Prevalence of diabetic retinopathy in Jimma University Hospital, Southwest Ethiopia.

BACKGROUND: Diabetic retinopathy accounts for 5% of global blindness and the incidence of diabetic blindness is increasing. Although the epidemiology of diabetic retinopathy has been well described in Western populations, there remains a paucity of prevalence data in many developing countries such as Ethiopia. OBJECTIVE: To determine the prevalence, pattern and associated risk factors of diabetic retinopathy. METHODS: A cross sectional hospital based study was done on a total of sampled 324 diabetic patients attending medical diabetic clinic at Jimma University Hospital from February to March 2009. Eye examination for diabetic retinopathy was carried out using slit lamp biomicroscope and 90D Volk lens, and clinical grading of diabetic retinopathy was done using the Diabetic Retinopathy Study and Early Treatment Diabetic Retinopathy Study guidelines. RESULTS: The prevalence of diabetic retinopathy was 41.4%. Of these, 2.2% of the cases had severe non-Proliferative diabetic retinopathy while about 6% of patients had clinically significant macular edema. Vision threatening diabetic retinopathy was found in 7.3% of patients. Only 14.5% of the patients had prior eye check. The mean duration of diabetes mellitus, mean fasting blood sugar, mean systolic blood pressure, and mean diastolic blood pressure were 6.26 years, 158.8 mg/dl, 124.6 mmHg and 77.65 mmHg respectively. There was a statistically significant association between diabetic retinopathy and duration of diabetes, fasting blood sugar, and systemic blood pressure (p < 0.05). CONCLUSION: The prevalence of diabetic retinopathy was high, and only a small proportion of the study subjects had diabetic eye check up. There is a need for integration of the Medical Diabetic Clinic and Eye Clinic for preventive diabetic care, better referral system and coordinated diabetic screening program in the study setting.

Rapid trachoma assessment in Kersa District, Southwest Ethiopia.

BACKGROUND: Trachoma is the leading cause of infectious blindness worldwide. Though trachoma can be treated with antibiotics (active trachoma) or surgery (trachomatous trichiasis), it is still endemic in most parts of Ethiopia. Despite the prevalence of this infectious disease in different parts of the country, district level data is lacking. This study was thus conducted to assess the prevalence estimate of trachoma and its risk factors in Kersa District, Southwest Ethiopia. METHODS: A community based cross sectional Rapid Assessment of Trachoma was conducted using a WHO guideline. Six sub-districts were selected from Kersa District based on primary high risk assessment and from each sub-district; 21-27 households were randomly selected. Active trachoma for children aged 1-9 years, trachomatous trichiasis for people above 15 years old and environmental risk factors for trachoma were assessed. Data were analyzed using SPSS version 16. RESULTS: The overall prevalence estimate of active trachoma was 25.2% (95% CI: 20.7-30.4%). Forty three percent of children had unclean faces, 11.5% of households had water source at more than half hour walking distance, 18.2% did not have functional latrine, and 95.3% of the households had solid waste disposal within a distance of 20 meters. Households with environmental risk factors were at an increased risk to active trachoma, but the association was not statistically significant (p>0.05). The prevalence estimate of trachomatous trichiasis inclusive of "trachoma suspects" was 4.5%. CONCLUSION: Trachoma is endemic in Kersa District with active trachoma being a public health problem in the studied sub-districts. Hence, SAFE strategy should be implemented.

Ocular manifestations of sickle cell disease at the Korle-bu Hospital, Accra, Ghana.

PURPOSE: To determine the magnitude and pattern of ocular manifestations in sickle cell disease at Korle-bu Hospital, Accra, Ghana. METHODS: Hospital-based cross-sectional study including all patients with sickle cell disease reporting for routine follow-up at the Sickle Cell Clinic at Korle-bu Hospital, Accra, Ghana. RESULTS: A total of 201 patients with sickle cell disease (67 male and 134 female) were enrolled, comprising 114 subjects with genotype HbSS, aged 6-58 years, mean 19.26 (SD 11.70), and 87 with genotype HbSC, aged 6-65 years, mean 31.4 (SD 16.76). Visual impairment was found in 5.6% of eyes examined. Causes were cataract, proliferative sickle retinopathy (PSR), optic atrophy, phthisis bulbi, and central retinal artery occlusion. Common anterior segment signs of sickle cell disease, which were more common in HbSC patients, were tortuous corkscrew conjunctival vessels, iris atrophy, and cataract. Eyes with iris atrophy or depigmentation were 1.8 times more at risk of PSR than eyes without. Overall, PSR was found in 12.9% of subjects examined (3.5% of HbSS, 25.3% of HbSC; 15.9% of males and 11.2% of females). The prevalence of proliferative sickle retinopathy increased with age and increased systemic severity of sickle cell disease; sex did not have an influence. CONCLUSIONS: There is a high prevalence of ocular morbidity in sickle cell disease patients at Korle-bu Hospital. Prevalence increased with age, systemic severity of sickle cell disease, and HbSC genotype.

Are blind people more likely to accept free cataract surgery? A study of vision-related quality of life and visual acuity in Kenya.

PURPOSE: To determine possible differences in visual acuity, socio-demographic factors and vision-related Quality of Life (QoL) between people accepting and people refusing sponsored cataract surgery. METHODS: Three hundred and fifty seven local residents with visually impairing cataract, presenting at screening sites in Kwale District, Kenya were clinically assessed and interviewed. The World Health Organization (WHO) QoL-questionnaire WHO/Prevention of Blindness and Deafness Visual Functioning Questionnaire 20 (PBD-VFQ20) was used to determine the vision-related QoL. A standardized questionnaire asked for socio-demographic data and prior cataract surgery in one eye. After interview, patients were offered free surgery. Primary outcome was the mean QoL-score between acceptors and non-acceptors. Secondary outcomes were visual acuity and socio-demographic factors and their contribution to QoL-scores and the decision on acceptance or refusal. RESULTS: Fifty nine people (16.5%) refused and 298 accepted cataract surgery. Vision-related QoL was poorer in people accepting than in those refusing (mean score 51.54 and 43.12 respectively). People with poor visual acuity were only slightly more likely to accept surgery than people with better vision; the strongest predictors of acceptance were the QoL-score and gender. Men were twice as likely to accept compared to women. Of people who accepted surgery, 73.8% had best eye vision of 20/200 or better. CONCLUSION: In this population, visual acuity was of limited use to predict a person's decision to accept or refuse cataract surgery. QoL-scores provide further insight into which individuals will agree to surgery and it might be useful to adapt the QoL-questions for field use. Gender inequities remain a matter of concern with men being more likely to get sight-restoring surgery.

The influence of central corneal thickness on intraocular pressure measured by goldmann applanation tonometry among selected Ethiopian communities.

BACKGROUND: Estimates of intraocular pressure (IOP) are influenced directly by the central corneal thickness (CCT). We assume and apply a single value for CCT (520 µm) in applanation tonometry estimates, although there is compelling evidence that CCT varies between individuals. OBJECTIVE: To determine the influence of CCT and other factors on IOP among Ethiopians. METHODS: A cross sectional study was conducted among 300 sampled individuals from June to July 2006. The CCT was measured using OcuScan® R×P Ophthalmic Ultrasound and readings of IOP were made with Goldmann applanation tonometer. The data was analyzed using SPSS version 12 and S-Plus 2000 of statistical packages. RESULTS: Out of 300 individuals, 184 (61.3%) were males. The mean age was 42.57 years (SD±16.71), mean IOP 13.39 mm Hg (SD±2.81), and mean CCT 518.68 µm (SD±32.92). There was statistically significant relationship between CCT and IOP (r=0.199, P<0.001) and a borderline statistically significant detectable change of CCT with age (r=0.012, P=0.057) with a downward trend of at least 0.001 mm decrease in CCT/decade starting from age 30 years but with pronounced change from 50 years onward. For every 30 µm difference in CCT from the mean in either way, there was an approximately 1.1 mm Hg difference in the estimated IOP from the mean IOP (13.40 mm Hg). No significant relationship was found between IOP and age, sex or ethnicity (P>0.05). CONCLUSION: The CCT of Ethiopians is thin and hence can result in underestimation of IOP measured by GAT.