Spectacle design preferences among school children in Enugu State, Nigeria.

BACKGROUND: Uncorrected refractive error has profound effects on children's educational and social development and spectacles are cost-effective in correcting this. However, the cosmetic appearance of spectacles may affect compliance to prescribed spectacles. AIMS: This study explored spectacle design preferences of school children in Enugu State, Nigeria and any associated sociodemographic factors. A cross-sectional study among children aged 5-15 years from schools in Enugu state, Nigeria. PATIENTS AND METHODS: The children independently selected from sets of spectacle frames, indicating their preferences on the basis of spectacle frame color, material, shape and size of the lens portion, design of the earpiece portions. Simple descriptive analysis was performed. Frequency tables were generated. Pearson's Chi-square test was used to test associations between categorical variables. Odds ratios were used to measure the strength of the associations where P < 0.05. Tests of significance were set at the 95% level. RESULTS: A total of 1,167 children (45.6% male and 54.4% female) were seen. Majority of the children preferred red colored spectacle frames 467 (40%), plastic frames 723 (62%), rectangular shaped lens-pieces (55.2%), and frames with a straight earpiece 987 (84.6%). There is a strong association between gender and choice of spectacle colour (P < 0.01), gender and lens size preference (P < 0.05), and between school location and shapes of spectacle earpiece (P < 0.01). CONCLUSIONS: Spectacle preferences exist among the study population and some demographic factors are associated with these preferences which should be considered in any childhood refractive error services.

Prevalence of refractive errors and visual impairment in school children in Enugu South-East Nigeria.

AIMS: To determine the prevalence of refractive errors and causes of visual impairment in school children in Enugu State, South-eastern Nigeria. METHODS: A descriptive cross-sectional, school-based survey in children aged 5-15 years from selected primary and junior secondary schools (public and private) in both urban and rural communities of Enugu State was carried out. Ocular examinations were performed on them according to the Refractive Error in School-age Children (RESC) protocol. RESULTS: A total of 1167 children were examined. The mean age (standard deviation) was 10.58 ± 3.0 years. Females were 653 (54.4%) of the study population. The uncorrected, presenting and best-corrected visual acuity of ≤20/40 (6/12) in the better eye of the children in this study were 3.6%. 3.5% and 0.4%. Among the children that had visual impairment, refractive error accounted for 33.3% of reduced vision while the overall prevalence of refractive error was 2.1%. Prevalence of myopia was 1.9% and hyperopia, 0.1%. The most prevalent astigmatism was ≤0.75 dioptre cylinder. CONCLUSION: The prevalence of refractive error in this study is low, with myopia being more common. Despite the low prevalence of refractive error, school vision screening is still important for African children as it serves as an opportunity to identify other ocular morbidities among the children.

Audit of ophthalmology discharge summaries in a Nigerian Teaching Hospital.

BACKGROUND: Discharge summaries are important components of hospital-care transitions in ensuring continuity of care. AIM: We assessed the adequacy and accuracy of discharge summaries written by junior doctors. METHODS: An instrument, adapted largely from the current hospital discharge summary template and recommendations regarding content from the Joint Commission International, was used to study 420 discharge summaries written in 2012 from the ophthalmology service of a Rural Teaching Hospital in Nigeria. The simple descriptive analysis was done with Statistical Package for the Social Science version 17. RESULTS: Completeness of entries was relatively high in many traditional areas (biodata of patient, admission/discharge dates, name of supervising consultant, principal diagnosis, surgical procedures done, follow-up instructions, and condition on discharge) of the summaries. The portion of the paper-based template titled "summary" of the admission was most problematic; with information on medication changes and result of tests missing in 368/420 (87.6%) and 334/420 (79.5%), respectively. CONCLUSION: Educational intervention for doctors in training with the provision of oversight and feedback by their supervisors is required. Standardized discharge summary templates recognizing the peculiarities of specialized patient groups are recommended. Transition to electronic discharge summary system is imperative.

Patients' satisfaction with eye care services in a Nigerian teaching hospital.

BACKGROUND: Understanding the patients' perception of services received is essential as the parameters important to the patient may be quite different from that to the eye health provider. AIM: This study aims to evaluate patients' satisfaction with the care received from the pioneer teaching hospital in south-eastern Nigeria and use it to audit services. MATERIALS AND METHODS: This was a descriptive cross-sectional study. An interviewer-administered questionnaire was administered to 307 consecutive consenting patients seen at the eye clinic of the University of Nigeria Teaching Hospital Enugu in April 2013. The questionnaire asked questions regarding satisfaction with the time spent in the clinic, attitude of various categories of staff, physical facilities, cleanliness of the clinic and willingness to come again to the clinic or recommend it to others. RESULTS: The respondents were more satisfied with the attitude of the doctors and nurses than that of revenue and medical records clerks (P = 0.001). Most patients, 288 (93.8%) expressed satisfaction with the overall cleanliness of the eye clinic; 220 (71.7%) and 288 (93.8%) were not satisfied with the toilet facilities and cost of services, respectively. Only 140 (45.6%) participants will recommend the hospital to others strongly, 145 (47.2%) will do so hesitantly. CONCLUSION: Majority of the patients were satisfied with the services received. The major dissatisfaction points were cost of services and inadequate toilet facilities.

Refractive errors in children with autism in a developing country.

BACKGROUND: In a resource-limited country visual problems of mentally challenged individuals are often neglected. AIM: The present study aims to study refractive errors in children diagnosed with autism in a developing country. MATERIALS AND METHODS: Ophthalmic examination was carried out on children diagnosed with autism attending a school for the mentally challenged in Enugu, Nigeria between December 2009 and May 2010. Visual acuity was assessed using Lea symbols. Anterior and posterior segments were examined. Cycloplegic refraction was performed. Data was entered on the protocol prepared for the study and analyzed using Statistical Package for the Social Sciences version 17 (Chicago IL, USA). RESULTS: A total of 21 children with autism were enrolled in the school; 18 of whom were examined giving coverage of 85.7%. The age range was 5-15 years, with a mean of 10.28 years (standard deviation ± 3.20). There were 13 boys and 5 girls. One child had bilateral temporal pallor of the disc and one had bilateral maculopathy with diffuse chorioretinal atrophy. Refraction revealed 4 children (22.2%) had astigmatism and 2 children (11.1%) had hypermetropia. CONCLUSION: Significant refractive error mainly astigmatism was noted in the children with autism. Identifying refractive errors in these children early and providing appropriate corrective lenses may help optimize their visual functioning and impact their activities of daily life in a positive way.

Evaluation of complications of extracapsular cataract extraction performed by trainees

Background: Cataract extraction is the most common intraocular surgery taught to residents. Aim: This study aims to review the complications of trainee-performed extracapsular cataract extraction (ECCE) so as to identify the steps in which the trainee can benefit from closer supervision and practice. Subjects and Methods: This was a descriptive retrospective study of complications in the initial 150 ECCE with intraocular lens implant performed by two Ophthalmologists; from the University of Nigeria Teaching Hospital; Enugu; who visited a high volume training center. Both the intraoperative and early post-operative complications were studied. Data entry and analysis were performed descriptively using the Statiscal Package for the Social Sciences; SPSS version 15.0 (Chicago; IL; USA). Results: The age range of the patients was 40-95 years. The intraoperative complications included capsular flaps 12/161 (7.5); posterior capsule rent; 10/161 (6.2) and vitreous loss; 8/161 (5.0). Corneal complications (striate keratopathy; superior corneal edema; generalized corneal edema and corneal folds) ranked highest in post-operative complications accounting for 34 (56/164). Conclusions: Performance of adequate and proper anterior capsulotomy; minimal handling of the cornea and avoidance of posterior capsular rent are some of the challenges of the trainee in mastering ECCE. Stepwise supervised training can help a trainee master these steps while keeping the complications at acceptably low levels

HIV seroprevalence in ophthalmic surgery patients at ESUT Teaching Hospital Enugu.

BACKGROUND: Many patients at high risk of contracting HIV infection may not seek voluntary counseling and testing but may have an unrelated ocular problem. The study aims to highlight the need to offer HIV voluntary counseling and testing services to ophthalmic surgery patients so that seropositive patients can be identified early and managed appropriately. METHODS: The medical records of patients who underwent major eye surgery at Enugu State University of Science and Technology (ESUT) Teaching Hospital Parklane Enugu from October 2005 to September 2006 were reviewed. The patients were routinely screened for the presence of HIV infection after pretest counseling. Information was sought on patients' bio-data, type of surgery and HIV status using a protocol designed for the study. RESULTS: A total of 133 patients had major eye surgeries during the study period; 67(50.4%) were males while 66 (49.6%) were females. The age range was 4 months to 82 years. Cataract extraction (54.9%), removal of eye (21.8%) and repair of penetrating injuries (15.1%) were the commonest operations. Four patients were HIV seropositive giving a prevalence of 3.0%. CONCLUSION: Patients have been identified to be HIV positive with apparently unrelated eye diseases. Routine HIV voluntary counseling and testing services is advocated for all ophthalmic surgery patients so that seropositive patients can be identified and early appropriate management commenced.

Management of primary congenital glaucoma by trabeculectomy in Nigeria.

AIM: To review the management of congenital glaucoma, bearing in mind the limited facilities available in developing countries. METHODS: The medical records of children aged < or = 3 years with primary congenital glaucoma seen at two teaching hospitals and one private eye hospital in Enugu, Nigeria over a 5-year period were reviewed retrospectively. All the children underwent trabeculectomy without use of anti-metabolites. RESULTS: Fifty-seven eyes of 32 patients (5 unilateral, 26 bilateral) were reviewed. Pre-operatively, 63.2% of the eyes had a corneal diameter of 12-15 mm. After surgery, the number with corneal haziness decreased from 25 (43.8%) to 15 (26.4%) (p=0.05). The mean (SD) pre-operative intra-ocular pressure (IOP) was 28.3 (7.5) mmHg and the mean post-operative IOP was 17 (5.6) mmHg (p=0.001). CONCLUSIONS: When facilities for other treatment modalities are not available, primary trabeculectomy without the use of anti-metabolites can be employed to manage primary congenital glaucoma.

Causes of childhood blindness: results from schools for the blind in south eastern Nigeria.

AIM: This cross sectional study was undertaken to identify the major causes of childhood severe visual impairment/blindness (SVI/BL) among students in schools for the blind in south eastern Nigeria with a view to offering treatment to those with remediable blindness. METHODS: 142 students attending three schools for the blind in the study area were interviewed and examined using the World Health Organization programme for prevention of blindness (WHO/PBL) childhood blindness proforma. RESULTS: By anatomical classification, the major causes of SVI/BL identified in the children (aged 15 years or less) were lesions of the lens (30.4%), corneal lesions (21.7%), whole globe lesions (mainly phthisis bulbi) (17.4%), and glaucoma/buphthalmos (10.9%). For the young adults (more than 15 years) these lesions accounted for 31.9%, 21.3%, 23.4%, and 8.5% of SVI/BL, respectively. For all the students, the commonest single diagnoses were cataract (23.5%) and corneal scarring (21.4%), of which 86.7% were caused by measles. By aetiological classification, childhood factors (38.6%) constituted the major cause of blindness: 37.0% in the children and 39.4% in the young adults. In 74.5% of all the students, blindness was considered avoidable. CONCLUSIONS: A high proportion of childhood blindness in schools for the blind in south eastern Nigeria is avoidable. Development of paediatric ophthalmology in Nigeria to manage childhood cataract and glaucoma is advocated.

Ophthalmic presentation of epidermoid cysts in an African community.

This retrospective study reviews the clinical and histopathological features of ocular epidermoid cyst. The 30-year laboratory records of all the patients of the Igbo ethnic group, whose surgical specimens were received at a central pathology laboratory service in south-eastern Nigeria, West Africa, were reviewed. The cases with the histopathologic diagnosis of epidermoid cyst involving ocular tissues were reviewed. The data analyzed included age at diagnosis, sex, location and size of cyst, clinical description of lesion and operative diagnosis. There were eighteen patients. Ten (55.6%) of these were males and 8 (44.4%) were females. Nearly three-quarters were below the age of 20 years. The cyst was present from birth in 4 (22.2%) patients and was acquired in the rest. It occurred on the external angle of the orbit in 7 patients; on the bulbar conjunctiva in 4 patients; in the lower fornix, upper lid and medial canthus in two patients each; and on the lower lid in one patient. There was no correct diagnosis of epidermoid cyst clinically, the most common misdiagnoses being dermoid cyst (55.6%) and conjunctival cyst (16.7%). Accordingly, epidermoid cyst should be included in the differential diagnosis of cystic lesions showing ophthalmic presentation.