Twenty-Four-Hour Intraocular Pressure Pattern In Glaucoma Suspects in an African Population.

PRCIS: Twenty-four-hour intraocular pressure measurement (Phasing) among glaucoma suspects showed higher intraocular pressure (IOP), greater fluctuation, and more varying peak times occurring mostly outside clinic hours, between 12 midnight and 8 am in 68.9% of them. PURPOSE: To characterise 24-hour variation in IOP, in glaucoma suspects and normal individuals in an African population. MATERIALS AND METHODS: A cross-sectional analytical study was carried out between March and October 2019 at the University of Ilorin Teaching Hospital. A total of 204 study participants, comprising 102 primary open angle glaucoma (POAG) suspects and 102 age and sex-matched controls with healthy eyes were recruited. Participants had a comprehensive ophthalmic examination. Measurements of IOP were taken every 2 hours during a 24-hour period using an iCare tonometer. RESULTS: The mean age was 43.64±14.02 SD and 43.02±13.55 SD ( P =1.000) for POAG suspects and controls, respectively. The mean peak IOP was significantly higher in POAG suspects (21.87± 4.65 mm Hg) compared with controls (17.17± 2.32 mm Hg) ( P <0.001). Whereas, the mean trough IOP reading was not significantly different between the 2 groups. In both groups of participants, the peak and trough IOP in the majority were recorded outside of clinic hours. The majority (68.9%) of POAG suspects had a peak IOP between midnight and 8 am, whereas the control group peaked mostly at 4 pm (16.7%) and 4 am (41.7%). Twenty-four-hour IOP variation was 6 mm Hg or less in 73.6% of control eyes, while in the POAG suspects, 83.3% of eyes had variation greater than 6 mm Hg. CONCLUSIONS: Compared with age and sex-matched healthy controls, glaucoma suspects of African descent showed significantly higher mean IOP and IOP variation, with most peak IOP detected outside of clinic hours.

Childhood traumatic cataract in Nigeria; a multicentre study: 2017-2021.

OBJECTIVE: To determine the frequency, demography, aetiology and mechanisms of ocular injuries associated with childhood traumatic cataract in Nigeria. METHODS: A retrospective multicentre study conducted across ten child eye health tertiary facilities in Nigeria between January 2017 and December 2021. Clinic records of all children aged 0-17 years who had been diagnosed with cataract at the various participating centres were reviewed. Information collected include: biodata, mechanism of injury; laterality, place of injury; object responsible; person responsible; duration before presentation and surgical intervention. RESULTS: A total of 636 out of 1656 children (38.4%) had traumatic cataracts during the study period. Their mean age was 109.4 ± 45.2 months with a male-to-female ratio of 2:1. Most injuries were unilateral, two (0.3%) children had bilateral involvement. Only 78 (15.3%) children presented within 4 weeks of the injury. Closed globe injuries were responsible for the traumatic cataract in 475 (74.7%) children, while open globe injuries were more likely to present within 24 h (P < 0.001). The commonest objects of injury were cane, sticks, plant, wood and play materials. Self-inflicted injuries occurred in about 82 (13%) children while 407 (64.0%) were caused by close relatives and contacts. The location where trauma occurred was home in 375 (59.8%) and school in 107 (16.8%) children. CONCLUSION: This multicentre study demonstrates that more than one-third of all childhood cataracts in Nigeria are trauma-related and majority are due to closed globe injuries. Public health interventions to reduce the occurrence of ocular trauma and to encourage early presentation after trauma are advocated.

Sex, gender, and retinoblastoma: analysis of 4351 patients from 153 countries.

OBJECTIVE: To investigate in a large global sample of patients with retinoblastoma whether sex predilection exists for this childhood eye cancer. METHODS: A cross-sectional analysis including 4351 treatment-naive retinoblastoma patients from 153 countries who presented to 278 treatment centers across the world in 2017. The sex ratio (male/female) in the sample was compared to the sex ratio at birth by means of a two-sided proportions test at global level, country economic grouping, continent, and for selected countries. RESULTS: For the entire sample, the mean retinoblastoma sex ratio, 1.20, was higher than the weighted global sex ratio at birth, 1.07 (p < 0.001). Analysis at economic grouping, continent, and country-level demonstrated differences in the sex ratio in the sample compared to the ratio at birth in lower-middle-income countries (n = 1940), 1.23 vs. 1.07 (p = 0.019); Asia (n = 2276), 1.28 vs. 1.06 (p < 0.001); and India (n = 558), 1.52 vs. 1.11 (p = 0.008). Sensitivity analysis, excluding data from India, showed that differences remained significant for the remaining sample (χ2 = 6.925, corrected p = 0.025) and for Asia (χ2 = 5.084, corrected p = 0.036). Excluding data from Asia, differences for the remaining sample were nonsignificant (χ2 = 2.205, p = 0.14). CONCLUSIONS: No proof of sex predilection in retinoblastoma was found in the present study, which is estimated to include over half of new retinoblastoma patients worldwide in 2017. A high male to female ratio in Asian countries, India in specific, which may have had an impact on global-level analysis, is likely due to gender discrimination in access to care in these countries, rather than a biological difference between sexes.

Case series of retinopathy of prematurity blindness in Nigeria: A wakeup call to policy makers, hospitals, ophthalmologists and paediatricians.

BACKGROUND STATEMENT: Inadequate retinopathy of prematurity (ROP) screening coverage portends a high risk for increasing the cases of ROP blindness. This study aims to report the clinical profile of pre-term babies who developed ROP blindness, highlight the usefulness in determining screening criteria and the role of private hospitals in ROP blindness prevention. CASE SERIES REPORT: Online Google form and telephone survey was conducted from May to December 2020 among paediatric ophthalmologists who provided the clinical details of ROP blind children seen between 2016 and 2020. The main outcome measured included type of the hospital of birth, gestational age, birth weight, ROP Screening and treatment, and blinding ROP Stage among children born premature. The SPSS-IBM version 26 was used for the analysis. Eighteen children blind from ROP with an equal male-to-female ratio were reported. Mean gestational age was 28.4 ± 2.2 weeks (range 26 - 34 weeks, median was 28.0 weeks). Mean birth weight was 1173.7 ± 317.9 grams (range 776 - 2100 grams, median 1125 grams). Six (33.3%) babies were born in private hospitals between 28 and 32 weeks. Sixteen (88.9%) children never had ROP screening. Fifteen (83.3%) were blind in both eyes. Six (33.3%) had Stage IVb and 12 (66.7%) Stage V. CONCLUSION: About 90% of the babies who became blind did not undergo ROP screening. It is crucial that all babies born at 34 weeks or earlier and have birth weight of < 1500 grams in public/private hospitals be screened for ROP to prevent this avoidable blindness in Nigeria.

Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020.

OBJECTIVES: Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria. DESIGN: Descriptive case study. SETTING: Neonatal intensive care units in Nigeria. PARTICIPANTS: Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria). METHODS AND ANALYSIS: A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. RESULTS: In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems. CONCLUSION: ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential.

Nigerian neonatologists perception and experience with retinopathy of prematurity.

BACKGROUND: Retinopathy of Prematurity (ROP) is an avoidable condition that affects premature infants exposed to oxygen stresses at or soon after birth. In low- and middle-income countries, like Nigeria, neonatal mortality rates are high and very few infants live to develop ROP. With recent better care, ROP is now being diagnosed. OBJECTIVE: This study aimed to characterize what Nigerian neonatologists understand about ROP. METHODS: At a joint meeting of Nigerian pediatric ophthalmologists and neonatologists in Kebbi State held 26-29 July 2018, questionnaires collected attendees' perspective and experience with ROP including causes, risk factors and experiences. RESULTS: Fifty-one neonatologists out of 71 returned a completed questionnaire (response rate: 71.8%). The male:female ratio was 1:1.8, and approximately 40% were aged 41-50 years (n=20, 39.22%). Only 3 (6.39%) had experience managing infants below 500g that survived. A majority managed babies with a mean weight of 913g ± 300.37 and age of 27.87 weeks ±2.37. Most had no access to oxygen monitors (n=39,78%). Most had 10 babies to one monitor and used average settings of 90-95%. One third had seen a case of ROP (n=15,29.41%). Only 5.88% (n=3) were unaware of uncontrolled oxygen use as a risk factor. Only 4 (8.89%) had a functional screening team. None were aware of local screening guidelines. CONCLUSIONS: Regular educational programs, collaborative clinical presentations and webinars about ROP targeted at the neonatologists and parents, including establishment of screening programs across country will likely help reduce the burden of ROP blindness in Nigeria.

International Classification of Retinopathy of Prematurity, Third Edition.

PURPOSE: The International Classification of Retinopathy of Prematurity is a consensus statement that creates a standard nomenclature for classification of retinopathy of prematurity (ROP). It was initially published in 1984, expanded in 1987, and revisited in 2005. This article presents a third revision, the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), which is now required because of challenges such as: (1) concerns about subjectivity in critical elements of disease classification; (2) innovations in ophthalmic imaging; (3) novel pharmacologic therapies (e.g., anti-vascular endothelial growth factor agents) with unique regression and reactivation features after treatment compared with ablative therapies; and (4) recognition that patterns of ROP in some regions of the world do not fit neatly into the current classification system. DESIGN: Review of evidence-based literature, along with expert consensus opinion. PARTICIPANTS: International ROP expert committee assembled in March 2019 representing 17 countries and comprising 14 pediatric ophthalmologists and 20 retinal specialists, as well as 12 women and 22 men. METHODS: The committee was initially divided into 3 subcommittees-acute phase, regression or reactivation, and imaging-each of which used iterative videoconferences and an online message board to identify key challenges and approaches. Subsequently, the entire committee used iterative videoconferences, 2 in-person multiday meetings, and an online message board to develop consensus on classification. MAIN OUTCOME MEASURES: Consensus statement. RESULTS: The ICROP3 retains current definitions such as zone (location of disease), stage (appearance of disease at the avascular-vascular junction), and circumferential extent of disease. Major updates in the ICROP3 include refined classification metrics (e.g., posterior zone II, notch, subcategorization of stage 5, and recognition that a continuous spectrum of vascular abnormality exists from normal to plus disease). Updates also include the definition of aggressive ROP to replace aggressive-posterior ROP because of increasing recognition that aggressive disease may occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources. ROP regression and reactivation are described in detail, with additional description of long-term sequelae. CONCLUSIONS: These principles may improve the quality and standardization of ROP care worldwide and may provide a foundation to improve research and clinical care.

Outcome of vision screening by community health workers at immunization outlets in Nigeria to support access to early visual evaluation in children aged 0-2 years.

PURPOSE: Routine eye examination in early life is not the practice in most resource-limited countries. Delay in the presentation for eye problems is typical. Community health officers are often consulted by caregivers for all health problems during routine immunization and well-baby clinics in primary healthcare for children aged 0-2 years. This study evaluated the value and limitation of interview, Bruckner red reflex test, and instrument vision screener by noneye care middle-level staff of rural and urban well-baby immunization clinics, in early detection and referral for childhood eye disorders. MATERIALS AND METHODS: This was a cross-sectional study. Middle-level community health workers (CHWs) working at well-baby/immunization clinics were trained to perform vision screening using interview of caregivers, red reflex eye examination with ophthalmoscope, and instrument vision screener (Welch Allyn SPOT™ Vision Screener) without mydriatic drugs during routine immunization of children aged 0-2 years. IRB approval was obtained. RESULTS: Over a 6-month period in 2017, the CHWs screened 5609 children. Overall, 628 (11.2%) patients were referred to the tertiary child eye care unit. Referred cases included cataract, glaucoma, congenital nasolacrimal duct obstruction, ophthalmia neonatorum, retinoblastoma, and significant refractive errors. Referral from the interview of mothers was enhanced if specific questions to elicit visual function were asked. Bruckner red reflex test was more effective than instrument vision screener in the detection of cataract and life-threatening diseases such as retinoblastoma. Instrument vision screener was preferred by parents and better at detecting amblyopic risk factors. CONCLUSION: Preschool vision screening during routine immunization by primary healthcare workers in resource-limited settings was effective. Whenever instrument vision screener does not give any recommendation during screening, consider vision- or life-threatening pathology and refer.

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries.

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Contemporary management of retinoblastoma in the context of a low-resource country.

Retinoblastoma (RB) is the most common ocular cancer, and it typically presents before the age of 5 years in over 90% of cases. In high resource countries, RB patients tend to survive and retain their sight. This is not the case in low-resource countries because of late presentation and delayed intervention arising mostly from sociocultural and socioeconomic challenges. RB has no gender or racial predilection; the incidence is estimated as 1:16,000-1:18,000 live-births or 11/1 million children under 5 years. Most of the world's RB cases are found in Asia and Africa while most RB treatment centres are in America and Europe. RB is easy to detect by caregivers as a glowing white 'cat eye reflex' at night or when captured on camera. Health workers at primary care level can detect RB in early life if red reflex test and/or squint (Hirschberg) tests are deployed as part of wellness checks done especially during routine immunisation and well-baby clinics in the first 24 months of life. In most cases of RB, biopsies for histological confirmation are not required for diagnosis and treatment decisions to be made. Clinical information, ophthalmic evaluation and imaging modalities are typically used. There have been significant changes in the management of RB using various treatment modalities such as enucleation with orbital implant, use of chemotherapy delivered through intravenous, intravitreal, periocular and intra-arterial routes and targeted treatment with laser, cryotherapy and brachytherapy. Algorithm for management and development of the national RB program within the context of a low-resource country is presented from review of data extracted from Mendeley library, PubMed library, Google Scholar and One Network; full-text articles were mostly retrieved through the American Academy of Ophthalmology.

Epidemiology of ROP update - Africa is the new frontier.

Several epidemics of blindness due to retinopathy of prematurity (ROP) have been described, with the most recent (the third) occurring in middle income countries in Latin America and Eastern Europe initially, and more recently in the more advanced economies in Asia. In these settings, which are characterized by variation in the quality of neonatal care and inadequate coverage of ROP screening and treatment, larger, more mature infants are affected as well as extremely preterm infants. In 2010 the annual incidence of blindness and visual impairment from ROP globally was estimated to be 32,300, with the lowest incidence in sub-Saharan countries. However, ROP is likely to become an increasingly important cause of blindness in children in sub-Saharan Africa as neonatal care expands unless policies and programmes for control are included at the outset.

The current state of retinopathy of prematurity in India, Kenya, Mexico, Nigeria, Philippines, Romania, Thailand, and Venezuela.

Retinopathy of prematurity (ROP) is one of the leading causes of preventable blindness in children worldwide. Middle-income nations are currently experiencing epidemic levels of ROP, because greater access to neonatal intensive care units has improved survival rates of premature infants, but without sophisticated oxygen regulation. The epidemiology, screening infrastructure, treatment options, and challenges that these countries face are often tied to unique local socioeconomic, cultural, geopolitical, and medical factors. We present an overview and narratives of the current state of ROP in eight countries that are or soon will be experiencing ROP epidemics-India, Kenya, Mexico, Nigeria, Phillipines, Romania, Thailand, and Venezuela-with a view to fostering both an understanding of the differences in the ROP landscape in various settings and an interest in the further development of ROP screening and treatment services tailored to local requirements.

Normal values of intraocular pressure in full-term Nigerian newborns.

PURPOSE: To determine the normative range of intraocular pressure (IOP) in full-term newborns and possible association with birth parameters during the first week of life. METHODS: This was an observational cross sectional study in which IOP was measured in 1000 eyes of 500 normal full-term newborns using the Perkins applanation tonometer under topical anesthesia. An average of three readings was taken as the IOP value. The relationship between IOP and birth parameters was analyzed. RESULTS: The male to female ratio was 1:1 with 254 (50.8%) male and 246 (49.2%) female babies. The (mean ± SD) value of IOP in the right eyes was 11.93 ± 1.80 mmHg, ranging between 9.00 and 16 mmHg. In the left eyes, the mean value of IOP was 11.84 ± 1.77 mmHg with a range of 8.00-15.00 mmHg. IOP in males (12.02 ± 1.84 mmHg) was not significantly different from that in females (11.89 ± 1.75 mmHg). There was no significant difference between right and left eyes (p = 0.42). The 95% range (mean ± 2 SD) was 15.53 mmHg for the right eye and 15.38 mmHg for the left. Correlational analysis showed that birth weight and gestational age were positively correlated with IOP. CONCLUSION: This study provides useful normative data on IOP among Nigerian full-term newborns. Further studies on possible ethnic/geographic variations of IOP in children may be beneficial.

Comparison of ocular biometry measurements by applanation and immersion A-scan techniques.

PURPOSE: The study compared ocular biometry values using applanation and immersion techniques to determine the most applicable method for our tertiary training centre where personnel with different levels of experience and expertise in biometry take measurements used in calculation of required intraocular lens before cataract surgery. METHODS: The study was a prospective cross-sectional comparative study of different techniques of ocular biometry from diagnostic equipment (biometry probe 10 MHz Sonomed(®) A-scan (PACSCAN 300A, USA). Measurement variables were obtained among children and adults undergoing cataract surgery. Scleral (Prager) shell was used for the immersion technique followed by the contact technique by the same examiner. RESULTS: The biometry values of 92 eyes of 92 adult were taken. Their ages ranged from 18 to 95 years with a mean of 64.7 (SD ± 12.9) years. There were 55 (59.8%) males and 37 (40.2%) females, with a male to female ratio of 1.5:1. Average axial length (22.0-24.4 mm) eyes were the most common eyes measured in 75 (81.5%) of the cases. The means of the axial lengths biometry values with immersion and contact technique were 23.66(±1.36) and 23.46 mm (±1.46); the axial length differences was 0.2 ± 0.26 mm (range 0.0-0.94 mm) and statistically significant (95% CI of the Difference 0.15 to 0.26, p = 0.000). The Standard deviation SD (mm) of Individual Eye Axial Length showed a mean of 0.03 ± 0.04 (0.0-0.3) mm for immersion and for contact technique 0.14 ± 0.12(0.0-0.6)mm. CONCLUSION: There was a significant difference in ocular biometry measurement with the contact and immersion ultrasound techniques. The immersion technique had better repeatability, thus it is ideal in a training hospital setting in a typical in sub-Saharan Africa who have limited resources to employ a dedicated person to do biometry; and where the different operators of A-scan machines have different levels of experience and expertise.

Psychological and social adjustment to blindness: understanding from two groups of blind people in Ilorin, Nigeria.

BACKGROUND: Blindness can cause psychosocial distress leading to maladjustment if not mitigated. Maladjustment is a secondary burden that further reduces quality of life of the blind. Adjustment is often personalized and depends on nature and quality of prevailing psychosocial support and rehabilitation opportunities. This study was aimed at identifying the pattern of psychosocial adjustment in a group of relatively secluded and under-reached totally blind people in Ilorin, thus sensitizing eye doctors to psychosocial morbidity and care in the blind. MATERIALS AND METHODS: A cross-sectional descriptive study using 20-item Self-Reporting Questionnaire (SRQ) and a pro forma designed by the authors to assess the psychosocial problems and risk factors in some blind people in Ilorin metropolis. RESULT: The study revealed that most of the blind people were reasonably adjusted in key areas of social interaction, marriage, and family. Majority were considered to be poorly adjusted in the areas of education, vocational training, employment, and mobility. Many were also considered to be psychologically maladjusted based on the high rate of probable psychological disorder of 51%, as determined by SRQ. Factors identified as risk factors of probable psychological disorder were poor educational background and the presence of another medical disorder. CONCLUSION: Most of the blind had no access to formal education or rehabilitation system, which may have contributed to their maladjustment in the domains identified. Although their prevailing psychosocial situation would have been better prevented yet, real opportunity still exists to help this group of people in the area of social and physical rehabilitation, meeting medical needs, preventive psychiatry, preventive ophthalmology, and community health. This will require the joint efforts of medical community, government and nongovernment organizations to provide the framework for delivery of these services directly to the communities.

Psychosocial characteristics of totally blind people in a nigerian city.

PURPOSE: To characterize the demographic and psychosocial problems of a group of blind people as a way of attracting more attention to and providing data that can improve the psychosocial care of the visually impaired. MATERIALS AND METHOD: A cross-sectional descriptive study of a population of totally blind people in Ilorin, Nigeria using a self-report questionnaire (SRQ). The questionnaire was verbally administered by the study personnel in the local language. Simple frequency tables were obtained and the Chi-square test was performed to determine significant differences between variables. P value <0.05 was considered statistically significant. RESULTS: Sixty one blind patients consented to participate. Most participants were engaged in street begging for their livelihood. Most subjects desired a job change, signifying dissatisfaction with the present occupation. Up to 80% of the cohort was married and had spouses who were also blind in at least one eye. Approximately two-thirds had five or more children and majority lived with family members who were responsible for taking care of their personal hygiene, cooking and mobility. The majority developed blindness in childhood and 16% had a family history of blindness and 77% had never used conventional eye care, with corneal disease being the most frequent cause of blindness. Many feared that their children may also become blind. Thirty-one (51%) scored ≥5 on SRQ and were classified as probable cases of psychological disorder. CONCLUSION: Blindness in a majority of cases that started in childhood was probably preventable. Inaccessibility to or failure of the formal rehabilitation and social welfare systems may have caused this psychosocial dilemma. The high level of social and family interaction provides opportunity for organized preventive ophthalmology, community health care services and psychosocial care.

Retinoblastoma--a clinico-pathological study in Ilorin, Nigeria.

Retinoblastoma is the commonest childhood primary malignant intraocular neoplasm that is often characterized by spontaneous regression. They display photoreceptor differentiation. This study provides the clinical presentations and histological profiles of retinoblastoma in Ilorin, Kwara-State, in the North Central geo-political zone of Nigeria. A retrospective study of clinically and histologically verified retinoblastoma at the University of Ilorin Teaching Hospital, Ilorin, Kwara-State, Nigeria from January 1989 to December 2000 was undertaken. The clinical and histological features were analyzed using the patient's case folder and surgical pathology records. There were 20 patients, 9 males and 11 females (M:F ratio 1: 1.2), age range from 5 (1/2) months to 6 years with 23 eyeball tumours histologically confirmed retinoblastoma during the study period. Proptosis with chemosis was the most common clinical presentation (84.6 %). Bilaterality was 15 % in this study. Enucleation and Exenteration combined with chemotherapy were offered to 15 (75 %) and 5 (25 %) patients respectively. A poorly differentiated type with extensive areas of tumour necrosis was the commonest histological pattern. Thirteen (65 %) of the patients died before completing the course of chemotherapy.