Prevalence and risk factors of Vernal Keratoconjunctivitis among a Ghanaian clinical cohort: A case-control study.

Background: Vernal Keratoconjunctivitis (VKC) has been determined to be highly prevalent in countries within the tropical climate region. However, little evidence from studies conducted within this region has been put forward to support this claim. Aim: To determine the prevalence and risk factors of VKC among a Ghanaian clinical cohort. Methods: A 3-year case-control study was conducted in a tertiary eye care institution, and medical records of patients who had been diagnosed of VKC between 2018 and 2021 were reviewed. Results: Medical records of 3800 patients were reviewed. Some 359 cases of VKC were identified, with a population prevalence rate of 9.45%. Males comprised 57.1% of the population with VKC, with a male-to-female ratio of 1.33:1. The disease was more prevalent (40.8%) in children (≤17 years), and the overall odds of incidence decreased by 10% for a unit increase in age. Age and sex-adjusted models revealed significant positive associations between Keratoconus [aOR = 40.760, 95% CI -5.948 to 339.937], Rhinitis [cOR = 5.183, 95% CI -2.074 to 12.022] and VKC. However, the incidence of VKC was relatively less expressive among pterygium cases [cOR = 0.315, 95% CI -0.077 to 0.846]. Conclusion: VKC is highly prevalent among children and is often associated with comorbidities of atopic origin that exacerbate the impact of the disease among this vulnerable population. It is imperative that clinicians provide holistic care for children with VKC.

Neurophysiology of corneal neuropathic pain and emerging pharmacotherapeutics.

The altered activity generated by corneal neuronal injury can result in morphological and physiological changes in the architecture of synaptic connections in the nervous system. These changes can alter the sensitivity of neurons (both second-order and higher-order projection) projecting pain signals. A complex process involving different cell types, molecules, nerves, dendritic cells, neurokines, neuropeptides, and axon guidance molecules causes a high level of sensory rearrangement, which is germane to all the phases in the pathomechanism of corneal neuropathic pain. Immune cells migrating to the region of nerve injury assist in pain generation by secreting neurokines that ensure nerve depolarization. Furthermore, excitability in the central pain pathway is perpetuated by local activation of microglia in the trigeminal ganglion and alterations of the descending inhibitory modulation for corneal pain arriving from central nervous system. Corneal neuropathic pain may be facilitated by dysfunctional structures in the central somatosensory nervous system due to a lesion, altered synaptogenesis, or genetic abnormality. Understanding these important pathways will provide novel therapeutic insight.

Risk of major myopia-associated non-communicable ocular health disorders in Ghana.

OBJECTIVE: To assess the differential association of myopia with major non-communicable ocular diseases in an African clinical cohort. METHODS: A five-year hospital-based retrospective study of myopia cases. Patients' folders, Optical Coherence Tomography scans, and fundus photographs were reviewed for the abstraction of relevant data. Only records that employed recognized standards and classification systems for diagnosing and staging the various ocular conditions were included. Demographic characteristics, non-cycloplegic objective refractive findings, and non-communicable eye diseases were retrieved from the records. Myopia-associated risk factors were then determined using logistic regression and correlation. RESULTS: Some 16018 patients (32027 eyes) met the inclusion criteria for at least one eye comprising 50.8% males (n = 8137) and 49.2% females (n = 7881). The mean age of the patients was 43.14 ± 17.88 years (range: 2-98 years). The mean spherical equivalent± Standard deviation for myopia was -2.30±3.23 DS (range: -0.50 to -25DS). Binary logistic regression analysis showed that myopic eyes had a higher odd of AC (OR, 0.53; 95% CI, 0.50-0.57), POAG (OR, 6.0; 95% CI, 5.26-6.82), DR (OR, 10.70; 95% CI, 3.91-29.27) and cataracts (OR, 20; 95% CI, 15.32-26.20) but not dry eye (OR, 0.74, 95% CI, 0.68-0.81), macular degeneration and pterygium (OR, 0.36; 95% CI, 0.32-0.40). CONCLUSION: Africans with myopia are more at risk of developing allergic conjunctivitis, cataracts, POAG, and DR but not for dry eye, macular degeneration, and pterygium.

Impact of SGLT2 Inhibitors on Corneal Nerve Morphology and Dendritic Cell Density in Type 2 Diabetes.

PURPOSE: This study aims to determine the effects of SGLT2 inhibitors on corneal dendritic cell density and corneal nerve measures in type 2 diabetes. METHODS: Corneal dendritic cell densities and nerve parameters were measured in people with type 2 diabetes treated with SGLT2 inhibitors (T2DM-SGLT2i) [n = 23] and those not treated with SGLT2 inhibitors (T2DM-no SGLT2i) [n = 23], along with 24 age and sex-matched healthy controls. RESULTS: There was a reduction in all corneal nerve parameters in type 2 diabetes groups compared to healthy controls (All parameters: p < 0.05). No significant differences in corneal nerve parameters were observed between T2DM-SGLT2i and T2DM-no SGLT2i groups (All parameters: p > 0.05). Central corneal dendritic cells were significantly reduced [mature (p = 0.03), immature (p = 0.06) and total (p = 0.002)] in the T2DM-SGLT2i group compared to the T2DM-no SGLT2i group. Significantly, higher mature (p = 0.04), immature (p = 0.004), total (p = 0.002) dendritic cell densities in the T2DM-no SGLT2i group were observed compared to the healthy controls. In the inferior whorl, no significant difference in immature (p = 0.27) and total dendritic cell densities (p = 0.16) between T2DM-SGLT2i and T2DM-no SGLT2i were observed except mature dendritic cell density (p = 0.018). No differences in total dendritic cell density were observed in the central (p > 0.09) and inferior whorl (p = 0.88) between T2DM-SGLT2i and healthy controls. CONCLUSION: The present study showed a reduced dendritic cell density in people with type 2 diabetes taking SGLT2 inhibitors compared to those not taking these medications.

Chronic Kidney Disease Has No Impact on Tear Film Substance P Concentration in Type 2 Diabetes.

PURPOSE: The study aimed to ascertain the potential effects of chronic kidney disease (CKD) on substance P concentration in the tear film of people with type 2 diabetes. METHODS: Participants were classified into two groups: type 2 diabetes with concurrent chronic kidney disease (T2DM-CKD (n = 25)) and type 2 diabetes without chronic kidney disease (T2DM-no CKD (n = 25)). Ocular surface discomfort assessment, flush tear collection, in-vivo corneal confocal microscopy, and peripheral neuropathy assessment were conducted. Enzyme-linked immunosorbent assays were utilized to ascertain the levels of tear film substance P in collected flush tears. Correlation analysis, hierarchical multiple linear regression analysis, and t-tests or Mann-Whitney U tests were used in the analysis of data for two-group comparisons. RESULTS: There was no substantial difference between the T2DM-CKD and T2DM-no CKD groups for tear film substance P concentration (4.4 (0.2-50.4) and 5.9 (0.2-47.2) ng/mL, respectively; p = 0.54). No difference was observed in tear film substance P concentration between the low-severity peripheral neuropathy and high-severity peripheral neuropathy groups (4.4 (0.2-50.4) and 3.3 (0.3-40.7) ng/mL, respectively; p = 0.80). Corneal nerve fiber length (9.8 ± 4.6 and 12.4 ± 3.8 mm/mm2, respectively; p = 0.04) and corneal nerve fiber density (14.7 ± 8.5 and 21.1 ± 7.0 no/mm2, respectively; p < 0.01) were reduced significantly in the T2DM-CKD group compared to the T2DM-no CKD group. There were significant differences in corneal nerve fiber density (21.0 ± 8.1 and 15.8 ± 7.7 no/mm2, respectively; p = 0.04) and corneal nerve fiber length (12.9 ± 4.2 and 9.7 ± 3.8 mm/mm2, respectively; p = 0.03) between the low- and high-severity peripheral neuropathy groups. CONCLUSION: In conclusion, no significant difference in tear film substance P concentration was observed between type 2 diabetes with and without CKD. Corneal nerve loss, however, was more significant in type 2 diabetes with chronic kidney disease compared to type 2 diabetes alone, indicating that corneal nerve morphological measures could serve greater utility as a tool to detect neuropathy and nephropathy-related corneal nerve changes.

Efficacy of intravitreal bevacizumab on diabetic macular oedema in an African population.

PURPOSE: To evaluate the short-term effect of intravitreal bevacizumab (avastin) injection on visual outcomes of patients with diabetic macular oedema. METHODS: A retrospective cross-sectional study was conducted to evaluate 39 eyes of thirty-nine patients (mean age ± SD: 61.4 ± 15.0 years) that received intravitreal bevacizumab injection (1.25 mg in 0.05 ml) as treatment for diabetic macular oedema between January 2014 and July 2019 in Ghana. Data on visual acuity and central macular thickness before treatment and 6 weeks post-treatment were collected and analysed using paired t-test. Ordinary least squares linear regression analysis was also conducted to determine the relationship between improvement in visual acuity and central macular thickness after treatment and other predictor variables. RESULTS: The mean ± SD visual acuity (LogMAR-equivalent of Snellen) of patients with diabetic macular oedema significantly improved from 0.84 ± 0.58 LogMAR before treatment to 0.69 ± 0.58 LogMAR at 6 weeks post-treatment (mean difference: 0.15 ± 0.32 LogMAR; 95% CI: 0.04 to 0.25; p = 0.01). Mean macular thickness ± SD on the other hand, reduced significantly (p < 0.001) from 316.54 ± 75.35 µm before treatment to 275.54 ± 57.43 µm after treatment. While age and worse pre-treatment visual acuity predicted improvement in visual acuity after treatment, a higher central macular thickness before treatment predicted an improvement in central macular thickness after intravitreal bevacizumab injection. CONCLUSION: Treatment with intravitreal bevacizumab injection produces short-term improvement in vision and reduction in central macular thickness in African patients with diabetic macular oedema.

Conjunctival microcirculation in ocular and systemic microvascular disease.

The conjunctival microcirculation is an accessible complex network of micro vessels whose quantitative assessment can reveal microvascular haemodynamic properties. Currently, algorithms for the measurement of conjunctival haemodynamics use either manual or semi-automated systems, which may provide insight into overall conjunctival health, as well as in ocular and systemic disease. These algorithms include functional slit-lamp biomicroscopy, laser doppler flowmetry, optical coherence tomography angiography, orthogonal polarized spectral imaging, computer-assisted intravitral microscopy, diffuse reflectance spectroscopy and corneal confocal microscopy. Furthermore, several studies have demonstrated a relationship between conjunctival microcirculatory haemodynamics and many diseases such as dry eye disease, Alzheimer's disease, diabetes, hypertension, sepsis, coronary microvascular disease, and sickle cell anaemia. This review aims to describe conjunctival microcirculation, its characteristics, and techniques for its measurement, as well as the association between conjunctival microcirculation and microvascular abnormalities in disease states.

Comparison of anterior segment parameters in myopia with and without primary open-angle glaucoma.

PURPOSE: To compare anterior segment parameters between myopes with and without primary open-angle glaucoma using Pentacam scheimpflug tomography. METHODS: This was a single-center retrospective cross-sectional study. Records of patients examined with a Pentacam scheimpflug tomographer (Wavelight-Allegro Oculyzer, GmbH, Erlangen, Germany) were reviewed. Variables studied were recorded from the topographic map and included anterior chamber angle, anterior chamber volume, anterior chamber depth, keratometric readings, and corneal thickness. A general linear model for age-and spherical equivalent refraction-adjusted intergroup comparisons of the anterior segment parameters was conducted. RESULTS: The study included myopes previously diagnosed with primary open-angle glaucoma (POAG) [Mild defect, n = 81; Moderate-severe defect, n = 50] and non-glaucomatous myopes (n = 247). The results revealed a smaller anterior chamber angle, shallower anterior chamber depth, and flatter cornea curvature in the mildly glaucomatous group compared to the non-glaucomatous group (p < 0.05). Smaller anterior chamber angle, shallower anterior chamber depth, and thinner cornea thickness were also observed in the moderate-severely glaucomatous group compared to the non-glaucomatous group (p < 0.05). CONCLUSION: Glaucomatous damage in myopic patients with POAG was associated with comparatively small anterior chamber angle, shallow anterior chamber depth, flat cornea curvature, and thin cornea.

Self-reported symptoms of ocular allergy and its comorbid factors among residents living near a landfill site in Ghana.

Residents close to landfill sites may be exposed to long-term emitted toxic compounds that may have effects on their eyes. The aim of this study was to determine the prevalence of symptomatic ocular allergy and its comorbid factors among residents living near a landfill site in Ghana. An exploratory cross-sectional design involving 400 inhabitants living around a landfill site was employed. The prevalence of symptomatic ocular allergy was 59.3%. In a bivariate analysis, comorbid conditions including respiratory disease, coughing, flu, cholera, skin disease, diarrhoea, and hypertension predicted symptomatic ocular allergy. However, only cholera remained a significant predictor of symptomatic ocular allergy in the multivariate analysis. Symptomatic ocular allergy was high among inhabitants around the landfill site in Ghana. While proper design and management of landfills in Ghana is crucial, further longitudinal and clinical studies are required to clinically establish the link between landfill and ocular allergy.

Impact of Peripheral and Corneal Neuropathy on Markers of Ocular Surface Discomfort in Diabetic Chronic Kidney Disease.

SIGNIFICANCE: There is a reduction in corneal nerve fiber density and length in type 2 diabetes mellitus with chronic kidney disease compared with type 2 diabetes mellitus alone; however, this difference does not result in worse ocular surface discomfort or dry eye disease. PURPOSE: This study aimed to determine the clinical impact of corneal nerve loss on ocular surface discomfort and markers of ocular surface homeostasis in people with type 2 diabetes mellitus without chronic kidney disease (T2DM-no CKD) and those with type 2 diabetes mellitus with concurrent chronic kidney disease (T2DM-CKD). METHODS: Participants were classified based on estimated glomerular filtration rates into two groups: T2DM-CKD (n = 27) and T2DM-no CKD (n = 28). RESULTS: There was a significant difference between the T2DM-CKD and T2DM-no CKD groups in corneal nerve fiber density (14.9 ± 8.6 and 21.1 ± 7.1 no./mm 2 , respectively; P = .005) and corneal nerve fiber length (10.0 ± 4.6 and 12.3 ± 3.7 mm/mm 2 , respectively; P = .04). Fluorescein tear breakup time was significantly reduced in T2DM-CKD compared with T2DM-no CKD (8.1 ± 4.4 and 10.7 ± 3.8 seconds, respectively; P = .01), whereas ocular surface staining was not significantly different (3.5 ± 1.7 and 2.7 ± 2.3 scores, respectively; P = .12). In terms of ocular surface discomfort, there were no significant differences in the ocular discomfort score scores (12.5 ± 11.1 and 13.6 ± 12.1, respectively; P = .81) and Ocular Pain Assessment Survey scores (3.3 ± 5.4 and 4.3 ± 6.1, respectively; P = .37) between the T2DM-CKD and T2DM-no CKD. CONCLUSIONS: The current study demonstrated that corneal nerve loss is greater in T2DM-CKD than in T2DM-no CKD. However, these changes do not impact ocular surface discomfort or markers of ocular surface homeostasis.

Impact of meibomian gland dysfunction on quality of life and mental health in a clinical sample in Ghana: a cross-sectional study.

OBJECTIVES: This study aimed to determine the impact of meibomian gland dysfunction (MGD) on quality of life and psychosomatic conditions. DESIGN: This was a clinic-based cross-sectional study. SETTING: This study was conducted at the eye clinic of the University of Cape Coast, Ghana. PARTICIPANTS: 215 clinical subjects visiting the clinic for a comprehensive eye examination. PRIMARY AND SECONDARY OUTCOME MEASURES: Symptomatic MGD, asymptomatic MGD, quality of life scores, depression, anxiety and stress. RESULTS: 215 clinical subjects consented to participate in the study, but 212 were included in the analysis. The mean age was 21.9 (± 3.8) years, 54 had MGD and 158 did not have MGD served as controls. There was no statistically significant difference in the mean quality of life scores between subjects with MGD and subjects without MGD (t=1.57, p=0.12). The quality of life scores (DEQS) (p=0.022) were significantly higher in the symptomatic MGD group compared with the asymptomatic MGD group. There was no significant difference in quality of life scores (DEQS) (p=0.251) in the asymptomatic MGD group compared with healthy controls. Using Pillai's trace in the MANOVA, there was a significant effect of MGD on depression, anxiety and stress (V=0.05, F(3,208)=3.76, p=0.012). Furthermore, Pillai's trace in the MANOVA showed a significant difference between asymptomatic and symptomatic MGDs for depression, anxiety and stress scores stress (V=0.24, F(3, 51)=5.24, p=0.003). CONCLUSION: The study revealed no difference in the quality of life scores between MGD and non-MGD groups. However, the symptomatic MGD group had worse quality of life and psychosomatic symptoms than the asymptomatic MGD group and non-MGD group.

Candidate Molecular Compounds as Potential Indicators for Meibomian Gland Dysfunction.

Meibomian gland dysfunction (MGD) is the leading cause of dry eye disease throughout the world. Studies have shown that several molecules in meibum, including but not limited to interleukins, amino acids, cadherins, eicosanoids, carbohydrates, and proteins, are altered in meibomian gland dysfunction compared with healthy normal controls. Some of these molecules such as antileukoproteinase, phospholipase A2, and lactoperoxidase also show differences in concentrations in tears between meibomian gland dysfunction and dry eye disease, further boosting hopes as candidate biomarkers. MGD is a complex condition, making it difficult to distinguish patients using single biomarkers. Therefore, multiple biomarkers forming a multiplex panel may be required. This review aims to describe molecules comprising lipids, proteins, and carbohydrates with the potential of serving various capacities as monitoring, predictive, diagnostic, and risk biomarkers for meibomian gland dysfunction.

Role of ocular surface neurobiology in neuronal-mediated inflammation in dry eye disease.

Inflammation is the consequence of dry eye disease regardless of its etiology. Several injurious or harmless processes to the ocular surface neurons promote ocular surface neurogenic inflammation, leading to the vicious cycle of dry eye disease. These processes include the regular release of neuromediators during the conduction of ocular surface sensations, hyperosmolarity-induced ocular surface neuronal damage, neuro-regenerative activities, and neuronal-mediated dendritic cell activities. Neurogenic inflammation appears to be the main culprit, instigating the self-perpetuating inflammation observed in patients with dry eye disease.

Tear film and ocular surface neuropeptides: Characteristics, synthesis, signaling and implications for ocular surface and systemic diseases.

Ocular surface neuropeptides are vital molecules primarily involved in maintaining ocular surface integrity and homeostasis. They also serve as communication channels between the nervous system and the immune system, maintaining the homeostasis of the ocular surface. Tear film and ocular surface neuropeptides have a role in disease often due to abnormalities in their synthesis (either high or low production), signaling through defective receptors, or both. This creates imbalances in otherwise normal physiological processes. They have been observed to be altered in many ocular surface and systemic diseases including dry eye disease, ocular allergy, keratoconus, LASIK-induced dry eye, pterygium, neurotrophic keratitis, corneal graft rejection, microbial keratitis, headaches and diabetes. This review examines the characteristics of neuropeptides, their synthesis and their signaling through G-protein coupled receptors. The review also explores the types of neuropeptides within the tears and ocular surface, and how they change in ocular and systemic diseases.

Age- and sex-related differences in the measures of anterior segment parameters in a myopic clinical sample using Pentacam Scheimpflug tomography.

PURPOSE: To assess age-and sex-related differences of anterior segment parameters in a myopic clinical sample. METHODS: This clinic-based retrospective study involved eligible subjects grouped into myopia (i.e., low-to-moderate) and high myopia. Demographics and anterior segment parameters measures were recorded and analyzed. RESULTS: Some 153 eligible eyes were analyzed-98 myopia and 55 high myopia-comprising 87 males and 66 females. The mean ages and ranges were 28.47 years (SD = 9.59 years), 8-50 years, and 27.82 years (SD = 9.69 years), 10-51 years, for the myopia and the high myopia groups, respectively. The means of the spherical equivalents were - 3.02 D (SD = 1.46 D, range: - 0.50 to - 5.85 D), for the myopia group and - 10.42 D (SD = 5.50 D, range: - 6.00 to - 21.86 D) for the high myopia group. No significant difference was found between degree of myopia and anterior segment measures. Males had larger anterior chamber volume (mean 175.71 ± 26.27, range: 124-225 mm3); (P = 0.007) and deeper anterior chamber depth (3.73 ± 0.27, range: 3.06-4.41 mm) (P = 0.017) than females in the myopia group. Females also had significantly steeper anterior corneal curvature, Km (ant.) but flatter posterior corneal curvature, Km (post.), (- 6.31 ± 0.25, range - 7.00 to - 5.90 D) in both the myopia group [Km (ant.): 44.06 D ± 1.33 D, range: 41.30-47.10; Km (post.): - 6.31 D ± 0.25 D, range: - 7.00 to - 5.90; P = 0.008, P = 0.002, respectively] and the high myopia group [Km (ant.): 43.79 D ± 0.33 D, range: 41.00-47.10; Km (post.): - 6.22 D ± 0.30 D, range: - 6.80 to - 5.60; P = 0.034, P = 0.049, respectively]. Age was not correlated with the anterior segment parameters in both degrees of myopia. CONCLUSION: Sex has significant influence on the corneal curvature, anterior chamber volume and anterior chamber depth regardless of the degree of myopia.

Correction: Dry eye, its clinical subtypes and associated factors in healthy pregnancy: A cross-sectional study.

[This corrects the article DOI: 10.1371/journal.pone.0258233.].

Posterior Blepharitis and Associated Potential Factors: A Study among Pregnant Women.

PURPOSE: This study evaluates in a cross-section of pregnant women the frequency of posterior blepharitis, its predisposing factors and how lipid profile impacts the occurrence of posterior blepharitis in pregnancy. METHODS: This was a hospital-based cross-sectional study of pregnant women. RESULTS: In this study, 201 pregnant women were recruited and included in the study's analysis. The participants' mean age was 29.96 (±4.74) years, with a median age of 30 and a range of 17 to 40 years. The frequency of posterior blepharitis among this cohort was 13.4% (95% confidence interval, 9.0% to 18.4%). The frequencies of MGD-associated posterior blepharitis and non-MGD associated posterior blepharitis were 6.0% and 7.4%, respectively. There was no statistically significant difference in the mean fluorescein tear breakup time and SPEED scores between non-MGD associated posterior blepharitis and MGD-associated posterior blepharitis, however, the mean tear breakup time(t = 3.999, p < .001) and SPEED scores (t = 6.76, p < .0001) showed a statistically significant difference in posterior blepharitis pregnant women compared to non-posterior blepharitis pregnant women. There was a statistically significant difference in the mean corneal staining scores between non-MGD-associated posterior blepharitis and MGD-associated posterior blepharitis (t = 3.99, p = .001). There was no association between lipid profile and posterior blepharitis in binary logistic regression analysis. CONCLUSION: The study showed that posterior blepharitis occurs in pregnancy, but it is not associated with cholesterol levels.

Impact of Chronic Kidney Disease on Corneal Neuroimmune Features in Type 2 Diabetes.

Aim: To determine the impact of chronic kidney disease on corneal nerve measures and dendritic cell counts in type 2 diabetes. Methods: In vivo corneal confocal microscopy images were used to estimate corneal nerve parameters and compared in people with type 2 diabetes with chronic kidney disease (T2DM-CKD) (n = 29) and those with type 2 diabetes without chronic kidney disease (T2DM-no CKD) (n = 29), along with 30 healthy controls. Corneal dendritic cell densities were compared between people with T2DM-CKD and those with T2DM-no CKD. The groups were matched for neuropathy status. Results: There was a significant difference in corneal nerve fiber density (p < 0.01) and corneal nerve fiber length (p = 0.04) between T2DM-CKD and T2DM-no CKD groups. The two diabetes groups had reduced corneal nerve parameters compared to healthy controls (all parameters: p < 0.01). Immature central dendritic cell density was significantly higher in the T2DM-CKD group compared to the T2DM-no CKD group ((7.0 (3.8−12.8) and 3.5 (1.4−13.4) cells/mm2, respectively, p < 0.05). Likewise, central mature dendritic cell density was significantly higher in the T2DM-CKD group compared to the T2DM-no CKD group (0.8 (0.4−2.2) and 0.4 (0.6−1.1) cells/mm2, respectively, p = 0.02). Additionally, total central dendritic cell density was increased in the T2DM-CKD group compared to T2DM-no CKD group (10.4 (4.3−16.1) and 3.9 (2.1−21.0) cells/mm2, respectively, p = 0.03). Conclusion: The study showed that central corneal dendritic cell density is increased in T2DM-CKD compared to T2DM-no CKD, with groups matched for peripheral neuropathy severity. This is accompanied by a loss of central corneal nerve fibers. The findings raise the possibility of additional local factors exacerbating central corneal nerve injury in people with diabetic chronic kidney disease.

Prevalence and risk factors for Falls among older adults in a primary care facility in Ghana.

Background: Falls are a serious problem and are among the leading causes of morbidity, functional dependency, and death in older adults. Falls have become a social and global public health concern due to the current aging population in Africa and across the globe. However, their prevalence and risk factors have received little attention in Africa. Purpose: Thus, this study aimed to provide a baseline survey to determine the prevalence and associated risk factors for falls among older adults attending a primary care facility in Cape Coast, Ghana. Results: Participants (n = 244) were patients aged 60 years and older who visited the University of Cape Coast Hospital. The prevalence of falls identified in this hospital-based study was 40.2%. The following independent variables were found to be statistically significant predictors of risk of falls among the participants when compared with their respective reference categories; age 80 years and above [OR = 3.707, 95% CI = 1.738 - 7.907, p = 0.001], participants who had a history of falls [OR = 2.234, 95% CI = 1.326 - 3.765, p = 0.003], participants with three or more co-morbidities [OR = 16.456, 95% CI = 2.099 - 129.020, p = 0.008] and obesity [OR = 2.211, 95% CI = 1.151 - 4.250, p = 0.017]. Conclusion: The prevalence of falls among older adults is high. Thus, clinicians in the primary care setting should screen for, give fall prevention education, and prescribe appropriate interventions to at-risk patients.

The utility of measures of anterior segment parameters of a Pentacam Scheimpflug tomographer in discriminating high myopic astigmatism from keratoconus.

The study aimed to evaluate and compare anterior segment parameters between keratoconic eyes and eyes with high myopic astigmatism using Pentacam Scheimpflug tomography. This was a retrospective cross-sectional study that included sixty keratoconic eyes (thirty-two persons) and seventy-three eyes (forty-six persons) with high myopic astigmatism with mean ages 24.72 ± 11.65years and 26.60 ± 10.69years, respectively. Twenty-three parameters from the topographic map and fifteen parameters from the Belin-Ambrosió enhanced ectasia display map of the printouts of a Scheimpflug principle-based Pentacam tomographer were evaluated for their diagnostic accuracy using Receiver Operating Characteristic (ROC) curve. All parameters except cornea volume, anterior chamber volume, and anterior chamber angle indicated a significant difference between high myopic astigmatism and keratoconic eyes. The area under the receiver operating characteristic (AUROC) of eighteen Pentacam parameters was excellent (0.9-1.0) in discriminating keratoconus from high myopic astigmatism, out of which four {anterior minimum sagittal curvature (ant. Rmin), posterior minimum sagittal curvature (post. Rmin), maximum Ambrosió relational thickness (ART max) and total deviation value (D)} indicated excellent (>90%) sensitivity and specificity in addition to the excellent AUROC values. Topographic and Belin-Ambrosió enhanced ectasia display (BAD) maps of a Scheimpflug principle-based Pentacam tomographer are useful in enhancing the diagnosis of keratoconus and may also provide valuable information in effectively screening for keratoconus cases among refractive surgery candidates with high myopic astigmatism.