Age at detection and age at presentation of childhood cataract at a tertiary facility in Ibadan, Southwest Nigeria.

BACKGROUND: To describe factors which influence the age at detection and age at presentation of patients with childhood cataract at a tertiary eye care facility in Southwest Nigeria. METHODS: A retrospective review of children who presented with cataract between 2011 and 2015. Case notes were reviewed and data on age at detection and presentation as well as other clinical information was collected and analyzed using Stata 12 statistical software. RESULTS: A total of 164 cases were reviewed, 52.4% of them were boys. Median age at presentation was 48 months while the median age at detection was 13.5 months. Seventy-four (45.1%) children had congenital cataract, 31.1% had developmental cataract, and 21.3% had traumatic cataract. The child's mother detected the cataract in 116 (70.7%) of the patients. Median age at presentation for patients with congenital cataract was 18 months and 84 months for developmental cataract. The median age at presentation for congenital cataracts that were noticed by the mother was 17 months compared with 72 months for those noticed by other caregivers (p = 0.0085). The median age at presentation for developmental cataracts that were noticed by the mother was 72 months compared with 114 months for those noticed by other caregivers (p = 0.0065). Gender of the child did not significantly influence the age at detection or presentation. The source of referral and the location of domicile did not significantly affect the time interval between detection of the cataract and presentation to hospital. CONCLUSION: The average age of children presenting with cataracts in our setting is older than in high income countries. Detection of the cataract by the mother increases the likelihood of early presentation; thus, focused maternal education may promote earlier detection and presentation.

Prevalence of congenital colour vision deficiency among secondary school students in Ibadan, South-West Nigeria.

AIM: The aim was to determine the prevalence and pattern of congenital colour vision deficiency among secondary school students in Ibadan, Nigeria. SUBJECTS AND METHODS: A descriptive cross-sectional study was conducted among students from three public secondary schools through a multi-staged sampling method. Ocular examination including visual acuity assessment and colour vision test with the Ishihara plate was performed for all students. Further assessment with the Farnsworth-Munsell D-15 panel was performed for those who failed the Ishihara test. RESULTS: One thousand six hundred and thirty-five students participated in the study. There were 769 (47.0%) males with mean age of 13.9 ± 1.9 years. The overall prevalence of congenital colour vision deficiency was 2.3% with prevalence of 3.8% and 0.9% in males and females, respectively, which was statistically significant (P = 0.00112), and equal proportion of deutans 11 (32.0%) and protans 12 (35.0%) ratio of 1:1.1. CONCLUSION: The prevalence of congenital colour vision deficiency among public secondary school students in Ibadan is comparable to findings in other parts of the country.

Unilateral visual impairment and blindness in school children - prevalence and aetiology in Saki-East LGA of Oyo State, Nigeria.

OBJECTIVE: This study determined the prevalence and aetiology of unilateral visual impairment (VI) and blindness and its associated factors in school children. METHODS: We conducted a multistage, cross-sectional study in primary and secondary schools of Saki-East Local Government Area of Oyo State, Nigeria. Unilateral VI was defined as presenting visual acuity (PVA) worse than +0.3 LogMAR (6/12) and unilateral blindness as PVA worse than +1.3 LogMAR (3/60) in the worse eye. Detailed ocular examinations were performed for students with unilateral VI, and Logistic regression analysis was performed to explore associations with independent variables. RESULTS: The mean age of participants was 11 ± 3.2 years. Thirty-six (0.98%) of 3671 children had unilateral VI, and fifteen children had unilateral blindness (0.41%), giving a combined prevalence of 1.39 ± 0.5%. History of ocular trauma was reported by 14 (27.5%) participants with unilateral VI and blindness. In addition, those with a history of ocular trauma were 6.5 times more likely to be blind or have a severe VI (95% CI 1.5-2.8) than those without a history of ocular trauma. Uncorrected refractive error was the major cause of unilateral VI in 26 (51%) participants, while traumatic cataract was the main cause of unilateral blindness seen in 5 (9.8%) participants, none of whom had a previous eye examination. CONCLUSION: Fourteen per thousand school children had unilateral VI in this study; the major causes were refractive error and cataract, which are treatable. Ocular trauma was a significant risk factor for unilateral VI and blindness.

Functional Vision of Pseudophakic Children Attending a Pediatric Ophthalmology Clinic in Southwest Nigeria.

PURPOSE: To determine the functional vision of pseudophakic children attending a child eye health tertiary facility in southwest Nigeria. METHODS: A hospital-based descriptive study of pseudophakic children attending the Pediatric Ophthalmology outpatient clinic of a tertiary facility in southwest Nigeria was conducted between June and November 2021. Details of demography and clinical examination findings were obtained using a semi-structured questionnaire. Information about functional vision was obtained using the Pediatric Eye Questionnaire (PedEyeQ). Data obtained from the PedEyeQ were entered into a Rasch-calibrated PedEyeQ Excel response data sheet. Data analysis was done using Statistical Package for Social Sciences (SPSS) software version 22 (SPSS, Inc). RESULTS: A total of 196 pseudophakic children were recruited. Their ages ranged from 2 to 16 years with a mean of 9.8 ± 3.4 years and there was a male-to-female ratio of 2.2:1. The median functional vision score of pseudophakic children across all age groups was 90.0. The functional vision scores were associated with the laterality of cataract, type of cataract, presence of comorbidities, visual acuity (distance and near) in the better eye, and number of surgeries. CONCLUSIONS: The functional vision scores of pseudophakic children were low. Significant predictors of low functional vision scores include surgery for congenital cataract, low average family income, longer duration of time between surgery and recruitment into the study, and poorer best corrected visual acuity in the better eye. The routine assessment of functional vision should be considered an important aspect of pseudophakic children's eye care with a view toward optimizing psychological and social well-being. [J Pediatr Ophthalmol Strabismus. 2024;61(2):138-146.].

Familial Cataracts: Profile of Patients and Their Families at a Child Eye Care Tertiary Facility in a Developing Country.

PURPOSE: The aim of this study is to describe the clinical profile, pedigree charting, and management of children with familial cataracts at a child eye health tertiary facility in southwest Nigeria. METHODS: The clinical records of children ≤16 years diagnosed with familial cataracts at the Pediatric Ophthalmology Clinic, University College Hospital Ibadan (Ibadan, Nigeria) from January 1, 2015, to December 31, 2019, were retrospectively reviewed. Information on demographic data, family history, visual acuity, mean refractive error (spherical equivalent), and surgical management was retrieved. RESULTS: The study included 38 participants with familial cataract. The mean age at presentation was 6.30 ± 3.68 years, with a range of 7 months to 13 years. Twenty-five patients (65.8%) were male. All patients had bilateral involvement. The mean duration from onset of symptoms to presentation at the hospital was 3.71 ± 3.20 years, with a range of 3 months to 13 years. In 16 of the 17 pedigree charts obtained, at least one individual was affected in each generation. The most common cataract morphology was cerulean cataract, observed in 21 eyes (27.6%). The most common ocular comorbidity was nystagmus which was observed in seven patients (18.4%). Sixty-seven eyes of 35 children underwent surgery within the period of the study. The proportion of eyes that had best-corrected visual acuity ≥6 / 18 before surgery was 9.1%; this proportion had increased to 52.7% at the last postoperative visit. CONCLUSIONS: Autosomal dominant inheritance appears to be the major pattern among our patients with familial cataract. The most common morphological type found in this cohort was cerulean cataract. Genetic testing and counseling services are vital for the management of families with childhood cataract.

Nigerian parents' perspectives on genetic testing in their children with genetic eye diseases.

The decision for genetic testing in children is usually taken by their parents or caregivers, and may be influenced by sociocultural and ethical concerns. This study evaluateds the perspectives of Nigerian parents towards genetic testing of their children with genetic eye diseases parental willingness for genetic testing in their children, and its determinants, in a hospital setting in Nigeria. This cross-sectional, hospital-based study was conducted at the Eye clinic, University College Hospital, Ibadan. The participants were 42 parents of children with genetic eye diseases purposively recruited from April to July 2021. The main variables of interest were overall willingness to test, and willingness to test given ten different scenarios. Summary statistics were performed, and determinants of willingness to test (parental sociodemographic and children's clinical characteristics) were assessed using Fischer's exact test. All the participants expressed willingness to test when presented with six of the ten scenarios.However, slightly fewer (83-95%) proportions were willing to test for the other four scenarios (out-of-pocket payment, if test will reveal a systemic association, if test may confirm a diagnosis with no current treatment, and prenatal testing). Willingness to test was not significantly associated with the determinants tested. Thirty-nine (93%) would join a support group, 38 (91%) would inform a family member at risk, and 28 (67%) would be unwilling to have more children if there wais a risk to future offspring. This study demonstrated a high degree of parental willingness for genetic testing of their children. This is important evidence that can guide policy and planning of ophthalmic genetics services.

Ocular injuries in a paediatric population at a child eye health tertiary facility, Ibadan, Nigeria.

PURPOSE: To determine the pattern, causes and risk factors for ocular injuries amongst children presenting to a tertiary facility in Ibadan, southwest Nigeria METHODS: A retrospective review of clinical records of patients aged 16 years and below who presented with ocular injuries to the eye emergency unit between May 2010 and April 2016. Information extracted includes patient's demography, location and circumstances of injury, clinical findings, and management. Data was analysed using IBM SPSS Statistics for Windows, Version 26.0. Descriptive and inferential statistics were calculated. Odds ratio were derived from regression models adjusted for confounders. Significance was set at a P-value of 0.05. RESULTS: A total of 109 children were studied. Majority were boys (male to female ratio=2.9:1). The median age at presentation was 9 years. Injury occurred at home in 67 (61.5%) children, and at school in 30 (27.5%). More than half of the children were injured during play, 18 (16.5%) during corporal punishment, and 34 (31.2%) by accidents during domestic/schoolwork. Majority (73.4%) were closed globe injuries. The odds of injury with sharp objects and ocular trauma score of 4 or less was were 3.2 times (95% Confidence interval {CI}: 1.3-7.7) and 3.9 times (95% CI:1.4-11.4) higher in children aged 0-5 years respectively. The odds of open globe injury was 9.8 times (95% CI: 3.4-28.6) higher in injury from sharp objects. Wood/stick, cane, stone, broomstick and fist/palm/finger were the agents responsible for two-thirds of injuries. CONCLUSION: This study revealed that children predominantly sustain ocular injuries at home and younger children have greater odds of severe injuries with profound implications for visual disability. Health education, adult supervision and the application of appropriate measures necessary for reducing the incidence and severity of childhood ocular trauma are advocated.

Burden and clinical profile of genetic eye diseases in children in Nigeria: a descriptive cross-sectional study.

Introduction: ophthalmic genetics is rapidly evolving globally but is still nascent in much of sub-Saharan Africa, with gaps in knowledge about the burden in the region. This study evaluated the burden and manifestations of genetic eye diseases in children in Ibadan, Nigeria. Methods: this was a hospital-based cross-sectional study in which new and follow-up paediatric eye clinic patients were recruited consecutively at the University College Hospital, Ibadan. Children with genetic eye diseases had comprehensive ocular and systemic examinations, and their pedigrees were charted to determine the probable modes of inheritance. The main outcome variables were the proportion of study participants with genetic eye diseases, the probable modes of inheritance, and the clinical diagnoses. Summary statistics were performed using means and standard deviations for numerical variables and proportions for categorical variables. Results: fifty-two (12%) of 444 children had genetic eye diseases, and their mean (SD) age was 88.8 ± 50.4 months. Thirteen different phenotypic diagnoses were made following the evaluation of the 52 children, including primary congenital glaucoma (13, 25%) and familial non-syndromic cataracts (8, 15%). The probable modes of inheritance were derived from the pedigree charts, and 30 (58%) conditions were presumed to be sporadic. Conclusion: this study demonstrated a significant burden and a wide range of paediatric genetic eye diseases in this tertiary referral centre in Nigeria. This information provides invaluable evidence for planning ophthalmic genetic services.

Survey of Blindness in Saki East, Oyo State, Nigeria.

Background: This survey was undertaken in a rural local government area (LGA) where eye care services recently commenced, with no known previous data on blindness or visual impairment. Aim and Objectives: The aim was to generate evidence for further planning and monitoring of the on-going eye care program. The objectives included determination of the prevalence of blindness and visual impairment, causes of blindness and visual impairment, and assessment of cataract services and barriers to cataract surgery uptake. Materials and Methods: This was a cross-sectional observational study. A population-based rapid assessment of avoidable blindness (RAAB) was undertaken among eligible individuals, aged 50 years and above, who were residents of Saki East LGA. A three-stage cluster sampling technique with probability proportional to size was employed to recruit 1100 respondents. Field data were analysed using the RAAB 5 computer software package. Results: The age- and sex-adjusted prevalence of blindness was 1.7% (95% confidence interval: 0.1-3.3). Cataract was the commonest cause of blindness (37.8%) and severe visual impairment (56.3%), whereas refractive error was the leading cause of moderate visual impairment (68.3%). The prevalence of blindness significantly increased with age (χ2= 38.01, P = 0.000). Avoidable conditions were responsible for 94.6% of the blindness. Conclusion: The burden of blindness and visual impairment in the survey area is significant, with more than 90% due to avoidable causes. Cataract, glaucoma, and uncorrected refractive error were important causes needing urgent attention.

Indications for surgery amongst new patients presenting to the paediatric ophthalmology unit of the University College Hospital, Ibadan.

OBJECTIVE: The objective of the study was to determine the proportion of children requiring ocular surgery amongst new patients presenting to the Paediatric Ophthalmology Unit of the University College Hospital, Ibadan, over a 2-year period, to enhance planning and improve the efficiency of service delivery. METHODS: The study was a retrospective review of records of all new patients aged 0-16 years who presented to the Paediatric Ophthalmology Unit of the University College Hospital, Ibadan, over a 2-year period (May 2015-April 2017). Information on age and gender, clinical diagnosis and indications for surgery and type of surgery scheduled were retrieved from the diagnosis register of the unit, and a descriptive analysis was performed. RESULTS: Of the 1240 children who presented to the clinic within the study period, 142 (11.5%) needed surgical interventions. Their ages ranged from 1 month to 16 years, with a mean age of 6.4 ± 4.7 years. Seventy-nine (55.6%) of these were males. The most common indications for surgery were cataract and cataract-related indications (n = 122, 85.9%), followed by glaucoma and strabismus. Other less common indications for surgery were nasolacrimal duct obstruction and epibulbar dermoid. CONCLUSION: Paediatric cataract, the leading cause of childhood blindness in this environment, presents the greatest surgical burden in our unit. It should, therefore, be a major focus of personnel training and equipment procurement for paediatric ophthalmology services in our environment.

Congenital aniridia: clinical profile of children seen at the University College Hospital, Ibadan, South-West Nigeria.

PURPOSE: To describe the clinical features of patients younger than 16 years with aniridia presenting to the Paediatric Ophthalmology unit of the Eye Clinic, University College Hospital, Ibadan, Nigeria. METHODS: The is a retrospective review of children with aniridia seen between May 2015 and April 2019 at the Paediatric Ophthalmology unit of the Eye Clinic, University College Hospital in Ibadan. Data on demographic characteristics, presenting complaints, ocular and systemic examination findings, and interventions were collected and descriptively summarised. RESULTS: A total of 28 eyes of 14 patients were studied. The mean age was 6.37 ± 4.98 years. Seven (50%) patients were male. Aniridia was diagnosed in first-degree relatives of nine patients. The most common complaint at presentation was poor vision in 11 (78.6%) patients. Objective visual acuity assessment was obtained in 22 (78.6%) eyes. Presenting visual acuity was worse than 20/60 in all 22 eyes and worse than 20/400 in 8 (36.4%) eyes. Refraction was performed in 17 (60.7%) eyes and revealed a mean spherical equivalent of -3.93 ± 5.99 diopters. Twenty (71.4%) eyes had corneal opacities, and lenticular opacities were seen in 15 (62.5%) of 24 eyes. Mean intraocular pressure (IOP) at presentation was 21.62 ± 10.4 mmHg; 12 (41.4%) eyes had elevated IOP at presentation. Ten (35.7%) eyes had cataract surgery and six (21.4%) eyes had glaucoma surgery. CONCLUSION: Familial aniridia was common in this study, and most of the patients presented with moderate to severe visual impairment. The common ocular associations were refractive error, cataract, corneal opacity and glaucoma.

Outcome of surgery for traumatic cataract in children in a child eye health tertiary facility, Ibadan, Nigeria.

OBJECTIVE: The objective of this study was to describe the outcome of surgery for traumatic cataract and associated factors in children aged 16 years and below operated in a tertiary facility. METHODS: This was a retrospective review of records of children who had surgery for traumatic cataract between August 2015 and August 2019. Information on biodata, preoperative visual acuity, surgical methods, complications, and postoperative visual acuity were retrieved. Data were analyzed using IBM SPSS Statistics 20.0. RESULTS: Traumatic cataract accounted for 87 (14.7%) of 593 eyes operated for childhood cataract during the period. Of these, a total of 79 records were available for review. There were 56 (70.9%) males with a mean age of 10.11 (±3.39) years. All injuries were unilateral; closed globe injuries accounted for 70 (88.8%) of the cataracts and the left eye was affected in 42 (53.2%) patients. Fifty-two (67.09%) eyes had other ocular injuries apart from cataracts. The morphology of the cataract was membranous in 44 (55.7%) eyes, and 76 (96.2%) eyes had cataract surgery with intraocular lens (IOL) implantation; 39 (51.3%) of these IOLs were implanted within the capsular bag. The preoperative best corrected visual acuity was worse than 6/18 in all 79 (100%) eyes and improved to 6/18 or better in 32 (40.5%) eyes at 3 months postoperatively. CONCLUSION: Traumatic cataract accounted for less than a quarter of all childhood cataracts in our center. Majority of the eyes had successful IOLs implantation during surgery, and the best corrected visual acuity improved in a moderate proportion of these patients.