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Performance of Polygenic Risk Scores for Primary Open-Angle Glaucoma in Populations of African Descent. JAMA Ophthalmol
By Chang-Wolf, J. M., Kinzy, T. G., Driessen, S. J., Cruz, L. A., Iyengar, S. K., Peachey, N. S., …Olusola Olawoye…… Genetics in Glaucoma Patients of African Descent (GIGA) Study Group. Genetics of Glaucoma in People of African Descent (GGLAD) Study Gr
Published on: 2024-11-14
Importance: Primary open-angle glaucoma (POAG) polygenic risk scores (PRSs) continue to be evaluated...
Importance: Primary open-angle glaucoma (POAG) polygenic risk scores (PRSs) continue to be evaluated in primarily European-ancestry populations despite higher prevalence and worse outcomes in African-ancestry populations.\r\nObjective: To evaluate how established POAG PRSs perform in African-ancestry samples from the Genetics in Glaucoma Patients of African Descent (GIGA), Genetics of Glaucoma in Individuals of African Descent (GGLAD), and Million Veteran Program (MVP) datasets and compare these with European-ancestry samples.\r\nDesign, setting, and participants: This was a multicenter, cross-sectional study of POAG cases and controls from Tanzania, South Africa, Nigeria, Ghana, and the US. Included were individuals of African descent from South Africa and Tanzania from the GIGA dataset; individuals of African descent from Ghana, Nigeria, and the US from the GGLAD dataset; and individuals of African or European descent from the US in the MVP dataset. Data were analyzed from January 2022 to July 2023.\r\nExposures: Three PRSs derived from large meta-analyses of European and Asian populations, namely Gharahkhani et al (Gharahkhani PRS), Han et al (Han PRS), and Craig et al (Craig PRS).\r\nMain outcomes and measures: Odds ratios (ORs) for POAG risk stratification comparing the highest and lowest quintiles; area under the receiver operating characteristic curve (AUROC), and liability coefficient of determination (R2) for the addition of PRS to a baseline of age, sex, and first 5 principal components.\r\nResults: A total of 11 673 cases and 66 432 controls were included in this study across 7 ancestral groups. Mean (SD) age of the total participants was 76.9 (8.7) years, with 74 304 males (95.1%). The following were included in each dataset: GIGA (663 cases, 476 controls), GGLAD (1471 cases, 1482 controls), and MVP (9559 cases, 64 474 controls). Increases in ORs were found for the highest POAG risk quintile ranging from an OR of 1.68 (95% CI, 1.17-2.43) in Ghanaians to 7.05 (95% CI, 2.73-19.6) in the South African multiple ancestry group (which derives from at least 5 distinct ancestral groups: Khoisan, Bantus, Europeans, Indians, and Southeast Asians) with the Gharahkhani PRS. The Han PRS showed OR increases for the highest POAG risk quintile ranging from 2.27 (95% CI, 1.49-3.47) in African American individuals in the GGLAD dataset to 7.24 (95% CI, 6.47-8.12) in Europeans. The Craig PRS predicted OR increases in the highest quintile for all groups ranging from 1.51 (95% CI, 1.05-2.18) in Ghanaians to 6.31 (95% CI, 5.67-7.04) in Europeans. However, AUROC and R2 increases above baseline were lower for all African-ancestry compared with European-ancestry groups in the 3 tested PRSs.\r\nConclusions and relevance: In this cross-sectional study, despite some improvements in OR-based risk stratification using the Gharahkhani PRSs, Han PRSs, and Craig PRSs, consistently lower improvements in AUROC and R2 for African-ancestry compared with European-ancestry groups highlight the need for risk prediction models tailored to diverse populations.\r\n
Distribution of Intraocular Pressure in Indigenous Black Africans and Related Risk Factors: A Population-Based Study in Southwest Nigeria
By TF Sarimiye, O Olawoye, C Bekibele, A Ashaye
Published on: 2024-08-15
Background: Elevated intraocular pressure (IOP) is a major risk factor for glaucoma and is presently...
Background: Elevated intraocular pressure (IOP) is a major risk factor for glaucoma and is presently the only modifiable risk factor. Even in a healthy population, IOP distribution varies among different racial groups. Objective: To determine the distribution of IOP and factors affecting it, among an indigenous African population in Southwest Nigeria. Methods: A population-based descriptive cross-sectional survey with an analytical component was performed. The study was conducted among participants 16 years and older who were residents of Akinyele Local Government Area of Oyo State and were all black Africans. A multi-stage sampling with probability proportional to size was used to identify the study population. All participants were examined at the local health center in their community, assessing the visual acuity, Goldmann applanation tonometry, central corneal thickness, anterior segment, fundoscopy, weight, height, and blood pressure. Results: A total of 1810 respondents completed the study; male patients accounted for 41.55%. Mean age was 49.43 ± 15.57 years. The mean IOP was 15.91 ± 4.74 mmHg. There was a significant association between elevated IOP and the\r\n\r\nmale gender. Intraocular pressure also had a significant positive correlation with increasing age, systolic blood pressure, and central cornea thickness. There was no significant relationship between IOP and self-reported diabetes mellitus. Conclusion: The mean IOP and distribution in this study were a bit different from that observed in studies in different geographical locations but similar to studies in West Africa. It may be advisable to employ a geographical approach to normal IOP interpretation.
Factors limiting glaucoma care among glaucoma patients in Nigeria: A scoping review
By Obasuyi OC, Yeye-Agba OO, Ofuadarho OJ
Published on: 2024-07-16
Glaucoma currently accounts for 11% of irreversible visual loss worldwide. Due to many factors, pati...
Glaucoma currently accounts for 11% of irreversible visual loss worldwide. Due to many factors, patients do not access the glaucoma care pathway and present late with poor vision, while many are undiagnosed or untreated. These factors may be personal-level dispositions or Institutional-level dispositions, limiting the awareness, diagnosis, and treatment of glaucoma or adherence to medications or follow-up clinic visits. This scoping review followed the JBI methodology for scoping reviews and was pre-registered on the open science platform (https://osf.io/wqx57/?view_only=727eb6c803764509a2809e5d0794e214). The PUBMED, EMBASE, WEB OF SCIENCE, AJOL, and GOOGLE SCHOLAR databases were systematically searched for studies published in English between 1990 and June 2023. Data were extracted and analysed along a conceptualised framework of factors limiting access to glaucoma care in Nigeria. Of the 336 records retrieved, 13 studies were included in this scoping review. These included one (1) mixed method (quantitative/qualitative) study, three qualitative studies, and nine quantitative studies spanning 2008–2022 covering eight states and 2,643 sampled respondents. Nine studies reported personal-level dispositions limiting glaucoma care, including\r\n\r\nlow levels of education, unemployment, gender, living distance from the hospital, cost of care, and faith/religion. Four reported institutional-level dispositions, including the lack of proper equipment and expertise to diagnose or manage glaucoma. The factors limiting Glaucoma care in Nigeria are varied and may act alone or combined with other elements to determine the awareness or knowledge of glaucoma, uptake of glaucoma surgery, medication adherence, or clinic follow-up. While most of these factors limiting glaucoma care in Nigeria may be amenable to policy, a bottom-up approach is needed to improve the community’s awareness and uptake of glaucoma services. A shift from the over-dependence and reliance on tertiary hospitals, which are often far away from the people who need them, is required to bridge the information and service gap currently being witnessed.
Patients’ acceptance of glaucoma therapy in sub-Saharan Africa.
By O Olawoye, T Sarimiye, J Washaya, GW Gessesse, K Balo, J Agre,
Published on: 2024-06-12
Purpose: To determine the frequency at which patients newly diagnosed with glaucoma in sub-Saharan A...
Purpose: To determine the frequency at which patients newly diagnosed with glaucoma in sub-Saharan Africa (SSA) decline recommended therapy and to characterize the reasons for declining therapy.\r\n\r\nMethods: This was a multicenter, cross-sectional study conducted on adult patients at the time of glaucoma diagnosis at 27 centers in 10 countries in SSA. Data collected from the diagnostic encounter included demographics, clinical glaucoma characteristics, treatment recommendations, patient acceptance of therapy, and reasons for declining therapy.\r\n\r\nResults: Among 2,282 eyes of 1,198 patients offered treatment for glaucoma, initially recommended treatment was accepted in 2,126 eyes (93.2%). Acceptance of therapy varied with the nature of treatment offered, with medical therapy accepted in 99.2% of eyes, laser therapy in 88.3%, and surgical therapy in 69.3%. The most common reasons cited for declining therapy were fear (42.9%) and cost (41.7%); cost was the primary reason for declining medical and laser\r\n\r\ntherapy, while fear was the most common reason for declining surgical therapy. Most patients declining laser or surgical therapy accepted medical therapy as an alternate therapy (98.1%).\r\n\r\nConclusions: Patients\' acceptance of glaucoma therapy was high overall, but lower for surgery than for laser or medical therapy. Most patients who declined laser or surgical therapy accepted medical therapy as an alternate therapy when offered. Educational interventions, sustainable incentives, and other approaches are needed to enhance patient acceptance of glaucoma therapy in this setting, particularly surgery when needed.
Engaging Faith Based Leaders in the Fight against Glaucoma Related Blindness.
By Arinze Anthony Onwuegbuna, Eze U, Apakama AI, AkujuobiChianakwalam E, Ezeude CM, Ochiogu BC, et al.
Published on: 2024-06-05
Purpose: To determine the role of faith leaders towards reducing glaucoma blindness in Africa.\r\n\r...
Purpose: To determine the role of faith leaders towards reducing glaucoma blindness in Africa.\r\n\r\nMethodology: This was a descriptive, cross-sectional study conducted among faith-based leaders in Anambra state. A pretested self-administered, semi-structured questionnaire was distributed among consenting faith-leaders. Responses obtained include biodata of respondents and roles. Data obtained was analyzed using IBM SPSS 23. Statistical significance was set at p˂0.05.\r\n\r\nResults: Out of 167 faith leaders who participated, 123 (73.7%) were males, giving a male to female ratio (M: F) of 2.8:1 and a mean age of 47.02 years ± 13.84 SD. Majority of the participants 54.5% were of the catholic extraction while only 1.2% were Sabbatarians and 65% have a 500-capacity congregation. About two-thirds (65.4%) believed that glaucoma could cause blindness and 79.7% have undergone an eye check for glaucoma. Routine eye/health check was\r\n\r\nreported among 85.8% of respondents as the main indication for eye examination. About half (51.8%) of those yet to have their eyes examined have no special reason while about 80% believed routine eye check is the best way to prevent glaucoma blindness through routine eye checks, with over half (57.1%) willing to participate in prevention campaigns and 60.4% believed church to be the best avenue for this campaign.\r\n\r\nConclusion: The results showed that faith leaders who wield great influence in our environment are willing to participate in campaign against glaucoma blindness in their respective churches.
West African College of Surgeons Basic Ophthalmology Resource: Development and Initial Evaluation. Medical Research Archives, [S.l.], v. 12, n. 5, May 2024. ISSN 2375-1924.
By Abdulsalam, Shuaib……..Olawoye OO…..
Published on: 2024-05-08
Purpose: To describe the process of development of the West African College of Surgeons (WACS) Basic...
Purpose: To describe the process of development of the West African College of Surgeons (WACS) Basic Ophthalmology Educational Resource and to report the feedback from the first five cohorts to utilise the resource at the commencement of their training in ophthalmology.\r\n\r\nMethods: After initial meetings topics considered essential foundations for training in ophthalmology were identified. Faculty members subsequently searched the internet to identify suitable online open source learning materials relevant to each topic, which were then collated and cataloged. Where suitable quality learning materials could not be identified, materials were created or re-used from existing WACS courses. Following the creation of the resource, questions were developed for a summative assessment, taken by learners upon completion of the resource.\r\n\r\nResults: The resource went \'live\' on 10th July 2019. As of March 2024, a total of 203 learners in 5 cohorts had completed the course. The feedback responses of 150 (74%) learners from the first 5 cohorts are described in this report. Regarding their overall assessment of the course, 64 (43%) learners rated the resource as very good\', 63 (42%) as \'good\', and 23 (15%) as \'satisfactory’. Most (>98%) respondents reported that the course met their expectations and that the content was relevant to their learning needs.\r\n\r\nConclusion: The WACS Basic Ophthalmology Resource appears to be a valuable opportunity for acquiring foundational knowledge.
The Value of Targeted Screening for Glaucoma: The University of Ilorin Teaching Hospital Experience.
By Obajolowo TS, Yusuf IA, Adeoti SG, Owoeye JFA, Taiwo MA, Olatunji FO
Published on: 2024-04-16
Background: Glaucoma is an irreversible silent and dangerous eye condition that leads to damage of t...
Background: Glaucoma is an irreversible silent and dangerous eye condition that leads to damage of the optic nerve head. This study aimed to determine the outcome of targeted glaucoma outreaches done in the University of Ilorin Teaching Hospital over three years with a view to early detection and timely institution of management.\r\n\r\nMethods: The study is a retrospective review of 3 targeted hospital-based glaucoma screenings, World Sight Day of 2019 (140 participants), World Glaucoma Week of 2020 (176 participants), and World Glaucoma Week of 2022 (183 participants). The criteria for diagnosing glaucoma and glaucoma suspects were taken from the national study of prevalence and types of glaucoma from the Nigerian national blindness survey and International Society for Geographical and Epidemiological Ophthalmology criteria.\r\n\r\nResults: The study population had a mean age of 45.54 years (SD 16.92) with individuals within the age group of 51-60 years comprising the majority of the participants (26.4%). Most participants had normal vision or mild visual impairment in the right eye (411, 86.1%) and left eye (405, 84.9%) while blindness was recorded in the right eye of 37 (7.7%) participants and left eye of 36 (7.5%). The prevalence of glaucoma cases and suspects among study participants was 29.4% and 42.5%, respectively. There was a statistically significant relationship between the diagnosis of glaucoma and older age, family history of glaucoma and elevated intraocular pressure.\r\n\r\nConclusion: This study showed that targeted screening for glaucoma is an invaluable tool for ensuring early detection of the disease.
Management of primary childhood glaucoma: Evaluation of practice, practice gaps, and needs in a low-resource country.
By Ugalahi M, Sarimiye TF, Obajolowo T, Nkanga ED, Abdulrahman A, Olusanya B, et al
Published on: 2024-02-06
Purpose: To evaluate the current practice, equipment availability, and training needs for managing c...
Purpose: To evaluate the current practice, equipment availability, and training needs for managing childhood glaucoma in Nigeria.\r\n\r\nMaterials and Methods: An online questionnaire (Google Forms) was distributed through E-mails and social media platforms of pediatric ophthalmologists and glaucoma specialists who practice in Nigeria and manage glaucoma in children aged 0–16 years. Information concerning sociodemographic characteristics, type of practice, location of practice, years of practice, status,\r\n\r\nand preferred practices in the management of childhood glaucoma cataracts were obtained and analyzed with SPSS.\r\n\r\nResults: Thirty (23.3%) out of 129 eligible participants indicated they perform glaucoma surgeries in children. The majority (66.6%) had practiced as specialists for 10 years or less, and 70% were pediatric ophthalmologists. A third of the respondents practiced in the country’s southwest region, with none in the Northeast region. The most common surgery performed for primary congenital glaucoma was combined trabeculotomy trabeculectomy, while trabeculectomy was the most common surgery performed for juvenile open-angle glaucoma. Two respondents reported performing glaucoma drainage device surgery and seven reported possessions of skills for goniotomy. All centers had trabeculectomy instrument sets, while three centers had facilities for endolaser cyclophotocoagulation, and only two centers had knives for goniotomy. Antimetabolites were routinely used for childhood glaucoma surgeries by 26 (86.7%) respondents, and the most common antimetabolite used was mitomycin (21; 80.8%).\r\n\r\nConclusion: There is a need for the development of in-country training programs and the exchange of skills through collaboration among those providing glaucoma services within Nigeria to improve the care of children with glaucoma.
A multi-cohort genome-wide association study in African ancestry individuals reveals risk loci for primary open-angle glaucoma. Cell. 2024 Jan 18;187(2):464-480.e10.
By Verma SS, Gudiseva HV, Chavali VRM,… Olawoye OO, Ramsay M, Ashaye A, …..
Published on: 2024-01-18
Primary open-angle glaucoma (POAG), the leading cause of irreversible blindness worldwide, dispropor...
Primary open-angle glaucoma (POAG), the leading cause of irreversible blindness worldwide, disproportionately affects individuals of African ancestry. We conducted a genome-wide association study (GWAS) for POAG in 11,275 individuals of African ancestry (6,003 cases; 5,272 controls). We detected 46 risk loci associated with POAG at genome-wide significance. Replication and post-GWAS analyses, including functionally informed fine-mapping, multiple trait co-localization, and in silico validation, implicated two previously undescribed variants (rs1666698 mapping to DBF4P2; rs34957764 mapping to ROCK1P1) and one previously associated variant (rs11824032 mapping to ARHGEF12) as likely causal. For individuals of African ancestry, a polygenic risk score (PRS) for POAG from our mega-analysis (African ancestry individuals) outperformed a PRS from summary statistics of a much larger GWAS derived from European ancestry individuals. This study quantifies the genetic architecture similarities and differences between African and non-African ancestry populations for this blinding disease.
The social construction of genomics and genetic analysis in ocular diseases in Ibadan, South-western Nigeria.
By Olawoye O, Salami KK, Azeez A, Adebola P, Sarimiye T, Imaledo J, Realini T, Hauser MA, Ashaye A.
Published on: 2023-11-23
Genomics, an emerging field to improve public health practice, has potential benefits to understandi...
Genomics, an emerging field to improve public health practice, has potential benefits to understanding ocular diseases. This study explored the social construction of genomics in ocular diseases in the blind community in Ibadan, Nigeria, through two focus group discussions and twelve in-depth interview sessions conducted among people living with ocular disorders. The data were thematic and content-analysed. Although the participants had limited knowledge about ocular diseases, genomics, and their nexus, they maintained a positive attitude toward its potential benefits. This informed their willingness to participate in genomics testing for ocular diseases. The participants preferred saliva-based sample collection over blood-based, and expressed concern for the procedure and accrued benefits of genomics studies. Thus, public\r\n\r\nsensitisation about ocular diseases and client-centred genomics testing procedures should be engendered
Comparing awareness of glaucoma before and after a campaign on glaucoma amongst staff of a District Hospital in Abuja
By AC Okudo, AS Kalambe, S Zubair, U Nwachukwu, N Adeleye, NN Ezuma, et al.
Published on: 2023-11-08
Aim: To determine the proportion of staff that are aware of glaucoma following a campaign on glaucom...
Aim: To determine the proportion of staff that are aware of glaucoma following a campaign on glaucoma awareness.\r\n\r\nMethodology: The study was a Knowledge, Attitude and Practice (KAP) study with intervention carried out amongst staff of Asokoro District Hospital (ADH), Abuja during a 1-day glaucoma screening outreach programme in March 2022 following a year-long campaign on glaucoma to create awareness among the staff. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 20 using descriptive analysis.\r\n\r\nResults: One hundred and sixty-four staff attended the screening exercise and consented to participate in the study. The mean age of the participants was 40.21 years with an age range of\r\n\r\n21 to 60 years. There were 61 (37.2%) males and 103 (62.8%) females. The proportion of staff that were aware of glaucoma had increased from 58.9% to 86%. Amongst the various cadre of staff, awareness had increased from 75.9% to 100% amongst the medical, 61.7% to 100% amongst the paramedical and 36.1% to 72% amongst the administrative staff. The proportion of staff that had been screened previously increased from 19.6% to 37.2% across the cadres. From 27.6% to 41.3% amongst the medical staff, 15% to 36.1% amongst the paramedical and 13.9% to 35. 4% amongst the admin staff.\r\n\r\nConclusion: There was an appreciable increase in the proportion of staff aware and screened for glaucoma after the campaign. Glaucoma awareness campaigns should be a continuous exercise to increase awareness and screening amongst staff, especially the admin staff.
Management of Secondary Glaucoma Postscleral Buckle Surgery: A Tertiary Hospital Experience in Southwest Nigeria.
By T Sarimiye, N Ijaiya-Olatoke, Y Babalola, O Majekodunmi, M Ijaduola,
Published on: 2023-10-24
Purpose: To evaluate the rate of postoperative intraocular pressure (IOP) elevation and its manageme...
Purpose: To evaluate the rate of postoperative intraocular pressure (IOP) elevation and its management in patients who have undergone scleral buckle surgery as a primary intervention for retinal detachment.\r\n\r\nMaterials and Methods: This was a retrospective review of hospital files of scleral buckle surgeries for retinal detachment from January 2016 to December 2021 at the University College Hospital Ibadan. All patients with a previous history of glaucoma, vitreoretinal surgery, or a combination of vitrectomy and scleral buckling procedures were excluded from the review. An IOP of ≥22 mmHg after surgery was considered elevated.\r\n\r\nResults: A total of 148 patients’ charts were reviewed with 125 patients (131 eyes) included in the study. There were 81 males (64.8%) and the mean age of patients was 45.2 (±18.8) years, with a range of 5–81 years. Rhegmatogenous retinal detachment accounted for 97.7% (128 eyes) of all cases and 118 eyes (90.1%) were recent detachments. Seventy-nine eyes (60.3%) recorded elevated IOP postscleral buckle surgery. The mean elevated IOP postbuckle surgery was 27.9 (±6.2) mmHg and the mean antiglaucoma medications prescribed was 2.4 (±2) with a range of 2–5 medications. Four eyes (5.1%) needed surgical intervention for the elevated IOP. The last follow-up mean IOP was 14.3 (±4.1) mmHg.\r\n\r\nConclusion: Elevated IOP frequently complicates scleral buckle procedure and medical treatment is usually sufficient. As a common complication, this should be considered in advance when planning for the procedure, especially in low-income countries like Nigeria where scleral buckling surgery is still in common practice.
Nigerian parents\' perspectives on genetic testing in their children with genetic eye diseases.
By Monye HI, Olawoye OO, Ugalahi MO, Oluleye TS. J
Published on: 2023-10-18
Abstract\r\n\r\nThe decision for genetic testing in children is usually taken by their parents or ca...
Abstract\r\n\r\nThe decision for genetic testing in children is usually taken by their parents or caregivers, and may be influenced by sociocultural and ethical concerns. This study evaluateds the perspectives of Nigerian parents towards genetic testing of their children with genetic eye diseases parental willingness for genetic testing in their children, and its determinants, in a hospital setting in Nigeria. This cross-sectional, hospital-based study was conducted at the Eye clinic, University\r\n\r\nCollege Hospital, Ibadan. The participants were 42 parents of children with genetic eye diseases purposively recruited from April to July 2021. The main variables of interest were overall willingness to test, and willingness to test given ten different scenarios. Summary statistics were performed, and determinants of willingness to test (parental sociodemographic and children\'s clinical characteristics) were assessed using Fischer\'s exact test. All the participants expressed willingness to test when presented with six of the ten scenarios.However, slightly fewer (83-95%) proportions were willing to test for the other four scenarios (out-of-pocket payment, if test will reveal a systemic association, if test may confirm a diagnosis with no current treatment, and prenatal testing). Willingness to test was not significantly associated with the determinants tested. Thirty-nine (93%) would join a support group, 38 (91%) would inform a family member at risk, and 28 (67%) would be unwilling to have more children if there wais a risk to future offspring. This study demonstrated a high degree of parental willingness for genetic testing of their children. This is important evidence that can guide policy and planning of ophthalmic genetics services
Multiple medications and quality of life of Nigerians with primary open angle glaucoma.
By Nnubia, C. A., Nwosu, S. N. N., Okpala, N. E., Apakama, A. I., Orji, I. J., Uba-Obiano, C. U., et al.
Published on: 2023-09-21
Purpose: To determine the impact of multiple medications on the quality of life of primary open angl...
Purpose: To determine the impact of multiple medications on the quality of life of primary open angle glaucoma (POAG) patients on medical treatment at Guinness Eye Centre Onitsha, Nigeria.\r\n\r\nMaterials and methods: Adult patients diagnosed with POAG who were undergoing medical therapy were selected through systematic sampling. They were asked to provide information on socio-demographic background, the number and types of glaucoma medications they were using and any adverse effects encountered while using these medications. The patients\' quality of life was assessed by utilizing the National Eye Institute Visual Function Questionnaire-25 (NEI-\r\n\r\nVFQ-25) and all patients completed ocular examination. Data analysis was with Statistical Package for Social Sciences (SPSS) version 23.\r\n\r\nResults: One hundred and seventy-one patients, aged 40-83 years, mean 59.1 ± 11.1 were studied; there were 79(46.2%) males and 92(53.8%) females. One hundred and nine (63.7%) patients were on multiple medications. Side effects of treatment increased with increasing number of medications. The mean quality of life score in monotherapy group and double therapy group were 89.3 ± 15.8 and 80.2 ± 21.1 respectively; while that in ≥ triple therapy group was 78.9 ± 18.8. This decrease in mean quality of life score with increasing number of medications was statistically significant in bivariate analysis (P < 0.01), however, multiple regression analysis showed that the number of medications did not significantly affect the quality of life scores after adjusting for confounding variables(p = 0.881).\r\n\r\nConclusion: Among the patients studied, use of multiple medications, unlike visual acuity (VA) and severity of glaucoma, was not an independent predictor of quality of life.
Correlation between Health-Related Quality Of Life Scores and Measures of Visual Function in an Abuja Cohort of Primary Open Angle Glaucoma Patients.
By Okudo AC, Babalola OE, Onakoya A, Ogunro AT
Published on: 2023-09-05
Background: This study aims to correlate quality of life measures with visual function parameters an...
Background: This study aims to correlate quality of life measures with visual function parameters and to determine the visual function parameters that independently affect the quality of Life in primary open angle glaucoma patients (POAG) in Abuja.\r\n\r\nMethodology: A cross sectional study carried out among 106 POAG patients attending Asokoro District Hospital, Abuja and Eye Foundation Hospital Abuja from Nov 2012 to April 2013. National Eye Institute Visual Function Questionnaire 25 (NEIVFQ25) and Glaucoma Symptom Scale (GSS) were used to assess Quality of Life (QoL) after biodata was obtained. The objective measures of visual function assessed include: visual acuity (VA), contrast sensitivity (CS), colour vision (CV) and visual fields (Mean Deviation). Data was analysed using SPSS Version 20 using Spearman Rho Correlation and linear regression.\r\n\r\nResults: There was a strong correlation between the NEIVFQ25 scores and all the measures of visual function. There was also a strong correlation between GSS and contrast sensitivity in both eyes, and mean deviation of the better eye while the others showed a moderate correlation with the scale. On multivariate analysis of the NEIVFQ25 scores by visual function, the independent visual functions that affects the NEIVFQ25 QoL measures were the visual acuity better eye and contrast sensitivity better eye. Contrast sensitivity in the better eye had a stronger correlation than visual acuity in the better eye. On multivariate analysis of GSS scores by visual function parameters, contrast sensitivity in the better and worse eye were the independent visual function parameters that affect the GSS. The contrast sensitivity of the better eye had a stronger correlation with NEIVFQ25 and GSS.\r\n\r\nConclusion: The study revealed the impact of contrast sensitivity on the quality of life and glaucoma symptoms the patients have. It is important that measures of contrast sensitivity be incorporated into evaluating glaucoma patients.
Profile of central corneal thickness in an adult non-glaucomatous population in Enugu, Southeast Nigeria.
By Uche NJ, Kizor-Akaraiwe NN, Okeke S, Shiweobi J.
Published on: 2023-08-23
Purpose: To determine the mean central corneal thickness (CCT) of healthy adult Nigerians from the I...
Purpose: To determine the mean central corneal thickness (CCT) of healthy adult Nigerians from the Igbo ethnic population in southeastern Nigeria which has the highest prevalence of glaucoma and to evaluate the relationship if any between mean CCT and patients’ demographics.\r\n\r\nMethods: A cross sectional study conducted at an eye screening center in Enugu Southeastern Nigeria. Subjects with healthy eyes from the Igbo ethnic population we\r\n\r\ncorneal thickness was measured with ultrasound pachymetry (Sonomed PacScan plus, model 300AP+) on eligible subjects. Topical anesthetic was instilled and 3 measurements of corneal thickness were taken. The average thickness for each eye was calculated and the relationship between mean CCT, age and gender were studied.\r\n\r\nResults: 706 eyes of 353 participants were examined. 52.7% of the subjects were females while 47.3% were males. The mean age of participants was 50.29 ± 16.58 years. The mean central corneal thickness (CCT) for RE was 527.68 ± 36.88μm (95% CI: 523.83 –531.55μm) and 527.45 ± 38.01μm for LE (95% CI: 523.47 – 531.43μm). There was a decrease in CCT values with increasing age (p= 0.016, p= 0.05 for RE and left eyes respectively). Males had a signicantly higher CCT compared to females for both right and left eyes (p=0.004, p=0.007).\r\n\r\nConclusion: Central corneal thickness values in the Igbo ethnic population of Southeast Nigeria, an ethnic group with the reported highest prevalence of glaucoma in Nigeria from our study is thinner than those reported from other regions both within Nigeria as well as some Sub-Saharan populations, Caucasians, Asians, and Hispanics but it is however comparable with values reported among Cameroonians and African Americans. CCT among Nigerian Igbos, seems to decrease with age and appears thicker in males compared with females.
Glaucomatocyclitic crisis in a Nigerian child: a case report
By TF Sarimiye, S Adebusoye.
Published on: 2023-08-08
Background: Glaucomatocyclitic crisis is a condition that elicits significant elevated intraocular p...
Background: Glaucomatocyclitic crisis is a condition that elicits significant elevated intraocular pressure (IOP) with minimal non-granulomatous anterior uveitis. It is usually unilateral,\r\n\r\noccasionally recurrent, and easily treatable in most cases. It is seen mainly in young adults but is rarely reported in children. This is to report an uncommon case of glaucomatous cyclitic crisis (Posner-Schlossman syndrome) in a Nigerian child.\r\n\r\nCase report: A 15-year-old boy presented with pain, haloes around light, photophobia, and decreased vision in the left eye over the course of the day. He has a similar history from 5 years ago, with a brief resolution on steroid eye drops. Ocular examination in the left eye revealed minimal non-granulomatous anterior uveitis with significantly elevated intraocular pressure. He was treated with topical steroid and ocular hypotensive and his IOP was 14 mmHg at 14 hours, down from 44 mmHg at the start. The anterior chamber was quiet by the fourth day of treatment. The clinical picture in this child was consistent with Posner-Schlossman syndrome. Following resolution of the inflammation and discontinuation of all medications, the patient is being followed up as a glaucoma suspect because of the subtle disc finding and the slight risk of glaucoma development later.\r\n\r\nConclusion: Although glaucomatocyclitic crisis is uncommon in children, it should be considered in the differential diagnosis of uveitis and glaucoma in paediatric patients.
Determinants of participation in glaucoma genomic research in Southeast Nigeria: A cross-sectional analytical study
By Uche NJ, Okoye O, Kizor-Akaraiwe N, Chuka-Okosa C, Uche EO
Published on: 2023-07-14
Background: Genomic research advances the understanding of human health and disease. It also drives ...
Background: Genomic research advances the understanding of human health and disease. It also drives both the discovery of salient genetic association(s) as well as targeted screening,\r\n\r\ndiagnostic and therapeutic strategies. Human subject participation is crucial for the success of genomic research.\r\n\r\nMethods: This is a cross sectional analytical study conducted at two tertiary centers in Enugu Southeast Nigeria. Semi structured questionnaires were administered to eligible consenting participants. Data on their demographics, willingness to participate in genomic research and motivation for participation were obtained. Data was analyzed using Stata version 17 and summarized using median, frequencies and interquartile range(IQR). Associations between covariates were evaluated with Chi square test and multivariable logistic regression.\r\n\r\nResults: Among 228 glaucoma subjects who participated in our study,119(52.2%) were female and 109(47.8%) were male. The median age was 64 years(IQR = 50-76). Although 219 (96.0%) participants expressed willingness to participate in a glaucoma genetic study, only 27(11.9%) of them will be willing to participate if there will not be feedback of results to participants (χ2 = 18.59, P<0.001). No participant expressed willingness to submit ocular tissue samples. Majority (96.2%) of subjects will not participate if the intended research required submission of body samples after death. Desire to know more about glaucoma (63%) was the most common reason for participation. In a multivariable logistic model, subjects between 61-90 years (p = 0.004, OR = 7.2) were 7 times more likely to express willingness to participate in glaucoma genetic research after adjusting for other covariates when compared to subjects aged 41-60 years. Other covariates did not influence participants\' willingness.\r\n\r\nConclusion: Glaucoma subjects are more likely to be willing to participate in genetic research, if they would receive feedback of results. Willingness to participate in genetic research is significantly associated with age.
Burden and clinical profile of genetic eye diseases in children in Nigeria: a descriptive cross-sectional study
By Monye HI, Olawoye OO, Ugalahi MO, Oluleye TS, Ashaye AO. Pan Afr Med J
Published on: 2023-07-06
Introduction: ophthalmic genetics is rapidly evolving globally but is still nascent in much of sub-S...
Introduction: ophthalmic genetics is rapidly evolving globally but is still nascent in much of sub-Saharan Africa, with gaps in knowledge about the burden in the region. This study evaluated the burden and manifestations of genetic eye diseases in children in Ibadan, Nigeria.\r\n\r\nMethods: this was a hospital-based cross-sectional study in which new and follow-up paediatric eye clinic patients were recruited consecutively at the University College Hospital, Ibadan. Children with genetic eye diseases had comprehensive ocular and systemic examinations, and their pedigrees were charted to determine the probable modes of inheritance. The main outcome variables were the proportion of study participants with genetic eye diseases, the probable modes of inheritance, and the clinical diagnoses. Summary statistics were performed using means and standard deviations for numerical variables and proportions for categorical variables.\r\n\r\nResults: fifty-two (12%) of 444 children had genetic eye diseases, and their mean (SD) age was 88.8 ± 50.4 months. Thirteen different phenotypic diagnoses were made following the evaluation of the 52 children, including primary congenital glaucoma (13, 25%) and familial non-syndromic cataracts (8, 15%). The probable modes of inheritance were derived from the pedigree charts, and 30 (58%) conditions were presumed to be sporadic.\r\n\r\nConclusion: this study demonstrated a significant burden and a wide range of paediatric genetic eye diseases in this tertiary referral centre in Nigeria. This information provides invaluable evidence for planning ophthalmic genetic services.
Impact of Covid-19 on clinical care among patients attending the Glaucoma clinic of University of Ilorin Teaching Hospital
By Obajolowo, Tokunbo Sarah; Ibrahim, Yusuf Abiodun; Aderounmu, Azeezzat Bola; Adeoti, Sodiq Gbolahon; Olatunji, Fatai Olasunkanmi.
Published on: 2023-06-14
Background: The outbreak of this novel disease brought about many challenges in non-COVID-19 patient...
Background: The outbreak of this novel disease brought about many challenges in non-COVID-19 patient care, including difficulty accessing eye care services, especially in developing countries. This study aimed to determine the impact of COVID-19 pandemic on clinical care among patients attending the glaucoma clinic of a teaching hospital.\r\n\r\nMethods: A hospital-based cross-sectional study was carried out at the glaucoma clinic of the teaching hospital. Clinic records of participants were reviewed, and questionnaires were filled out over the phone by a trained ophthalmic assistant.\r\n\r\nResults: One hundred and five participants were recruited into the study with a M:F of 1.6:1 and a mean age of 51.1 years (±18.9). As a primary treatment for glaucoma, 58 (55.2%) participants were on intra-ocular pressure (IOP)-lowering medication, while 43 (40.9%) participants had trabeculectomy with mitomycin C application. Seventy (66.7%) participants missed their clinic appointment on an average of 1.52 ± 1.0 (SD) and a range of between one and five. Most of the participants (52, 51.5%) missed their clinic appointment largely on the assumption that the clinic was not running. Thirty-one (29.5%) participants reported that they experienced a reduction in income as a result of the pandemic, which affected the procurement of intra-ocular pressure (IOP)-lowering medications.\r\n\r\nConclusion: Effective delivery of clinical care for participants was severely affected by the pandemic. Social, economic, and financial status of participants were all affected, which had a negative effect on the maintenance of quality care and may worsen IOP control in glaucoma care, which may lead to disease progression.
Sociodemographic characteristics of glaucoma patients in Abuja (a case control study)
By AC Okudo, OE Babalola, A Onakoya, AO Ogunro, AS Kalambe.
Published on: 2023-06-14
Aim: The study aims to describe the sociodemographic characteristics of glaucoma patient, in order t...
Aim: The study aims to describe the sociodemographic characteristics of glaucoma patient, in order to understand the impact of glaucoma on the patients’ sociodemographic profile.\r\n\r\nMaterials and Methods: A case control study carried out among 106 POAG patients and an equal number of age-sex matched controls ie, non POAG patients that have no vision impairing ocular\r\n\r\ndisorder other than presbyopia, attending Asokoro District Hospital, Abuja and Eye Foundation Hospital Abuja from November 2012 to April 2013. Data was analyzed using SPSS Version 20 using Chi square test, independent t test and Analysis of Variance (ANOVA).\r\n\r\nResults: A total of 212 participants were enrolled into the study, they had ages that ranged from 40 to 88 with a mean age of 55.2 among the cases and 55.24 among the controls. The main sociodemographic profile that showed a statistically significant difference was the employment status as 14 of the 17 ie, 82.35% of those unemployed and 27 of the 47 ie, 57.44% of the retirees were glaucoma participants. There was a 5.95 greater odds of glaucoma patients to be unemployed. There was a 4.27 times greater odds of those with severe glaucoma to be unemployed and retired. There was a 4.31 times greater odds of those older than 60 to have severe glaucoma. Majority of the glaucoma participants and those with severe disease were Igbo’s.\r\n\r\nConclusion: There is a clear need for an increased social support to help glaucoma patients cope with the disease.
A Survey on Patients\' Opinions of Alternative Drug Delivery Systems for the Treatment of Glaucoma in South-South Nigeria
By Echieh CI, Mercieca K, Eze UA, Weber C, Akinyemi A, Ibanga AA, Echieh CP.
Published on: 2023-06-12
Purpose: Despite the human ocular surface being easily accessible, ocular drug delivery can be chall...
Purpose: Despite the human ocular surface being easily accessible, ocular drug delivery can be challenging. When applied improperly, topical medications, the most popular first-line treatment used to treat glaucoma, can have a very brief contact time with the ocular surface and may not have the desired therapeutic impact. Drug delivery devices are gadgets that can address some of these problems. This study aims to determine patients\' opinions on ocular drug delivery devices used in the treatment of primary open-angle glaucoma (POAG).\r\n\r\nMethods: A pretested interviewer-administered questionnaire was used in a cross-sectional study of 115 POAG patients recruited from outpatient clinics in two Nigerian tertiary health institutions. Participants were asked about their understanding and acceptance of five Ocular drug delivery systems (ODD), namely drug-emitting contact lenses (CL), punctual plugs, subconjunctival injections, intracameral implants, and trabecular meshwork micro-stents, for the treatment of POAG.\r\n\r\nResults: Sixty (52.2%) participants, whose average age was 50 ± 9.8 years, were men. Self-pay was used for eye health treatments by 65% of participants. Of the participants, 68.7% admitted to using eye drops on their own. 57% of people were said to take their glaucoma medications consistently. CL and subconjunctival implants were seen to be most acceptable according to 39% and 30% of participants, respectively. Major factors determining the acceptability of ODD for POAG treatment were observed to be cost and effectiveness.\r\n\r\nConclusion: Patients in our cohort who are being treated for POAG have a fairly positive attitude towards ODD. The prospective use of these devices for POAG treatment in Nigeria will depend on their efficacy and cost, as well as how ophthalmologists will weigh ODD options.
Comparing Central Corneal Thickness Using Ultrasound and Anterior Segment Optical Coherence Tomography Pachymetry in Adults Attending A Private Eye Clinic in Abuja.
By Okudo AC, Babalola OE.
Published on: 2023-05-16
Background: Central Corneal Thickness (CCT) measurement is useful in the management of glaucoma, ocu...
Background: Central Corneal Thickness (CCT) measurement is useful in the management of glaucoma, ocular hypertension, corneal lesions and kerato-refractive surgeries. The study aims to compare the CCT measurements between Ultrasound Sonography (USS) and Optical Coherence Tomography (OCT), to analyze correlation and agreement between these instruments as well as repeatability of each instrument.\r\n\r\nMethodology: A cross sectional comparative study carried in 100 eyes of 50 patients attending Rachel Eye Center in Abuja from January to March 2021. The CCT were taken using the USS and OCT. CCT was measured using the Pachscan ultrasound and the Optovue machine utilised for the OCT technique. Data was analysed using SPSS version 20 using Paired Sample t Test, Pearson\'s correlation, Interclass Correlation and Bland Altman Methods.\r\n\r\nResults: Patients were aged between 18 and 79 (mean age of 39.1), 72 males and 28 females. The mean CCT was 537.36 ±33.26 and 510.94 ±33.13 for USS and OCT respectively with a mean difference of (26.42±9.53 p<0.001). There was a very strong correlation of the 2 sets of measurement r = 0.997 p<0.001. There was a high average mean intraclass correlation coefficient of 0.843 between the two instruments and this was excellent (0.961) within the 95 percentile upper limit but poor in the (0.096) lower limit. There was a high correlation and no statistical significant difference in the comparing repeated mean USS and OCT measurements. There was an excellent average mean Intraclass Correlation Coefficient of 0.999/0.997 for the repeated OCT and USS values and this was found to be excellent(0.999/0.998) within the 95 percentile upper limit and (0.997/0.994)lower limit respectively.\r\n\r\nConclusion: We find that measurements of CCT using the Pachscan ultrasound and the Optovue OCT correlate well, but the mean Pachscan measures were significantly higher than Optovue measures.
Prcis: Twenty-four-hour intraocular pressure measurement (Phasing) among glaucoma suspects showed higher intraocular pressure (IOP), greater fluctuation, and more varying peak times occurring mostly outside clinic hours, between 12 midnight and 8 am in 68.9% of them.\r\n\r\nPurpose: To characterise 24-hour variation in IOP, in glaucoma suspects and normal individuals in an African population.\r\n\r\nMaterials and methods: A cross-sectional analytical study was carried out between March and October 2019 at the University of Ilorin Teaching Hospital. A total of 204 study participants, comprising 102 primary open angle glaucoma (POAG) suspects and 102 age and sex-matched controls with healthy eyes were recruited. Participants had a comprehensive ophthalmic examination. Measurements of IOP were taken every 2 hours during a 24-hour period using an iCare tonometer.\r\n\r\nResults: The mean age was 43.64±14.02 SD and 43.02±13.55 SD ( P =1.000) for POAG suspects and controls, respectively. The mean peak IOP was significantly higher in POAG suspects (21.87± 4.65 mm Hg) compared with controls (17.17± 2.32 mm Hg) ( P <0.001). Whereas, the mean trough IOP reading was not significantly different between the 2 groups. In both groups of participants, the peak and trough IOP in the majority were recorded outside of clinic hours. The majority (68.9%) of POAG suspects had a peak IOP between midnight and 8 am, whereas the control group peaked mostly at 4 pm (16.7%) and 4 am (41.7%). Twenty-four-hour IOP variation was 6 mm Hg or less in 73.6% of control eyes, while in the POAG suspects, 83.3% of eyes had variation greater than 6 mm Hg.\r\n\r\nConclusions: Compared with age and sex-matched healthy controls, glaucoma suspects of African descent showed significantly higher mean IOP and IOP variation, with most peak IOP detected outside of clinic hours.
Impact of a short online course on the accuracy of non-ophthalmic diabetic retinopathy graders in recognising glaucomatous optic nerves in Vietnam
By Olawoye OO, Ha TH, Pham N, Nguyen L, Cherwek DH, Fowobaje KR, et al.
Published on: 2023-04-05
Purpose: To test an online training course for non-ophthalmic diabetic retinopathy (DR) graders for ...
Purpose: To test an online training course for non-ophthalmic diabetic retinopathy (DR) graders for recognition of glaucomatous optic nerves in Vietnam.\r\n\r\nMethods: This was an uncontrolled, experimental, before-and-after study in which 43 non-ophthalmic DR graders underwent baseline testing on a standard image set, completed a self-paced, online training course and were retested using the same photographs presented randomly. Twenty-nine local ophthalmologists completed the same test without the training course. DR graders then underwent additional one-to-one training by a glaucoma specialist and were retested. Test performance (% correct, compared with consensus grades from four fellowship-trained glaucoma experts), sensitivity, specificity, positive and negative predictive value, and area under the receiver operating (AUC) curve, were computed.\r\n\r\nResults: Mean age of DR graders (32.6±5.5 years) did not differ from ophthalmologists (32.3±7.3 years, p=0.13). Online training required a mean of 297.9 (SD 144.6) minutes. Graders\' mean baseline score (33.3%±14.3%) improved significantly after training (55.8%±12.6%, p<0.001), and post-training score did not differ from ophthalmologists (58.7±15.4%, p=0.384). Although grader sensitivity reduced before [85.5% (95% CI 83.5% to 87.3%)] versus after [80.4% (78.3% to 82.4%)] training, specificity improved significantly [47.8 (44.9 to 50.7) vs 79.8 (77.3 to 82.0), p<0.001]. Grader AUC also improved after training [66.6 (64.9 to 68.3)] to [80.1 (78.5 to 81.6), p<0.001]. Additional one-to-one grader training by a glaucoma specialist did not further improve grader scores.\r\n\r\nConclusion: Non-ophthalmic DR graders can be trained to recognise glaucoma using a short online course in this setting, with no additional benefit from more expensive one-to-one training. After 5-hour online training in recognising glaucomatous optic nerve head, scores of non-ophthalmic DR graders doubled, and did not differ from local ophthalmologists. Intensive one-to-one training did not further improve performance.
Comparison of Ocular Biometry in Primary Open Angle Glaucoma and Non-glaucoma in South West Nigeria.
By Oluwaniyi AT, Olawoye O, Sarimiye TF, Ajayi BGK. J West
Published on: 2023-03-14
Background: Glaucoma is a public health problem in Nigeria. The number of individuals affected by gl...
Background: Glaucoma is a public health problem in Nigeria. The number of individuals affected by glaucoma in Nigeria is much higher than the individuals known to have the disease. Ocular parameters such as intraocular pressure, central cornea thickness, axial length and\r\n\r\nrefractive error have all been documented as risk factors of glaucoma especially among Caucasians and African Americans, with little documentation in Africa where there\'s an alarming rate of blindness.\r\n\r\nAim and objectives: To compare central cornea thickness (CCT), intraocular pressure (IOP), axial length (AL) and refractive state in participants with primary open angle glaucoma (POAG) and non-glaucoma in South-West Nigeria.\r\n\r\nMaterials and methods: This hospital-based case-control study was carried out among 184 newly diagnosed POAG and non-glaucoma adult participants attending the outpatient clinic of Eleta eye institute. The CCT, IOP, AL and refractive state were measured in each participant. Test of significance between proportions in categorical variables were assessed using chi square test (χ2) in both groups. The means were compared using independent t-test while correlation between parameters were analyzed using Pearson correlation coefficient.\r\n\r\nResults: The mean age of the POAG participants was 57.16 + 13.3 years and the mean age of the non-glaucoma participants was 54.15 + 13.4 years. The mean IOP in the POAG group was 30.2 + 8.9mmHg while non- glaucoma group was 14.2 + 2.6mmHg (P < 0.001), other ocular parameters were not significantly different in both groups. In the POAG group, decreased spherical equivalent refractive error (i.e increasing myopia) was significantly associated with increased axial length (r= -0.252, P = 0.01), but not significant in the non- glaucoma group. However, in the non-glaucoma group, central cornea thickness increased with increasing intraocular pressure (r= 0.305, P = 0.003), which was not significant in the glaucoma group.\r\n\r\nConclusion: Patients with POAG had much higher IOP and thus, IOP remains a significant risk factor in its development. There was a significant relationship between refractive state and axial length in the POAG group while a significant relationship was identified between central cornea thickness and intraocular pressure in the non- glaucoma group.
Clinical Characteristics and Stage at Presentation of Glaucoma Patients in Sub-Saharan Africa.
By Olawoye O, Kizor-Akaraiwe N, Pons J, Sarimiye T, Washaya J, Hughes S, et al. J Glaucoma.
Published on: 2023-03-08
Prcis: The initial presentation of glaucoma varies meaningfully across SSA. A comprehensive strategy...
Prcis: The initial presentation of glaucoma varies meaningfully across SSA. A comprehensive strategy with regional customization based on local differences is needed to reduce glaucoma blindness in SSA.\r\n\r\nPurpose: To explore regional variations in the presentation of newly diagnosed glaucoma in Sub Saharan Africa (SSA).\r\n\r\nMethodology: This was a multicenter, cross-sectional study in which newly diagnosed, consecutive, glaucoma patients aged older than or equal to 18 years were recruited from 27 eye clinics in 10 countries throughout SSA. Demographic and ophthalmic examination data were collected. Glaucoma severity was based on optic nerve head and visual field assessment. Statistical analyses were performed using STATA version 14.0.\r\n\r\nResults: Among 1214 enrolled patients with newly diagnosed glaucoma from Western, Eastern, and Southern Africa, the overall mean (SD) age was 59.9 (17.1) years. More than half of all patients (716/1178; 60.8%) presented with severe glaucoma in the worse eye, and one-third (36.9%) had severe glaucoma in both eyes. Primary open angle glaucoma was the commonest form of glaucoma in all regions (77.4%). A family history of blindness (260/1204, 21.6%) was common. Patients from Western Africa had lower mean presenting intraocular pressure (26.4 [11.1] mm Hg, P <0.001), but had worse glaucoma in the better eye based on mean cup-disc ratio (0.8; P <0.001) and mean visual field mean deviation [10.4 (8.4)] dB, P =0.016) compared with other regions. Exfoliation glaucoma was more common in Eastern Africa (30/170=17.7%, P <0.001) compared with other regions.\r\n\r\nConclusion: The initial presentation of glaucoma varies meaningfully across SSA. A comprehensive strategy with regional customization based on local differences is needed to reduce glaucoma blindness in SSA.
Amsler Grid Versus 10-2 Test in Primary Open Angle Glaucoma
By Gbadegesin TM, Olawoye O, Sarimiye TF, Idowu OO, Ajayi BGK.
Published on: 2023-02-15
Background: Glaucoma is the leading cause of global irreversible blindness. The goal of management i...
Background: Glaucoma is the leading cause of global irreversible blindness. The goal of management in glaucoma lies in its early detection and treatment to prevent further optic\r\n\r\nneuropathy. Available equipment for early glaucoma detection is not cost-effective or readily available in resource-scarce settings such as Nigeria. Thus, there is a need for a simple cost-effective tool to detect glaucomatous central visual field (CVF) defects in all the stages of glaucoma within the community in resource scarce-settings. Aims and Objectives: The aim of this article is to determine the validity of the Amsler grid in detecting central glaucomatous visual field defects in primary open angle glaucoma (POAG).\r\n\r\nMaterials and Methods: This was a cross-sectional study of follow-up glaucoma patients at a secondary eye care hospital in Nigeria. All patients had detailed ophthalmic examination in addition to 24-2 and 10-2 CVF tests and Amsler grid test. POAG was classified using the Hodapp–Parrish–Anderson criteria into mild, moderate, and severe on 24-2 CVF. The diagnostic validity of the Amsler grid was calculated using the 10-2 CVF as a reference standard. Regression analyses were performed between the Amsler grid scotoma area and 10-2 CVF parameters [mean deviation (MD), scotoma extent (SE), and scotoma mean depth (SMD)].\r\n\r\nResults: A total of 150 eyes of 150 patients were enrolled. The sensitivity, specificity, and positive predictive value and negative predictive value of the Amsler grid compared with the 10-2 CVF was 49.5%, 95.9%, 96.2%, and 47.9%, respectively, with an area under curve of 0.7. Sensitivity increased with increasing severity (P < 0.001) from 20.0%, 31.0%, and 76.6% in mild, moderate, and severe POAG, respectively. The Amsler grid scotoma area had the strongest relationship with the 10-2 MD, followed by 10-2 SE and 10-2 SMD with a quadratic R2 of 0.579, 0.370, and 0.307, respectively.\r\n\r\nConclusion: The Amsler grid has a low sensitivity in mild-to-moderate POAG. However, it may serve as an adjunctive tool in resource-scarce settings for detection of severe POAG in the community by primary eye care providers.
Optical Coherence Tomography Retinal Nerve Fibre Layer and Ganglion Cell Complex Measurements in Normal Southern Nigerian Eyes.
By Obasuyi OC, Osuji UE, Ifijen CO, Imafidon MA, Ovienria WA, Eguaojie IE, et al. Cureus.
Published on: 2023-01-03
Introduction: Glaucoma is the leading cause of irreversible blindness worldwide. It is more severe i...
Introduction: Glaucoma is the leading cause of irreversible blindness worldwide. It is more severe in people with African heritage, and intraocular pressure remains the only modifiable risk factor in managing glaucoma. Attempts to improve the diagnosis and monitoring of glaucoma are ongoing. One of those attempts is the development of optical coherence tomography (OCT). However, there is a theoretical possibility of a delayed or wrong diagnosis of glaucoma using the OCT because of racial, age, and sex differences in the RNFL (retina nerve fibre layer), GCL (ganglion cell layer), and GCL+IPL (ganglion cell layer and inner plexiform layer) thickness.\r\n\r\nObjective: This study aims to provide the measurements of RNFL, GCL, and GCL+IPL in normal eyes of southern Nigerian patients and specifically to evaluate the relationship of these measurements to gender, age, intra-eye variability, and the Topcon SD-OCT normative database.\r\n\r\nMethod: Three hundred and four eyes of 152 patients who had normal OCT scans using the 6x6 RNFL (four sectors) and Macula scans of the Topcon OCT-1 3D Maestro OCT machine were included for analysis. Parametric tests were used to interrogate the relationship between normally distributed parameters and gender, age, and the Topcon reference database. Non-parametric tests were used for non-normally distributed data.\r\n\r\nResults: The male-to-female ratio was 1:1, and ages ranged between 18 and 71 for both genders. The average RNFL values were 111.49 ± 10.44 (right eye - RE) and 111.96 ± 9.66 (left eye - LE). For the GCL, average values were 66.23 ± 4.4 (RE) and 66.34 ± 4.19 (LE). GCL+IPL values were 104.02 ± 6.71 (RE) and 103.89 ± 6.66 (LE). There was no difference between genders (X2 = 56.467; df = 46; p = 0.160), and RNFL, GCL, and GCL+IPL values showed a significant reduction as the age of the respondents increased. There was a significant difference between RNFL, GCL, and GCL+IPL values and the Topcon reference database, p < 0.001.\r\n\r\nConclusion: Significant differences exist between the Southern Nigerian eyes\' RNFL, GCL, and GCL+ IPL values and the Topcon OCT-1 3D Maestro reference database. While randomised control trials and extensive multi-centre studies have not been conducted to determine the possible effects of these differences between measured values and reference databases of the OCTs, they need to be considered while diagnosing and managing glaucoma with the OCT.
Effectiveness of community outreach screening for glaucoma in improving equity and access to eye care in Nigeria. Br J Ophthalmol. 2023 Jan;107(1):30-36. doi: 10.1136/bjophthalmol-2021-319355
By Olawoye OO, Fawole O, Ashaye AO, Chan VF, Azuara-Blanco A, Congdon N
Published on: 2023-01-03
Purpose: To determine the effectiveness of community outreach screening for glaucoma in improving eq...
Purpose: To determine the effectiveness of community outreach screening for glaucoma in improving equity and access to eye care in Nigeria.\r\nMethodology: This was a prospective study in which two cohort of participants were recruited in Nigeria: 1 from 24 outreach screenings and another from consecutive patients presenting spontaneously to a tertiary eye clinic in Nigeria. Sociodemographic and clinical data were obtained from participants and compared.\r\nResults: Our sample consisted of 120 patients with glaucoma or suspected glaucoma (6.38% of 1881 screenees) recruited from the 24 outreach screenings, and another 123 patients with glaucoma who presented spontaneously at the eye clinic. Participants from the screenings were significantly older (p=0.012), less educated (p<0.001), had lower incomes (p<0.001), lower glaucoma knowledge scores and were less aware of their glaucoma (both p<0.001) and were more likely to be dependent on relations and children (p=0.002) compared with clinic participants. Of the 120 patients identified at the screenings and referred to the clinic for definitive care, 39 (32.5%) presented at the clinic within 3 months. Reasons for poor uptake of referral services were lack of a felt need and lack of money for transportation. Considering only patients who accepted referral, they were still less educated (p<0.001), poorer (p=0.001) and less knowledgeable about glaucoma (p=0.003) than spontaneous clinic presenters.\r\nConclusion: Outreach screening improved equity of access but its effects were somewhat reduced by poor uptake of referral care. Interventions such as free transportation and educational efforts may improve the uptake of referral services and maximise equity gains.
Toward Universal Eye Health Coverage-Key Outcomes of the World Health Organization Package of Eye Care Interventions: A Systematic Review. JAMA Ophthalmol. 2022 Dec 1;140(12):1229-1238.
By Keel S, Lingham G, Misra N, Block S, Bourne R, Calonge M, Cheng CY, Friedman DS, Furtado JM, Khanna R, Mariotti S, Mathenge W, Matoto E, Müeller A, Rabiu M, Rasengane T, Resnikoff S, Wormald R, Yasmin S, Zhao J, Evans JR, Cieza A, Olawoye OO; Package of
Published on: 2022-12-01
Importance: Despite persistent inequalities in access to eye care services globally, guidance on a s...
Importance: Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed.\r\n\r\nObjective: To describe the key outcomes of the PECI development.\r\n\r\nEvidence review: A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review.\r\n\r\nFindings: Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI.\r\n\r\nConclusions and relevance: This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.
An algorithm to convert optical coherence tomography central corneal thickness values to ultrasound central corneal thickness values and its corresponding correction factor.
By A.C. Okudo, O.E. Babalola
Published on: 2022-07-05
Objective: To develop an algorithm to convert OCT CCT values to USS CCT values and apply the corresp...
Objective: To develop an algorithm to convert OCT CCT values to USS CCT values and apply the corresponding correction factor in managing patients.\r\n\r\nDesign: A cross sectional comparative study carried in 100 eyes of 50 patients attending Rachel Eye Center in Abuja from January to March 2021. CCT was measured using the Pachscan ultrasound and the Optovue machine utilised for the OCT technique. Data was analysed using SPSS version 20 using the linear regression analysis. The linear regression formula was then applied to develop an algorithm to convert OCT CCT values to USS CCT values and apply the corresponding correction factor.\r\n\r\nSettings: The study was conducted in a private eye hospital, Rachel Eye Center, Abuja, Nigeria.\r\n\r\nSubjects or Participants: 100 eyes of 50 consecutive patients attending Rachel Eye Center in Abuja from January to March 2021.\r\n\r\nIntervention: The linear regression formula was developed and then applied to develop an algorithm to convert OCT CCT values to preset USS CCT values and it’s the corresponding correction factor.\r\n\r\nMain outcome measures: The linear regression formula OCT=-2.184+ (0.955 x USS) p<0.001\r\n\r\nResults: A linear regression formula OCT=-2.184+ (0.955 x USS) p<0.001 was derived. The linear regression formula was then imputed into Microsoft excel to derive the OCT CCT values of preset USS CCT values alongside their corresponding correction factors, which was obtained from the modified Ehler’s scale.\r\n\r\nConclusions: The algorithm enables us to convert OCT CCT values to USS CCT values and apply the corresponding correction factor in managing our patients.
Background: \r\nThe COVID-19 pandemic greatly affected eye care globally in terms of service provisi...
Background: \r\nThe COVID-19 pandemic greatly affected eye care globally in terms of service provision and training. It is important to recognize the challenges faced and the adaptations instituted to overcome them.\r\n\r\nAim: The aim of this study was to determine the impact of the COVID-19 pandemic on eye care services and training in eye institutions in Nigeria.\r\n\r\nMaterials and Methods: This was a cross-sectional survey involving ophthalmologists and senior ophthalmology trainees selected purposively to ensure a varied representation in terms of location and type of practice. Data collection was done through a web-based questionnaire (Google Forms). The main outcome of interest was the impact of the pandemic on four major aspects of practice: outpatient care, surgical care, inpatient care, and residency training. Data on respondents\' sociodemographic features and practice details were descriptively summarized with means and standard deviations (SDs) for the continuous variables and proportions for the categorical variables. Practice patterns before and at the height of the pandemic were compared for the four aspects of practice, and P < 0.05 was considered statistically significant.\r\n\r\nResults: A total of 59 responses were received from eye institutions in 28 states in Nigeria. The mean age of respondents was 38.1 years (SD 6) and 36 (61%) were female. Forty-seven (81.4%) responses were from participants working in public institutions and 40 (67.8%) responses were from respondents whose institutions run ophthalmology residency training programs. Glaucoma was the most affected subspecialty during the pandemic (24, 40.7%). Respondents reported complete closures of clinics (21, 35.6%), theaters (40, 67.8%), and wards (18, 30.5%) at the height of the pandemic. Training activities requiring physical contact were negatively affected, while reports on the use of virtual seminars increased to 75% (n = 30) at the peak of the pandemic from 5% (n = 2) before the pandemic. Overall, all respondents affirmed that the pandemic negatively affected their practice, and 51 (86%) reported an extent of more than 25%.\r\n\r\nConclusion: The COVID-19 pandemic has disrupted most aspects of ophthalmology practice. Adaptations are required to ensure the optimization of patient care and training experiences in the post-COVID era.
Clinical Characteristics and Stage at Presentation of Glaucoma Patients in Sub-Saharan Africa.
By Olawoye O, Kizor-Akaraiwe N, Pons J, Sarimiye T, Washaya J, Hughes S, Ashaye A, et al …Realini T
Published on: 2022-06-06
Precis: The initial presentation of glaucoma varies meaningfully across SSA. A comprehensive strateg...
Precis: The initial presentation of glaucoma varies meaningfully across SSA. A comprehensive strategy with regional customization based on local differences is needed to reduce glaucoma blindness in SSA.\r\n\r\nPurpose: To explore regional variations in the presentation of newly diagnosed glaucoma in Sub Saharan Africa (SSA).\r\n\r\nMethodology: This was a multicenter, cross-sectional study in which newly diagnosed, consecutive, glaucoma patients aged older than or equal to 18 years were recruited from 27 eye clinics in 10 countries throughout SSA. Demographic and ophthalmic examination data were collected. Glaucoma severity was based on optic nerve head and visual field assessment. Statistical analyses were performed using STATA version 14.0.\r\n\r\nResults: Among 1214 enrolled patients with newly diagnosed glaucoma from Western, Eastern, and Southern Africa, the overall mean (SD) age was 59.9 (17.1) years. More than half of all patients (716/1178; 60.8%) presented with severe glaucoma in the worse eye, and one-third (36.9%) had severe glaucoma in both eyes. Primary open angle glaucoma was the commonest form of glaucoma in all regions (77.4%). A family history of blindness (260/1204, 21.6%) was common. Patients from Western Africa had lower mean presenting intraocular pressure (26.4 [11.1] mm Hg, P <0.001), but had worse glaucoma in the better eye based on mean cup-disc ratio (0.8; P <0.001) and mean visual field mean deviation [10.4 (8.4)] dB, P =0.016) compared with other regions. Exfoliation glaucoma was more common in Eastern Africa (30/170=17.7%, P <0.001) compared with other regions.\r\n\r\nConclusion: The initial presentation of glaucoma varies meaningfully across SSA. A comprehensive strategy with regional customization based on local differences is needed to reduce glaucoma blindness in SSA.
Cross-sectional survey to determine awareness and uptake of Glaucoma surgery.
By Nkiru N Kizor-Akaraiwe, Ifeoma N Asimadu, Nkechi J Uche, Suhanyah Okeke, Obinna Shiweobi.
Published on: 2022-05-02
Introduction: This study aimed to determine the awareness and uptake of surgery as a treatment optio...
Introduction: This study aimed to determine the awareness and uptake of surgery as a treatment option in patients with glaucoma on medical treatment.\r\n\r\nMethods: A cross-sectional survey was conducted among consenting patients with primary glaucoma who were on medical treatment. The survey was conducted in two eye care facilities (government-owned and private). After responding to a questionnaire, patients had ocular examinations, including visual acuity, anterior/posterior segment examinations, gonioscopy and central visual field testing. Information was obtained on the patients’ awareness of a surgical option, and reasons for non-uptake among those offered surgery were recorded. Logistic regression analysis was used to identify possible predictors of awareness of glaucoma.\r\n\r\nResults: Across both facilities, 299 patients with glaucoma with a mean age of 63.9 years participated in this study. There were 167 (55.9%) male and 132 (44.1%) female participants. Two hundred and sixty-seven (89.3%) had a formal education, and of the 169 evaluated for visual fields in the worse eye, 129 (76.3%) had severe (advanced) glaucoma. Only 79 (26.4%) of the participants were aware of surgery as a treatment option for glaucoma. The multivariate analysis found that female patients, patients from the private eye care facility and patients with primary angle closure glaucoma patients were more likely to be aware of glaucoma surgery than male patients, patients from the government-owned eye care facility and patients with primary open-angle glaucoma. Patients with primary angle closure glaucoma were more likely to be aware of glaucoma surgery than those with primary open-angle glaucoma. Cost was identified as the major barrier to the uptake of glaucoma surgery when it was recommended, followed by fear of blindness. Age, level of education and severity of disease had no statistical relationship to awareness of glaucoma surgery.\r\n\r\nConclusion: Incorporating routine glaucoma education and counselling into glaucoma care protocols will likely improve awareness of glaucoma surgery as a treatment option
The Impact of the COVID-19 Pandemic on Postgraduate Ophthalmology Training Program in Nigeria.
By TF Sarimiye, H Monye, O Olawoye, S Hughes
Published on: 2022-02-09
Background: The severe acute respiratory syndrome coronavirus 2 which causes coronavirus disease 201...
Background: The severe acute respiratory syndrome coronavirus 2 which causes coronavirus disease 2019 (COVID-19) has resulted in a challenging and an unprecedented pandemic in the 21st century. This pandemic affects almost all aspects of human life including the medical field.\r\n\r\nMethods: This was a cross-sectional, descriptive multicenter survey of resident doctors in ophthalmology training programs in Nigeria. An anonymous web survey was created on Google form and circulated to ophthalmology residents in Nigeria using electronic communication tools between April and July 2020.\r\n\r\nResults: Seventy-two ophthalmology residents in 25 residency training institutions across five geopolitical zones of the country participated in the online survey. There was a significant decrease in the number of patients attended to in the clinic per week by respondents, time spent in consulting per patient, number of unit admissions per week, frequency of eye camps and outreaches per month, and number of surgeries performed by the unit per month (P = 0.000) in the COVID era compare to the pre-COVID era. Two-thirds of respondents felt their posting schedules had been affected at least to a moderate extent, this in turn affected their eligibility for examinations. Three-quarters of the respondents also felt that the pandemic had negatively affected trainer–trainee and mentor–mentee relations in terms of knowledge transfer. Respondents recommended a greater focus on online learning.\r\n\r\nConclusion: In this survey, the impact of the COVID-19 pandemic has been shown to negatively impact ophthalmology residency training. A need for a paradigm shift in training may be the way forward.
Visual improvement following Trabeculectomy in a 17‑year‑old
By T.F Sarimiye, J. Ofuadar
Published on: 2022-01-04
Glaucoma is a leading cause of blindness globally; however, in terms of the irreversibility of blind...
Glaucoma is a leading cause of blindness globally; however, in terms of the irreversibility of blindness, it is the number one cause. Glaucoma treatment aims at slowing the progression and reducing the risk of further structural and functional damage as much as possible. A rare subset of glaucoma is juvenile open-angle glaucoma (JOAG) diagnosed in individuals between 3 and 40 years of age. The JOAG tends to have rapid progression and it is associated with higher intraocular pressure (IOP) and fluctuations compared to primary open-angle glaucoma. The IOP also tends to be refractory to medical therapy control and often requires surgical intervention. In the treatment of glaucoma, functional improvement is not an expectation. This is a case report of a JOAG patient with visual improvement following trabeculectomy. A 17-year-old female presented with a 4-year history of gradual visual loss in both eyes. Diagnosed elsewhere to have glaucoma with no known baseline IOP value and is already on travoprost. Visual acuity (VA) at presentation was counting finger (close to face right eye, 2 m left eye) and IOP were 22 and 19 mmHg, respectively. The patient subsequently underwent trabeculectomy with mitomycin C in both eyes at a single sitting. She had a marked improvement in vision postoperatively. At 6 weeks postoperative review, VA was 6/36 and 6/18 in the right and left eyes, respectively, and pressures were 9 and 8 mmHg, respectively. There is currently no proven mechanism to explain visual recovery; however, visual improvement may have resulted from some reversal of retinal ganglion cell damage following significant IOP lowering. Improvement in vision is not an expectation following treatment for glaucoma; however, some case reports have reported this occurrence following trabeculectomy. Hence, even in very advanced presentations, especially in young individuals as in this case, there should not be hesitation with surgical intervention following appropriate counseling.
Prevalence of blood born viral infections among glaucoma patients in south-east, Nigeria
By Arinze Anthony Onwuegbuna, Akunne Ijeoma Apakama, Emeka Akujobi Chianakwalam, Chisom God’swill Chigbo and George Uchenna Eleje
Published on: 2022-01-04
Background: The hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (...
Background: The hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are blood-borne viral infections. They can predispose to occupational related infections in health care settings, including ophthalmology practice. \r\nObjectives: To determine the prevalence of and risk factors associated with HBV, HCV, and HIV among glaucoma patients. \r\nMethods: A retrospective cross-sectional study was conducted in a private specialist eye hospital on glaucoma patients managed between 1st August, 2020 and 31st July, 2021. A total of 594 patients met inclusion criteria of primary diagnoses of glaucoma. All blood samples were tested for HBsAg, anti-HCV, and anti-HIV. The data was collected, entered and analyzed using STATA version 17.0 (College Station, TX: StataCorp LLC). The descriptive statistics were determined by means of percentages. Chi-square was used for trend analysis and p-value was used to declare the statistical significance between the variables. \r\nResults: The overall prevalence of HBV, HCV and HIV was 2.41% (15/622, 95%CI=1.35-3.98), 1.45% (9/622, 95%CI=0.66-2.75) and 3.22 (20/622, 95%CI=1.96-4.97) respectively. The prevalence of HBV was significantly higher in males compared to female counterparts. The prevalence of HBV was not influenced by age while the prevalence of HCV and HIV were not influenced by gender nor age. \r\nConclusion: The prevalence of HBV, HCV, and HIV are high among glaucoma patients in south-east Nigeria. These findings have implications for practice on the need to strengthen the health care education and practice of universal safety precautions in ophthalmology practice.\r\n
