Physical properties of soft contact lens multipurpose solutions commercially available in Ghana.

Purpose: To investigate the physical properties of commercially available multipurpose soft contact lens solutions in Ghana. Methods: pH (Kelilong ICL-099 pH meter, China), osmolality (OSMOMAT 3000, GONOTEC, Germany), surface tension (Sigma 700 Tensiometer, Sweden), and viscosity (CFOC-200 Viscometer, Cannon Company, USA) of various soft contact lens multipurpose solutions (MPS) were measured in triplicates at room temperature. Viscosity measurements were also taken at 34 °C ocular surface temperature. The solutions examined were Opti-Free Replenish (OFR), Trufresh (TF), Avizor (AV), Freshlook (FL), and Refresh (RF). Results: Several solutions were largely hypo-osmotic in the range of 108-231 mOsm/kg, the exception being Avizor, which had osmolality values that were closer to human tears (301 ± 0.58 mOsm/kg). The range of pH values of the solutions (6.33-8.24, mean (SD) = 7.53 ± 0.18) fell within the reported tolerable range for the ocular surface (6.20-9.00). Surface tension values ranged from 35.86 to 42.27 mNm with a mean of 38.49 ± 2.32 mNm. The average viscosity of most solutions at room temperature (25 °C) was 1.44 ± 0.49 cP with a range of 1.04-2.15 cP. Significantly lower values ranging from 0.79 to 1.58 cP were obtained at ocular surface temperature (34 °C), p = 0.0001). Conclusions: The physical properties of many of the solutions used as MPS in Ghana are markedly variable. Nevertheless, pH, surface tension, and viscosity fall within the acceptable limits of ocular physiological tolerance; except for osmolality, which majority were outside the reported tolerable range for the ocular surface. This information may partly explain the reason some patients exhibit strong preferences for certain care systems and should aid clinical decision-making when prescribing eye care systems to patients.

Contact Lens Prescribing Patterns in a University Clinic in Trinidad and Tobago.

The study assessed the contact lens prescribing patterns and associated factors in a university optometry clinic in Trinidad and Tobago. The data relating to habitual or new contact lens (CL) prescribing patterns among wearers over a two-year period were reviewed. Pearson's chi-squared test and logistic regression models were used to analyze the findings. The Hosmer-Lemeshow goodness-of-fit test was used to examine the model calibration. A total of 243 CL fits were analyzed, and the Homeshow-Lemeshow goodness-of-fit test indicated a good fit (χ2 (7) = 7.296, p = 0.399). The mean age of lens wearers was 29.6 ± 12.4 (mean ± SD); the majority, 155 (63.8 %) of whom, were 21 to 40 years old. Most lenses were fitted on females (64.2% of fits overall) and about half of the wearers (n = 122, 50.2%) were prescribed lenses for cosmetic purposes. Conventional soft CL were the most prescribed modality of wear, accounting for 129 (53.1%) of the fits. Age from 21 to 40 years was the predictor of lens type prescribed, and those in that age range were four times more likely to be prescribed soft lenses compared to other ages. The patterns of CL prescribing in a university optometry clinic in Trinidad and Tobago are similar to the global market trends with slight variations.

Demographic profiles of contact lens wearers and their association with lens wear characteristics in Trinidad and Tobago: A retrospective study.

PURPOSE: Contact lenses (CL) remain a popular mode of refractive error correction globally and in the Caribbean, mostly among young people. However, no data on the characteristics of the CL population wearers in the Caribbean is available. This study reported on the characteristics of CL wearers and the associated factors in Trinidad and Tobago (T&T). METHODS: This retrospective study reviewed the clinical records of 243 CL wearers who attended the University of the West Indies (UWI) optometry clinic between 2017 and 2018. Data on their demographic profiles, CL wearing characteristics including lens type, material, purpose of wear, replacement schedule and lens care systems were extracted and analyzed. The associations between the demographic characteristics and CL wearing characteristics were also determined. RESULTS: About half of the CL wearers used them for fashion (more among those aged 18 to 30 years, 61.0%), therapeutic (more among those <18 years, 43.8%, P = 0.001) and refractive error correction purposes (more in those >40 years, P = 0.001). Females were more likely to use CLs for fashion compared with males (67.0% versus 40.7%). Age (P<0.0005) and gender (P = 0.030) were associated with the lens materials. Those aged 18-30 years were more likely use hydrogels compared with the younger ones (64.1% versus 25.0%). Rigid gas permeable (RGP) CL use was more common in males than females (21.8% versus 10.9%, P = 0.031). Daily disposables were predominantly used by younger respondents (18-30 years old, 31.3%, P < 0.001) and more in females than males (66.7% vs 49.4%, P = 0.040). CONCLUSION: The study found that the CL appears to be more commonly worn for fashion in younger females and for refractive error correction in older males. Age, gender, and employment status were the main determinants of lens wear among respondents attending the university clinic in T&T.

Assessment of four validated questionnaires for screening of dry eye disease in an African cohort.

PURPOSE: To evaluate the 5-item dry eye questionnaire (DEQ-5) for measurement precision and unidimensionality, and assess the ability of Ocular Surface Disease Index (OSDI), McMonnies Dry Eye Questionnaire (MQ), Ocular Comfort Index questionnaires (OCI), and DEQ to predict clinical measures of DED in an African population. METHOD: Participants (n = 113; mean age 24.7 ± 5.4 years) completed all four questionnaires administered in a randomized order. Internal consistency and test-retest reliability of the instruments were assessed. A masked examiner performed clinical dry eye tests in both eyes of participants and the results used to classify into either "dry" or "non-dry" groups. The diagnostic criteria for dry eye disease were tear break up time (TBUT) < 10 s plus at least one of Schirmer <15 mm in 5 min., > 5 corneal staining spot, or > 9 conjunctival staining spots. Rasch analysis was performed to assess the DEQ for unidimensionality and measurement precision, and receiver operating characteristic curve (AUC) analysis was used to assess the ability of the four questionnaires to predict clinical measures of DED. RESULTS: The responses from the DEQ-5 met the Rasch analysis criterion of unidimensionality with infit and outfit values of between 0.74-1.43 mean-square and 0.69-1.49 mean-square, respectively, and measurement precision of 2.33. Internal consistency and test-retest reliability of each test was high, with Cronbach alpha >0.70 for the questionnaire and their respective subscales but internal consistency reliability of the MQ was poor (Cronbach's alpha = 0 .29-0 0.52). Each test segregated the "dry" and "non-dry" groups with moderate (all AUC 0.70-0.80) and similar accuracy (P > .05). CONCLUSION: The DEQ -5 demonstrated adequate measurement precision and unidimensionality. Each of the four questionnaires showed psychometric validity for clinical use in the African population, and modest and similar accuracy when screening for dry eye signs but the performance of the McMonnies questionnaire was limited in terms of internal consistency reliability.

Accuracy of Noncycloplegic Refraction for Detecting Refractive Errors in School-aged African Children.

SIGNIFICANCE: Cycloplegia is often restricted in screening settings. Previous studies have evaluated noncycloplegic refraction for screening, but their data are not fully applicable to school-aged African children. This article adds to the literature by investigating this in school-aged African children. PURPOSE: The purpose of this study was to evaluate the ability of noncycloplegic autorefraction (NCA) and noncycloplegic retinoscopy (NCR) to detect refractive errors in school-aged African children and quantify differences between noncycloplegic and cycloplegic refraction measures. METHODS: Autorefraction and retinoscopy were performed on 150 children aged 6 to 15 years before and after cyclopentolate cycloplegia. Subjective refraction was performed by the same examiner after cycloplegia. Noncycloplegic and cycloplegic measurements were compared, and the data were assessed with receiver operating characteristic curves and Bland-Altman plots. RESULTS: With the exception of cylindrical vector J0 (P = .17) and J45 (P = .08) obtained with NCR, all mean measures of NCA and NCR significantly differed from mean cycloplegic subjective refraction measurements by -0.71 ± 0.67 (P ≤ .001; 95% confidence interval, -2.02 to +0.60) and -0.75 ± 0.68 (P ≤ .001; 95% confidence interval, -2.08 to +0.58), respectively. Mean spherical power between the two tests did not differ (NCA -NCR, mean bias of -0.037 ± 0.675 and 95% limits of agreement of -1.36 to 1.286; P = .51). The sensitivities for detecting any refractive error for NCR and NCA were 86.8 and 82.9%, respectively, and the specificities were 82.0% for NCR and 82.4% for NCA. Performance of both tests was excellent for myopia (area under the curve, >0.90; sensitivity, ≥90%) and similar (P = .13), but the specificities for detecting hyperopia were 78.0% for NCR and 80.0% for NCA. CONCLUSIONS: Noncycloplegic refraction may accurately detect astigmatism and myopia in this population but may elicit higher myopic values and lower hyperopic values than using cycloplegic refraction.

Contact Lens- and Patient-related Factors Associated with Contact Lens Discomfort among Contact Lens Wearers in an African Cohort.

SIGNIFICANCE: No information is available on contact lens discomfort in any African population. Such information may be helpful in developing the scope and priorities for intervention. PURPOSE: The purpose of the study was to examine contact lens- and patient-related factors associated with contact lens discomfort among wearers in Ghana. METHODS: In this multicenter cross-sectional study, contact lens wearers 18 years and older were recruited. The Contact Lens Dry Eye Questionnaire-8 and a standardized scripted interview were administered to 72 contact lens wearers at five clinical sites, and 40 participants' lens storage cases were collected and cultured. A variety of patient- and contact lens-related factors were examined. Univariate and multivariate logistic regression modeling were used to assess risk factors associated with contact lens discomfort. RESULTS: Seventy-two contact lens wearers aged 18 to 45 years completed the study. The mean age was 27.5 ± 6.4 years, 65.3% of them were females, 86.1% wore soft contact lens, and 13.9% wore rigid gas-permeable lens. Contact lens discomfort was reported by 66.7% of the subjects. Most frequent lens storage cases isolates were Bacillus species (40%) and fungi (31.1%). Significant association was found between disinfecting with tap water (5.98; 95% confidence interval [CI], 1.22 to 29.27; P = .03), heavy visual display terminal use (3.39; 95% CI, 1.01 to 11.34; P = .05), high water content (1.16; 95% CI, 1.02 to 1.33; P = .03), and contact lens discomfort. Demographic factors, wear modality, and care solutions were not significant (all P > .05). CONCLUSIONS: In considering the use of contact lenses for refractive correction in this population, strategies for preventing contact lens discomfort that should be targeted include use of low-water-content lenses, disinfecting with multipurpose solutions, and reducing the time spent daily on visual display terminal use.

Socio-demographic factors modify awareness, knowledge, and perceived risk of glaucoma in rural and urban residents in Ghana: a population-based survey.

PURPOSE: To evaluate the awareness, knowledge and the perception of risks of glaucoma among rural and urban dwellers in Ghana, a high prevalent country, in order to provide information for health promotion planning. METHOD: In a population-based descriptive cross-sectional survey, 1200 adults were selected from household settings, using a two-stage cluster and simple systematic random sampling. Quantitative data collection, using interviewer-administered questionnaire, was employed. Descriptive statistics were performed using chi-square, ordinal univariate, multinomial and multivariate logistic regression models used to calculate odds ratio with 95% confidence interval (CI) to identify predictive factors. RESULTS: Overall, only 326 (27.2%, 95% CI = 24.6-29.7) indicated they were aware of glaucoma, whereas 331 (27.6%, 95% CI = 24.6-29.7) had ever undergone an eye screening. Low knowledge was demonstrated in 152 (46.6%, 95% CI = 41.2-52.0) and high knowledge in 99 (30.4%, 95% CI = 25.4-35.4) glaucoma-aware participants. Only 238 (19.8%, 95% CI = 17.6-22.1) of respondents presumed themselves to be at risk of developing glaucoma. Having eye examination (within the last 6 months) was positively associated with knowledge (adjusted odds ratio (AOR) = 1.413; 95% CI = 0.9-1.896) and awareness (AOR = 1.13; 95% CI = 0.938-2.449). Three levels of education (no education (AOR = 0.041; 95% CI = 0.016-0.11), primary (AOR = 0.057; 95% CI = 0.018-0.179), and middle school (AOR = 0.254; 95% CI = 0.127-0.51)) were associated with low knowledge while all levels of education were inversely associated with awareness. Perceived risk of glaucoma was also influenced by area of residence (rural (AOR = 0.344; 95% CI = 0.21-0.57)), being young (18-24 years (AOR = 4.308; 95% CI = 2.36-7.88)) and having previously undergone screening for glaucoma (AOR = 13.200; 95% CI = 5.318-32.764). CONCLUSION: The main modifiers of glaucoma awareness and knowledge were education and previous eye examination, but awareness had additional factor of area of residence. Perceived risk of glaucoma was influenced by being young and living in urban areas.

Ocular Symptoms of SARS-CoV-2: Indication of Possible Ocular Transmission or Viral Shedding.

The recently identified novel coronavirus (CoV), the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causes the coronavirus disease 2019 (COVID-19). While published data about other highly infectious human COVs [that is, the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV)] provide helpful information about the infectivity of SARS-CoV-2, there is limited understanding surrounding knowledge of ocular manifestation of the virus. This paper reviews published data which reveal the presence of SARS-CoV-2 RNA in tears and conjunctival scrappings of some COVID-19 patients by real-time-polymerase chain reaction assay, although the detection rate is low compared to samples from respiratory sites. Nevertheless, the ocular complications from SARS-CoV-2 infection are uncommon. The evidence partly supports the eye as a portal of entry for SARS-CoV-2 to infect respiratory cells or viral shedding from respiratory cells via the nasolacrimal duct unto the ocular surface. The possibility of ocular secretions as source for SARS-CoV-2 to spread externally has substantial public health implications.

Oral consumption of Garcinia kola(Bitter kola) lowers intraocular pressure.

PURPOSE: Garcinia kola (bitter kola) is locally ingested across the West African subregion. It has ocular hypotensive effects similar to some commonly used glaucoma medications when administered topically. The study assessed the effect of oral ingestion of G. kola on intraocular pressure (IOP). METHOD: A randomized, single-blind, placebo-controlled, cross-over design was used in this study. Forty-six healthy subjects, aged between 19 and 27 years were recruited and randomized into two groups (A and B). Subjects in group A ingested 100 mg/kg body weight bitter kola in a 200 ml solution on their first visit and group B ingested 200 ml of water. On the second visit, the order of treatment was reversed, IOP was measured at baseline and every 45 min interval for 135 min. The mean difference between the baseline and post-treatment IOP measurements were tested for statistical significance using repeated-measures analysis of variance (95% confidence intervals [CIs]). RESULTS: Mean IOP measurements decreased by 7.9, 18.2 and 20.6% at 45, 90 and 135 min, respectively, after G. kola treatment. The reduction, though variable across subjects, was statistically significant (F [2.13, 95.62] = 90.35, p < 0.0001) across the respective time points. Repetition of an identical protocol without G. kola caused clinically negligible changes in IOP. There was no statistically significant influence of gender or age in G. kola effect on IOP reading. CONCLUSION: Oral ingestion of G. kola lowered the intraocular pressure of healthy young adults by 21%. Such an effect may be of therapeutic benefit to patients with POAG or ocular hypertension in low-income settings.

Normative Values of Retinal Nerve Fibre Layer Thickness and Optic Nerve Head Parameters and Their Association with Visual Function in an African Population.

PURPOSE: To determine normative values of retinal nerve fibre layer thickness (RNFL) and optic nerve head (ONH) parameters and their association with routine clinical tests such as refractive error (RE), stereoacuity (SA), and contrast sensitivity (CS) in an African population. METHODS: In a cross-sectional observational study, 100 normal subjects aged 20 to 78 years were evaluated using the Cirrus HD-OCT 5000 and matched with 200 glaucoma patients. RESULTS: Average (±SD) RNFL thickness for normal subjects was found to be 102.37 ± 7.45 (range, 82-119 microns) compared with 90.74 ± 14.50 found for glaucoma subjects. Females had higher average RNFL values (104.84 ± 6.90) compared with males (99.80 ± 7.18). Significant associations were calculated between quadrant RNFL thickness and SA, SE, and CS (all p < 0.05). The mean cup to disc ratio (CDR) was 0.49 ± 0.12, and mean optic disc area (DA) was 2.08 mm2 ± 0.40. Smaller DA was recorded for participants aged 60+ years (1.86 ± 0.25), followed by 40-59 age group (2.01 ± 0.41) and then 20-39 age group (2.19 ± 0.41). Significant associations were calculated between SA and ONH parameters, except rim area (all p < 0.05). The mean cup to disc ratio (CDR) was 0.49 ± 0.12, and mean optic disc area (DA) was 2.08 mm2 ± 0.40. Smaller DA was recorded for participants aged 60+ years (1.86 ± 0.25), followed by 40-59 age group (2.01 ± 0.41) and then 20-39 age group (2.19 ± 0.41). Significant associations were calculated between SA and ONH parameters, except rim area (all p < 0.05). The mean cup to disc ratio (CDR) was 0.49 ± 0.12, and mean optic disc area (DA) was 2.08 mm2 ± 0.40. Smaller DA was recorded for participants aged 60+ years (1.86 ± 0.25), followed by 40-59 age group (2.01 ± 0.41) and then 20-39 age group (2.19 ± 0.41). Significant associations were calculated between SA and ONH parameters, except rim area (all. CONCLUSION: RNFL thickness in healthy black Ghanaian population was significantly higher than that reported in other races. The values and associations reported in this study can inform clinical decision on the normal variation in RNFL and optic disc parameters.

Inter-regional trends in causes of childhood blindness and low vision in Ghana.

BACKGROUND: Inter-regional trends of visual loss in most developing countries remain largely unknown. We compared the causes of childhood blindness among children attending blind schools in the northern (one school) and southern (two schools) regions of Ghana and assessed their need for spectacles and low-vision devices. METHODS: Using a standardised methodology, children were examined by an ophthalmologist and optometrists in each location. Causes of visual loss were classified anatomically and by time of onset, and avoidable causes identified. Children identified with functional low vision were assessed and provided with low-vision devices. RESULTS: A total of 252 children under 16 years of age were examined in the schools. The overall prevalence of total blindness was 73 (29.0 per cent), with similar proportions (p = 0.87) in the north (29 [28.4 per cent]) and south (44 [29.3 per cent]); 92 (36.5 per cent) had functional low vision. Two children improved with spectacles and 35 benefited from low-vision devices. Corneal scarring was significantly (p = 0.045) more prevalent in southern Ghana (n = 150) than in the north (n = 102), responsible for visual loss in 36 (24.0 per cent, 95% CI 17.2-30.8 per cent) and 14 (13.7 per cent, 95% CI 7.0-20.4 per cent) cases, respectively. No significant difference (p = 0.321) was observed in the prevalence of cataract between northern (28: 27.5 per cent, 95% CI 18.3-36.2 per cent) and southern Ghana (33: 22.0 per cent, 95% CI 15.4-28.6 per cent). Over 87 per cent of children had 'avoidable' causes of visual loss, with a higher proportion being treatable (124: 49.2 per cent) than preventable (96: 38 per cent). CONCLUSION: Cataract was the major cause of visual loss in the overall population. The south had a higher proportion of corneal scarring and late-onset blindness compared with the north. More than one-third of blindness in blind schools in Ghana could have been prevented by primary care interventions and nearly half could have been treated surgically to prevent visual loss. Two in five children in blind schools in Ghana could benefit from optical intervention.

Self-adjustable Spectacle Wearing Compliance and Associated Factors among Rural School Children in Ghana.

SIGNIFICANCE: Self-adjustable spectacles are increasingly being used in refractive service delivery programs in developing countries. Despite the success of self-refraction as a refraction technique, compliance with actual wear of adjustable spectacles has not been evaluated. Findings in this study have significant programmatic implications for the effectiveness and sustainability of this mode of correction in developing countries. PURPOSE: The purpose of this study was to assess compliance with wearing of adjustable spectacles and factors associated with compliance in pre-teen schoolchildren at 6 months after spectacles were dispensed. METHODS: A cohort of 86 children aged 6 to 12 years with presenting vision worse than or equal to 6/12 in the better eye that could be improved to better than or equal to 6/7.5 by subjective refraction and who were identified from a randomized sample of 18 primary schools in the coastal areas of Cape Coast in Ghana received free FocusSpecs adjustable spectacles after successfully completing self-refraction and cycloplegic subjective refraction. Follow-up examination to assess compliance and to determine reasons for noncompliance was conducted at 6 months after spectacle provision. Logistic regression models assessed factors associated with spectacle wear compliance (95% confidence intervals [CIs]). RESULTS: Spectacle wear compliance was 33.7% (95% CI, 31.3 to 36.1%); an additional 29% had their spectacles with them but were not wearing them. The major reasons given by the children for noncompliance were "loss" (32%; 18/57) and "breakage" (23%; 13/57). Modest compliance (49%) was observed among the poorer children who attend public schools. Attending public school was the only predictor of compliance to spectacle wear (odds ratio, 3.096; 95% CI, 1.228 to 7.805; P = .02). CONCLUSIONS: Despite accurate self-refraction by most children, only a small proportion was compliant with actual wear of the spectacles. Loss and breakage were the major reasons for noncompliance. The poorer children who attend public schools, who stand to benefit most from the technology, were the ones more likely to be compliant with wear.

Knowledge, usage and barriers associated with contact lens wear in Ghana.

BACKGROUND: Despite findings that contact lens wear for vision correction provides better quality of life than spectacles, contact lens use in developing countries is low. This study evaluated knowledge, usage and barriers associated with contact lens wear among spectacle wearers in Cape Coast, Ghana. METHOD: A cross-sectional survey using a structured questionnaire was conducted on an adult population of spectacle wearers to assess their knowledge of contact lens wear for vision correction. The participants were proportionately sampled from three eye clinics in the Cape Coast Metropolis, Ghana. Questionnaires were either self-administered or completed with the help of a research assistant. RESULTS: Of the 422 participants, only 147 (34.8%) knew of contact lens wear for vision correction. The proportion of spectacle wearers reporting history of contact lens wear was 14 (3.3%). Barriers to contact lens wear reported were satisfaction with vision through spectacles 102 (25.0%), lack of adequate information 111 (27.2%), fear of side effects 94 (23.0%) and cost 78 (19.1%). The younger adults and those with higher number of changes of spectacles were more likely to know of contact lenses. CONCLUSION: Knowledge and usage of contact lenses among spectacle wearers was low. Contact lens education and demonstration of visual performance through fitting of trial contact lenses on potential candidates may help overcome barriers to contact lens wear.

Prevalence and Causes of Visual Impairment and Blindness among Cocoa Farmers in Ghana.

PURPOSE: To determine the prevalence and causes of visual impairment and blindness among cocoa farmers in Ghana in order to formulate early intervention strategies. METHODS: A cross-sectional study using multistage random sampling from four cocoa growing districts in Ghana was conducted from November 2013 to April 2014. A total of 512 cocoa farmers aged 40 years and older were interviewed and examined. The brief interview questionnaire was administered to elicit information on the demographics and socioeconomic details of participants. The examination included assessment of visual acuity (VA), retinoscopy, subjective refraction, direct ophthalmoscopy, slit-lamp biomicroscopy and intraocular pressure (IOP). For quality assurance, a random sample of cocoa farmers were selected and re-examined independently. RESULTS: Moderate to severe visual impairment (VA <6/18 to 3/60 in the better-seeing eye) was present in 89 participants (17.4%) and 27 (5.3%) were blind (presenting VA <3/60 in the better eye) defined using presenting VA. The main causes of visual impairment were cataract (45, 38.8%), uncorrected refractive error (42, 36.2%), posterior segment disorders (15, 12.9%), and corneal opacity (11, 9.5%). CONCLUSION: The prevalence of visual impairment and blindness among cocoa farmers in Ghana is relatively high. The major causes of visual impairment and blindness are largely preventable or treatable, indicating the need for early eye care service interventions.

Effect of preserved and preservative-free timolol eye drops on tear film stability in healthy Africans.

BACKGROUND: Preserved versus nonpreserved formulations for ophthalmic use have been well described in the literature although not specifically in the African population where beta blockers are frequently used as the first-line therapy due to economic and availability issues. This study sought to determine the effect of preserved and preservative-free Timolol eye drops on tear film stability in healthy black Africans. MATERIALS AND METHODS: Sixty healthy nondry eye subjects aged 19-25 years were randomly assigned into four groups (n = 15) and differently treated with eye drops of phosphate buffered saline (PBS), preservative-free timolol (PFT), benzalkonium chloride (BAK) only, and BAK-preserved timolol (BPT). Noninvasive tear break-up time (NITBUT) was measured using the keratometer at baseline and 30, 60, and 90 min after drop application. RESULTS: No significant decline in NITBUT was observed following treatment with PFT and PBS. However, BAK treatment showed a positive time-dependent significant decline in NITBUT (P < 0.001) while a significant decline in the BPT-treated group was only found at 90 min (-3.52 s; P < 0.001). In comparison to the PFT-treated group, treatment with BAK and BPT showed significantly lower NITBUT (P < 0.001). CONCLUSION: BPT is associated with a significant decline in tear film stability in black Africans. This finding has implications in the management of glaucoma in patients with high-risk of dry eyes in this population.

Evaluation of Blood Transfusions in Anemic Children in Effia Nkwanta Regional Hospital, Sekondi-Takoradi, Ghana.

Blood transfusion is a common practice in sub-Saharan Africa as a way of correcting anemia in children with mild and severe sicknesses. This study evaluated this practice in a secondary health-care institution in Ghana. A retrospective study was done over a 3-year period from January 2010 to December 2012. Medical records of children admitted, successfully treated, and discharged from the hospital were collected and analyzed. Data were analyzed using Epi Info version 7. Transfusions were more among male children (89, 63.1%) than female children (52, 36.9%). The highest number of blood transfusions were carried out on children in the age range 0-1 year (66, 46.8%). The majority of the blood transfusions were done on children with hemoglobin concentration level of 5 g/dL and below. Children with malaria parasitemia (83, 58.9%) had more transfusions than children without malaria parasitemia (58, 41.1%). Fever alone (43, 30.5%) and fever with gastrointestinal symptoms (33, 23.4%) were the predominant symptoms among children who had blood transfusions. In conclusion, younger children received more transfusions than older children. Also, male children received more blood transfusions than female children. Malaria was observed as a major contributory factor to the requirement for blood transfusions among the children.

Epidemiology of Ocular Toxoplasmosis in Three Community Surveys in the Central Region of Ghana, West Africa.

PURPOSE: To conduct the first ever population-based survey on ocular toxoplasmosis in the Central Region of Ghana. METHODS: A cross-sectional population-based study was conducted in three randomly selected communities in the Central Region, Ghana. Visual acuity (VA) measurement, dilated fundus examination by indirect ophthalmoscopy and serology testing were performed on all participants. Ocular toxoplasmosis was diagnosed based on characteristic retinal lesions and supported by positive serologic testing using commercial enzyme-linked immunosorbent assay (ELISA) kits. RESULTS: A total of 390 subjects aged 10-100 years (mean age 47 years) were examined; 118 (30.3%) were male and 272 (69.7%) female. Ten subjects (6 females and 4 males) had toxoplasmic ocular lesions (prevalence 2.6%). Of these, two had bilateral lesions and eight had unilateral lesions. Subjects with toxoplasmic ocular lesions were older than those without lesions (p = 0.028). The development of ocular toxoplasmosis was not associated with rural dwelling, sex, keeping cats, or consumption of meat. CONCLUSION: The prevalence of ocular toxoplasmosis in our Ghanaian study population was lower than findings from Southern Brazil, where there is a similar prevalence of infection in the general population.

Fasting Plasma Sugar: A Predictor of Accommodative Function in Diabetes.

BACKGROUND: Diabetes has been associated with decline in accommodative function in some ethnic groups. This outcome, however, could differ since ethnic variations in accommodation have been noted. This study investigated the relationship between plasma sugar level on subjective accommodative amplitude and accommodative lag in black Africans with type-1 diabetes. METHODS: An examiner-blind study of subjective accommodative amplitude and accommodative lag between 45 diabetic subjects (15 males, 30 females) aged 12-39 years and 45 age- and sex-matched healthy non-diabetic controls was conducted. Accommodative amplitude was measured by the push-up to blur/push-down to clear methods using a RAF rule, the accommodative lag by the MEM retinoscopy, and the fasting plasma sugar (FPS) by a glucose meter. RESULTS: Comparatively, the diabetic subjects had significantly lower accommodative amplitude (10.1 ± 2.7 D versus 11.5 ± 2.4 D, respectively; p = 0.010) and greater accommodative lag (1.1 ± 0.4 D versus 0.7 ± 0.2 D; p < 0.001, respectively) than the controls. Multiple regression analyses showed that after adjusting for age, FPS concentration significantly predicted accommodative amplitude (R(2 )= 0.05, p = 0.022) and accommodative lag (R(2 )= 0.30, p < 0.001) in diabetes. Duration of diabetes was not significantly related to accommodative amplitude and accommodative lag. CONCLUSION: Diabetes mellitus in black Africans was associated with lower accommodative amplitude and greater accommodative lag. An adequate control of the plasma sugar concentration may be vital to maintain proper accommodative function.

Factors associated with protective eyewear use among cocoa farmers in Ghana.

To determine the factors that are associated with the use of protective eyewear (PEW) among cocoa farmers in Ghana, a multistage random sample of 556 cocoa farmers were recruited from four districts in the country. A questionnaire was used to elicit information on the use of PEW and barriers to its use among these farmers. Only 34 (6.1%) participants reported using PEW. Being female, old age and perception of good distance vision was associated with lower odds of PEW use. However, higher educational attainment, application of fertiliser and pesticides were associated with higher odds of PEW use. Participants cited non-availability, unaffordability and ignorance/lack of training as the main barriers to the use of PEW. The low use of PEW could be addressed through ocular health education and occupational health and safety policy initiatives.

Visual impairment attributable to uncorrected refractive error and other causes in the Ghanaian youth: The University of Cape Coast Survey.

PURPOSE: To determine the prevalence of visual impairment attributable to refractive error and other causes in a youthful Ghanaian population. METHODS: A prospective survey of all consecutive visits by first-year tertiary students to the Optometry clinic between August, 2013 and April, 2014. Of the 4378 first-year students aged 16-39 years enumerated, 3437 (78.5%) underwent the eye examination. The examination protocol included presenting visual acuity (PVA), ocular motility, and slit-lamp examination of the external eye, anterior segment and media, and non-dilated fundus examination. Pinhole acuity and fundus examination were performed when the PVA≤6/12 in one or both eyes to determine the principal cause of the vision loss. RESULTS: The mean age of participants was 21.86 years (95% CI: 21.72-21.99). The prevalence of bilateral visual impairment (BVI; PVA in the better eye ≤6/12) and unilateral visual impairment UVI; PVA in the worse eye ≤6/12) were 3.08% (95% CI: 2.56-3.72) and 0.79% (95% CI: 0.54-1.14), respectively. Among 106 participants with BVI, refractive error (96.2%) and corneal opacity (3.8%) were the causes. Of the 27 participants with UVI, refractive error (44.4%), maculopathy (18.5%) and retinal disease (14.8%) were the major causes. There was unequal distribution of BVI in the different age groups, with those above 20 years having a lesser burden. CONCLUSION: Eye screening and provision of affordable spectacle correction to the youth could be timely to eliminate visual impairment.