Optometry student clinical practice at public health facilities: A systematic review.

Background: Clinical training, supervision and practice are the most important aspects of health profession education, including optometry. Institutions implore various methods for students to gain access, exposure and experience in different clinical environments, away from their normal academic settings. Aim: This review aimed to investigate studies and related documentary evidence to determine existing standards and methods for educational institutions in conducting optometry clinical training at the external sites. Setting: The electronic databases - ProQuest One, Scopus, EBSCOhost, Sabinet, Science Direct and Google Scholar - were searched systematically for studies on the implementation of workplace clinical training of undergraduate optometry students. Methods: The study followed the Joanna Briggs Institute (JBI) systematic review methodology and a systematic search of various electronic databases was conducted for studies on implementation of workplace clinical training. Of the 450 full-text studies searched, 13 studies were found to be reputable sources of evidence and were included in this systematic review. Results: Four themes relating to student clinical training emerged, namely, clinical training approaches implemented, expected minimum standards at the training sites, clinical training environment wherein students and supervisors find themselves and clinical competence of the supervisors and students. They encompass important factors to consider in the planning and provision of quality, efficient and effective student clinical supervision at the external training facilities. Conclusion: There is a dearth of scholarly studies to guide clinical training of optometry training within the public health sector. However, more studies are undertaken in other health disciplines, and they provide generic guidelines, which can be adapted for optometry. Contribution: The article highlights the need for further studies in optometry student clinical training, focussing on programme designs and standardisation of clinical training in multi-institutional, low-income contexts.

Experiences of keratoconus patients attending public eye care facilities in South Africa.

BACKGROUND: Keratoconus (KC) is a progressive condition that usually affects young persons between their first and fourth decades. Myopia and irregular astigmatism are the common presentations which are proceeded by corneal steepening and thinning. Keratoconus is a progressive ectasia of the cornea that presents bilaterally, although often asymmetrical. AIM: To explore the experiences of KC patients attending public eye care facilities in Capricorn District of Limpopo province. SETTING: Capricorn District, Limpopo province, South Africa. METHODS: Descriptive qualitative phenomenology approach was used in the study to explore the lived experiences of patients diagnosed with KC, attending public eye care facilities. Purposive sampling was used to select 16 patients who were diagnosed with KC and referred for contact lens fitting. Data were collected through face-to-face, one-on-one interviews. RESULTS: Patients reported to have developed gradual vision loss which worsened when they grew older. There was lack of knowledge of KC amongst patients and this was exacerbated by limited health literacy and vocabulary barriers. Patients had difficulty performing daily activities where some had dropped out of school while others worked at a slower pace and reduced working distances. CONCLUSION: Patients with KC received inadequate information on their condition due to limited health literacy and vocabulary barriers. Programmes to promote practitioner and patient education are required to improve the perceived service level provided to KC patients.Contribution: The findings of this study will assist to improve the experiences of KC patients on perceived service quality received from public facilities.

Barriers to the Diagnosis and Management of Keratoconus Among Optometrists in Kenya.

Background: Early diagnosis and management of keratoconus (KC) are important for limiting visual complications of the disease. This study aimed to explore the perspectives of optometrists on the barriers to effective diagnosis and management of KC in Kenya. Methods: An online questionnaire was distributed to optometrists in Kenya to collect data on barriers to the diagnosis and management of KC. Results: The majority (60.9%) of optometrists were confident in retinoscopy and subjective refraction. Fewer were confident in the use of keratometers (46.4%) and corneal topographers (24.9%) and in the fitting of rigid gas permeable (RGP) contact lenses (25.0%). The most commonly reported barriers to improving their knowledge and skills were, limited continuous professional development opportunities (87.4%), high costs of conferences (86.1%) and the lack of diagnostic tools (79.5%). Impediments cited to diagnosing and managing KC effectively were a lack of national guidelines (64.9%), patient education material (71.5%), equipment (58.9%) and RGP supply (68.2%) and cost (67.5%). Most commonly reported barriers related to patients were compliance (91.4%), affordability (90.7%), RGP discomfort (89.4%), willingness to pay (88.1%) and the lack of patient education about KC (87.4%). Conclusion: This study showed that the lack of national guidelines, essential equipment and adequate practitioner knowledge and skills were barriers to KC diagnosis and management. Regulation of optometric education and clinical practice, development of national guidelines for diagnosis and management of KC, up-skilling of practitioners and cost-effective solutions for equipment procurement and maintenance may improve both access to, and quality of, care to patients with KC.

Prevalence and clinical profile of keratoconus in patients presenting at a provincial hospital in KwaZulu, Natal, South Africa: A case study.

Keratoconus (KC) is a progressive, asymmetrical corneal disease, characterized by stromal thinning that leads to distortion, causing vision loss. The visual loss is secondary to corneal scarring, irregular astigmatism, and myopia. The prevalence of KC has been reported to differ in different parts of the world. The study aimed to determine the prevalence and profile of patients with KC presenting to a provincial hospital in KwaZulu-Natal, South Africa. A retrospective study design was used to review 412 clinical records of patients attending the McCord Provincial Eye Hospital (MPEH) during a five-year period (2016-2020). Data on age, race, refraction, clinical profile, treatment plan, and diagnosis were ascertained. The prevalence of KC in MPEH was found to be 13.7% with a mean age of 24.7±7.94 years. Black African and females had a higher frequency of KC compared to males and other ethnic groups. Most of the patients presented with a severe stage of KC and referral was the most common management. Central corneal thinning and Munson's sign were the most prevalent clinical signs. There was no statistically significant difference between the worse and better eye when comparing the clinical signs. The prevalence and clinical profile of patients with KC in this study was similar to that reported by previous studies and more in Blacks and females. Population based epidemiological studies are needed to determine the prevalence of KC in South Africa to enable early clinical interventions.

Situation analysis of optometric education in the Eastern Mediterranean Region.

Background: There is a scarcity of research evidence on the state of optometry education in the Eastern Mediterranean Region (EMR). Aims: To assess the state of optometry education in the EMR and provide evidence for policymakers and stakeholders. Methods: Twenty-two purposively selected key academic stakeholders from 21 countries and the Eastern Mediterranean Council of Optometry completed a semi-structured optometry situation analysis questionnaire about the state of optometry education in their respective countries between August 2021 and January 2022. Data was analysed using SPSS version 25. Results: Data from 19 (86%) of the 21 countries and 1 territory were included in this analysis. Eight (36.4%) countries offered bachelor's degree programmes and 5 (22.7%) offered a diploma, 6 (27.3%) countries did not offer any optometry education. Saudi Arabia offered a doctor of optometry programme. Programmes were accredited by an accreditation body through periodic quality audits in 7 countries. Morocco had the highest average number of graduates per annum (n = 305), while Yemen had only 20. Conclusion: EMR countries differ in the number of optometry education programmes offered, as well as in their curricular competency levels and systems to monitor quality standards. There is a need for regional collaboration to harmonize and improve the quality of optometry education in the EMR.

Diagnosis and management of keratoconus by eye care practitioners in Kenya.

BACKGROUND: To explore current eye care practice in keratoconus diagnosis and management in Kenya. METHODS: An online questionnaire was distributed to ophthalmic clinical officers (OCO) and optometrists. RESULTS: A total of 203 responses were received from 52 OCOs and 151 optometrists with a response rate of 24.4% and 53.5% respectively. The majority reported having access to retinoscopes (88.5%; p = 0.48) and slit lamps (76.7; p = 0.14). Few practitioners had access to a corneal topographer (13.5%; p = 0.08) and rigid contact lens (CL) fitting sets (OCOs 5.8%, optometrists 33.8%; p < 0.01). One-third did not feel that retinoscopy (38.7%; p = 0.21), slit lamp findings (30.3%; p = 0.10) and corneal topography (36.6%; p = 0.39) are important investigations in keratoconus diagnosis. Corneal topography was not recommended in two-thirds of patients (59.0%; p = 0.33) with vernal keratoconjunctivitis (VKC). The majority counselled against eye rubbing in mild (73.6%; p = 0.90) VKC, 52.9% in moderate (p = 0.40) and 43.6% in severe (p = 0.24) cases. The majority prescribed spectacles in mild (90.2%; p = 0.95), 29% (p = 0.97) in moderate and 1.9% (p = 0.05) in severe cases. When the binocular best corrected visual acuity (BCVA) with spectacles was ≤ 6/18, 76.9% of OCOs and 58.9% of optometrists referred for CLs (p = 0.02). When binocular BCVA with CLs dropped to ≤ 6/18, 83.7% (p = 0.18) referred to the ophthalmologist for surgical intervention. Few OCOs fitted rigid CLs (15.4% OCOs, 51.0% optometrists; p = 0.01), majority referred to optometrists (82.7% OCOs, 43.7% optometrists; p < 0.01). Progression was monitored in 70.1% (p = 0.11) of mild, 50.9% (p = 0.54) moderate and 25.3% (p = 0.31) advanced cases. Few OCOs (15.4%) performed corneal cross-linking (CXL). A few respondents (5.4%; p = 0.13) did not know when to refer keratoconus patients for CXL. Co-management with ophthalmologists was reported by 58.0% (p = 0.06) of respondents. CONCLUSION: The results of this study highlight the need to map services for keratoconus patients, review current curricula and continuous education priorities for mid-level ophthalmic workers, develop guidelines for the diagnosis and management of keratoconus and improve interdisciplinary collaboration.

Self-reported knowledge and skills related to diagnosis and management of keratoconus among public sector optometrists in the Limpopo province, South Africa.

BACKGROUND: Keratoconus (KC) has been regarded as a rare condition, although recent studies, including those in South Africa, suggest it is common and is increasing in prevalence. Furthermore, South African-based studies have shown that KC is normally detected at advanced or severe stages. Knowledge and skills for examination, diagnosis and management of KC by optometrists are important for the early detection and management of the disease. AIM: This study aimed to evaluate self-reported knowledge and skills for examination, diagnosis and management of KC patients among public sector optometrists. SETTING: Seven public hospitals of the Capricorn district of the Limpopo province, South Africa. METHODS: A quantitative cross-sectional descriptive study design was used. A self-administered online questionnaire was used to collect data on demographic characteristics of participants and their knowledge, skills and practice for the diagnosis and management of KC. RESULTS: Twenty-four optometrists (n = 24) with a mean age of 39 ± 5.67 years, 18 (75%) of whom were female, participated in the study. Nineteen (79%) reported that their hospitals did not have the appropriate equipment to examine, diagnose and manage KC patients. Lack of equipment, poor knowledge, skills and competencies, hospital's level of services, policy and lack of interest were cited as barriers to contact lens fittings in KC patients. Using a dichotomised summation of self-reported knowledge and skills of KC, 13 (54.2%) of the optometrists were knowledgeable and skilled on risk factors of KC and examining, diagnosing and managing KC patients. CONCLUSION: A significant proportion of optometrists did not have the appropriate knowledge and skills to examine, diagnose and manage KC patients. Lack of equipment and poor knowledge and skills were the main barriers to contact lens fittings in managing KC.Contribution: This article highlights the need for the district to upskill the optometrists through a structured programme with a theory and practical component and also provide the necessary equipment to enhance patient care.

The profile of patients with haemophilia managed at a haemophilia treatment centre in Pretoria, Gauteng.

BACKGROUND: Haemophilia A and B are X-linked recessive bleeding disorders resulting from a deficiency of factors VIII and IX, respectively. Early diagnosis and a comprehensive approach to management is mandatory. This study aimed to describe the profile of patients with haemophilia (PWH) managed at Dr George Mukhari Academic Hospital (DGMAH) with the view to identify potential areas to improve haemophilia care. METHODS: A cross-sectional, descriptive study that retrospectively reviewed clinical and laboratory records of PWH managed at DGMAH haemophilia treatment centre from 01 January 2003 to 31 December 2017. RESULTS: Forty-four males were identified, with the majority being adults (~61%). Haemophilia A patients (~82%) outnumbered those with haemophilia B (~18%). Spontaneous mucocutaneous bleeding was the most frequent presenting feature followed by haemarthrosis. Disease-related complications included joint complications and life-threatening bleeds. There was a delay in diagnosis in 11% PWH. Management included episodic plasma-derived factor replacement and bypassing agents for patients with inhibitors. Only 13% of PWH were on home therapy. Prevalence of inhibitor development was 18%. There was a paucity of recorded data regarding prophylaxis, genetic counselling, psychological and physiotherapy support. CONCLUSION: The majority of PWH were adults, and haemophilia A was more prevalent than haemophilia B. A delay in haemophilia diagnosis could be addressed by increasing the awareness of haemophilia in health facilities. Expanding home therapy and introducing prophylaxis will likely improve the quality of life in PWH. Study outputs have included compilation of diagnostic and management algorithms to optimise haemophilia care at DGMAH.

Risk Profile of Keratoconus among Secondary School Students in the West Region of Cameroon.

This study determined the risk factors of keratoconus (KC) among secondary school students in the West Region of Cameroon. A stratified, random sampling technique was used to select the 3015 secondary school students, 8 years and older, within the West Region of Cameroon. Selected school students completed the validated Keratoconus Risk Investigative Survey (KRIS) and a structured demographic questionnaire to determine the risk profile of KC. Descriptive analysis, logistic regression and p-values were used to provide an overview of the demographic findings and the risk factors of KC. Estimates were made as the proportion of affected school students and presented with a 95% confidence interval (CI). Multivariate logistic regression analysis was performed to explore the association between KC and the independent predictors that were found significant in the univariate analysis. The ages of the majority (93.2%) of students ranged from eight years to 18 years (mean = 13.18 ± years) and were mostly female (59.7%). Gender (OR 2.024, p < 0.001), eye rubbing (OR 3.615, p < 0.001), exposure to sunlight (OR 2.735, p < 0.001), blood relations with KC (OR 41.819, p < 0.001) and allergic experience (OR 1.070, p < 0.001) were considered. Eye rubbing was the most significant risk factor of keratoconus followed by refractive error, allergic experiences and sunlight exposure. These findings support the evidence that the etiology of KC is multifactorial, with eye rubbing being the most significant factor in this cohort. There is a need to address eye rubbing among students to minimize the risk of KC. Furthermore, 34.46% of students in Cameroon were at risk of developing KC. Hence the risk profile is that one engages in eye rubbing, has a family member with KC, spends more than eight hours per week in the sun and is prone to allergies. It will therefore be prudent for these risk factors for keratoconus to be included in the school health education programs.

Normative Data for Parameters of Accommodation in African Schoolchildren.

SIGNIFICANCE: The reported interracial differences in normative data for parameters of accommodation call for investigating population-specific normative values. The study investigated and presents expected data for accommodative parameters among Ghanaian children. PURPOSE: This study aimed to determine expected values for parameters of accommodation among schoolchildren in the Central Region of Ghana. METHODS: This prospective cross-sectional study used a multistage cluster sampling approach. Normal participants were asymptomatic (Convergence Insufficiency Symptom Survey score ˂16), with unaided visual acuity or best-corrected visual acuity of 0.0 or better logMAR for each eye and having no ocular disease or no manifest strabismus. Normal participants underwent push-up and minus-lens-to-blur amplitude of accommodation tests, accuracy of accommodative response (using the monocular estimation method), and monocular and binocular accommodative facility testing. RESULTS: A total of 1261 normal participants within ages 11 to 17 years (mean, 14.75 ± 1.53 years) met the inclusion criteria. The mean normative data for the population include push-up amplitude of accommodation (14.04 ± 2.95 D), minus-lens-to-blur amplitude of accommodation (12.33 ± 2.55 D), and accuracy of accommodative response using the monocular estimation method (0.62 ± 0.22 D), monocular accommodative facility (9.80 ± 3.20 cycles per minute), and binocular accommodative facility (9.40 ± 3.30 cycles per minute). Age-predicted linear regression equations for the amplitude of accommodation are push-up amplitude of accommodation (16.74 - 0.18 × age in years) and minus-lens-to-blur amplitude of accommodation (15.7 - 0.23 × age in years). CONCLUSIONS: The study provides normative data for accommodative parameters that clinicians may use with Ghanaian populations of similar ages.

Normative Data for Nonstrabismic Binocular Vision Parameters in African Schoolchildren.

SIGNIFICANCE: With reported population differences in parameters of nonstrabismic binocular vision, the present study investigated and reports normative data among a sample of African children. PURPOSE: This study aimed to determine expected binocular visual function data among schoolchildren in the Central Region of Ghana. METHODS: The study used a prospective cross-sectional design and used a multistage cluster sampling approach. Eligible normal participants selected through the administration of Convergence Insufficiency Symptom Survey questionnaire (score <16) and preliminary vision screening underwent comprehensive binocular vision testing. Only data for participants who expressed no difficulty with the specific procedures were analyzed. RESULTS: A total of 1261 normal participants (11 to 17 years [mean, 14.75 ± 1.530 years]) were selected for comprehensive binocular vision testing in the normative data study. The means with ±1 standard deviation for normative data for the nonstrabismic binocular vision parameters include the following: accommodative target near point of convergence (NPC) break (6.10 ± 1.67 cm), NPC recovery (8.17 ± 1.67 cm), fixation light with red-green anaglyph (RG NPC) break (8.51 ± 2.43 cm), RG NPC recovery (10.95 ± 2.60 cm), cover test distance phoria (0.12 ± 0.79 exophoria), cover test near phoria (2.1 ± 2.3 exophoria), modified Thorington test near phoria (1.9 ± 2.5 exophoria), negative relative accommodation (+2.54 ± 0.75 D), positive relative accommodation (-2.58 ± 0.81 D), and the accommodative convergence over accommodation ratio (2.80 ± 1.07:1). Age (in years)-predicted normal linear regression equations for NPC break (5.13 + 0.07 × age), RG NPC break (10.00 - 0.10 × age), RG NPC recovery (12.83 - 0.13 × age), positive relative accommodation (2.05 + 0.04 × age), and the gradient accommodative convergence over accommodation ratio (3.97 - 0.08 × age) serve as a guide. CONCLUSIONS: The study provides expected data that optometrists may use with similar aged Black African populations.

A review of corneal imaging methods for the early diagnosis of pre-clinical Keratoconus / Revisión de los métodos de imagen corneal para el diagnóstico temprano del queratocono pre-clínico

BACKGROUND: Keratoconus (KC) is a corneal ectasia characterised by steepening corneal curvature, changes in refractive error and corneal thickness that result in visual impairment. Early signs of KC include displacement of the thinnest part of the cornea from the central position, changes in the corneal epithelial layer cell distribution, variations in the anterior corneal astigmatism/posterior corneal astigmatism relationship and a variation in corneal thickness. It is important that we review the corneal imaging methods for the diagnosis of preclinical KC. METHOD: An online literature search was carried out on PubMed. Only publications detailing corneal assessment procedures were considered for this review and any publication on instruments that did not generate KC predictability indices were also excluded from the review. The 308 publications were reviewed. DISCUSSION: Corneal assessment techniques, with the ability to characterise both the anterior and posterior corneal surfaces, are invaluable in the diagnosis of pre-clinical KC. Reflection based and elevation based corneal imaging systems should be used in conjunction with other assessments such as higher order aberration measuring systems to improve sensitivity and reliability in the diagnosis of pre-clinical KC. Ultra high resolution ultrasound can detect pre-clinical KC. The ability to asses both the epithelium and endothelium makes anterior surface optical coherence tomography a superior technique for pre-clinical KC diagnosis. There is a positive correlation between central corneal thickness and corneal hysteresis. Corneal biomechanics should be considered in conjunction with other corneal assessments in the diagnosis of pre-clinical KC

ANTECEDENTES: El queratocono (KC) es una ectasia corneal caracterizada por incremento de la curvatura corneal, cambios del error refractivo y espesor corneal que deriva en trastornos visuales. Los primeros signos de KC incluyen desplazamiento de la posición del punto más delgado de la córnea desde su posición central, cambios en la distribución de las células epiteliales de la córnea, variaciones en términos de la relación entre astigmatismo corneal anterior y posterior, y variación del espesor corneal. Es importante revisar los métodos de análisis por imagen corneal para diagnosticar el KC pre-clínico. MÉTODO: Se realizó una búsqueda online en la literatura científica en PubMed. Para esta revisión consideramos únicamente las publicaciones que detallaban los procedimientos de valoración corneal, excluyendo de la revisión cualquier publicación sobre los instrumentos que no generaban índices de predictabilidad del KC. Se revisaron 308 publicaciones. DISCUSIÓN: Las técnicas de valoración corneal con capacidad para caracterizar las superficies corneales anterior y posterior son inestimables para el diagnóstico del KC pre-clínico. Deberán utilizarse las técnicas de imagen corneal basados en reflexión y elevación, junto con otro tipo de valoraciones tales como los sistemas de medición de aberraciones de alto orden, para mejorar la sensibilidad y fiabilidad del diagnóstico del KC pre-clínico. La ecografía de ultra alta resolución puede servir también para detectar el KC pre-clínico. La capacidad de valorar tanto el epitelio como el endotelio hace de la tomografía de coherencia óptica una técnica superior para el diagnóstico del KC pre-clínico. Existe una correlación positiva entre el espesor corneal central y la histéresis corneal. Deberá considerarse la biomecánica corneal, junto con otros métodos de valoración corneal, para el diagnóstico del KC pre-clínico

Visual Acuity and Refractive Error Improvement in Keratoconic Patients: A Low-Income Context Management Perspective.

INTRODUCTION: Visual acuity (VA) and refractive error (RE) remain important parameters in the management of keratoconic (KC) patients. Despite rapid amelioration in capacity of diagnostic equipment, these remain inaccessible to the majority of practitioners in low-income countries. Notwithstanding limitations, practitioners are expected to utilize existing resources to satisfactorily manage their increasing numbers of keratoconic patients. PURPOSE: To determine the changes in visual acuity and refractive errors with diagnostic and management options available in low-income contexts. METHODS: A descriptive, retrospective chart analysis of medical records dating back 5 years was employed in this study. Records of patients prescribed with corneal rigid gas permeable (RGP) and scleral lenses were analyzed. Data on age, gender, stage of keratoconus, pre-, and post-visual acuities and refractive errors, mode of correction and lens parameters were evaluated. RESULTS: A total of 124 medical records were analyzed. Males comprised 58.9% and females 41.1% of the total sample, with a mean age 20.86 ± 9.50 years. The mean unaided VA in logMAR notation was 1.0±0.19, while corrected VA was 0.18±0.17. There was a significant improvement (p=0.001) in VA with corneal RGP contact lenses (mean 0.19±0.17) as compared to unaided VA (mean 1.29±0.20). Scleral lens VA also improved from a median of 1.06 to -0.01 logMAR; p=0.001. The mean RE before RGP contact lens fitting was -9.43±2.37 diopters (D) which improved to -0.41±0.78D. RE reduced significantly (p=0.001) after fitting with both corneal RGP lenses (from a mean of -9.80±4.46D to -0.45±0.80D) and scleral lenses (from a median of -8.00D to -0.02D). CONCLUSION: Significantly improved visual acuity and refractive error status were achieved with all KC patients. Despite the diagnostic equipment and contact lenses design limitations, practitioners in low-income contexts can fit the relatively more affordable corneal RGP lenses to positively impact the daily living experiences of their KC patients.

A review of corneal imaging methods for the early diagnosis of pre-clinical Keratoconus.

BACKGROUND: Keratoconus (KC) is a corneal ectasia characterised by steepening corneal curvature, changes in refractive error and corneal thickness that result in visual impairment. Early signs of KC include displacement of the thinnest part of the cornea from the central position, changes in the corneal epithelial layer cell distribution, variations in the anterior corneal astigmatism/posterior corneal astigmatism relationship and a variation in corneal thickness. It is important that we review the corneal imaging methods for the diagnosis of preclinical KC. METHOD: An online literature search was carried out on PubMed. Only publications detailing corneal assessment procedures were considered for this review and any publication on instruments that did not generate KC predictability indices were also excluded from the review. The 308 publications were reviewed. DISCUSSION: Corneal assessment techniques, with the ability to characterise both the anterior and posterior corneal surfaces, are invaluable in the diagnosis of pre-clinical KC. Reflection based and elevation based corneal imaging systems should be used in conjunction with other assessments such as higher order aberration measuring systems to improve sensitivity and reliability in the diagnosis of pre-clinical KC. Ultra high resolution ultrasound can detect pre-clinical KC. The ability to asses both the epithelium and endothelium makes anterior surface optical coherence tomography a superior technique for pre-clinical KC diagnosis. There is a positive correlation between central corneal thickness and corneal hysteresis. Corneal biomechanics should be considered in conjunction with other corneal assessments in the diagnosis of pre-clinical KC.

Need for optical intervention in children attending a school for the blind in Eritrea.

PURPOSE: To identify the need for optical intervention including spectacles and low vision devices (LVDs) in children attending the only school for the blind in Eritrea. METHODS: A total of 92 children were examined using the World Health Organization Prevention of Blindness program form for the recording of children with blindness and vision impairment. Examination included distance and near visual acuity (VA), refraction, trial of LVDs and evaluation of anterior and posterior segments. All the children who showed at least one line improvement in distance or near VA with refractive correction and/or LVDs were provided with these devices. RESULTS: Six children had distance VA of ≥6/18 (no vision impairment, NVI) at presentation and were excluded from analysis. For the remaining 86 children, male to female ratio was 1.2:1.0 with a mean age of 11.8 ± 2.8 years (range: 6-17 years). At presentation, 47 (54.7 per cent) children were blind (VA <3/60) and 24 (27.9 per cent) were severely visually impaired (VA <6/60-3/60), which reduced to 42 (48.9 per cent) and seven (8.1 per cent) children after refraction, respectively. A further 5.8 per cent (five children) achieved NVI with refractive correction. Using distance LVDs, 26 (30.2 per cent) and 16 (18.6 per cent) children had NVI and moderate vision impairment (VA <6/18-6/60), respectively. In terms of near vision, eight (9.3 per cent) children had near VA better than 1.00 M at presentation, which improved to 11 (12.8 per cent) with refractive correction and 19 (22.1 per cent) with near LVDs. A total of 29 spectacles and 42 LVDs were provided. CONCLUSION: A significant number of children at the school for the blind benefited from refractive correction and LVDs. With such optical intervention, many of these children could study at mainstream schools with print media. A system including comprehensive vision examinations before admission to the school, refractive services and low vision rehabilitation is required to ensure that children with adequate residual vision do not have to be limited to learning in Braille media.

Causes of Childhood Vision Impairment in the School for the Blind in Eritrea.

SIGNIFICANCE: Our study provides the much-needed evidence on causes of childhood blindness in Eritrea. This will assist authorities to plan appropriate strategies and implement preventive, curative, and rehabilitative services to address these causes of vision loss in children in this resource-limited country. PURPOSE: This study aims to identify the causes of severe vision impairment and blindness in children attending the only school for the blind in Eritrea. METHODS: All children enrolled in the school were examined, and the World Health Organization form for the examination of visually impaired children was used to record the data. Examination included visual acuity, refraction, anterior segment, and fundus assessment. Causes of vision loss for children with severe vision impairment (visual acuity <6/60 to 3/60) and blindness (visual acuity <3/60) are reported. Causes were classified by the anatomical site affected and by underlying etiology based on the timing of the insult and causal factor. RESULTS: A total of 92 children were examined, and 71 (77.2%) of them had severe vision impairment and blindness. The major causes of vision loss were corneal scars (16.9%), cataract (12.7%), phthisis bulbi (11.3%), congenital eye deformities (11.3%), optic atrophy (9.3%), and presumed chorioretinal Toxoplasma scars (7.0%). Hereditary factors were the major known etiological category (15.5%) followed by the sequel of eye injuries (12.7%). Blindness due to vitamin A deficiency was not found, whereas infectious causes such as measles and ophthalmia neonatorum were relatively absent (one case each). Potentially avoidable causes of vision impairment were accounted for in 47.9% of children. CONCLUSIONS: This study provides the first direct evidence on childhood vision impairment in Eritrea. Despite the limitations, it is clearly shown that nearly half of the vision loss is due to avoidable causes. Thus, preventive public health strategies, specialist pediatric eye care, and rehabilitative services are recommended to address childhood vision impairment in Eritrea.

A correlation analysis of cone characteristics and central keratometric readings for the different stages of keratoconus.

BACKGROUND: Knowledge of the cone characteristics for the different stages of keratoconus may potentially assist practitioners in diagnosing and managing keratoconic patients. AIM: This study aims to determine if any correlation exists between the central keratometric readings and the cone characteristics for the different stages of keratoconus. SETTING: A university eye clinic. MATERIALS AND METHODS: In this retrospective study, a saturated sample of 190 eyes from 106 cases of previously diagnosed keratoconic patient files was analyzed. The stage of keratoconus and cone characteristics, namely, cone location, cone decentration, topographical patterns, and morphology were analyzed using an Oculus 3M corneal topographer. RESULTS: Analysis revealed a correlation between cone decentration and stage of keratoconus (P = 0.007). The association was found to exist when central K-readings were between 45D and 52D and with an apical cone decentration of 3-4 mm. No correlations were obtained for the stage of keratoconus and the cone location; topography and morphology. CONCLUSION: It can be concluded that cone apices are not central in all stages. Practitioners should consider the peripheral cornea when diagnosing and managing keratoconic patients. No correlation between stage, morphology or topography was respectively revealed.