Onchocerciasis and other eye problems in developing countries: a challenge for optometrists.

BACKGROUND: Onchocerciasis, also known as River Blindness, affects about 18 million people around the world, resulting in severe visual impairment or blindness for approximately 2 million. METHODS: The disease is transmitted through the bite of a tiny black fly, which breeds in fast moving rivers and streams. The fly injects immature forms of the parasite worm, Onchocerca volvulus, whose microfilariae migrate to superficial tissues, and may invade any part of the eye. In the eye, living microfilariae may be found in any ocular structure, however, sclerosing keratitis, a severe corneal involvement is the major cause of blindness from the disease. RESULTS: Substantial efforts are currently underway to control the disease in Latin America and equatorial Africa, now that an effective, nontoxic medication, ivermectin, is available. CONCLUSIONS: Optometrists are helping to solve the logistic challenges for treatment of this disease, as most onchocerciasis endemic areas are remote with difficult access.

PIP: Onchocerciasis is commonly known as River Blindness and affects about 18 million people around the world. It is transmitted by black flies that breed in river and stream rapids and transmit the parasitic microfilariae, Onchocerca volvulus, to people who live and work near such rivers. Infection with the microfilariae results in blindness or visual impairment for 1 or 2 million people. The microfilariae migrate to superficial tissues and may invade any part of the eye and ocular structure. Living worms cause little damage, however, their death triggers a localized inflammation which can lead to blindness. Sclerosing keratitis, a severe corneal involvement, is the major cause of blindness from the disease. The World Health Organization (WHO) Expert Committee on Onchocerciasis has estimated that 9% of the disease is found in Africa, the rest occur in Yemen and Latin America. Treatment with ivermectin is contraindicated for pregnant and lactating women, children under 5 years of age, asthmatics, and people with other diseases. The WHO Onchocerciasis Control Program in 11 countries of West Africa has eliminated the risk of onchocerciasis by aerial spraying of black fly breeding sites only from 1 country. A single annual oral dose (150 mg/kg) of ivermectin can reverse early lesions in the cornea. Ivermectin must be taken annually to sustain protection against blindness, thus its incorporation into primary health care along with malaria, AIDS, trachoma, xerophthalmia, and cataract is most cost effective. Nigeria and Tanzania have optometry schools, and optometrists can play a significant role in onchocerciasis control and blindness prevention programs by training local health care workers to distribute invermectin in vision screening programs.

The frequency distribution of ocular disease by age in Imo State Nigeria.

BACKGROUND: A total of 600 'first-time served' patients with confirmed ocular pathologies visited our clinic between 1987 and 1988. METHODS: These patients and their ocular diseases were classified according to age, sex, and employment. Gender mix was 53.5 percent male, 46.5 percent female. RESULTS: Of the total disease conditions, 42 percent fell within the 0-30 age group, 44 percent fell within the 31-60 age group and 14 percent fell between 61-90. The relative incidence of ocular disease within this clinic population was: 32.8 percent conjunctivitis; 28.8 percent cataract; 15.5 percent glaucoma; 11.5 percent pterygium; 1.8 percent optic atrophy; and 9.5 percent other. CONCLUSIONS: Caution is made to generalize these data to the population at large since those without financial means were not represented in this study.

Testing the FOCOMETER--A new refractometer.

The FOCOMETER, an optometer which measures spherical refractive errors, is intended to provide rural or economically disadvantaged populations spherical prescriptions without the need for complicated protocols, expensive equipment, or electricity. FOCOMETER readings were compared with the spherical equivalent determined from autorefraction and subjective trial lens refractions in children, and with retinoscopy in adults. Over the range of refractive errors tested (-4 to +5 D) reasonably close readings, within one-half a diopter, were found for comparisons with autorefraction and retinoscopy and about one-tenth of a diopter difference was found between subjective refractions and the FOCOMETER.

Preference of hospital employees for work-related outcomes.

A list of five possible work-related outcomes was compiled and included in a questionnaire. This was administered to 490 employees, categorized into seven occupational groups, in three different hospitals in Manila, The Philippines. Responses were compared among work outcomes, identical occupational groups and three hospitals; the most valued outcome was established for all respondents. Findings indicate that variables apt to motivate employees depend on the occupational group to which they belong, the kind of work they perform and the type of hospital in which they work. These findings have implications for the ability of hospital administrators to motivate their employees to perform in a manner that meets expected standards.