Dry Eye Disease: Concordance Between the Diagnostic Tests in African Eyes.

OBJECTIVE: To assess the concordance between the diagnostic tests for dry eye disease (DED) in a Nigerian hospital population. METHODS: The study was a hospital-based cross-sectional survey of adults (≥18 years) presenting at the eye clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu; September-December, 2011. Participants' socio-demographic data were collected. Each subject was assessed for DED using the "Ocular Surface Disease Index" (OSDI) questionnaire, tear-film breakup time (TBUT), and Schirmer test. The intertest concordance was assessed using kappa statistic, correlation, and regression coefficients. RESULTS: The participants (n=402; men: 193) were aged 50.1±19.1 standard deviation years (range: 18-94 years). Dry eye disease was diagnosed in 203 by TBUT, 170 by Schirmer test, and 295 by OSDI; the concordance between the tests were OSDI versus TBUT (Kappa, κ=-0.194); OSDI versus Schirmer (κ=-0.276); and TBUT versus Schirmer (κ=0.082). Ocular Surface Disease Index was inversely correlated with Schirmer test (Spearman ρ=-0.231, P<0.001) and TBUT (ρ=-0.237, P<0.001). In the linear regression model, OSDI was poorly predicted by TBUT (ß=-0.09; 95% confidence interval (CI): -0.26 to -0.03, P=0.14) and Schirmer test (ß=-0.35, 95% CI: -0.53 to -0.18, P=0.18). CONCLUSION: At UNTH, there is poor agreement, and almost equal correlation, between the subjective and objective tests for DED. Therefore, the selection of diagnostic test for DED should be informed by cost-effectiveness and diagnostic resource availability, not diagnostic efficiency or utility.

Awareness and Utilization of Welders' Personal Protective Eye Devices and Associated Factors: Findings and Lessons From a Nigerian Population.

This study assessed commercial welders' awareness and utilization of personal protective eye devices (PPEDs), and their associations, in Enugu, Nigeria, between January and March, 2011. The participants included 343 males, age 33.9 years±10.0 SD years. The participants reported high awareness of welding-associated ocular hazards (99.4%) and PPEDs (75.2%-98.3%), but low PPED possession and utilization rates. Cost and "presumed lack of utility" were the leading barriers to PPED possession; non-utilization was mainly attributed to "user inconvenience" and "presumed lack of protective benefit." PPED utilization was significantly associated with lower educational status (p=.030) and electric welding (p<.0001). The underlying causes are amenable to preventive occupational eye health education, enhanced ergonomics and affordability of PPEDs, and legislative enforcement of their use.

Mapping the pathways to eye care in a rural south-east Nigerian population: any implications for practice, eye care programs and policy?

INTRODUCTION: The appropriateness of the initial pathway to care, especially eye care, is critical for timeliness and outcomes of care. Individual-dependent and health system-determined factors influence the preferred initial pathway to care. This study aimed to map the initial pathways to eye care in a rural population in south-east Nigeria and identify the associated factors. METHODS: This study was a population-based, cross-sectional descriptive survey conducted in Abagana, a rural south-east Nigeria community, in September 2011. Using a researcher-administered questionnaire, data on participants' sociodemographics, preferred initial eyecare pathway when confronted with an eye disorder and their reason(s) for the choice of pathway were collected. Descriptive and analytical statistics were performed. Regression analysis was used to identify independent predictors of visiting an ophthalmologist when confronted with an eye disorder. In all comparisons, p < 0.05 was considered statistically significant. RESULTS: The participants (n = 501: 263 men; 238 women) were aged 48.9±16.3 years (range 18-93 years). The majority of the participants were married (339; 67.7%) and possessed formal education (415; 82.8%). The participants' frequently preferred initial pathways to eye care were to consult a patent medicine dealer (178; 35.0%), to consult an ophthalmologist (165; 33.0%), and to self-medicate (125; 25.0%). Possession of formal education (odds ratio 0.3; 95% confidence interval 0.1-0.5; p < 0.001) was the only significant sociodemographic predictor of consulting an ophthalmologist when confronted with an eye disorder The participants' main reasons for not consulting an ophthalmologist were ignorance (190; 56.5%), cost (199; 59.2%), and restricted spatial access (228; 67.9%). CONCLUSIONS: The majority of the respondents chose an inappropriate eyecare pathway in the event of an eye disorder. The reported barriers to appropriate pathway selection are amenable to community-based eye health education, enhanced affordability, and even distribution of eyecare services. Integrating other alternative care pathways into orthodox eye care should be considered.

Dry eye disease: prevalence, distribution and determinants in a hospital-based population.

OBJECTIVES: To determine the prevalence, distribution and risk factors for dry eye disease (DED) in a tertiary ophthalmic outpatient population. METHODS: The study was a cross-sectional descriptive hospital-based survey conducted at the Eye clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu, between September and December, 2011. The participants comprised adult ophthalmic outpatients aged 18 years or older. Participants' sociodemographic data were obtained. Dry eye disease was assessed subjectively with the Ocular Surface Disease Index (OSDI) questionnaire; and objectively with Schirmer's test and Tear-film Break-up Time (TBUT). An OSDI score of ≥ 50 with a TBUT of <10s or Schirmer's test reading of <10mm was considered diagnostic of DED. Descriptive and analytical statistics were performed. In all comparisons, a p<0.05 was considered statistically significant. RESULTS: The participants (n=402) comprised 193 males and 209 females who were aged 50.1 ± 19.06 SD years (range 18-94 years). The majorities of the participants were married - 74.1%, possessed formal education - 86.0% and were civil servants - 33.6%. The prevalence of DED was 19.2%. Dry eye disease was significantly associated with age>40 years (OR 1.88, 95% CI 1.06-3.35, p=0.0004), non-possession of formal education (OR 0.40, 95% CI 0.21-0.74, p=0.001) but not gender (OR 1.48, 95% CI 0.89-2.46, p=0.158). CONCLUSION: The prevalence of DED among ophthalmic outpatients at UNTH, Enugu, is comparatively high. Older age and illiteracy are predictors of DED. There is need for high index of diagnostic suspicion to prevent sight-threatening complications of DED.

Utility and effectiveness of orbito-ocular B-scan ultrasonography in an African developing country.

BACKGROUND: Diagnostic orbito-ocular ultrasonography is a safe, affordable, and cost-effective procedure that is especially suited for resource-poor developing countries. Periodic evaluation of its utility and effectiveness is important in the light of phenomenal advances in medical imaging. OBJECTIVES: To assess the utility and effectiveness of B-scan orbito-ocular ultrasonography in a Nigerian ophthalmic patient population. METHODS: The Hansa Clinic's database was retrospectively reviewed, between January 2006 and December 2010, to obtain patients' relevant demographic and clinical data. Results . The subjects comprised 119 males and 81 females. The leading sonographic diagnoses were ocular (90.4%): retinal detachment-23.3%, cataract-14.0%, and vitreous haemorrhage-10.5%; orbital (8.3%): 'mass lesion'-4.8% and myopathies-0.8%. The agreement between clinical and sonographic diagnoses was complete in 35.5% eyes. CONCLUSION: At Hansa Clinics, intraocular lesions are the main findings of diagnostic orbito-ocular sonography. There is poor agreement between clinical and sonographic diagnoses. Improved correlation of patients' clinic-pathologic data is suggested.

Oculopalpebral dimensions of adult Nigerians: report from the Enugu normative ocular anthropometry study.

OBJECTIVE: To determine the normal oculopalpebral anthropometric measurements of a Nigerian adult population. SUBJECTS AND METHODS: A population-based prospective observational random survey was conducted in Enugu, South-Eastern Nigeria between January and April 2010. The participants were healthy adults comprising 248 males and 252 females aged 18-76 years. One thousand eyes were examined. Demographic data, and bilateral direct manual millimetre measurements of the horizontal palpebral fissure (HPF), vertical palpebral fissure (VPF), upper lid crease (ULC), brow height (BH), and margin reflex distance (MRD) were obtained from all participants. Data were categorised by demographic variables and analysed to yield frequencies, percentages and proportions. Between-gender comparisons, using the independent t test, were considered significant at p < 0.05. RESULTS: The mean age of the participants was 36.5 ± 14.6 years. There was no significant difference between the genders in mean age (men: 37.3 ± 15.7 vs. women: 35.8 ± 13.3, p = 0.2302). The mean values of the parameters were (male, female) HPF: 32.8 ± 2.0 vs. 32.6 ± 3.0; VPF: 10.6 ± 1.2 vs. 10.6 ± 1.2; ULC: 8.2 ± 2.5 vs. 7.9 ± 2.2; BH: 13.1 ± 2.4 vs. 13.6 ± 2.7; and MRD: 4.1 ± 0.5 vs. 4.2 ± 0.8. Significant between-gender difference was observed only in BH measurements (p = 0.029) and variable trends with age. CONCLUSION: Oculopalpebral measurements of normal adult Nigerians in Enugu showed variations by age and gender. This may have implications for clinical evaluation and surgical management of oculopalpebral disorders in adult South-Eastern Nigerians. Future longitudinal studies are needed.

Assessing the knowledge and skills in clinical ophthalmology of medical interns: survey results from enugu, South-eastern Nigeria.

PURPOSE: To compare the skills and knowledge of clinical ophthalmology among medical interns in Enugu, Nigeria, to the recommendations of the International Council of Ophthalmology (ICO). MATERIALS AND METHODS: A questionnaire-based cross-sectional survey was conducted of Medical Interns attending the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital, from April 2010 to June 2010. Data on cohort demographics, undergraduate ophthalmology exposure, clinical skills and diagnostic competencies were collected and analyzed. Statistical significance was indicated by P < 0.05. RESULTS: The cohort comprised 81 males and 48 females (sex ratio = 1.7 : 1), aged 21-35 years (mean: 26.8 ± 2.4 years). The gender difference was significant (P < 0.05). The response rate was 88.7%. The duration of undergraduate ophthalmology exposure ranged from 1 to 4 weeks. Exposure was often adequate in cornea/external eye (95.3%), lens/cataract (95.3%) and glaucoma (92.2%); but not in vitreo-retinal disease (47.3%), neuro-ophthalmology (45.7%) and refractive surgery (0.0). The majority were competent at visual acuity testing (97.7%) and visual field examination (93.0%). There was lower competency at anterior chamber assessment (49.6%) and slit-lamp examination (39.5%). The majority could confidently diagnose conjunctivitis (96.1%) and cataract (90.7%), but not strabismus (42.6%) or macular degeneration (20.2%). CONCLUSIONS: Medical interns in Enugu displayed gaps in their undergraduate ophthalmology exposure, clinical knowledge and skills. This has implications for stakeholders in medical education and eye care delivery. Review of the curriculum, provision of training resources and compliance with ICO guidelines could address the deficiencies.

Assessing the Knowledge and Skills in Clinical Ophthalmology of Medical Interns: Survey Results from Enugu; South-Eastern Nigeria

Purpose: To compare the skills and knowledge of clinical ophthalmology among medical interns in Enugu; Nigeria; to the recommendations of the International Council of Ophthalmology (ICO). Materials and Methods: A questionnaire-based cross-sectional survey was conducted of Medical Interns attending the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital; from April 2010 to June 2010. Data on cohort demographics; undergraduate ophthalmology exposure; clinical skills and diagnostic competencies were collected and analyzed. Statistical significance was indicated by P 0.05. Results: The cohort comprised 81 males and 48 females (sex ratio . The duration of undergraduate ophthalmology exposure ranged from 1 to 4 weeks. Exposure was often adequate in cornea/external eye (95.3); lens/cataract (95.3) and glaucoma (92.2); but not in vitreo-retinal disease (47.3); neuro-ophthalmology (45.7) and refractive surgery (0.0). The majority were competent at visual acuity testing (97.7) and visual field examination (93.0). There was lower competency at anterior chamber assessment (49.6) and slit-lamp examination (39.5). The majority could confidently diagnose conjunctivitis (96.1) and cataract (90.7); but not strabismus (42.6) or macular degeneration (20.2). Conclusions: Medical interns in Enugu displayed gaps in their undergraduate ophthalmology exposure; clinical knowledge and skills. This has implications for stakeholders in medical education and eye care delivery. Review of the curriculum; provision of training resources and compliance with ICO guidelines could address the deficiencies

Ophthalmic manifestations of leukemia in a tertiary hospital population of adult nigerian africans.

PURPOSE: To determine the prevalence and pattern of leukemic ophthalmopathy among adults at the University of Nigeria Teaching Hospital (UNTH), Enugu, south-eastern, Nigeria. MATERIALS AND METHODS: This prospective, observational case series surveyed adult leukemia patients presenting at UNTH's departments of Hematology/Immunology and Ophthalmology from July 2003 to August 2008. The demographic profile, clinical data from for each individual in the cohort were statistically collated and analyzed. A P <0.05 was considered as statistically significant. RESULTS: There were 72 participants (45 males and 27 females), aged 32.7 ± 9.8 years (range, 18 years to 72 years). Leukemic ophthalmopathy was present in 77.8% of subjects. The leading ophthalmic manifestations of leukemia were retinal vascular abnormalities in 50.0% of subjects, conjunctival pallor in 27.8% of subjects, sub-conjunctival hemorrhage in 19.4% of subjects, and retinal hemorrhage in 16.7% of subjects. Ocular co-morbidity was present in 47.2% of subjects. Vision loss occurred in 37.5% of subjects, of which 32.1% was leukemia related, and the remaining due to ocular co-morbidity. Leukemic ophthalmopathy was more prevalent in chronic leukemia (P <0.05), frequently affected the ocular posterior segment (P < 0.05), and often resulted from secondary hematologic complications (P <0.05). There was no gender difference in the prevalence of leukemia (P = 0.0822) or leukemic ophthalmopathy (P = 0.6624). CONCLUSION: The prevalence of leukemic ophthalmopathy in Enugu is high. It is often associated with significant ocular co-morbidity and vision loss. These have implications for clinicians involved in leukemia management. Early diagnosis and regular ophthalmic examinations are recommended to optimize treatment outcomes.

The burden of pediatric malignant solid tumors in a developing country.

OBJECTIVE: This study evaluates the burden of pediatric malignant solid tumors (PMST) in southeastern Nigeria. METHODS: Analysis of 174 cases of PMST managed at the University of Nigeria Teaching Hospital Enugu, from January 2002 to November 2007. RESULTS: PMST comprised 2.8% of pediatric admissions. Tumors encountered were lymphomas 77 (44.3%), Wilms' tumor 35 (20.1%), sarcomas 20 (11.5%), neuroblastoma 15 (8.6%), retinoblastoma 14 (8.0%), teratomas 8 (4.6%) and hepatoma 5 (2.9%). Mean time for diagnosis was 3.3 +/- 2.4 months. Advanced disease occurred in 135 (77.6%), while 39 (22.4%) had early disease. Only 166 (95.4%) commenced planned therapy, with 67 (40.4%) lost to follow-up. Of 99 children available for evaluation, 43 died (11 treatment related and 32 from relapse). Overall, 56 (56.6%) were alive after a mean follow-up of 20.7 +/- 10.5 months. CONCLUSION: PMST are enormous challenge in our setting. Delayed presentation, poor treatment compliance and healthcare funding have to be addressed to improve outcomes.