Kofi Asiedu

Ocular Surface Disease Index (OSDI) Versus the Standard Patient Evaluation of Eye Dryness (SPEED): A Study of a Nonclinical Sample.

Purpose: To compare the Standard Patient Evaluation of Eye Dryness (SPEED) and the Ocular Surface Disease Index (OSDI) questionnaires, and to further validate the SPEED questionnaire using the OSDI in a nonclinical sample. Methods: This was a cross-sectional study involving 657 undergraduate students aged 18–34 years. Subject selection was by systematic random methods. Results: The Cronbach alphas of the SPEED and OSDI questionnaires were 0.895 and 0.897, respectively. Classification of participants based on OSDI grading of severity indicated that the total mean SPEED score were 2.2, 5.0, 6.6 and 9.9 for the asymptomatic, mild, moderate and severe dry eye groups respectively (F(3,653) = 141.3 P < 0.001,&eegr;2=0.394). Post hoc testing for all between-group differences was statistically significant (P < 0.05; Tukey test of multiple comparisons). There was a significant correlation between the total scores of the OSDI and SPEED questionnaires (rs = 0.68 P < 0.001). The receiver operating characteristic curve (ROC) of the SPEED questionnaire was plotted, and the area under the curve (AUC) was estimated to be 0.82 (95% CL: 0.79–0.85; P < 0.001). Factor analysis revealed 3 dimensions as responsible for the substantial amount of variance in the data generated by the SPEED questionnaire. Conclusions: The SPEED questionnaire was good in separating asymptomatic and symptomatic participants in comparison with the OSDI. This indicates that the SPEED questionnaire is a valid measure for dry eye symptoms even in a nonclinical sample and would be useful in epidemiological studies and clinical practice for dry eye symptom assessment.

Symptomatic Dry Eye and Its Associated Factors: A Study of University Undergraduate Students in Ghana.

Background: To estimate the prevalence and risk factors of symptomatic dry eye disease (DED) among undergraduate students in a Ghanaian university. Methods: This cross-sectional study included 700 undergraduate students of the University of Cape Coast, aged 18 to 34 years. Participants completed questionnaires delivered directly to randomly and systematically selected subjects to detect symptomatic dry eye and its predictive factors. Symptomatic dry eye was defined as any reported symptom on the Standard Patient Evaluation Eye Dryness (SPEED) questionnaire reported as often or constant or if any symptom on the Ocular Surface Disease Index (OSDI) was reported as most of the time or all of the time. Furthermore, OSDI ≥13 and SPEED ≥6 were used to defined symptomatic dry eye and prevalence were also estimated with these criteria as secondary measures. Current symptoms of dry eye and possible risk factors such as age, gender, current alcohol drinking, use of oral contraceptives, use of computer more than an hour daily, environmental conditions, allergies, and self-medication with over-the-counter eye drops were the main outcome measures. We used logistic regression analysis to examine the associations between dry eye and its predictive factors. Results: Of the 700 participants, 650 completed the questionnaire. The prevalence of symptomatic dry eye was 44.3% (95% confidence interval [CI], 40.6%–48.2%). There was a significant association between symptomatic dry eye and discomfort with eyes in windy conditions (&khgr;2=110.1; df=4; P<0.001), areas with low humidity (&khgr;2=91.6; df=4; P<0.001), and air-conditioned rooms (&khgr;2=89.0; df=4; P<0.001). Self-medication with over-the-counter eye drops (OR 4.20; 95% CI, 2.61–6.74; P<0.001), any allergies (OR 2.46; 95% CI, 1.42–4.29; P=0.001), and use of oral contraceptives (OR 4.04; 95% CI, 1.02–16.01; P=0.047) were predictive factors of symptomatic dry eye. Sex was predictive in univariate analysis but was not significantly associated in multivariate analysis. Conclusions: The prevalence of symptomatic dry eye among undergraduate students in Ghana is high and it is associated with self-medication with over-the-counter eye drops, allergies, use of oral contraceptive, windy conditions, very low humid areas, air-conditioned rooms, and sex. Relevant input directed against modifiable risks factors may have a positive impact on the well-being of undergraduate students in Ghana.

Autorefraction, Retinoscopy, Javal's Rule, and Grosvenor's Modified Javal's Rule: The Best Predictor of Refractive Astigmatism

The aim of the study was to determine the level of agreement between Javals rule, autorefraction, retinoscopy, and refractive astigmatism and to determine which technique is the most suitable substitute when subjective refraction is not applicable using a clinical sample. A total of 36 subjects, 14 males and 22 females, were involved in this study. The intraclass correlation coefficients between subjective refraction, autorefraction, and retinoscopy were 0.895 and 0.989, respectively, for the spherical equivalent. The Bland-Altman 95% limits of agreement between subjective refraction and autorefraction; subjective refraction and retinoscopy; and autorefraction and retinoscopy were −2.84 to 3.58, −0.88 to 1.12, and −3.01 to 3.53, respectively, for the spherical equivalent. The intraclass correlation coefficients between spectacle total astigmatism and the following techniques were as follows: retinoscopy (0.85); autorefraction (0.92); Javals rule (0.82); and Grosvenor et al. version (0.85). The Bland-Altman 95% limits of agreement between subjective refraction and autorefraction; subjective refraction and retinoscopy; subjective refraction and Javals rule; and subjective refraction and Grosvenor et al. version were −0.87 to 1.25, −1.49 to 1.99, −0.73 to 1.93, and −0.89 to 1.7, respectively, for the total astigmatism. The study showed that autorefraction and Javals rule may provide a starting point for subjective refraction cylinder power determination but only retinoscopy may satisfactorily replace subjective refraction total astigmatism when subjective refraction is not applicable.

Survey of eye practitioners’ preference of diagnostic tests and treatment modalities for dry eye in Ghana

PURPOSE This study sought to provide an evidence-based profile of the diagnosis, treatment and knowledge or opinions on dry eye among optometrists and ophthalmologists in Ghana. METHODS This was a cross-sectional survey RESULTS: The responses of 162 participants are included in the analysis. The most commonly used test to diagnosed dry eye disease was tear break-up time followed by patient history. The most common symptom doctors heard from dry eye patients were burning sensation followed by foreign body sensation. The most often prescribed first- line treatment for dry eye was aqueous-based artificial tears followed by lipid-based artificial tears. Most practitioners considered meibomian gland dysfunction as the most common cause of dry eye followed by pterygium. The most often used test to guide or gauge therapeutic effect is patient history followed closely by tear break-up time. Most practitioners reported that 10%-20% of all their patients they see in a day are diagnosed of dry eye. CONCLUSION This study showed tear break up time was the main test majority of practitioners in Ghana used to diagnose dry eye but patient history was the main test used to gauge therapeutic effect over time. Burning sensation was the commonest symptom practitioners heard from dry eye patients whilst artificial tears was their main and first-line treatment for dry eye.

Association between dry eye symptoms and signs

Purpose To evaluate the association between subjective dry eye symptoms and the results of the clinical examinations. Methods The study was a clinical-based survey involving 215 first-year students selected consecutively during a regular ocular health examination at the University of Cape Coast Optometry Clinic. The data collection process spanned for a period of four months. Out of the 215 students, 212 returned their completed questionnaires and were subsequently included in the study. Dry eye tests including meibomian gland assessment, tear break up time, fluorescein staining, Schirmer test, and blink rate assessment, were performed on each subject after completion of the Ocular Surface Disease Index (OSDI) questionnaire. Shapiro–Wilk test was used to determine the normality of the clinical tests, and Spearmans correlations co-efficient was used to determine the correlations between the clinical test results and dry eye symptoms. Results Statistically significant associations were found between OSDI scores and blink rate (rs = 0.140; P < 0.042), and associations between OSDI scores and contrast sensitivity scores (rs = 0.263; P < 0001). However, the results of corneal staining (rs = −0.006; P < 0.926), Schirmer test (rs = −0.033; P = 0.628), tear break up time (rs = −0.121; P < 0.078), meibomian gland expressibility (rs = 0.093; P < 0.180), and meibomian gland quality (rs = 0.080; P < 0.244) showed no significant association with OSDI. The correlation coefficients range from −0.006 to 0.263 showed low to moderate correlation between dry eye symptoms and the results of clinical test. Conclusion Associations between dry eye symptoms and clinical examinations are low and inconsistent, which may have implications for the diagnoses and treatment of dry eye disease.

The impact of topical intraocular pressure lowering medications on the ocular surface of glaucoma patients: A review

Purpose To assess the literature on the effects of topical intraocular pressure (IOP)-lowering medications on the ocular surface. Ocular surface assessment in these patients is seldom a priority for most clinicians since the ultimate goal of management is to preserve vision. Methods A literature search of articles (English only) on the subject matter was conducted and their findings summarized. Results This review assesses the prevalence of dry eye symptoms in glaucoma patients on topical IOP-lowering medications. We extensively reviewed the effects of the preservatives and active ingredients in these medications on the ocular surface. In particular, the effects of benzalkonium chloride (BAK), a widely used preservative, on meibomian glands are explored. Also mentioned in this review is the association between duration of therapy and severity of dry eye symptoms. The role of the pH of medications in the development of ocular surface disease is also reviewed. Finally, we probed the occurrences of ocular allergic reactions with the use of topical IOP-lowering medications. Conclusions The preservatives and active agents in most topical glaucoma medications are implicated in the prevalence of ocular surface discomfort. Whilst clinicians involved in glaucoma care are encouraged to assess the ocular surface routinely, further studies are needed to demonstrate the contributions of other physiochemical properties of these medications to the development of ocular surface disease in these patients.

Clinical subtypes of dry eye in youthful clinical sample in Ghana

PURPOSE To evaluate in a cohort of patients with dry eye disease (DED) the distribution of patients with asymptomatic and symptomatic dry eye involving aqueous deficient or the evaporative subtype of DED. METHODS This was a clinic-based cross-sectional study of consecutive patients visiting the University of Cape Coast eye clinic for a comprehensive eye examination. Eligible participants completed the Ocular Surface Disease Index (OSDI), ocular surface staining and tear break up time. Subjects with dry eye (symptomatic or asymptomatic) underwent clinical examination comprising lid margin assessments, meibomian gland expressibility and quality assessments, and Schirmer 1 test. RESULTS A total of 172 patients were included in the study. The mean age of the eligible participants was 22.7 (±3.7) years, with a range of 17-35 years. There were 83 males and 89 females in the sample. There was an association between the form of the dry eye whether symptomatic or asymptomatic and sex, (X2 = 6.51 df = 1 p = 0.011). The frequency of symptomatic aqueous-deficient dry eye was 9(5.2%) whiles that of the symptomatic evaporative dry eye was 20(11.6%). The frequencies of the asymptomatic aqueous-deficient dry eye and asymptomatic evaporative dry eye were 9(5.2%) and 12(7.0%) respectively. The frequency of symptomatic mixed dry eye was 30(17.4%) and the asymptomatic mixed dry eye was 8(4.7%). The distribution of unclassifiable dry eye among the symptomatic dry eye group was 41(23.8%) and 43(25%) among the asymptomatic dry eye group. CONCLUSION The number of patients exhibiting signs of the evaporative dry eye resulting from meibomian gland dysfunction far outnumbers those of aqueous deficient dry eye but there remains a high unclassifiable group with an unknown etiology. Further, studies are needed to explore the other etiology or etiologies of dry eye apart from meibomian gland dysfunction and reduced aqueous production.

Microbial contamination of multiple-use bottles of fluorescein ophthalmic solution: Microbial contamination of fluorescein

The contamination of ophthalmic solutions in ophthalmic practices remains an important cause of a myriad of secondary eye infections and a source of aggravation of ocular disorders such as corneal ulcers and keratitis. The aim of this study was to investigate the possible microbial contamination of fluorescein sodium dye solutions used in eye clinics in Ghana.

Onset and duration of cycloplegic action of 1% cyclopentolate – 1% tropicamide combination

Purpose To study the time course (onset, time and duration of maximal cycloplegia, and the full duration) of cycloplegic action of 1% Cyclopentolate — 1% Tropicamide. Methods Seventy-seven students, aged 15–24 years were purposively sampled from the University of Cape Coast and Cape Coast Technical Institute. Subjective near addition (ADD) determination and pupil diameter measurement before and after a drop of the test agent (1% Cyclopentolate — 1% Tropicamide combination in the right eye) and the control (1% Cyclopentolate in the left eye) were performed. Measurements of subjective near ADD and pupil diameter were made after the initial reading at 5 minutes interval for the first hour and every 30 minutes for the next 7 hours for each participant. Time of onset, time of peak cycloplegia, duration of peak cycloplegia and duration of total cycloplegic effect was indirectly determined. Results 1% Cyclopentolate — 1% Tropicamide combination had rapid onset of cycloplegia (5–10 minutes), shorter time of maximal cycloplegia (55 versus 90 minutes), and recovery (7 versus ≥ 8hours) in the majority (79.2%) of subjects. Conclusion Cyclopentolate -Tropicamide combination was comparable to Cyclopentolate in depth of cycloplegia produced, and clinically superior to 1% Cyclopentolate in rapidity of cycloplegic onset, time of maximal cycloplegia and recovery from cycloplegia.

A case of leukemic retinopathy mimicking common ischemic retinopathies

Reported case of leukemic retinopathy mimicking common ischemic retinopathies in a young adult where ophthalmic visit was the first step to the diagnosis of chronic myeloid leukemia. It highlights the importance of routine eye exams and that clinicians should suspect leukemia in an otherwise healthy patient presenting with ischemic retinopathy.