Adeola Olukorede Onakoya

Quality of life of primary open angle glaucoma patients in lagos, Nigeria: clinical and sociodemographic correlates.

PurposeTo evaluate the quality of life (QOL) of primary open angle glaucoma (POAG) patients attending a tertiary eye institution in Lagos, Nigeria and identify clinical and sociodemographic factors affecting it. MethodsA hospital-based cross-sectional analytical study design was used to compare 132 patients with varying degrees of severity of glaucoma (cases) with age-matched and sex-matched controls with essentially normal eyes and no family history of glaucoma. ResultsPOAG patients had reduced QOL as defined by the 2 instruments used: the National Eye Institute Visual Function Questionnaire25 (NEIVFQ25) and the 15-item Glaucoma Quality of life Questionnaire (GQL-15). The mean QOL score obtained with the NEIVFQ25 for the cases was 85.2 (±16.07) and 96.7 (±2.34) for the controls. Using the GQL-15 scale, the mean QOL score for the cases was 24.07 (±12.4), whereas for the controls the score was 15.75 (±1.85). Early or mild glaucoma was associated with reduced QOL compared with the controls. Glaucoma patients had the greatest difficulty with glare and dark adaptation subscale of the GQL-15. Increasing severity of disease defined by increasing visual field deficit (mean deviation values) correlated significantly with worsening QOL [Spearman &rgr; (r) values ranging from 0.32 to 0.43]. Contrast sensitivity correlated moderately with QOL (r ranges from 0.43 to 0.47; P=0.001). Cup-to-disc ratios, visual acuity, and visual field indices (mean deviation) correlated with QOL scores of both tools with r values ranging from 0.28 to 0.49 for the GQL-15 and 0.38 to 0.54 for the NEIVFQ25. Age had a negative impact on QOL (r=−0.30 for the NEIVFQ25 and 0.30 for the GQL-15) and affected all the subscales of the GQL-15 and most subscales of the NEIVFQ25 except ocular pain (P=0.40), mental health (P=0.13), color vision (P=0.05), and role difficulty (P=0.11). Women generally had better vision-related QOL scores (P=0.001 for the NEIVFQ25 and 0.005 for the GQL-15). Higher educational status was associated with better QOL scores (P<0.05). Ethnicity, religion, marital status, and living situation had no significant effect on QOL scores. ConclusionsPOAG reduces QOL even in the early stages of the disease, as there was a significant reduction in the QOL of patients with mild glaucoma compared with the controls. It showed a clear trend of worsening QOL scores with increasing severity of disease. The correlation observed between QOL scores and objective measures of visual function suggest that inclusion of QOL assessment in clinical practice could be highly informative and should be explored further.

A comparison of the NEIVFQ25 and GQL-15 questionnaires in Nigerian glaucoma patients

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The awareness, perceptions and experiences of primary open angle glaucoma patients in Lagos Nigeria.

The awareness, perceptions and experiences of Nigerian Primary Open Angle Glaucoma (POAG) patients were assessed using a hospital based cross-sectional study design. One hundred and twenty POAG patients attending a glaucoma clinic in Lagos Nigeria were recruited consecutively. They underwent face-to-face interviews with trained interviewers using a semi-structured questionnaire and an interview guide consisting of open-ended questions. A comprehensive ocular examination which included static automated perimetry, gonioscopy, stereoscopic optic nerve head assessment and contrast sensitivity was carried out for all participants. Twenty per cent (n = 24) of the respondents did not know they were being managed for a disease called Glaucoma. Age, gender, religion, ethnicity, marital status and occupation did not significantly affect the awareness of glaucoma diagnosis (p > 0.05). Positive family history of glaucoma, educational status and duration of disease were the most significant factors associated with awareness of glaucoma diagnosis (p < 0.05). POAG patients in Nigeria lack the depth of perception that can equip them to educate and motivate their family members to screen for glaucoma. There is an urgent need to develop continuous eye health education programmes to improve their perception and outlook; thereby increasing the uptake of glaucoma screening by first degree relatives of glaucoma patients.

Central corneal thickness changes following manual small incision cataract surgery

Aim To determine changes in post-cataract surgery central corneal thickness (CCT) at Lagos University Teaching Hospital by assessing the time it takes for the cornea to return to its preoperative thickness value. Methods This study is a prospective, hospital-based open within-patient controlled study with the unoperated eye controlling for the operated one. Results Two hundred patients with 400 eyes were analyzed, with bilateral mature cataract in 47.0%. All the patients had manual small incision cataract surgery with posterior chamber intraocular lens implant. There is an increase in mean baseline CCT from 520.6±20.3 μm by 76.9 μm (597.9±30.4 μm) 24 hours after cataract surgery followed by relative reduction in the mean CCT to 555.2±24.7 μm and 525.1±19.7 μm at 2 weeks and 12 weeks, respectively. Increase in mean CCT in the unoperated and contralateral eyes were recorded in this study. Conclusion There was a transient increase in corneal thickness following cataract surgery with subsequent decrease to preoperative thickness by 12th and fourth week in the operated and unoperated eyes, respectively. Corneal manipulations during cataract surgery must be minimal to reduce visual rehabilitation time to barest minimum. Postoperative refraction will be better at eighth week to 12th week considering the time it takes for the CCT to return to its stable preoperative values.

Views of West African surgeons on how well their educational and professional backgrounds may have prepared them for health leadership roles

Background: Because of the appalling health indices in West Africa, Physicians there need to be at the forefront of the organizational challenge in managing and improving health systems. Aim: To collate the views of West African surgeons on how well their educational and professional backgrounds may have prepared them for leadership and managerial roles in health care, and draw appropriate policy implications. Material and Methods: Filled structured questionnaires from 110 surgeons that were attending an annual conference were analyzed. The respondents’ bio data, professional, educational, health administrative backgrounds were probed. Their views on justifications for physicians’ involvement in health managerial roles, probable influence of some physicians’ characteristic traits and professional attributes on health leadership roles, and suggestions for improvement were also collated. Results: 71.8% of the respondents had held or were then holding health-related administrative posts; 90% had attended different varieties of management courses; 95.4% identified physicians as the inherent leaders of the health care team; but only 28.4% adjudged their health management role “strongly important” (28.4%) among their multi-faceted roles; and they largely agreed that some stated professional and characteristic traits of physicians tend to make them poor leaders and managers. Conclusions: Our findings suggest that the preparations that the respondents got from their formal and professional education for leadership and managerial roles in health care were not optimal. We recommend for a paradigm shift for physicians on health leadership issue which is to be facilitated by a well-focused short time duration health management course for all physicians, particularly specialists.

Indications for destructive eye surgeries at a Nigerian tertiary eye care centre: A ten-year review

Background: Destructive eye surgeries are terminal treatment modalities for some ophthalmic conditions with psychological, emotional and cosmetic implications, especially for the patients and their relatives. Objective: The aim of this study was to determine the frequency and indications for destructive eye surgeries at an Eye Centre of a Nigerian Tertiary Hospital with a view to identifying the preventable indications for which appropriate preventive measures could be recommended. Patients and Methods: A retrospective, descriptive study of all patients who underwent evisceration, enucleation or exenteration at the Guinness Eye Centre, Lagos University Teaching Hospital from January 2003 to December 2012 was performed. Their outpatient, ward and theatre records were retrieved and reviewed. Information obtained included age, sex, eye affected, duration of symptoms before presentation, visual acuity of affected eye at diagnosis, indication for surgery and type of destructive surgery. Results: A total of 186 eyes of 185 patients were surgically removed constituting 4.8% of a total of 3866 surgeries performed during the period of study. Children below 16 years accounted for 33.5% of the cases while 30.3% were in their first decade of life. Overall, the most common indication for destructive eye surgery was trauma (36.2%) followed by tumour (27.6%) and ocular infection (18.4%). However, tumour (73.2%) was the most common indication in the first decade of life with retinoblastoma accounting for 92.7% of these. Conclusion: Ocular trauma, tumour and infection were the most common indications for destructive eye surgery in this centre.

Surgical output and clinic burden of glaucoma in lagos, Nigeria.

Purpose:To estimate the outpatient clinic burden and surgical workload related to glaucoma in Lagos, Nigeria. Methods:A multicentre study involving the 2 tertiary eye institutions, 7 secondary eye centers with eye care facilities, and the largest private eye hospital in Lagos state, Nigeria. Data on outpatient department (OPD) visits were collected over a 4-week period, using a specially designed tally sheet. Theater records were examined in each hospital over a 1-year period (2009) for the number and types of glaucoma surgeries performed. Results:A total of 6240 patients visited the OPD over the 4-week period, out of which 1577 (25.3%) were glaucoma patients. OPD visit per ophthalmologist were 274, 323, and 61, whereas glaucoma visits per ophthalmologist were 75, 70, and 23 in the tertiary, secondary, and private centers, respectively. Glaucoma surgeries constituted 8.6% of total surgeries (n=4050). Trabeculectomy with intraoperative 5-fluorouracil was the most common procedure (81.0%). Number of glaucoma surgeries per ophthalmologist per month in the tertiary, secondary, and private centers were 0.5, 0.9, and 1.4, respectively. Overall number of glaucoma surgery per ophthalmologist per month was 1. Conclusions:Glaucoma visits constitute a significant proportion of eye clinic visits in Lagos state, Nigeria, and therefore, necessary manpower, infrastructure, and equipments should be mobilized for its optimal management. Also, there is a relatively low output of glaucoma surgeries that needs to be further investigated and appropriate measures taken to manage it.

Two cases of Vogt–Koyanagi–Harada’s disease in sub-Saharan Africa

Vogt–Koyanagi–Harada’s (VKH) disease has been reported to be rare in sub-Saharan Africa. Two Nigerians with the disease are presented in this report. The first patient, a 32-year-old pregnant Nigerian woman presented with a 1-month history of bilateral blurring of vision, persistent headache, and alopecia. Presenting visual acuity was 1 m counting fingers in both eyes. Examination revealed vitiligo and poliosis with bilateral panuveitis as well as bilateral exudative retinal detachment. A clinical assessment of complete VKH disease was made. The patient commenced systemic and topical steroids that resulted in remarkable recovery of vision and control of inflammation. The second patient, a 56-year-old Nigerian woman presented with severe headache, tinnitus, and visual loss in both eyes of 2 weeks duration. There was associated redness of both eyes and photophobia. Examination showed visual acuity of Hand motion (HM) and counting fingers at 1 meter (CF). in the right and left eye, respectively, with bilateral panuveitis and bilateral exudative retinal detachment. Subsequent follow-up showed poliosis, vitiligo, and sunsetting fundus appearance. The patient improved with systemic and topical corticosteroids. Developing a high index of suspicion is necessary in diagnosing VKH disease, even in sub-Saharan Africa. Prompt institution of appropriate treatment prevents blindness.

Current practice of ophthalmic anesthesia in Nigeria.

Purpose: To assess the current techniques of ophthalmic anesthesia in Nigeria. Materials and Methods: A cross sectional survey among Nigerian ophthalmology delegates attending the 36th Annual Scientific Congress of the Ophthalmology Society of Nigeria. Self administered and anonymous questionnaires were used and data were collected to include details of the institution, preferred local anesthesia techniques, the grade of doctor who administers the local anesthesia, complications, preferred facial block techniques (if given separately), and type of premedication (if used). Results: Out of the 120 questionnaires distributed, 81 forms were completed (response rate 67.5%). Out of the 74 who indicated their grade, 49 (66.2%) were consultants, 22 (29.7%) were trainees, and 3 (7.1%) were ophthalmic medical officers. For cataract surgery, peribulbar anesthesia was performed by 49.1% of the respondents, followed by retrobulbar anesthesia (39.7%). Others techniques used were topical anesthesia (5.2%), subtenon anesthesia (4.3%), subconjunctival anesthesia (2.6%), and intracameral anesthesia (0.9%). For glaucoma surgery, 47.2% of the respondents use peribulbar anesthesia, 32.1% use retrobulbar anesthesia, 9.4% used general anesthesia, and 6.6% used subconjunctival anesthesia. Among the trainees, 57.8% routinely perform retrobulbar anesthesia while 55.6% routinely perform peribulbar anesthesia. At least one complication from retrobulbar anesthesia within 12 months prior to the audit was reported by 25.9% of the respondents. Similarly, 16.1% of the respondents had experienced complications from peribulbar anesthesia within the same time period. Retrobulbar hemorrhage is the most common complication experienced with both peribulbar and retrobulbar anesthesia. Conclusion: Presently, the most common technique of local anesthesia for an ophthalmic procedure in Nigeria is peribulbar anesthesia, followed by retrobulbar anesthesia. Twelve months prior to the study, 25.9% of the respondents had experienced at least one complication from retrobulbar anesthesia and 16.1% from peribulbar anesthesia. Retrobulbar hemorrhage was the most common complication reported.

Pattern of childhood visual impairment and blindness among students in schools for the visually impaired in Lagos State: An update

Aim: The aim of this study was to determine the pattern of childhood visual impairment and blindness (VI and BL) among students attending schools for the visually impaired in Lagos State, with a view to providing information on avoidable causes as well as emerging trends that would be useful to policy-makers for the planning and implementation of strategies for the control of avoidable childhood BL in Lagos State. Subjects and Methods: The study was conducted among students enrolled in two schools for the visually impaired in Lagos State who developed VI/BL before the age of 16 years. Participants and their parents/guardians were interviewed to obtain medical history. Ocular and systemic examinations were also performed. Information was recorded using a modified World Health Organization/Prevention of BL Eye Examination Record for Children with BL and Low Vision and analysed using the Statistical Package for the Social Sciences version 23.0. Z-test determined differences in the proportions of the causes of VI/BL between this study and an earlier study. Results: A total of 116 students were enrolled in this study of which 65 (56.0%) were males. Avoidable causes accounted for 58.5% of VI/BL. Preventable causes predominated with measles (15; 12.9%) accounting for the largest proportion. Surgical complications (16; 13.8%) were the largest cause of VI/BL. A statistically significant decrease (P = 0.004; 95% confidence interval = 0.09–0.50) in the proportion of avoidable BL between a previous study carried out in Lagos State and this study was found. Hereditary cataract and cortical VI were the findings of this study not recorded in the previous study. Conclusion: Avoidable causes of childhood VI/BL still predominate among students in the schools for the visually impaired in Lagos State; however, there is a statistically significant decrease.