Oluwatoyin Helen Onakpoya

Determinants of previous dilated eye examination among type II diabetics in Southwestern Nigeria

PURPOSE To assess the prevalence and factors influencing previous dilated eye examination in screening for retinopathy among type II diabetics. METHODOLOGY Cross-sectional study of type II diabetic patients receiving treatment at a tertiary hospital in southwestern Nigeria was conducted with information on gender, age, duration of diabetes, current medication and previous dilated eye examination recorded. Eye examination included visual acuity, pen torch examination, applanation tonometry and direct ophthalmoscopy of the dilated eye in a dark room. Visual acuity was presented as classified by WHO while data was analyzed using SPSS version 11 and statistical significance inferred at P<0.05. RESULTS Eighty three type II diabetics with mean age 57.5+/-10.8 years and mean duration of diabetes of 6.6 years were studied. Visual impairment (<6/18 in the better eye) and blindness (<3/60 in the better eye) were recorded in 3.6% and 12% of the patients respectively while diabetic retinopathy was present in 21.6%. Only 24 [28.9%] diabetics had previous dilated eye examination; absence of eye symptoms [50.8%] and lack of referral [45.8%] were the main barriers to having previous dilated eye examination. Previous dilated eye examination was significantly influenced by the presence of visual impairment/blindness [P=0.002], longer duration diabetes mellitus [P=0.006], current insulin treatment [P=0.040] and presence of non-diabetic vision threatening eye diseases [P=0.016]. CONCLUSION Dilated eye examination rate is low; inadequate knowledge about diabetic retinopathy as well as low referral rates is contributory. Massive health education on diabetic retinopathy as well as development of sustainable retinopathy screening protocol would be helpful.

Childhood eye diseases in southwestern Nigeria: a tertiary hospital study

BACKGROUND Eye diseases are important cause of medical consultation in children, with the spectrum varying in different localities. This study aimed to determine the spectrum of childhood eye diseases in a tertiary hospital serving rural and semi-rural communities. METHODS We conducted a retrospective review of all patients less than 15 years old who presented to the eye clinic of Wesley Guild Hospital Ilesa, Nigeria between January 2001 and December 2006. Data on age at presentation, age at onset of disease, sex and diagnosis were collected and analyzed using SPSS. A p value less than 0.05 was considered statistically significant. RESULTS We evaluated the reports of 286 children, with a male:female ratio of 1:1.1. Children aged 11–15 years made up the largest group (p=0.013). Ocular trauma (21.7%), allergic conjunctivitis (17.8%), infections of the eye and its adnexa (15.4%) and refractive errors (14.3%) were the most common conditions. Ocular injury was more common in males (p=0.002) and children aged 6–10 years, and 87.1% of these cases were a closed globe injury. Infections were seen more commonly among females and children aged 0–5 years, with keratitis representing 40.9% of these cases. Congenital eye disease represented 13.3% of childhood eye diseases. CONCLUSION The prevalent childhood eye diseases recorded here can lead to absenteeism from school and are potentially blinding. Health education aimed at the prevention of ocular trauma and prompt presentation for the management of other eye diseases should be encouraged.

Epidemiology of ocular trauma among the elderly in a developing country

Purpose: To study the epidemiology of ocular trauma among the elderly in a developing country. Method: This is a multi-center retrospective clinical study of patients aged 65 years and above managed for ocular trauma between 2001 and 2007 at 4 hospitals in southwestern Nigeria. Age, sex, occupation, residential address, location at time of injury, activity preceding injury, agent of injury, treatment modalities offered and presenting visual acuity were recorded in a predesigned form. Type of injury was classified according to Birmingham Eye Trauma Terminology. Data were recorded and analyzed with descriptive statistics and Chi square using SPSS 11 (SPSS Inc., Chicago, IL) and statistical significance accepted at P < 0.05. Results: 78 patients with overall mean age of 70.1 ± 5.5 years and male to female ratio of 1.9: 1 (P = 0.007) were studied. Mean age for males was 70.0 ± 5.4 years and 70.1 ± 5.7 years for females. Eye injury occurred most commonly on the farm (37.2%), during farm related activities (35.9%) with sticks/twigs (41.1%) being commonest agent of ocular trauma among the elderly. However, injury occurred most frequently at home (51.9%) and during a fight/dispute (25.9%) with inciting agents being most frequently (33.3%) home related in elderly females. Eye injury was mainly of closed globe variety (85.9%); open globe injury was associated with higher incidence of hospitalization (P < 0.0001) and visual impairment (P = 0.004) at presentation. Conclusion: Although eye injury in elderly occurred more commonly on the farm during farm related activities, gender related differences are present with injury occurring more commonly in the home and during assaults/disputes.

Perception and attitude of people toward onchocerciasis (river blindness) in south western Nigeria

Background: Onchocerciasis (river blindness) is a major cause of bilateral blindness with devastating socioeconomic consequences. Since Nigeria is the most heavily onchocerciasis endemic country in the world, the information on people’s knowledge about this disease is significant. This could influence their response to current preventive measures of the African Programme for Onchocerciasis Control. Aim: This study was designed to estimate the level of knowledge and attitudes of rural/semi-urban communities in Ife North Local Government Area of Osun State toward onchocerciasis. Materials and Methods: Cluster random sampling was used to select 500 adults for the study. Semi-structured questionnaires were administered to subjects. Data on knowledge of the local name, cause, mode of transmission, manifestation, severity, treatment, and prevention of onchocerciasis were collected and analysed. Statistical analysis included frequency distribution of the responses and a Chi-square test for comparison of variables with the P value for statistical significance set at 0.05. Results: Onchocerciasis was well known by its local name among 458 (91.6%) of the respondents. Only seven (1.4%) knew that it affects both the eyes and skin. The cause was commonly attributed to impure blood by 114 (22.8%), whereas transmission was thought to be through fomites by 161 (32.2%). Only 12 (2.4%) respondents attributed the disease to blackfly bites. The level of education and the association of onchocerciasis with a river were significantly associated (P = 0.001). Subcutaneous nodules were felt to contain water (85.4%), baby worms (3.2%), and fat (0.6%). There was a negative attitude toward sufferers of the disease. Conclusion: Adequate information transfer in simple local dialect by trained personnel to the communities at risk of onchocerciasis is essential for better uptake of all aspects of the onchocerciasis control programme.

Retinal Diseases in a Tertiary Hospital: The Need for Establishment of a Vitreo-Retinal Care Unit

AIM To evaluate the need for vitreo-retinal care for suburban and rural communities of southwestern Nigeria. METHODOLOGY A retrospective review of patients with posterior segment diseases attending the general ophthalmology clinics of Obafemi Awolowo University Teaching Hospitals complex, Ile Ife, southwestern Nigeria, between January 2001 and December 2006 was conducted. The age, sex and diagnosis were analyzed and needs assessment conducted. RESULTS Three-thousand, one-hundred-thirty-one new cases were reviewed of which 407(13%) patients presented with retinal diseases. Their mean age was 46.3 +/- 21.4 years, mode 60 years and male:female ratio 1.3:1 (P=0.05). Macula diseases (35.6%), hypertensive retinopathy (12%), retinochoroiditis (11.5%) and diabetic retinopathy (9.6%) were the predominant retinal diseases. Age-related macular degeneration was the most frequent of the macular diseases (38.6%), with a female preponderance (p=0.06). It is estimated that fundus photography +/- fluorescein will be beneficial in 89.4%, laser photocoagulation in 36.4% and vitreo-retinal surgical procedure in 16.4%. CONCLUSION Posterior segment diseases are not uncommon in rural communities of southwestern Nigeria. Facilities for fundus angiography, laser photocoagulation and a vitreoretinal surgical unit in trained hands will improve the capacity for specific diagnosis and appropriate management of vitreo-retinal diseases in these communities.

Awareness and utilization of protective eye device among welders in a southwestern Nigeria community

OBJECTIVE To determine the level of awareness and practice of use of protective eye devices among welders in Ile-Ife. METHODS This is a cross-sectional descriptive study of 405 consenting welders. A pretested proforma was utilized to obtain information on sociodemographic characteristics, as well as awareness and use of protective eye device. RESULTS The age of the respondents ranged from 16 to 80 years. The mean age was 39 ± 13 years. A large proportion (315, 78%) of the welders was aged between 21 and 50 years. The youngest group aged ≤ 20 years accounted for 15 (4%) of all welders, while the oldest group aged > 60 years accounted for 21 (5.2%). 402 were males (99.3%) and three were females (0.7%). Three hundred thirty-six (83%) of the welders had practiced for 6 years and above. There was a high level of awareness of protective eye devices among the welders (367, 90.6%), being higher among arc welders compared with gas welders (P < 0.001). Less than half (186, 45.9%) of the welders possessed protective eye devices. Of these, only 39 (9.6%) made use of the devices always. Some of the reasons for not using the protective eye devices include discomfort and poor visibility (56, 13.6%) and inadequate appreciation of the necessity to wear it (49, 12.1%). CONCLUSION The findings of this study suggest that a significant proportion of welders in Ile-Ife were not utilizing protective eye device. Health education and awareness campaigns about the importance and benefits of utilizing protective eye devices are recommended.

Screening for ophthalmic disorders and visual impairment in a Nigerian school for the deaf.

Purpose. To detect the presence of ophthalmic abnormalities and visual impairment in deaf students. Methods. A cross-sectional survey of all students in the school for the deaf was conducted following ethical clearance from the Ministry of Health. Age, sex, and previous eye examination was recorded for each student as well as visual acuity, penlight eye examination, intraocular pressure, dilated funduscopy and refraction (when applicable). Data were analyzed with SPSS version 11 and statistical significance inferred at p<0.05. Results. The 156 (100%) students at the school for the deaf with age range 6–25 years, mean ± standard deviation of 15.6±3.3 years, and modal age of 14 years were studied. A total of 110 (70.5%) had no previous eye examination, 2 (1.3%) students were blind, 5 (3.2%) were visually impaired, 4 (2.6%) had unilateral visual impairment, and 4 (2.6%) had unilateral blindness. Blindness was caused by Usher syndrome in 1 (50%) and bilateral pigmented macular scar in 1 (50%) patient. Uncorrected refractive errors were the leading cause of unilateral visual impairment (75%), visual impairment (60%), and unilateral blindness (50%). Ocular abnormality was present in 53 (34%) students while uncorrected refractive error (18.6%), retina changes (7%), and allergic conjunctivitis (3.8%) were the leading disorders. Previous eye examination was more common among primary school students (p<0.0001) and students with ocular abnormalities (p=0.046). Conclusions. Institutions for deaf children should be aware of the high prevalence of ophthalmic disorders and the importance of vision to development of a deaf child, and conduct an initial and periodic eye examination for every intake.

Cataract surgical outcomes in diabetic patients: Case control study

Purpose: To determine the visual outcome of cataract surgery in diabetes mellitus with advanced cataract in a tertiary institution in Nigeria. Design: A retrospective case control study conducted at the University College Hospital, Ibadan Nigeria. Subjects: Twenty three consecutive patients with diabetes and 23 age and sex matched non-diabetic control patients who had extracapsular cataract extraction for advanced cataract between 2002-2005. Main outcome: Mean post operative visual acuity and surgical complications. Results: Twenty three patients with diabetes mellitus and 23 non diabetic controls were studied; mean duration of diabetes was 8.1 ± 7.2 years. The mean post operative visual acuity in diabetics was 0.11±0.38, 0.33±0.57 and 0.38±0.49 at one week, two months and six months compared with 0.23±0.19, 0.46±0.37 and 0.48±0.31 in non diabetics. (p=0.207, 0.403 and 0.465 respectively). Improvement in preoperative visual acuity was noted in 84.2% and 90% in diabetics and non-diabetics respectively. Poor visual outcome in diabetics was mainly due to diabetic retinopathy, maculopathy or diabetes related surgical complications. Conclusion: Visual improvement was seen following surgery for advanced cataract in diabetics in this study population. Post operative monitoring for treatment of diabetic retinopathy may enhance visual outcome.

The prospect of anatomy as a career choice among clinical year medical students in Nigeria

BACKGROUND Medical doctors are potential important source of anatomy teachers. The aim of this study was to determine the choice of anatomy as a career option among medical students in a Nigerian medical school METHOD Descriptive survey of second- and third-year medical students using a self-administered questionnaire to asses age, sex, perception of anatomy as a subject, anatomy training experience and choice of anatomy as a career among respondents. Analysis was conducted using the SPSS and statistical significance inferred at P RESULTS: Three hundred and fifty three (85.3% response rate) who completely filled questionnaire were returned and analyzed of which 195 (55.2%) were males and 158(44.8%) were females. Their ages ranged between 18 and 37 years with a mean of 22.4 9.9 years. Although most students agreed that anatomy was an important subject in medical sciences 346 (98%), they had benefited from anatomy training in their clinical classes 320 (90.7%), and the knowledge of anatomy is useful in investigating patients with certain diseases 251 (71.1%), only 22 (6.2%) would choose anatomy as a career. Male students were more likely to choose anatomy as a career (P=0.026). Textbooks were the most common 334 (94.5%), while radiological means were the least 23 (6.5%) method employed in learning anatomy. CONCLUSION Anatomy as a subject is perceived positively by clinical medical students, but the choice as a career option is low; attempt at increasing career interest is needful.

Bilateral Blindness: Prevalence and Their Utilization of Existing Eye Care Facilities in a Nigerian Rural Community

Background: Blindness, which is potentially avoidable, is a serious public health problem globally. Thi s study was carried out to determine prevalence of bilateral blindness and the utilization of existing eye care facilities by the bilaterally blind. Methods: A randomi ze d cross sectional community-based study. Participants were community members aged 5years and above who were selected from 30 enumeration areas determined with EPI INFO V6 statistical software in line with standard practice. They had detailed ocular examinations and data were analyzed with SPSS. Results: Eligible participants were 1,236 (Male: Female = 1:2). Age ranged 5-103 years (median age, 55years). Prevalence of blindness was 4% (49/1236) for which Cataract (42.9%); Glaucoma (24.5%), Couching (10.2%) and Cornea opacity (8.2%) were the common causes. Most of those that were blind (57.1%) had never utilized eye care services available in the study area and lack of awareness was the reason in majority of them. Conclusions: Blindness as a result of avoidable causes is high in this community. Despite this, the level of utilization of available eye care facilities is low and this is mainly as a result of lack of awareness. Eye health promotion campaign at the rural level is recommended.