Effect of Age and Parity on Physiological Changes in the Eye During Pregnancy: A Prospective Longitudinal Study.

BACKGROUND: The hormonal and metabolic changes that occur during uncomplicated pregnancy affect the eye. The effects of maternal age and parity on the physiological eye changes in pregnancy have been scarcely documented. AIM: To determine these effects on some physiological eye changes that occur in pregnancy. METHODS: A longitudinal study involving consecutively recruited 140 pregnant women aged 18-48 years attending antenatal clinic at the University of Nigeria Teaching Hospital, Enugu. A structured questionnaire was administered to consenting women, after which the Schirmer test, tear break-up time (tBUT), corneal sensitivity, central corneal thickness (CCT), and intraocular pressure (IOP) was measured in the second and third trimesters, and six weeks after delivery. RESULTS: The mean CCT showed a significantly greater increase among the multiparous (≥para 2) women in both the second and third trimesters compared with the primigravida/primiparous women (P = 0.032 and 0.049, respectively). There was no difference in mean CCT between the two parity groups at six weeks postpartum. Women aged 18-35 years showed a significantly greater increase in the mean CCT in the second trimester compared to those aged less than 35 years (P = 0.04). However, there was no difference in the mean CCT between the different age groups in the third trimester and at six weeks postpartum. CONCLUSION: The age and parity of women affect their level of CCT changes in pregnancy. Consideration of this effect may guide clinicians on their approaches to eye care and treatment during pregnancy.

Quantitative and qualitative assessment on individual perception and self-care practice of refractive error in a rural community in Enugu, South East Nigeria.

Background: Globally, uncorrected refractive errors have been identified as the most common cause of visual impairment and the second leading cause of treatable blindness. Aim: This study quantitatively and qualitatively assessed individual perception and self-care practice of refractive error (RE) in a rural community in Enugu State. Subjects and Methods: A descriptive, cross-sectional, population-based survey was done in Amorji community, Enugu State. A pretested, researcher-administered questionnaire was used to interview the respondents on knowledge of causes, features and treatment of RE, their self-care practices, and attitudes toward RE. Focus group discussions (FGDs) and in-depth interviews (IDIs) were also carried out to qualitatively assess these parameters. Data was analyzed using SPSS version 20. Results: A total of 522 adults, 307 (58.8%) males, and 215 (41.2%) females aged 43 ± 31.6 (range 18-83) years participated in the study. Of the participants, 235 (45.0%) had good knowledge of RE; 272 (52.1%) had positive attitude toward RE, while only 51 (9.8%) had good self-care practice. Educational status was significantly (p = 0.02) associated with participants' knowledge, attitude, and self-care practices. Good knowledge significantly (p = 0.001) influenced attitude and self-care practices among the participants. Results from FGDs and IDIs were in agreement with those obtained from the questionnaire-based part of the study. Conclusion: The participants from Amorji community had good knowledge of the features of RE but poor knowledge of its causes and treatment. They also exhibited positive attitude, but poor self-care practices toward refractive errors.

Distribution of ocular perfusion pressure and its relationship with intraocular pressure in patients with primary open angle glaucoma in Enugu, South East, Nigeria.

Background: Ocular perfusion pressure (OPP) has been suggested as a possible risk factor for the development and progression of primary open angle glaucoma (POAG). Aim: To determine the distribution of OPP and its relationship with intraocular pressure (IOP) in Nigerian patients with POAG. Patients and Methods: : A descriptive and comparative survey was adopted. A total of 120 subjects, 60 newly diagnosed POAG and 60 non-glaucomatous (NG) subjects, aged 40 years and above, who attended the ophthalmic clinic of University of Nigeria Teaching Hospital Enugu were recruited over a six-month period in 2019. All the subjects had ocular examination, blood pressure and IOP measurements. Statistical package for social sciences software version 25 was used for data analysis. Chi-square test, independent samples t-test, and Mann-Whitney U test were used for comparison while Pearson correlation and simple linear regression were used to ascertain the relationship. A P value of <0.05 was considered significant. Result: The mean age of the participants was 57.9 + 11.9 years. The mean OPP was found to be significantly lower in the POAG subjects (Right eye, R = 43.6 ± 12.6, Left eye, L = 41.9 ± 13.3) mmHg compared with the NG group (R = 53.9 ± 10.9, L = 53.7 ± 10.9) mmHg (p < 0.001 for both eyes). A significant inverse relationship was observed between OPP and IOP in POAG subjects (p < 0.001), while there was none in NG subjects. Conclusion: OPP was lower in POAG subjects than in NG subjects. The observed relationship suggests that reduced OPP may play a role in the development of POAG.

Factors associated with depression and anxiety among glaucoma patients in a tertiary hospital South-East Nigeria.

OBJECTIVE: To explore the factors associated with depression and anxiety among glaucoma patients. SUBJECTS AND METHODS: This was a cross-sectional study involving adult glaucoma patients, who attended the eye clinic of Enugu State University Teaching Hospital, Parklane, Enugu, from April to September 2018. In total, 182 glaucoma patients with no other significant ophthalmic or medical conditions were recruited. Information on their socio-demographic and clinical characteristics was obtained using a close-ended, interviewer-administered questionnaire. Detailed ophthalmic evaluation to characterize the glaucoma was done. Depression and anxiety were assessed using the hospital anxiety and depression scale. Data were analyzed using SPSS version 21. Bivariate analysis was done to identify factors associated with depression and anxiety. The level of significance was at P < 0.05. RESULTS: The participants were mainly females, 108 (59.3%), married, civil servants with tertiary education and mean age of 59.7 ± 13.3 SD years. Majority of them had advanced stage of primary open angle glaucoma. Eighty (44%) of the participants had anxiety, while 76 (41.8%) had depression. Severe/blind stage of glaucoma and reduced visual acuity were significantly associated with anxiety and depression; occupation (trading) and intraocular pressure of <21 mmHg also significantly associated with depression. CONCLUSION: The prevalence of anxiety and depression among glaucoma patients in Enugu was high. Severe/blind stage of glaucoma and reduced visual acuity were the most important factors that associated with both anxiety and depression. Incorporating a psychological health approach to glaucoma care especially in patients with severe glaucoma and reduced visual acuity may promote effective communication between clinicians and patients and treatment adherence.

Glaucoma care in Nigeria: Is the current practice poised to tackle this emerging sight-threatening disease?

PURPOSE: To investigate the current practice on glaucoma care with the aim of highlighting its poise to tackle this emerging sight-threatening disease in Nigeria. METHODS: This was a cross-sectional, descriptive, population-based survey involving 88 ophthalmologists. Information on their demographic characteristics, practice profile, challenges and prospects on glaucoma care was collected using a semi-structured, self-administered questionnaire in August 2016. Data were analysed using SPSS 20. RESULTS: The participants are comprised of 46 (52.3%) males and 42 (47.7%) females, with a mean age of 42.2 ± 8.7 SD years. They were 45 (51.1%) consultants, 31 (35.2%) residents and 12 (13.6%) diplomates. Their years of practice were 8.8 ± 6.7 SD years. They worked mainly in government hospitals located at the southern part of Nigeria. The current practice was mainly comprehensive ophthalmology, 63 (71.6%). Only 2 (2.3%) had strict subspecialty practice. Others, 23 (26.1%), had combined practice. Eleven (12.5%) were glaucoma specialists and had combined practice. The majority of the participants, 57 (64.8%), were routinely diagnosed glaucoma properly. Sixty-three (71.6%) participants underwent trabeculectomy, 48 (54.5%) combined cataract surgery with trabeculectomy, 7 (8.0%) drainage implants, 5 (5.7%) laser trabeculoplasty, and 2 (2.3%) minimally invasive glaucoma surgery. Poor patients' acceptance and satisfaction, fear of complications, lengthy post-operative care and cost were the main deterrents to surgeries. Advocacy, public awareness, training of glaucoma specialists, provision of equipment and health insurance were the major recommendations on improving glaucoma care. CONCLUSION: Given the meagre number of specialists and lack of strict subspecialty practice, optimal glaucoma care in Nigeria is still far from reality.

Relationship between corneal biomechanical properties among pregnant women in a tertiary hospital in Nigeria.

OBJECTIVE: In Nigeria, many pregnant women as well as health-care providers are unaware of the effect of pregnancy on the eye. The present study investigated the changes in central corneal thickness (CCT), corneal sensitivity (CS), and intraocular pressure (IOP) among pregnant women in a tertiary hospital in Nigeria and the relationship between them. MATERIALS AND METHODS: A prospective longitudinal study was used. One hundred and thirty-four pregnant women attending the Obstetric Clinic of the University of Nigeria Teaching Hospital, Enugu, were consecutively recruited in their second trimester for the study. Changes in CCT, CS, and IOP were monitored at the second and third trimesters and 6-week postpartum. Data obtained were analyzed using Statistical Package for the Social Sciences version 20. The effect of duration of pregnancy on these variables was determined using simple linear regression and further analysis was done using Bonferroni's post hoc test. RESULTS: The women were aged 18-48 years, with a mean age of 30.81(±5.49) years and majority of them (61.2%) were multigravida. The duration of pregnancy varied inversely and significantly with CS (P < 0.05) and IOP (P < 0.000) with the least values recorded in the third trimester, while it varied directly and also significantly with CCT (P < 0.000) with the highest value obtained in the third trimester. A negative correlation that was significant only in third trimester was found between CCT and IOP (P < 0.02) and CS (P < 0.03). CONCLUSION: There was a progressive increase in CCT with a corresponding decrease in CS and IOP across the trimesters of pregnancy, but these changes reversed 6-week postpartum.

Effect of Hibiscus sabdariffaon blood pressure and electrolyte profile of mild to moderate hypertensive Nigerians: A comparative study with hydrochlorothiazide.

BACKGROUND: Hibiscus sabdariffa (HS) is widely consumed in Nigeria as a refreshing beverage and also as an antihypertensive agent. Since three decades ago when its antihypertensive activities were reported in several animal experiments, its consumption has greatly increased. AIM: The aim of this study is to investigate the effect of HS consumption on blood pressure (BP) and electrolytes of mild to moderate hypertensive Nigerians and compare it with that of hydrochlorothiazide (HCTZ), a diuretic widely used as first-line antihypertensive drug. SUBJECTS AND METHODS: Eighty newly diagnosed, but untreated mild to moderate hypertensive subjects attending Medical Out-Patients clinic of Enugu State University Teaching Hospital, Enugu, were recruited for the study. They were randomly divided into three groups: A, B and C. Those in Groups A were given placebo; those in Group B took HCTZ while those in Group C were given HS. Treatment lasted for 4 weeks. BP, serum, and urine electrolytes were measured at baseline, weekly during treatment and 1 week after withdrawal of treatment. RESULTS: At the end of treatment, both HCTZ and HS significantly (P<0.001) reduced systolic BP, diastolic BP, mean arterial pressure and serum Na+ compared to placebo. When compared to each other, HCTZ significantly (P<0.001) reduced serum Na+ and Cl- compared to HS and significantly (P<0.001) increased K+ and Cl- output in urine. After withdrawal of treatment, the fall in BP and serum Na+ in HS group were significant compared to HCTZ where they returned to baseline values. No side effect was reported during the study. CONCLUSION: HS was a more effective antihypertensive agent than HCTZ in mild to moderate hypertensive Nigerians and did not cause electrolyte imbalance. HS showed longer duration of action compared to HCTZ and reduction in serum Na+ may be another antihypertensive mechanism of action of HS.