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.

Quality of sleep and psychological distress in glaucoma

Background: People living with glaucoma are psychologically burdened because of the threat of visual loss. Therefore, understanding the psychosocial issues and quality of sleep holds important implications for the recognition, prevention, and treatment of emotional problems among people with glaucoma. This study investigated the quality of sleep and psychological distress among people with glaucoma.Methods: This was a cross-sectional study of adults recruited over a period of 12 weeks from a glaucoma clinic of a Teaching Hospital in south-west Nigeria. The quality of sleep and psychological distress were evaluated using the Pittsburgh Sleep Quality Index and General Health Questionnaire respectively.Results: Ninety-three adults with glaucoma participated in the study. The mean age was 62.33 ± 15.25 years. Fifty-seven (61.3%) of the subjects were poor sleepers while 27 (29.0%) were psychologically distressed. Psychological distress correlated with global sleep score (r = 0.399, p = 0.000), subjective sleep quality (r = 0.341, p = 0.001), sleep latency (r = 0.245, p = 0.018) and sleep disturbance (r = 0.279, p = 0.007).Conclusion: Psychological distress and sleep disturbances were common among patients with glaucoma. Concerns about these issues should be incorporated into routine clinical evaluations of patients with glaucoma

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.

Experience with extra-capsular cataract exraction and intra-ocular lens implant in children.

BACKGROUND: in developing countries congenital cataract has become an important cause of treatable blindness in childhood. However, difficulty in correcting aphakia is one of the reasons for poor visual outcome. OBJECTIVE: to determine the visual outcome after extra capsular cataract extraction and intra ocular lens implant and factors militating against good visual outcome in children. METHODS: a prospective interventional study of cataract extraction in children with intra ocular lens implant. Extra capsular cataract extraction with intra ocular lens implant was performed using the superior limbal approach. Polymethyl Methacrylate lenses were inserted. Posterior capsulotomy was done with a 25G needle bent at the tip in 26 eyes. RESULTS: thirty two eyes of twenty five children aged between 4 months and 16 years were operated. Extra capsular cataract extraction with posterior chamber intraocular lens implant was done in 27 (83.4%) eyes, plain extra capsular cataract extraction in 3 (9.4%) eyes, extra capsular cataract extraction with anterior chamber intraocular lens implant in 1 (3.1%) eye and vectis extraction in 1 (3.1%) eye. Twenty six eyes had primary posterior capsulotomy. Thirty-two (100%) eyes and 15 (60%) children were blind before surgery. Result of post operative visual acuity in 18 children after refraction was 6/18 or better in 4 (22.2%) children 6/24-6/60 in 11 (61.1%) and< 3/60 in 3 (16.7%) children. CONCLUSION: visual rehabilitation following extra capsular cataract extraction with Intra Ocular Lens Implant is encouraging in children.

Arteriovenous malformation of the occipital lobes in a Nigerian.

AIM: To present the clinical features of arteriovenous malformations of the occipital lobe in order to assist in making a diagnosis prior to intracerebral haemorrhage. METHODS: A Sixty one year old Nigerian male patient complained of constant frontal headache for five years with associated gradual visual loss. Six months before presentation he suffered two episodes of severe headache associated with dizziness and profound visual loss. On examination his visual acuity was Hand Movement in each eye, the pupils were active and both optic discs were normal. Neurological examination was normal. A Computed Tomography was normal. He suddenly fell down and died within one week of presentation. Autopsy report revealed arteriovenous malformations of both occipital lobes and left parietal lobe. CONCLUSION: Visual loss may be the only clinical sign in occipital lobe lesions. A visual field test is helpful in the diagnosis. Computed tomography has limitations in the diagnosis of intracranial lesions especially suspected vascular lesions. Early presentation, visual field analysis and angiographic studies are essential.

Experience with Extra-capsular Cataract Exraction and Intra-ocular Lens Implant in Children

BACKGROUND: In developing countries congenital cataract has become an important cause of treatable blindness in childhood. However; difficulty in correcting aphakia is one of the reasons for poor visual outcome. OBJECTIVE: To determine the visual outcome after extra capsular cataract extraction and intra ocular lens implant and factors militating against good visual outcome in children. METHODS: A prospective interventional study of cataract extraction in children with intra ocular lens implant. Extra capsular cataract extraction with intra ocular lens implant was performed using the superior limbal approach. Polymethyl Methacrylate lenses were inserted. Posterior capsulotomy was done with a 25G needle bent at the tip in 26 eyes. RESULTS: Thirty two eyes of twenty five children aged between 4 months and 16 years were operated. Extra capsular cataract extraction with posterior chamber intraocular lens implant was done in 27 (83.4) eyes; plain extra capsular cataract extraction in 3 (9.4) eyes; extra capsular cataract extraction with anterior chamber intraocular lens implant in 1 (3.1) eye and vectis extraction in 1 (3.1) eye. Twenty six eyes had primary posterior capsulotomy. Thirty-two (100) eyes and 15 (60) children were blind before surgery. Result of post operative visual acuity in 18 children after refraction was 6/18 or better in 4 (22.2) children 6/24-6/60 in 11 (61.1) and 3/60 in 3 (16.7) children. CONCLUSION: Visual rehabilitation following extra capsular cataract extraction with Intra Ocular Lens Implant is encouraging in children

Assessing the visual status of truck drivers in a developing country.

We undertook an interventional prospective study of truck drivers from a cement factory in Nigeria to assess their visual status after licensing. Out of 149 drivers, 122 (81.9%) were visually eligible to drive and 27 (18.1%) were not. Causes for failing the vision test included refractive error, cataracts, glaucoma, corneal leucoma and pterygia.

Burkitt's lymphoma presenting with blindness: a case report.

A 10-year-old schoolboy was referred to the Ophthalmic Unit of Ahmadu Bello University Teaching Hospital because of sudden loss of sight following 5 days of severe frontal headache. The child had bilateral ptosis with internal and external ophthalmoplegia and fixed and dilated pupils. There was no papilloedema. Eight days later, a jaw tumour and a rapidly enlarging abdominal tumour appeared. A fine needle aspiration biopsy of the jaw tumour confirmed Burkitt's lymphoma. Combination chemotherapy with cyclophosphamide, vincristine and methotrexate (COM) led to a rapid resolution of the jaw and abdominal tumour but the child never regained his sight. Cerebrospinal fluid examination was not helpful in reaching a diagnosis.