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.

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.

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.

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.

Indications for destructive eye surgeries at a Nigerian tertiary eye care centre: A ten-year review.

BACKGROUND: Destructive eye surgeries are terminal treatment modalities for some ophthalmic conditions with psychological, emotional and cosmetic implications, especially for the patients and their relatives. OBJECTIVE: The aim of this study was to determine the frequency and indications for destructive eye surgeries at an Eye Centre of a Nigerian Tertiary Hospital with a view to identifying the preventable indications for which appropriate preventive measures could be recommended. PATIENTS AND METHODS: A retrospective, descriptive study of all patients who underwent evisceration, enucleation or exenteration at the Guinness Eye Centre, Lagos University Teaching Hospital from January 2003 to December 2012 was performed. Their outpatient, ward and theatre records were retrieved and reviewed. Information obtained included age, sex, eye affected, duration of symptoms before presentation, visual acuity of affected eye at diagnosis, indication for surgery and type of destructive surgery. RESULTS: A total of 186 eyes of 185 patients were surgically removed constituting 4.8% of a total of 3866 surgeries performed during the period of study. Children below 16 years accounted for 33.5% of the cases while 30.3% were in their first decade of life. Overall, the most common indication for destructive eye surgery was trauma (36.2%) followed by tumour (27.6%) and ocular infection (18.4%). However, tumour (73.2%) was the most common indication in the first decade of life with retinoblastoma accounting for 92.7% of these. CONCLUSION: Ocular trauma, tumour and infection were the most common indications for destructive eye surgery in this centre.

Central corneal thickness changes following manual small incision cataract surgery.

AIM: To determine changes in post-cataract surgery central corneal thickness (CCT) at Lagos University Teaching Hospital by assessing the time it takes for the cornea to return to its preoperative thickness value. METHODS: This study is a prospective, hospital-based open within-patient controlled study with the unoperated eye controlling for the operated one. RESULTS: Two hundred patients with 400 eyes were analyzed, with bilateral mature cataract in 47.0%. All the patients had manual small incision cataract surgery with posterior chamber intraocular lens implant. There is an increase in mean baseline CCT from 520.6±20.3 µm by 76.9 µm (597.9±30.4 µm) 24 hours after cataract surgery followed by relative reduction in the mean CCT to 555.2±24.7 µm and 525.1±19.7 µm at 2 weeks and 12 weeks, respectively. Increase in mean CCT in the unoperated and contralateral eyes were recorded in this study. CONCLUSION: There was a transient increase in corneal thickness following cataract surgery with subsequent decrease to preoperative thickness by 12th and fourth week in the operated and unoperated eyes, respectively. Corneal manipulations during cataract surgery must be minimal to reduce visual rehabilitation time to barest minimum. Postoperative refraction will be better at eighth week to 12th week considering the time it takes for the CCT to return to its stable preoperative values.

Nucleus drop during small incision cataract surgery: A report of four cases.

Small incision cataract surgery (SICS) offers the benefits of a phacoemulsification (phaco) surgery without the attendant high cost, but it is not without certain risk such as nucleus drop into the vitreous as seen in phaco. A retrospective study of SICS and associated factors leading to nucleus drop during surgery, challenges of management and the visual outcomes. Of 793 eye surgeries performed during the study 586 were SICSs. Nucleus drop during SICS occurred in 0.68% of patients. Can-opener technique of capsulotomy, use of dispersive viscoelastic, diabetes mellitus, lack of anterior vitrectomy machine and poor access to immediate posterior vitrectomy were important problems in the management of the cases of nucleus drop in this study. The visual outcomes were poor in all the cases of nucleus drop. Careful patient selection for SICS and the use of continuous curvilinear capsulorhexis are advocated. An interior vitrectomy machine should be available to all cataract surgeons. It is good professional practice to be acquainted with the available vitreo-retina surgeons for urgent assistance in cases of nucleus drop.

The awareness, perceptions and experiences of primary open angle glaucoma patients in Lagos Nigeria.

The awareness, perceptions and experiences of Nigerian Primary Open Angle Glaucoma (POAG) patients were assessed using a hospital based cross-sectional study design. One hundred and twenty POAG patients attending a glaucoma clinic in Lagos Nigeria were recruited consecutively. They underwent face-to-face interviews with trained interviewers using a semi-structured questionnaire and an interview guide consisting of open-ended questions. A comprehensive ocular examination which included static automated perimetry, gonioscopy, stereoscopic optic nerve head assessment and contrast sensitivity was carried out for all participants. Twenty per cent (n = 24) of the respondents did not know they were being managed for a disease called Glaucoma. Age, gender, religion, ethnicity, marital status and occupation did not significantly affect the awareness of glaucoma diagnosis (p > 0.05). Positive family history of glaucoma, educational status and duration of disease were the most significant factors associated with awareness of glaucoma diagnosis (p < 0.05). POAG patients in Nigeria lack the depth of perception that can equip them to educate and motivate their family members to screen for glaucoma. There is an urgent need to develop continuous eye health education programmes to improve their perception and outlook; thereby increasing the uptake of glaucoma screening by first degree relatives of glaucoma patients.

Quality of life of primary open angle glaucoma patients in lagos, Nigeria: clinical and sociodemographic correlates.

PURPOSE: To evaluate the quality of life (QOL) of primary open angle glaucoma (POAG) patients attending a tertiary eye institution in Lagos, Nigeria and identify clinical and sociodemographic factors affecting it. METHODS: A hospital-based cross-sectional analytical study design was used to compare 132 patients with varying degrees of severity of glaucoma (cases) with age-matched and sex-matched controls with essentially normal eyes and no family history of glaucoma. RESULTS: POAG patients had reduced QOL as defined by the 2 instruments used: the National Eye Institute Visual Function Questionnaire25 (NEIVFQ25) and the 15-item Glaucoma Quality of life Questionnaire (GQL-15). The mean QOL score obtained with the NEIVFQ25 for the cases was 85.2 (±16.07) and 96.7 (±2.34) for the controls. Using the GQL-15 scale, the mean QOL score for the cases was 24.07 (±12.4), whereas for the controls the score was 15.75 (±1.85). Early or mild glaucoma was associated with reduced QOL compared with the controls. Glaucoma patients had the greatest difficulty with glare and dark adaptation subscale of the GQL-15. Increasing severity of disease defined by increasing visual field deficit (mean deviation values) correlated significantly with worsening QOL [Spearman ρ (r) values ranging from 0.32 to 0.43]. Contrast sensitivity correlated moderately with QOL (r ranges from 0.43 to 0.47; P=0.001). Cup-to-disc ratios, visual acuity, and visual field indices (mean deviation) correlated with QOL scores of both tools with r values ranging from 0.28 to 0.49 for the GQL-15 and 0.38 to 0.54 for the NEIVFQ25. Age had a negative impact on QOL (r=-0.30 for the NEIVFQ25 and 0.30 for the GQL-15) and affected all the subscales of the GQL-15 and most subscales of the NEIVFQ25 except ocular pain (P=0.40), mental health (P=0.13), color vision (P=0.05), and role difficulty (P=0.11). Women generally had better vision-related QOL scores (P=0.001 for the NEIVFQ25 and 0.005 for the GQL-15). Higher educational status was associated with better QOL scores (P<0.05). Ethnicity, religion, marital status, and living situation had no significant effect on QOL scores. CONCLUSIONS: POAG reduces QOL even in the early stages of the disease, as there was a significant reduction in the QOL of patients with mild glaucoma compared with the controls. It showed a clear trend of worsening QOL scores with increasing severity of disease. The correlation observed between QOL scores and objective measures of visual function suggest that inclusion of QOL assessment in clinical practice could be highly informative and should be explored further.