Clinico-cytological analysis of conjunctiva and ocular surface symptoms of patients on topical anti-glaucoma medications attending Lagos University Teaching Hospital, Lagos, Nigeria: A case-control study.

Background: The long-term use of topical anti-glaucoma medications is often associated with ocular surface toxicity that can affect the patient's drug compliance and quality of life. This study assessed the effect of these medications, using cytological changes of the conjunctiva and ocular surface symptoms. Materials and Methods: This was a clinic-based, case-control study that was conducted at the Lagos University Teaching Hospital that compared glaucoma patients on topical medications with age-sex-matched controls. The controls were non-glaucoma patients, who were not on any topical ocular medications at least 6 months prior to the study. The Ocular Surface Disease Index (OSDI) questionnaire was used to assess ocular surface symptoms. Schirmer's I test, tear film break-up time (TBUT) test and corneal fluorescein staining of the ocular surface were used for ocular surface disease (OSD) assessment and conjunctival impression cytology (CIC) for histological assessment and grading. Results: Six hundred and ninety-six eyes of 348 respondents, 174 cases and 174 controls, were assessed for OSD. The mean ages of the case and control groups were 56.3 ± 12.9 years and 55.5 ± 13.2 years, respectively, with no statistical difference (P = 0.589). All ocular parameters assessed were significantly abnormal in the case group compared to the control group. The use of topical anti-glaucoma medications was significantly associated with abnormal TBUT (P < 0.001), Schirmer's test (P < 0.001), ocular surface staining (P < 0.001), CIC (P < 0.001) and OSDI scores (P = 0.001). A significant association was seen between abnormal TBUT and the number of medications (P = 0.044, odds ratio [OR] =0.79, 95% confidence interval [CI]: 0.44-1.14), between abnormal ocular surface staining and duration of anti-glaucoma medications usage (P = 0.0104, OR = 1.2, 95% CI: 1.04-1.43) and between abnormal CIC and the duration of anti-glaucoma medications (P = 0.0007, OR = 0.7, 95% CI: 0.59-0.86). Conclusion: The study demonstrates that prolonged use of topical anti-glaucoma medications may be associated with damage to the ocular surface structures.

Glaucoma Treatment Patterns in Sub-Saharan Africa.

PRCIS: Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma. Laser therapy was underutilized where they were available. Physicians were more likely to recommend surgery in severe glaucoma, laser therapy in mild glaucoma, while recommendation of medical therapy did not depend on glaucoma severity. PURPOSE: To characterize treatment patterns for newly diagnosed glaucoma in sub-Saharan Africa (SSA). METHODS: This was a multicenter cross-sectional study of adults newly diagnosed with glaucoma at 27 eye care centers in 10 African countries. In addition to demographic and clinical data, physician treatment recommendations (medication, laser, surgery, or no treatment) were recorded. Statistical analyses were performed using STATA version 14.0. RESULTS: Data from 1201 patients were analyzed. Physicians were most likely to recommend primary medical therapy upon diagnosis of glaucoma (69.4%), with laser (13.2%), surgery (14.9%), and no treatment (2.5%) recommended to the remaining patients. All sites had medical therapy available and most (25/27, 92.6%) could provide surgical treatment; only 16/27 (59.3%) sites offered laser, and at these sites, 30.8% of eyes were recommended to undergo primary laser procedures. As glaucoma severity increased, the laser was recommended less, surgery more, and medications unchanged. Patient acceptance of medical therapy was 99.1%, laser 88.3%, and surgery 69.3%. CONCLUSIONS: Medical therapy for first-line glaucoma management is preferred by most physicians in SSA (69%). Laser therapy may be underutilized at centers where it is available. These findings underscore the need for comparative studies of glaucoma treatments in SSA to inform the development of evidence-based treatment guidelines and of programs to reduce glaucoma blindness in SSA. Strategic approaches to glaucoma therapy in SSA must address the question of whether medical therapy is the most optimal first-line approach in this setting.

A Study of Visual Functions Amongst Primary Open-Angle Glaucoma Patients in Abuja, Nigeria.

Background: To objectively measure visual function amongst Primary Open Angle Glaucoma (POAG) patients and compare these with age and sex-matched controls by describing the characteristics of visual function in relation to the severity of POAG. Methodology: A case-control study was carried out among 106 POAG patients and an equal number of age-sex matched controls attending Asokoro District Hospital, Abuja, and Eye Foundation Hospital Abuja from Nov 2012 to April 2013. The objective measures of visual function assessed include visual acuity (VA), contrast sensitivity (CS), colour vision (CV), and visual fields (MD) in the better eye (BE)]. Results: All measures of visual function were found to be reduced comparing cases to controls and this was statistically significant. VABE (0.39±0.73; 0.0017±0.02p<0.001); MDBE (-8.02±6.80; 0.17±0.3P<0.001); CSBE (1.46±0.59; 1.90±0.16p<0.001): Colour vision defects (54.7%; 6.6% p<0.001). In comparing mild; moderate; severe glaucoma: VABE (0.0053±0.03; 0.057±0.08; 0.766±0.90 p<0.001); MDBE (-3.46±1.93;-8.17±3.55;-16.43±6.01p <0.001); CSBE (1.88±0.26; 1.69± 0.37; 1.11±0.59 p<0.001): Color vision defects (20.6%; 31.6%; 86.9%) respectively (BE: Better Eye). While looking at the two independent groups above, mild and moderate were not statistically significant except for the visual field, but comparing mild with severe and moderate with severe, they had a statistically significant relationship across all the visual functions tested. In comparing controls with mild, color vision and visual field had a statistically significant difference. Comparing the groups with mild and moderate glaucoma, only visual fields as a visual function were statistically significant. Whereas comparing both groups with the severe group independently, they had statistically significant in all the visual functions tested. Conclusion: In conclusion, visual function was reduced in glaucoma patients as compared to controls. Visual acuity, contrast sensitivity and colour vision differed significantly in comparing mild with severe and moderate with severe. Color vision differed significantly in comparing mild to controls.

Comparative Evaluation of Activities of Daily Living Using Virtual Reality Simulation in Glaucoma and Non-Glaucoma Patients.

Purpose: To compare the performance of activities of daily living (ADL) in Primary open-angle glaucoma patients and non-glaucoma normal controls using virtual reality (VR) simulation at the Lagos State University Teaching Hospital. Materials and Methods: This was a comparative clinical analysis involving primary open-angle glaucoma (POAG) patients. A total of 86 patients were enrolled (43 cases and 43 normal non-glaucoma). Each participant completed four VR simulation tasks. Chi-square/Fisher exact test was used to compare variables. The confidence interval was set at 95% for all statistical tests, and a P value of <0.05 was considered significant. Results: The mean age of participants in the glaucoma group was 60.3 years, and the mean age in the normal non-glaucoma group was 56.5 years. The number of clicks in the driving task in the normal non-glaucoma and glaucoma group differed by 4.84 clicks (mean normal 21.00, confidence interval [CI], 19.96-22.14, mean glaucoma 16.16, CI, 14.30-18.03, P < 0.001). The number of newspapers seen differed by 0.88 (mean normal 9.74, CI, 9.40-10.09; mean glaucoma 8.86, CI, 8.21-9.51, P = 0.020). The mean time taken to complete the bus stop simulation task differed by 41.23 s (mean normal 29.72 s, CI, 25.02-34.42; mean glaucoma, 70.95 s, CI, 53.26-88.65, P < 0.001). The mean time taken to complete the best dress task differed by 14.39 s (mean normal 9.49, CI, 8.18-10.80; mean glaucoma 23.88, CI, 10.03-37.74, P = 0.038). Patients with advanced and severe stages of glaucoma took longer to complete the VR task than those with early glaucoma. Conclusions: The VR simulation used in assessing the performance of ADL among POAG participants highlights limitations that vary with varying severity of glaucoma. The conventional clinical investigation used in assessing glaucoma severity might not define the real-time social effect of the disease.

Clinical Characteristics and Stage at Presentation of Glaucoma Patients in Sub-Saharan Africa.

PRCIS: The initial presentation of glaucoma varies meaningfully across SSA. A comprehensive strategy with regional customization based on local differences is needed to reduce glaucoma blindness in SSA. PURPOSE: To explore regional variations in the presentation of newly diagnosed glaucoma in Sub Saharan Africa (SSA). METHODOLOGY: This was a multicenter, cross-sectional study in which newly diagnosed, consecutive, glaucoma patients aged older than or equal to 18 years were recruited from 27 eye clinics in 10 countries throughout SSA. Demographic and ophthalmic examination data were collected. Glaucoma severity was based on optic nerve head and visual field assessment. Statistical analyses were performed using STATA version 14.0. RESULTS: Among 1214 enrolled patients with newly diagnosed glaucoma from Western, Eastern, and Southern Africa, the overall mean (SD) age was 59.9 (17.1) years. More than half of all patients (716/1178; 60.8%) presented with severe glaucoma in the worse eye, and one-third (36.9%) had severe glaucoma in both eyes. Primary open angle glaucoma was the commonest form of glaucoma in all regions (77.4%). A family history of blindness (260/1204, 21.6%) was common. Patients from Western Africa had lower mean presenting intraocular pressure (26.4 [11.1] mm Hg, P <0.001), but had worse glaucoma in the better eye based on mean cup-disc ratio (0.8; P <0.001) and mean visual field mean deviation [10.4 (8.4)] dB, P =0.016) compared with other regions. Exfoliation glaucoma was more common in Eastern Africa (30/170=17.7%, P <0.001) compared with other regions. CONCLUSION: The initial presentation of glaucoma varies meaningfully across SSA. A comprehensive strategy with regional customization based on local differences is needed to reduce glaucoma blindness in SSA.

Sub-specialization among Nigerian ophthalmologists: status, disposition and barriers.

PURPOSE: To determine the status of sub-specialization among Nigerian ophthalmologists as well as their dispositions and barriers against sub-specialization with a view to providing valuable information for the purpose of human resources for eye care planning thereby providing useful insight into the future of ophthalmic practice in Nigeria. METHODS: This was a web-based, cross-sectional study conducted among ophthalmologists in Nigeria. An online questionnaire was distributed through e-mails using Qualtrics software (Qualtrics, Provo, UT, USA). Information concerning socio-demographic characteristics, type of practice, location of practice, years of practice, status and disposition to sub-specialization as well as barriers to sub-specialization were obtained through the questionnaire. RESULTS: Two hundred and four Nigerian ophthalmologists participated in the study out of which 118 (57.8%) were females. One hundred and ten (54.0%) respondents had undergone sub-specialty training. The sub-specialties with the highest number of patronage was Paediatric Ophthalmology and Strabismus (14.2%). Respondents who had practised for more than 7 years were three times more likely to have undergone sub-specialty training compared to respondents who had practised for 7 years and below [odds ratio (OR) = 3.01, 95% confidence interval (CI) = 1.33-6.83, p = 0.01]. The main barriers to the availability and uptake of sub-specialty services as well as the challenges of sub-specialty services at the centres with established sub-specialty practice were non-availability/inadequate trained specialist and inadequate equipment. CONCLUSION: Nigerian ophthalmologists are well disposed to sub-specialization although the extent of sub-specialization among them was a little above average. The main barriers to the availability and uptake of sub-specialty services as well as the challenges of sub-specialty services at the centres with established sub-specialty practice in this study were non-availability/inadequate trained specialist and inadequate equipment.

The Quality of Life of Medically Versus Surgically Treated Primary Open-angle Glaucoma Patients at a Nigerian Hospital.

PURPOSE: The purpose of this study is to compare the quality of life (QoL) of medically treated versus surgically treated primary open-angle glaucoma (POAG) patients attending Lagos University Teaching Hospital, Lagos, Nigeria. METHODS: The study was a hospital-based, comparative cross-sectional study. Consecutive consenting POAG participants who met the inclusion criteria were recruited until the sample size was achieved. QoL of all participants was assessed using the glaucoma QoL-15 and National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) questionnaires. Analysis was done using the IBM statistical package for the social sciences version 25.0. RESULTS: The study involved 81 participants who were only on medical treatment for POAG and 81 age- and sex-matched POAG participants who had trabeculectomy surgery. Surgically treated participants had a lower mean intraocular pressure 11.68 mmHg when compared to the medically treated participants 14.82 mmHg. Medically treated participants however had a better overall mean glaucoma QoL using the glaucoma QoL-15 (medical 34.36 ± 10.4, surgical 39.11 ± 13.9 P = 0.015) and NEI-VFQ-25 questionnaires (medical 68.32 ± 15.0, surgical 62.44 ± 18.8 P = 0.029). Controlling for the severity of glaucoma using the glaucoma QoL-15 questionnaire, medically treated participants had a better QoL only among participants with severe POAG (medical 49.13 ± 5.9, surgical 54.06 ± 4.6 P = 0.003). While using the NEI-VFQ-25 questionnaire, medically treated participants had a significantly better QoL only among participants with moderate (medical 74.70 ± 6.6, surgical 67.07 ± 15.6 P = 0.012) and severe POAG (medical 54.52 ± 6.3, surgical 45.51 ± 10.0 P = 0.004). CONCLUSION: The study demonstrated that although participants that had trabeculectomy had a lower mean intraocular pressure, their overall mean QoL was reduced compared to the medically treated participants.

Correlation between Health-Related Quality Of Life Scores and Measures of Visual Function in an Abuja Cohort of Primary Open Angle Glaucoma Patients.

Background: This study aims to correlate quality of life measures with visual function parameters and to determine the visual function parameters that independently affect the quality of Life in primary open angle glaucoma patients (POAG) in Abuja. Methodology: A cross sectional study carried out among 106 POAG patients attending Asokoro District Hospital, Abuja and Eye Foundation Hospital Abuja from Nov 2012 to April 2013. National Eye Institute Visual Function Questionnaire 25 (NEIVFQ25) and Glaucoma Symptom Scale (GSS) were used to assess Quality of Life (QoL) after biodata was obtained. The objective measures of visual function assessed include: visual acuity (VA), contrast sensitivity (CS), colour vision (CV) and visual fields (Mean Deviation). Data was analysed using SPSS Version 20 using Spearman Rho Correlation and linear regression. Results: There was a strong correlation between the NEIVFQ25 scores and all the measures of visual function. There was also a strong correlation between GSS and contrast sensitivity in both eyes, and mean deviation of the better eye while the others showed a moderate correlation with the scale. On multivariate analysis of the NEIVFQ25 scores by visual function, the independent visual functions that affects the NEIVFQ25 QoL measures were the visual acuity better eye and contrast sensitivity better eye. Contrast sensitivity in the better eye had a stronger correlation than visual acuity in the better eye. On multivariate analysis of GSS scores by visual function parameters, contrast sensitivity in the better and worse eye were the independent visual function parameters that affect the GSS. The contrast sensitivity of the better eye had a stronger correlation with NEIVFQ25 and GSS. Conclusion: The study revealed the impact of contrast sensitivity on the quality of life and glaucoma symptoms the patients have. It is important that measures of contrast sensitivity be incorporated into evaluating glaucoma patients. Key Messages: Contrast sensitivity of the better eye was the visual function parameter that affected the vision related quality of life scale the most.

Case series of retinopathy of prematurity blindness in Nigeria: A wakeup call to policy makers, hospitals, ophthalmologists and paediatricians.

BACKGROUND STATEMENT: Inadequate retinopathy of prematurity (ROP) screening coverage portends a high risk for increasing the cases of ROP blindness. This study aims to report the clinical profile of pre-term babies who developed ROP blindness, highlight the usefulness in determining screening criteria and the role of private hospitals in ROP blindness prevention. CASE SERIES REPORT: Online Google form and telephone survey was conducted from May to December 2020 among paediatric ophthalmologists who provided the clinical details of ROP blind children seen between 2016 and 2020. The main outcome measured included type of the hospital of birth, gestational age, birth weight, ROP Screening and treatment, and blinding ROP Stage among children born premature. The SPSS-IBM version 26 was used for the analysis. Eighteen children blind from ROP with an equal male-to-female ratio were reported. Mean gestational age was 28.4 ± 2.2 weeks (range 26 - 34 weeks, median was 28.0 weeks). Mean birth weight was 1173.7 ± 317.9 grams (range 776 - 2100 grams, median 1125 grams). Six (33.3%) babies were born in private hospitals between 28 and 32 weeks. Sixteen (88.9%) children never had ROP screening. Fifteen (83.3%) were blind in both eyes. Six (33.3%) had Stage IVb and 12 (66.7%) Stage V. CONCLUSION: About 90% of the babies who became blind did not undergo ROP screening. It is crucial that all babies born at 34 weeks or earlier and have birth weight of < 1500 grams in public/private hospitals be screened for ROP to prevent this avoidable blindness in Nigeria.

Is primary open-angle glaucoma a risk factor for diabetic retinopathy?

PURPOSE: To compare the prevalences of diabetic retinopathy in diabetes mellitus patients, with and without primary open-angle glaucoma, with a view to determine if glaucoma is a risk factor for the development of diabetic retinopathy. METHODS: Cross-sectional, comparative study consisting of 86 diabetic patients with glaucoma matched with 86 diabetic patients without glaucoma. The two groups were matched by age, sex and duration of diabetes mellitus. Demographic data were obtained via patient medical records and self-administered questionnaires. Participants underwent a standardized examination protocol including blood pressure measurement and ocular examination. Main outcome measure was the presence of diabetic retinopathy. RESULTS: Two hundred and ninety-two eyes (144 glaucomatous eyes and 148 non-glaucomatous eyes) of 172 participants with diabetes mellitus were assessed. The prevalence of diabetic retinopathy among 86 participants with glaucoma comorbidity was 23.6%, while the prevalence among 86 non-glaucomatous participants was 33.8% (p = 0.06). After the regression analysis, controlling for systemic and ocular risk factors for diabetic retinopathy, the odds of developing diabetic retinopathy were significantly higher in the glaucomatous eyes compared with eyes without glaucoma (OR: 2.75; p = 0.03; 95% CI: 1.10-6.87). CONCLUSION: This study demonstrated that glaucomatous diabetic eyes were almost three times more likely to develop diabetic retinopathy compared to non-glaucomatous diabetic eyes. Prospective studies may be required to establish a risk-cause relationship. Ocular perfusion pressure control should be considered in patients with diabetes mellitus and glaucoma.

Relationship between corneal sensitivity and diabetic retinopathy among diabetics attending a Nigerian Teaching Hospital.

PURPOSE: To determine the relationship between corneal sensitivity and diabetic retinopathy among diabetics attending Lagos University Teaching Hospital, compared to their age-sex-matched non-diabetics, with a view to proposing its use as a screening tool for diabetic retinopathy. METHODS: The study was a hospital-based comparative cross-sectional study among diabetics aged 25-65 years and their age-sex-matched non-diabetics at Lagos University Teaching Hospital, Lagos, Nigeria. Interviewer-based questionnaire was administered. Corneal sensitivity was assessed with Cochet-Bonnet aesthesiometer. Dilated fundoscopy examination was carried out using slit-lamp bio-microscope with 78D lens and binocular indirect ophthalmoscope. RESULTS: A total of 120 diabetics and 120 age- and sex-matched non-diabetics were enrolled into the study. Among the diabetics, the mean corneal sensitivity was 52.6 ± 6.9 mm, which was statistically lower than among non-diabetics - 58.2 ± 3.0 mm (p-value < 0.05). Twenty-one percent of the diabetic respondents had diabetic retinopathy. The mean cornea sensitivity was statistically lower among diabetics who had developed diabetic retinopathy compared to those with no diabetic retinopathy (48.9 ± 7.3 vs. 55.3 ± 5.4, p < 0.05). The sensitivity and specificity of the aesthesiometer for proliferative diabetic retinopathy at 55 mm cut-off were 100% and 58%, respectively. CONCLUSION: Cornea sensitivity was significantly lower among diabetics with retinopathy compared to those without retinopathy. Also, the degree of cornea sensation loss among diabetics reduced significantly with severity of diabetic retinopathy. Larger validity studies need to be conducted to further assess the use of corneal aesthesiometer as a screening tool for diabetic retinopathy among non-ophthalmologists and other cadres of health workers.

Correlation between clinical and cytological parameters of dry eye among diabetics in a Nigerian tertiary hospital.

PURPOSE: To correlate the clinico-cytological features of dry eye among diabetic patients attending Lagos University Teaching Hospital, Lagos. METHODS: This was a cross-sectional, comparative study among 104 diabetic and 104 age-/sex-matched non-diabetic participants. Demographics were obtained using interviewer-administered questionnaire. Ocular Surface Disease Index (OSDI) questionnaire was used for subjective assessment of dry eye. All participants underwent ocular examination and dry eye assessment including Schirmer I test, tear film break-up time (TBUT) and ocular surface staining. In addition, conjunctival impression cytology (CIC) samples were taken for histological assessment. Data were analysed using IBM Statistical Package for the Social Sciences version 20.0 (IBM Corp., Armonk, NY USA). RESULTS: The mean age was 58.5 ± 10.05 years and 58.32 ± 10.48 years among the diabetics and non-diabetics, respectively (p = 0.856). The male/female ratio was 1:1.4. Three hundred and ninety-seven (199 diabetic and 198 non-diabetic) eyes were assessed. Diabetics had a significantly higher median OSDI score and ocular surface staining grade compared to non-diabetics (p = 0.002 and 0.005, respectively). The TBUT was slightly lower, while the Schirmer test was slightly higher among the diabetics, but not significant (p = 0.058 and 0.033, respectively). The diabetics had a significantly higher CIC grade (p < 0.001). There was a moderate positive correlation between conjunctival cytology and ocular surface staining (r = 0.50, p < 0.01). CONCLUSION: This study demonstrates worse ocular surface damage among diabetics characterised by ocular surface staining and abnormal CIC. Furthermore, it shows a positive correlation between ocular surface staining and CIC. Dry eye assessment should be incorporated in routine diabetic eye screening.

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.

Visual impairment and ocular morbidities among schoolchildren in Southwest, Nigeria.

AIM: The purpose of this study was to determine the prevalence of visual impairment and ocular morbidities among primary and secondary schoolchildren aged 5 years to

Pattern of childhood visual impairment and blindness among students in schools for the visually impaired in Lagos State: An update.

AIM: The aim of this study was to determine the pattern of childhood visual impairment and blindness (VI and BL) among students attending schools for the visually impaired in Lagos State, with a view to providing information on avoidable causes as well as emerging trends that would be useful to policy-makers for the planning and implementation of strategies for the control of avoidable childhood BL in Lagos State. SUBJECTS AND METHODS: The study was conducted among students enrolled in two schools for the visually impaired in Lagos State who developed VI/BL before the age of 16 years. Participants and their parents/guardians were interviewed to obtain medical history. Ocular and systemic examinations were also performed. Information was recorded using a modified World Health Organization/Prevention of BL Eye Examination Record for Children with BL and Low Vision and analysed using the Statistical Package for the Social Sciences version 23.0. Z-test determined differences in the proportions of the causes of VI/BL between this study and an earlier study. RESULTS: A total of 116 students were enrolled in this study of which 65 (56.0%) were males. Avoidable causes accounted for 58.5% of VI/BL. Preventable causes predominated with measles (15; 12.9%) accounting for the largest proportion. Surgical complications (16; 13.8%) were the largest cause of VI/BL. A statistically significant decrease (P = 0.004; 95% confidence interval = 0.09-0.50) in the proportion of avoidable BL between a previous study carried out in Lagos State and this study was found. Hereditary cataract and cortical VI were the findings of this study not recorded in the previous study. CONCLUSION: Avoidable causes of childhood VI/BL still predominate among students in the schools for the visually impaired in Lagos State; however, there is a statistically significant decrease.

Prevalence and pattern of amblyopia among primary school pupils in Kosofe town, Lagos state, Nigeria.

OBJECTIVE: The objective of this study was to determine the prevalence and pattern of amblyopia in primary school pupils in Kosofe town of Lagos State with a view to providing baseline data that may facilitate the establishment of routine school eye screening programs in primary schools in Lagos State. MATERIALS AND METHODS: A descriptive, cross-sectional study was conducted among pupils from public and private primary schools in Kosofe town. The pupils underwent visual acuity assessment with the HOTV charts, detailed ocular examinations and cycloplegic refractions. Data obtained were analysed using the Statistical Package for Social Sciences version 20.0. RESULTS: A total of 1702 pupils participated in the study, out of which 899 (52.8%) were males. The age range was 4-16 years with 1630 (95.8%) pupils within the ages of 4 and 10. Amblyopia was detected in 24 (1.4%) of the screened pupils (95% confidence interval = 0.610-0.914). There was no significant sex predilection (P = 0.367) or age trend (P = 0.158) in this study although amblyopia occurred more in boys (54.2%). Refractive amblyopia (58.4%) was the most common type of amblyopia out of which anisometropic amblyopia accounted for 78.6%. Unilateral amblyopia was observed in 87.5% of the amblyopic pupils, and the left eye was more commonly affected than the right eye. All the types of amblyopia were more common within the age group of 4-10 years and in public school children (P = 0.039 and P = 0.015, respectively). CONCLUSION: The prevalence of amblyopia in this study was low and it falls within the general prevalence range for amblyopia in Nigeria.

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.

Presbyopia and near spectacle correction coverage among public school teachers in Ifo Township, South-West Nigeria.

BACKGROUND: Presbyopia is an age-related loss of lens accommodation resulting in difficulty in performing near task with attendant effect on the quality of life. OBJECTIVE: The objective of the study was to determine the prevalence of presbyopia and presbyopic spectacle correction coverage among public school teachers in Ifo township, with a view to providing a baseline information that could be useful for advocacy and planning appropriate intervention. STUDY DESIGN: The study was a descriptive, cross-sectional study. MATERIALS AND METHODS: Six hundred public school teachers aged 30 years and above were examined in 25 clusters using a multistage random sampling technique with probability proportional to size. Questionnaire was used to obtain information on demographic data, sources of spectacle and barriers to spectacle use. All participants underwent a standardised protocol including visual acuity assessment (distance and near acuity), anterior and posterior segment examinations and refraction. RESULTS: Six hundred teachers were examined with an age range of 30-61 years. The mean age was 44.7 ± 7.5 years and the male to female ratio was 1:2.2. The prevalence of presbyopia was 81.3% and 38.5% of the presbyopic teachers did not have presbyopic correction. However, the average age of onset of presbyopia was earlier in females 33 years compared to 36 years observed in males, although not statistically significant (P = 0.88). The presbyopic correction coverage was 61.5%. One hundred and eighty-six (62%) presbyopic teachers obtained their spectacle from opticians, and the main barriers to the use of near vision spectacle were lack of awareness (23.7%) and cost (13.7%). CONCLUSION: This study demonstrated a high prevalence of presbyopia among public school teachers in Ifo town, South-West Nigeria, but less presbyopic spectacle correction coverage.