The Journal of Ophthalmology of Eastern, Central and Southern Africa <p>The Journal of Ophthalmology of Eastern, Central and Southern Africa (JOECSA) is the official Journal of the College of Ophthalmology of Eastern, Central and Southern Africa (COECSA) with a subscribed membership of about 500. <em>JOECSA</em> is an open access journal, published in English in hard and soft copy formats and is dedicated to all aspects of ophthalmology and community eye health.</p> <p>This peer-reviewed scientific journal publishes research papers contributing towards new knowledge in eye care, prevention of blindness and poverty eradication efforts relevant to Eastern, Central and Southern Africa. JOECSA’s broad objective is to produce a high quality, regular, self-sustaining, peer reviewed ophthalmic journal which will increase local and international visibility and citation of ophthalmic research from the Eastern and central African Region.</p> <p><em>JOECSA</em> is a fully open access journal, providing authors with a distinctive new online submission and interactive review service on its recently improved portal:</p> <p><a href=""></a></p> College of Ophthalmology of Eastern, Central and Southern Africa en-US The Journal of Ophthalmology of Eastern, Central and Southern Africa Diabetic Retinopathy Screening Program in Southwestern Uganda <p><strong>Objectives: </strong>The projected near doubling of prevalence of diabetes mellitus (DM) between 2019 and 2045 is a global public health crisis; associated with this, the burden of diabetic retinopathy (DR) is also expected to increase, especially in low-resourced settings. To prevent avoidable visual impairment and blindness, early detection through screening and early treatment are necessary. However, in Uganda this was severely lacking at a population level.</p> <p><strong>Methods: </strong>We developed the Lions Diabetic Retinopathy Project for southwestern Uganda to serve a region including 17 Districts with eight million inhabitants. This included a three-pronged strategy for mass screenings, human resources development, and capacity building of the region’s referral eye hospital and primary health centres.</p> <p><strong>Results: </strong>In 1.5 years, 60 DR screening camps were implemented; this led to screening of 9,991 high risk individuals for DM and 5,730 DM patients for DR. We referred 1,218 individuals with DR for further management at the referral eye hospital, but only 220 (18%) attended referral. The main barrier for not attending referral was long travel distance and the associated direct and indirect costs. Human resources trained included 34 ophthalmic nurses, five midlevel providers, and one vitreoretinal surgeon. Major equipment procured included a vitrectomy system, an outreach vehicle, and non-mydriatic fundus cameras.</p> <p><strong>Conclusions: </strong>This project provided evidence that a DR screening can be successfully implemented in a resource-limited setting and be integrated into the general health system. However, geographic barriers need to be bridged and models of care delivery bringing services closer to areas with poorer access are needed to manage the burden of DR.</p> Simon Arunga Tu Tran Pliers Tusingwire Teddy Kwaga Raheel Kanji Ritah Kageni Lakoulo Hortense Sam Ruvuma Amos Twinamasiko Bernard Kakuhikire Benon Kataate Karen Kilberg Gillian Gibbs Michael Kakinda Roger Harrie John Onyango Copyright (c) 2021 Professor Simon Arunga, Tu Tran, Pliers Tusingwire, Teddy Kwaga, Raheel Kanji, Ritah Kageni, Lakoulo Hortense, Sam Ruvuma, Amos Twinamasiko, Bernard Kakuhikire, Benon Kataate, Karen Kilberg, Gillian Gibbs, Michael Kakinda, Roger Harrie, John Onyango 2021-07-12 2021-07-12 24 2 Development of attributes relevant to satisfying ophthalmic care among health providers and adult patients: A qualitative study at Harare Central Hospital, Zimbabwe. <p><strong>Objective</strong>: To develop attributes relevant to satisfying ophthalmic care among health providers and patients.</p> <p><strong>Design:</strong> Mixed-method study.</p> <p><strong>Settings</strong>: Harare Central Hospital Eye Unit, Zimbabwe.</p> <p><strong>Subjects</strong>: A convenience sample of 30 eligible adult patients who had come for eye care at the outpatients’ department and 18 health care providers.</p> <p><strong>Methods</strong>: This study was conducted as the first phase of a two-phase broader study. We held five focus groups with patients and doctors separately and twelve in-depth key informant interviews with nurses. Participants were asked to identify attributes of the care process they regarded as leading to satisfying eye care. We recorded full details and used a tallying method to record frequencies. We then ranked and identified key attributes, with the top three attributes regarded as the most important.</p> <p><strong>Results</strong>:&nbsp; The study developed nine attributes from health providers and seven attributes from health users. The most important attributes for health providers were the availability of drugs, good staff attitude and the availability of equipment. Patients prioritised good staff attitude, adequate information and the availability of doctors. All the attributes mentioned by health users were mentioned by health providers but ranked differently.</p> <p><strong>Conclusion</strong>: Both clinical and nonclinical attributes of care were considered by health providers and health users. Overall, attributes that were important to patients were linked to interpersonal relations (attitudes, communication, availability of, and access to doctors). Health providers’ preferences were mostly clinical (drugs and equipment). Acknowledging these differences in perspectives may help policymakers when designing frameworks for quality health services.</p> <p>&nbsp;</p> MARTINA KAWOME Rangarirai Masanganise Sherpherd Shamu Copyright (c) 2021 MARTINA KAWOME, prof, DR 2021-07-12 2021-07-12 24 2 54 58 The Ingredients and Microbiology Studies of Traditional Eye Medicine in a Teaching Hospital in Southwest Uganda. <p><strong>Purpose</strong>: The aim of this study is to investigate the usage, ingredients, and microbiological profile of traditional eye medicine (TEM) at a teaching hospital in southwest Uganda.</p> <p><strong>Methods</strong>: This was a single-center prospective pilot study that included 11 individuals who used TEM before presenting to a tertiary eye center of the Mbarara University of Science and Technology between Feb 15, 2017, and Feb 24, 2017. We noted the patients’ demographics, chief complaints, reasons for using TEM, and duration of treatment. We obtained the 19 samples of TEM and reviewed botanical contents and the microbiologic profile via gram staining, KOH staining, and cultures on blood-heart infusion agar, blood agar, chocolate agar, and potato dextrose agar.</p> <p><strong>Results</strong>: The most common reason for using TEM was cultural belief, followed by the cost of western medications and distance to the eye clinic. Cataracts and allergic conjunctivitis were the most common diagnoses made. The major contents were botanical sources. Sixteen out of 19 samples (84%) showed positive microbial culture; 6 samples were polymicrobial, and 10 were monomicrobial. <em>Klebsiella </em>species was the most common microorganism, being isolated from 13 samples. Other bacterial organisms included <em>Staphylococcus</em> aureus and <em>Bacillus</em> species. Fungal species such as <em>candida</em> and <em>aspergillus</em> species were isolated as well.</p> <p><strong>Conclusion</strong>: Most of our patients used TEM due to cultural beliefs. Eighty-five percent of the TEM samples showed positive microbiology culture, predominantly with <em>Klebsiella</em> species. Further microbiologic studies are warranted to identify the correlation between the use of TEM, corneal contamination, and corneal ulcers.</p> Chang Sup Lee Shruti Aggarwal Simon Arunga Sandra Johnson Copyright (c) 2021 Chang Sup Lee, Shruti Aggarwal, Simon Arunga, Sandra Johnson 2021-07-12 2021-07-12 24 2 59 63 Mooren’s Ulcer in Uganda: A Prospective Observational Case Series <p class="Default" style="text-align: justify;"><strong><span lang="EN-GB" style="font-family: 'Arial',sans-serif;">Purpose: </span></strong><span lang="EN-GB" style="font-family: 'Arial',sans-serif;">Mooren’s ulcer is an aggressive, chronic, and painful ulceration of the cornea, commonly seen in adult men. It is difficult to treat, often resulting in poor visual outcomes. There is limited published evidence on its management. Our aim was to describe the presentation, treatment and outcomes of patients presenting with Mooren’s ulcer in Mbarara, Uganda over a defined time period.</span></p> <p class="Default" style="text-align: justify;"><strong><span lang="EN-GB" style="font-family: 'Arial',sans-serif;">&nbsp;</span></strong><strong><span lang="EN-GB" style="font-family: 'Arial',sans-serif;">Methods: </span></strong><span lang="EN-GB" style="font-family: 'Arial',sans-serif;">A prospective observational case series conducted over 3 months from August 2017 to November 2017, with scheduled reviews up to 3 months. Participants’ history, presentation, management and clinical course were captured. Laboratory investigations for underlying systemic diseases were performed, in addition to corneal microbiology testing. </span></p> <p class="Default" style="text-align: justify;"><strong><span lang="EN-GB" style="font-family: 'Arial',sans-serif;">Results: </span></strong><span lang="EN-GB" style="font-family: 'Arial',sans-serif;">We enrolled a total of 8 patients (6 males). The median age was 26 years (IQR 22-27.5, full range 16-32). A history of trauma was present in 3 (38%) of cases. The earliest presenting time was 1 month after start of symptoms. <a name="_Hlk42110052"></a>At presentation, 2 (25%) patients had normal vision, 3 (38%) had moderate vision impairment (VI), 1 (12%) had severe VI, and 2 (25%) were blind. There was no systemic disease diagnosed on investigation, but corneal microbiology revealed 3 (38%) ulcers had fungal co-infections. <a name="_Hlk42110071"></a>At 3 months, 4 (50%) patients had normal vision, 1 (12%) had moderate VI, and 3 (38%) were blind. No patients required evisceration or enucleation.</span></p> <p class="Default" style="text-align: justify;"><span lang="EN-GB" style="font-family: 'Arial',sans-serif;">&nbsp;</span><strong><span lang="EN-GB" style="font-family: 'Arial',sans-serif;">Conclusion: </span></strong><span lang="EN-GB" style="font-family: 'Arial',sans-serif;">Mooren’s ulcer is difficult to treat and further studies to assess risk factors would be beneficial in providing evidence for better management of this condition, particularly in resource limited settings.</span></p> Denise Kavuma Simon Arunga John Onyango Astrid Leck Jeremy Hoffman Victor Hu Mathew Burton Copyright (c) 2021 Denise, Simon, John, Astrid, Jeremy, Victor, Mathew 2021-07-12 2021-07-12 24 2 64 71 A Concurrent Retinoblastoma And Morning Glory Disc Anomaly <p>Concurrent occurrence of retinoblastoma and ocular anomalies is rare. We present a case of retinoblastoma and morning glory disc anomaly in a baby. Both conditions had leukocoria in each eye, which was noted at different stages of the clinical evaluation. &nbsp;Although our patient did not have other associated features, this scenario requires distinct multi- disciplinary approach for management of each of the conditions and any accompanying clinical conditions.&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> Lucy Njambi Kahaki Kimani Beatrice Nyabuga Copyright (c) 2021 Lucy Njambi, Kahaki Kimani, Beatrice Nyabuga 2021-07-12 2021-07-12 24 2 72 74 Argon laser for subhyoid retinal haemorrhage <p>To present a case of severe pre-retinal hemorrhage that was treated with Argon laser posterior hylodotomy.</p> RAHEEL Kanji Copyright (c) 2021 RAHEEL Kanji 2021-07-12 2021-07-12 24 2 75 77