors (4.8%). Presence of spastic quadriplegia was associated with an increased risk of ocular abnormalities. Ocular abnormalities are a frequent problem in children with cerebral palsy. Evaluation of all children with cerebral palsy must include amongst other things, a full ophthalmologic evaluation, even when no gross eye anomalies are visible to the attending physician. Early identification of these defects in children with CP is crucial in order to institute prompt therapy in cases with defects that are amenable to treatment.

Unexpectedly high prevalence of target-organ damage in newly diagnosed Nigerians with hypertension.

INTRODUCTION: Hypertension remains a formidable cardiovascular problem in the entire world. Untreated or poorly controlled hypertension predisposes to target-organ damage and is often followed by serious cardiovascular events. Knowledge of the type and distribution of endorgan damage in newly diagnosed hypertensive patients would help to determine the interventions or preventative measures needed in such patients. OBJECTIVE: To assess target-organ involvement in newly diagnosed, untreated hypertensive patients presenting at the University College Hospital, Ibadan, Nigeria. METHODS: Newly diagnosed hypertensive men and women were recruited consecutively into the study. Target-organ damage was assessed using electroctrocardiography, echocardiography, renal function assessment (including tests for albuminuria) and fundoscopy. RESULTS: A total of 68 subjects were recruited, but only 54 (79.4%), with a mean age of 59.1 ( +/- 12.4) years, completed the study. There were 29 ( +/- 53.7%) men, mean age 63.5 ( +/- 12.6) years, and 25 (46.3%) women, mean age 54.1 ( +/- 10.4) years. Fifty per cent of the subjects had no symptoms. Some form of albuminuria was found in about 40.7%. Seventy-one per cent (71%) had between grade 1 and 2 hypertensive retinopathy. Only six (11.1%) had glomerular filtration rate greater than 90 ml/min. Systolic function was impaired in three (5.6%) of the subjects. Diastolic dysfunction was present in 36 (66.7%) subjects. CONCLUSION: Target-organ damage already exists in newly diagnosed hypertensive subjects before presentation. We suggest early screening for cardiovascular risk factors and possibly a reduction in the criteria for the definition of hypertension in black Africans.

Causes of blindness in Southwestern Nigeria: a general hospital clinic study.

PURPOSE: This hospital-based study was carried out to assess the common causes of blindness in Ibadan, the largest city in the southwestern part of Nigeria, and to strengthen the primary eye care approach to control and reduction of cases of blindness in the community. METHODS: Following Hospital Ethical Board approval and informed consent of participants, a prospective study was performed in which 1,544 consecutive patients with bilateral or unilateral blindness seen between January and December 2003 at the Ring Road State Hospital, Ibadan, Nigeria, were evaluated for causes of blindness. Visual acuity was measured with an illuminated Snellen chart placed 6 meters away from the participants. This was followed by pen torch examination and dilated funduscopy with a direct ophthalmoscope. Friedman field analyzer was used to measure visual field. Patients with corrected visual acuity of less than 3/60 in the better eye or with visual field of less than 10 degrees from fixation were considered blind according to the World Health Organization criteria. RESULTS: The 1,544 patients had a mean age of 53.5 years (range, 4 to 96 years); 858 (56%) were male and 686 (44%) were female. Blindness was bilateral in 471 (30%) patients and unilateral in 1,073 (70%). When those persons with unilateral and bilateral blindness were grouped together, individuals within the 60 to 79 years age bracket were 667 (44%) and constituted the largest group of all blind persons. The leading causes of bilateral blindness were cataract, 171 (36%); glaucoma, 138 (29%); and optic atrophy, 21 (4%). The most common causes of unilateral blindness were cataract, 446 (41%); glaucoma, 213 (20%); and those referable to trauma, 116 (11%). CONCLUSIONS: Cataract and glaucoma are the main causes of bilateral and uniocular blindness in the study area.

Non-operative management of benign intracranial hypertension presenting with complete visual loss and deafness.

Benign intracranial hypertension (BIH) may lead to blindness and rarely deafness. We describe the case of a rapidly deteriorating 14-year-old African girl who presented with headaches associated with complete visual and hearing loss due to BIH. This was managed non-operatively with lumbar cerebrospinal fluid tap, weight reduction, nicotinic acid and acetazolamide. Response to treatment was quite dramatic with resolution of severe headaches and regaining of light perception 8 days after commencing treatment. By 3 months hearing recovered to normal and there was resolution of vision. This to the best of our knowledge is the first reported case of complete visual and hearing loss occurring in a patient with BIH, which was managed successfully non-operatively. When indicated, non-operative management is an effective treatment option even in malignant BIH.

The aetiology of optic atrophy in Nigerians--a general hospital clinic study.

This study aimed at reviewing cases presenting with optic atrophy at the eye clinic of the University College Hospital, Ibadan, Nigeria with a view to identifying some of the diagnostic problems. The study was a retrospective review of 100 cases selected by systematic random sampling method of a total of 6160 patients presenting with optic atrophy to the eye clinic over 6 years (April 1990 to March 1996). Diagnosis was based on ophthalmoscopic appearance of optic disc corroborated with visual field studies. The mean age of the patients was 40.8 years. The male to female ratio was 2:1 bilateral. Eighty percentages were bilateral, whereas 20% were unilateral. Only in 38% of cases could the cause of the optic atrophy be identified. The most frequently diagnosed were cranio-orbital neoplasms (8%), those referable to trauma (8%), hydrocephalus (7%), retinitis pigmentosa (3%) and post infectious (2%). Other causes include toxins, congenital, seizure disorders, birth asphyxia and papilloedema. In 62% of cases, the aetiology cannot be satisfactorily elicited. Some suggestions have been made to overcome some of these diagnostic problems.

Prevalence and causes of blindness and visual impairment among school children in south-western Nigeria.

The aim of the study was to assess the prevalence and identify the causes of blindness and visual impairment in school children of Ilesa-East Local Government Area of Osun State, Nigeria. A total of 1144 school children in primary and secondary schools were selected using a 2-stage random sampling method and examined to determine the prevalence and causes of blindness and visual impairment. A total of 17 (1.48%) children were blind or visually impaired. These comprised of 11 (0.96%) children who were visually impaired and 4 (0.3%) who were severely visually impaired. Only 2 (0.15%) school children were blind. The causes of visual impairment were refractive error 10 (0.87%) and immature cataract 1 (0.08%), causes of severe visual impairment included corneal opacities 2 (0.2%), amblyopia leading to squint 1 (0.08%) and 1 cataract 1 (0.08%). The causes of blindness in school children were corneal scars presumed to be due to vitamin A deficiency 1 (0.08%) and keratoconus 1 (0.08%). Causes of blindness and visual impairment in children attending regular schools in Nigeria were treatable. Prevention, early recognition and prompt treatment of these diseases by regular screening of school children would definitely reduce unnecessary visual handicap in Nigerian school children so that they can attain their full potential in the course of their education. Also, information from this study is relevant for the purpose of planning eye care programmes for the prevention of blindness in Nigerian school children. This will go a long way in the prevention of unnecessary blindness and visual impairment in school children.

Cataract blindness and barriers to cataract surgical intervention in three rural communities of Oyo State, Nigeria.

BACKGROUND: The study was a community based field survey that used a rapid assessment method to determine the prevalence of cataract blindness in people aged 50 years and above in 3 rural communities. OBJECTIVE: The purpose of the study was to determine the prevalence of cataract blindness and barriers to cataract surgical intervention in an area served by a health facility managed by a tertiary institution. METHOD: Abedo, Akinyele and Ketepe Villages in Akinyele Local Government Area of Oyo State Nigeria were selected based on their nearness to the primary health care centre in Abedo. RESULT: A total of 477 persons aged 50 years and above were seen being 73.3 percent of expected. Those with visual acuity of less than 3/60 in an eye and those with visual acuity of less than 3/60 in the better eye were examined in more details using a pen torch, an ophthalmoscope and tonometer to determine the cause of blindness. All persons who have had surgery were examined. The prevalence of blindness in persons aged 50 years and above was 1.47% and that of cataract blindness in the same age group in the villages was 0.84% constituting 57.14% of blindness. The main barriers to hospital presentation were cost of surgery (52.8%) and distance to hospital (33.8%). The constraints and limitations encountered during the study included rural-urban migration and population discrepancies between what obtained at the villages and those supplied by the Local Government Population Commission. CONCLUSION: It is hoped that this study will serve as a preliminary survey and a base line for further studies and the initiation of a blindness prevention programme in the area.

The Ibadan glaucoma study.

To obtain epidemiological data on the prevalence and risk factors for open angle glaucoma in hospital workers of African origin, and investigate appropriate methods of a rapid, cost-effective screening procedure for glaucoma. A cross-sectional study of workers in the University College Hospital (UCH) Ibadan, using a structured questionnaire for data collection. The variables available for data analysis include workers demographic characteristics, visual acuity, pupil status, intraocular pressure, cup-disc ratio, central visual fields, family history of glaucoma, chronic diseases such as hypertension and diabetes. The data was analysed with EPI-INFO version 6.02 for simple analysis, while the SPSS package was used for multivariate analysis. A total of two thousand, one hundred and nine (2,109) UCH workers participated in the screening exercise for glaucoma. A high majority of the workers 1794 (85.1%) were negative to the diagnosis of glaucoma, while the remaining 315 (14.9%) were suspected to have glaucoma out of which 57 (2.7%) were confirmed as definite glaucoma cases. The prevalence of glaucoma among UCH workers was 27 per 1000, 95%, confidence interval = 20 per 1000, 35 per 1000. Factors associated with glaucoma were relative afferent pupillary defect, cup-disc ratio greater than 0.7, intraocular pressure, family history of glaucoma and the presence of chronic diseases such as diabetes. The left eye appears to have a higher probability of ocular problems compared with the right eye. The prevalence of glaucoma among hospital workers was 2.7% The cup-disc ratio appears to be a better diagnostic tool for glaucoma since it gives the best positive predictive value (with a cut-off point of 0.7) than all other variables.