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> en-US (Emmanuel Muindi Nyenze) (JOECSA) Wed, 19 Apr 2023 00:00:00 -0400 OJS 60 Malignant hypertensive retinopathy in a postnatal patient with pregnancy induced hypertension: Case report <p>Pregnancy Induced Hypertension (PIH) is one of the leading causes of maternal and perinatal mortality, especially in developing countries. Hypertensive retinopathy is a common condition in patients with PIH. Patients mostly present with mild hypertensive retinopathy changes such as arteriolar narrowing and arteriovenous nicking. Malignant hypertensive retinopathy is a rare finding in PIH patients. We present a case of a 32 year old postnatal woman with PIH who developed malignant hypertensive retinopathy in both eyes during post-partum period.</p> Zungu TL, Mdala S, Gandiwa M, Mhango P, Kayange PC Copyright (c) 2023 Zungu TL, Mdala S, Gandiwa M, Mhango P, Kayange PC Wed, 19 Apr 2023 00:00:00 -0400 Indications for destructive eye surgery at Sekuru Kaguvi Eye Hospital, Zimbabwe <p><strong>Background:</strong> Destructive Eye Surgery (DES) is a management option that is offered as a final resort where<br>keeping the globe risks jeopardizing life or the general health of an individual. The three destructive eye<br>operations are: evisceration, enucleation and exenteration in order of increasing aggressive nature of the<br>operation.<br><br><strong>Objective:</strong> To find out the common indications for destructive eye surgeries (DES) at Sekuru Kaguvi Hospital<br>(SKH).<br><br><strong>Methods:</strong> Patients who presented to Sekuru Kaguvi Hospital in the period January to March 2017 who ended<br>up having some form of DES were enrolled into the study. Data was collected on participant demography,<br>occupation, the affected eye, diagnosis and the subsequent DES done.<br><br><strong>Results:</strong> A total of 37 eyes of 37 patients had DES done during the period January to March 2017. Generally<br>more males had DES done on them compared to females (73%). Percentages of the DES done were:<br>eviscerations 51.4%, enucleations 29.7% and exenterations 18.9%. The main indication for DES was trauma in<br>32.4%, followed by retinoblastoma in 21.6%, panophthalmitis in 21.6%, ocular surface squamous neoplasia<br>in 18.9%, staphyloma and painful blind eye in 5.4%. The commonest indication for the eviscerations was<br>a ruptured globe in 57.9%, the remainder being panophthalmitis. There was a total of 11 ruptured globes<br>requiring an evisceration and 10 (90.9%) were males. Globe ruptures attributed to assault were 71.2%. The<br>mean age for eviscerations was 39.21 years. Of the total enucleations done, 72.7% were children under 5<br>years (average age 2 years), the commonest indications being retinoblastoma in this group (87.5%). A total<br>of 7 exenterations were performed, the commonest indication being ocular surface squamous neoplasia in<br>85.7%. Males were at a higher chance of being exenterated than females (5:2). Most of the removed eyes had<br>no vision (no light perception in 73%, light perception in 18.9%, hand movement in 5.4% and 3/60 in 2.7%).<br><strong><br>Conclusion:</strong> The main indication for DES was trauma followed by panophthalmitis and retinoblastoma.<br>The commonest indication for exenteration was OSSN which can be treated earlier before warranting eye<br>removal. There is thus need to address these preventable conditions and risks that can lead to eye removal.</p> Mangombe S, Masanganise R Copyright (c) 2023 Mangombe S, Masanganise R Wed, 19 Apr 2023 00:00:00 -0400 Conjunctival malignant melanoma mimicking scleromalcia perforans: a case report <p>Malignant melanoma of the conjunctiva is a relatively infrequent neoplasm that can be associated with<br>significant morbidity and cause diagnostic difficulty to both the ophthalmologist and pathologist. We herein<br>describe a case of malignant conjunctival melanoma which clinically simulated scleromalcia perforance<br>causing sclerouveal staphyloma or huge conjunctival cyst. Being rare but potentially lethal tumour,<br>conjunctival melanoma should be included in the differential diagnosis of slowly growing conjunctival<br>masses or sclerouveal staphylomas for early detection and management.</p> Mulatu DG, Adamu Y, Ayalew M Copyright (c) 2023 Mulatu DG, Adamu Y, Ayalew M Wed, 19 Apr 2023 00:00:00 -0400 Central corneal thickness and its relationship with IOP, visual fields and optic disc parameters among glaucoma patients attending the Eye Hospital at University Teaching Hospitals in Lusaka, Zambia <p><strong>Background:</strong> Glaucoma is a heterogeneous group of optic neuropathies characterized by an acquired loss<br>of retinal ganglion cells, optic nerve atrophy and Visual Field Defects (VFD). Raised Intraocular Pressure (IOP)<br>is the only causal risk factor for glaucoma that can be therapeutically and surgically manipulated to change<br>the course of the disease process. Though Goldman Applanation Tonometry (GAT) is the “gold standard”<br>for IOP measurement, readings of IOP with GAT are believed to be influenced by Central Corneal Thickness<br>(CCT). The study evaluated the correlation of CCT and IOP with VFD parameters like Mean Deviation (MD),<br>Pattern Standard Deviation (PSD) and Cup-to-Disc Ratio (CDR) in Primary Open Angle Glaucoma (POAG)<br>patients.<br><strong><br>Objective:</strong> To determine the relationship of central corneal thickness, intraocular pressure, visual fields and<br>optic disc parameters in Zambian primary open angle glaucoma patients.<br><br><strong>Methods:</strong> A cross-sectional study was conducted in 2014 from January to September and all glaucoma<br>patients visiting the University Teaching Hospitals – Eye Hospital during the study period were included<br>if they consented to it and met the inclusion criteria. A total of 166 randomly selected newly diagnosed<br>glaucoma patients aged 18 years and above were recruited. The CCT was measured using Kacon Ophthalmic<br>Ultrasound system and IOP was measured by GAT. Analyses were carried out considering the level of<br>significance at 5%.<br><strong><br>Results:</strong> One hundred and sixty-six newly diagnosed glaucoma patients aged 18 to 88 years were included<br>into the study. There were 85 (51.2%) males and 81 (48.8%) females with a mean age being 51.31 years. The<br>mean IOP was 23.60 (±10.40) mmHg. The mean CCT was 531.9 (±40.59). All the participants had primary<br>open angle glaucoma POAG. Thin CCT was significantly correlated with vertical CDR (r= - 0.023, and 0.011).<br>Thin CCT was also significantly associated with worsened MD of visual field (r= - 0.033 and p=0.023) and PSD<br>(r= - 0.027 and p=0.012).<br><br><strong>Conclusions:</strong> The mean CCT of Zambian POAG patients is thinner as compared to other races. CCT was<br>positively correlated with IOP. Patients who had thicker CCT were more likely to have low IOP compared to<br>patients who had thinner CCT. In the POAG patients thinner CCT was associated with greater cup disc ratio<br>and Visual Field (VF) damages than those with a thicker CCT.</p> Muma MKI, Nyalazi JIM, Mumba T, Zulu G, Syakantu G, Chinama – Musonda LM, Bailey R, Simulundu E, Michelo C Copyright (c) 2023 Muma MKI, Nyalazi JIM, Mumba T, Zulu G, Syakantu G, Chinama – Musonda LM, Bailey R, Simulundu E, Michelo C Wed, 19 Apr 2023 00:00:00 -0400 What is a good PhD program in ophthalmology?: Students’ perspective <p>Access to doctoral studies is increasing and the impact of PhD programs is generally understood to be<br>positive. However, the lack of clarity about what a PhD entails can be a barrier to student entry into the<br>programs. During the pre-entry period, students need to consider the reasons for choosing to take PhD and<br>the value expected from it. In practice, this involves complex considerations related to personal, institutional,<br>logistical and PhD program characteristics. As such, prospective students would benefit from a reflection<br>on these factors in advance of registering for the PhD. Realising that there is a limited published literature<br>on what makes a PhD ‘good’, in this paper we explore the factors that contribute to students’ perception<br>of a good scholarly engagement. We use an interview format to report on some broad areas of relevant<br>consideration. We conclude that sustained student motivation, effective supervision, adequate facilities and<br>a supportive environment are pertinent for the learning that makes a PhD ‘good’.</p> Mwangi N, Rono H, Arunga S, Mdeme F Copyright (c) 2023 Mwangi N, Rono H, Arunga S, Mdeme F Wed, 19 Apr 2023 00:00:00 -0400 Retinopathy of prematurity: Prevalence and risk factors among infants in rural Kenya <p><strong>Background:</strong> Retinopathy of Prematurity (ROP) is a potentially blinding eye disorder that is seen in premature<br>infants. Data is scanty on prevalence rates in Africa. This study was done to determine the prevalence and<br>risk factors for ROP in a rural hospital in Kenya.</p> <p><strong>Design:</strong> A prospective cohort study.</p> <p><strong>Methods:</strong> The study was carried out at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu,<br>Kenya between March 2015 and April 2016 in the neonatal unit and outpatient eye clinic. Infants less than<br>32 weeks gestation and/or weighing less than 1500 grams at birth, plus those with an unstable clinical<br>course had a dilated fundoscopic examination starting at 28 days of life. Exam findings were recorded using<br>standard IC-ROP classification. Examinations were repeated every 1-2 weeks until mature vasculature in<br>zone III was confirmed. Infants were excluded if they died before the ROP outcome or if they did not show<br>up for the first outpatient exam.</p> <p><strong>Results:</strong> One hundred and thirty one neonates were included in the study, with a male to female ratio of<br>1:0.95 (64/67). Mean gestational age was 30.64 ± 3.6 weeks and mean birth weight was 1478 ± 414.08 grams.<br>Of these, 91 (69.5%) had been on oxygen, with a mean of 4.6 ± 5.9 days on oxygen. Four babies developed<br>ROP (a prevalence of 3.05%). Three (75%) had zone II, stage 1 ROP and one (25%) had zone II, stage 2 ROP;<br>all regressed without treatment. No infant developed vision-threatening ROP. Peri-natal risks identified<br>in this group included respiratory distress syndrome, prolonged oxygen administration, intra-ventricular<br>haemorrhage and seizures.<br><br><strong>Conclusion:</strong> ROP prevalence was much lower than that reported in other studies, with all cases of ROP<br>regressing without treatment. The presence of ROP in this setting however, makes a case for screening in<br>hospitals in rural areas.</p> Sitati SM, Ojuma MS, de Alba CAG Copyright (c) 2023 Sitati SM, Ojuma MS, de Alba CAG Wed, 19 Apr 2023 00:00:00 -0400 Primary open angle glaucoma as seen at the University Teaching Hospital, Lusaka, Zambia <p><strong>Objective:</strong> To determine the prevalence of Primary Open-Angle Glaucoma (POAG) among patients attending<br>eye clinic at University Teaching Hospital (UTH).</p> <p><strong>Design:</strong> A cross sectional survey.</p> <p><strong>Methods:</strong> The POAG survey was carried out at the eye clinic of the University Teaching Hospital (UTH), Lusaka<br>from January to December 2013. The clients (n = 1,625) had a full ocular examination and their demographic<br>information (specifically age, sex, residence and ethnicity) was captured. The ocular examination included<br>visual acuity and intraocular pressure (IOP) among others. Multivariate logistic regression, stratified by age<br>group and gender, was used to determine the association between demographic factors and POAG.</p> <p><strong>Results:</strong> Of the 1,714 patients randomly sampled for the study, 89 (5.2%) declined to participate in the study;<br>hence the response rate of 94.8%. The ages ranged from 20 to 98 years, with a median age of 51 years (IQR<br>45, 59). The prevalence of POAG was 19.0% (95% CI, 14.6%, 23.8%), distributed as 5.7% (95% CI 3.2, 9.1) in<br>males and 13.3% (95% CI 11.7, 21.3) for females. Females were more likely to have POAG than males (72.9%<br>vs. 27.1%; OR 2.78, 95% CI 2.1, 5.8). Surprisingly, age groups younger than 40 years had higher proportion of<br>POAG compared to the older population (61.6% vs. 38.4%, P&lt;0.001). The main determinants of POAG were<br>age, sex and Diabetic Retinopathy (DR). There was a significant negative correlation between POAG and HIV<br>infection (r2 = 0.0269; p&lt;0.001).</p> <p><strong>Conclusion:</strong> The prevalence of POAG in this population of 19.0% was higher and certainly not comparable<br>to those in black populations in Barbados, St. Lucia, Nigeria, Ghana and South Africa. The striking finding<br>of this study was that 40.7% of all the identified POAG cases were below the age of 40 years. There was no<br>association between POAG and HIV infection</p> Muma MKI, Bailey R, Michelo C Copyright (c) 2023 Muma MKI, Bailey R, Michelo C Wed, 19 Apr 2023 00:00:00 -0400 Outcomes of paediatric cataract surgery at Lighthouse for Christ Eye Centre - Mombasa, Kenya: A retrospective case series <p><strong>Background:</strong> Paediatric cataract is one of the main and treatable causes of childhood blindness and visual<br>impairment in developing countries, with varied outcome because of lack of properly equipped facilities,<br>late presentation and poor follow-up.</p> <p><strong>Objective.</strong> This study aimed to assess the outcome of non-traumatic cases of paediatric cataract surgically<br>managed at Lighthouse for Christ Eye Centre, Mombasa, Kenya.</p> <p><strong>Methods:</strong> This was a retrospective case series carried out from 1st January 2013 to 31st December 2014. Eyes<br>of children&lt;16 years of age operated for non-traumatic cataract, were included. The clarity of the visual axis<br>and the Visual Acuity (VA) were the primary outcome measures. The types of surgery, the method of aphakic<br>correction and complication rates were also recorded.</p> <p><strong>Results:</strong> Most patients were males (male: female ratio of 2.5:1). Majority of patients were in the 1-5 year age<br>category (48.7%). Most patients were bilaterally affected (70.5%), with developmental cataract being the<br>most common in 67.7% of eyes. Majority of the surgeries done were lensectomy + anterior vitrectomy (AV)<br>+ intraocular lens (IOL) implantation. Foldable IOLs were the most commonly implanted, in 82 eyes (75.2%).<br>Twenty-four eyes were left aphakic (18%). The most common type of post-operative refractive correction<br>was spectacles (55.6%). Majority of eyes with post-operative VA recorded, fell in the good outcome category<br>as per World Health Organization (WHO) and Kilimanjaro Centre for Community Ophthalmology (KCCO)<br>guidelines, for each follow-up visit. More than 90% of eyes had a clear visual axis for each follow-up period.<br>At 12 weeks follow-up period, post-operative findings and complications were noted in approximately 40%<br>of eyes, the most common finding was amblyopia (8.8 %).<br><br><strong>Conclusion:</strong> Lens washout, primary posterior capsulotomy, anterior vitrectomy and primary intra-ocular<br>lens implantation offers an effective method for correction of aphakia related to paediatric cataract surgery.<br>It also maintained a clear visual axis for up to 1 year post-operatively with a significant number (&gt;90%)<br>remaining clear at each follow up visit. A majority of eyes (50%) had good visual outcome.<br>Recommendations: Strict follow up schedule is advised for consistent visual rehabilitation to further<br>improve the outcome.</p> Shiramba B, Mukiri M, Njambi L, Matende I Copyright (c) 2023 Shiramba B, Mukiri M, Njambi L, Matende I Wed, 19 Apr 2023 00:00:00 -0400 Impairment of vision among commercial motorcyclists (Bodaboda riders) in Uganda <p><strong>Background:</strong> To determine the prevalence and factors associated with impaired vision among commercial motorcyclists (bodaboda) riders in Uganda.</p> <p><strong>Objective:</strong> To determine the prevalence and factors associated with impaired vision among commercial motocyclists (bodaboda) riders in Uganda.Methods: This was a descriptive cross-sectional study done in Kawempe South division in Kampala district. Socio-demographic characteristics, relevant medical and riding history were recorded. All riders underwent a general medical examination and a detailed ocular examination which included vision, anterior and posterior segment assessment. A rider with impaired vision was defined as one whose presenting visual acuity was 6/12 or less in either eye.</p> <p><strong>Results:</strong> Seven hundred and twenty four male riders, aged between 17 to 56 years (mean 30.3 years, Standard deviation=7.2 years) were recruited. Thirty riders (4.1%, 95%CI: 2.7- 5.6) had impaired vision in either eye. Eight riders (1.1%) had visual impairment in both eyes. The ocular disorders associated with impaired vision included: refractive errors 12 (40%), uveitis 6 (20%) and anophthalmic socket 4 (13.3%), ptosis 2 (6.7%), amblyopia 2 (6.7%) corneal scar 2 (6.7%) and cataract 2 (6.7%).</p> <p><strong>Conclusion:</strong> A significant proportion of bodaboda riders in Kampala have impaired vision. The causes of impaired vision were ocular disorders that are treatable and reversible if diagnosed early.</p> Lusobya RC, Ssali-Nsibirwa G, Kiggundu JB, Atukunda I, Samia HA, Otiti- Sengeri J Copyright (c) 2023 Lusobya RC, Ssali-Nsibirwa G, Kiggundu JB, Atukunda I, Samia HA, Otiti- Sengeri J Wed, 19 Apr 2023 00:00:00 -0400 Traumatic central retinal artery occlusion with optic neuropathy: a case report <p>Traumatic optic neuropathy with central retinal artery occlusion is rare. We report a case of an 11 year old male<br>patient who presented with poor vision in the left eye after blunt trauma to the forehead. The visual acuity was<br>light perception and he had relative afferent pupillary defect. Examination and investigations revealed optic<br>neuropathy with central retinal artery occlusion and patent cilioretinal artery. In spite of treatment with oral<br>prednisolone for 2 weeks the visual acuity remained light perception after 3 months of follow up. The right eye<br>was found to be normal. Traumatic central retinal artery occlusion is rare but should be ruled out in patients with<br>poor vision due to trauma to the head.</p> Sonjoy KD, Situma PW, Kareko CW Copyright (c) 2023 Sonjoy KD, Situma PW, Kareko CW Wed, 19 Apr 2023 00:00:00 -0400 Profile of amblyopia at Sabatia Eye Hospital <p>Background: Amblyopia is a visual development disorder whose onset is in childhood. It becomes resistant<br>to treatment after the critical age of 7 – 8 years when the visual system is estimated to have matured. Early<br>diagnosis is vital to the prevention of visual impairment caused by amblyopia.<br><strong>Objective:</strong> This study aims to determine the proportion and profile of amblyopia among children who presented<br>at the Sabatia Eye Hospital in 2014.<br><strong><br>Methods:</strong> This was a quantitative, hospital-based, retrospective case series. All children aged below 16 years who<br>fit the amblyopia case definitions and were seen at Sabatia Eye Hospital between 1st January and 31st December<br>2014 were included in the study. The 2014 outpatient records were used to recruit the study population.<br><strong><br>Results:</strong> A total of 268 patients (451 eyes) were recruited in the study from the 4,269 files assessed, giving a<br>proportion of 6.3%. Most patients [183 (68.28%)] had bilateral amblyopia. Refractive amblyopia (56.54%) was the<br>most common type and it was predominantly due to ametropia. Two thirds of children with refractive amblyopia<br>presented after the age of 8 years. The second most common type of amblyopia was combined (31.49%) followed<br>by sensory deprivation (9.31%) and strabismic (2.66%) amblyopia. Moderate amblyopia (58.47%) was more<br>common than deep amblyopia (41.53%) and was predominantly due to refractive errors.<br><br><strong>Conclusion:</strong> Refractive amblyopia is the most common type of amblyopia and has a predominantly late</p> Wanyonyi M, Njambi L, Kariuki M, Sitati S Copyright (c) 2023 Wanyonyi M, Njambi L, Kariuki M, Sitati S Wed, 19 Apr 2023 00:00:00 -0400 Prevalence of keratoconus in patients with allergic conjunctivitis attending Kenyatta National Hospital eye clinic <p><strong>Objective:</strong> To determine the prevalence of keratoconus among patients with allergic conjunctivitis aged<br>between 8 and 30 years, attending Kenyatta National Hospital eye clinic.<br><strong><br>Methods:</strong> A cross sectional study of patients on follow up for allergic conjunctivitis. They were examined on the<br>slit lamp, clinical signs of keratoconus were elicited, and then keratometry and corneal topography was done on<br>each of them. The social demographic and clinical data was captured in a questionnaire. Descriptive analysis of<br>the data was done to determine means, frequencies and proportions of the various variables. The relationship<br>between the demographic characteristics of the patients, the duration and severity of allergic conjunctivitis,<br>with keratoconus was assessed.<br><strong><br>Results:</strong> Two hundred and forty six eyes of 123 patients were examined. Keratoconus prevalence was found to<br>be 10.6% by clinical diagnosis, 14.6% by keratometry and 30.9% by topography. Majority of those diagnosed<br>with keratoconus were aged 10 to 14 years (42.1%). The male: female ratio of those with keratoconus was 1.9:1,<br>and among them 34.2% had moderate allergic conjunctivitis, and 42.1% had severe allergic conjunctivitis, which<br>was statistically significant. Patients with allergy symptoms for more than 10 years formed the largest proportion<br>of those with keratoconus (42.1%).<br><br><strong>Conclusion:</strong> The prevalence of keratoconus in patients with allergic conjunctivitis was found to be high and<br>the majority were male. Corneal topography diagnosed more patients with keratoconus, and therefore is highly<br>recommended as part of the follow up investigations for all patients with allergic conjunctivitis. This will ensure<br>early detection and management of the condition.</p> Mugho SN, Ilako D, Nyenze EM Copyright (c) 2023 Mugho SN, Ilako D, Nyenze EM Wed, 19 Apr 2023 00:00:00 -0400 Outcomes of trabeculectomy among glaucoma patients in Uganda: A 4-year hospital based audit <p><strong>Objective:</strong> To determine the outcomes of trabeculectomy surgery and predictors of post-operative Intra Ocular<br>Pressure (IOP) among glaucoma patients attending Ruharo Eye Centre.<br><br><strong>Materials and Methods:</strong> In a clinical audit conducted from January to June 2016, we reviewed records of all<br>patients who had undergone trabeculectomy at Ruharo Eye Centre (REC), at least in one eye prior to recruitment.<br>We made phone calls to patients inviting them for a clinical examination. For the patients who turned up, we<br>recorded their Best Corrected Visual Acuity (BCVA), Visual Fields (VFs), Intra Ocular Pressure (IOP), Cup-Disc<br>Ratio (CDR), and any post-operative complications. We also asked patients about their general satisfaction with<br>both the operation and vision. We did a before and after comparison analysis on several outcome measures<br>using STATA v14. These included: visual acuity, intra ocular pressure, cup disc ratio and visual field. We defined<br>treatment success as a post-operative IOP reduction of 40% from baseline and analyzed for its predictors in a<br>multivariate regression model.<br><br><strong>Results:</strong> Sixty-two eyes of 38 patients were included in this study. Median age was 66 years (range 24 to 91<br>years). Median observation time was 2.8 years (range 0.2-4.6 years). Overall treatment success rate was 95%.<br>Mean IOP pre-and post-operatively was 32 mmHg (95% CI 29.3-34.7) and 12.9 mmHg (11.7-14.2) respectively,<br>P=0.001; there was no significant worsening of visual acuity and visual field loss. Mean visual acuity Log MAR pre<br>and post-operatively was 0.58 (95% CI 0.48-0.68) and 0.65 (95% CI 0.52-0.78), P=0.21. Mean visual field defect<br>was 23.4 (95% CI 21.4-25.5) and 22.9 (95% CI 20-9-25.0), P=0.44.<br><br><strong>Conclusion:</strong> Trabeculectomy in our setting seemed to have a good success rate and provided good IOP control,<br>preservation of vision and visual fields.</p> Mbumba FB, Hirnschall N, Arunga S, Kwaga T, Onyango J, Rigal K Copyright (c) 2023 Mbumba FB, Hirnschall N, Arunga S, Kwaga T, Onyango J, Rigal K Wed, 19 Apr 2023 00:00:00 -0400 Outcomes of surgery for stage 4 and 5 retinopathy of prematurity in a developing country <p><strong>Objective:</strong> To assess anatomical and visual outcomes plus complications of surgeries in patients with stage 4<br>and 5 retinopathy of prematurity in a tertiary eye care centre in Bangladesh.<br><br><strong>Methods:</strong> Retrospective case series of all patients that underwent surgery for stage 4 and 5 retinopathy of<br>prematurity between January 2015 and January 2018 was carried out. Anatomic outcomes, qualitative visual<br>acuity as well as the complications were assessed.<br><br><strong>Results:</strong> Thirty three eyes of 25 patients were recruited in the study (12 male and 13 female). Overall 22 (66.7%)<br>of the eyes had complete retinal re-attachment. The percentage for complete re-attachment for stage 4A, 4B,<br>and 5 were 89.5%, 66.7% and 12.5% respectively. Overall 19 eyes (57.6%) had ability to fix and follow objects. This<br>included 14 eyes (73.7%) in stage 4A, 4 eyes (66.7%) in stage 4B and 2 eyes (25.0%) in stage 5. The commonest<br>complications noted were cataracts (15.2%), vitreous haemorrhage (15.2%) and glaucoma (9.1%).<br><br><strong>Conclusion:</strong> Anatomical outcomes of surgery for stage 4A retinopathy of prematurity are very encouraging<br>while those of stage 4B and 5 are poorer. Consequently, visual outcomes for stage 4A are also better than those<br>for stage 4B and 5.</p> Nazmun N, Situma PW, Sonjoy KD, Malek A Copyright (c) 2023 Nazmun N, Situma PW, Sonjoy KD, Malek A Wed, 19 Apr 2023 00:00:00 -0400 Development of attributes relevant to satisfying ophthalmic care among health providers and adult patients at Harare Central Hospital, Zimbabwe: a mixed method study <p>Objective: To develop attributes relevant to satisfying ophthalmic care among health providers and patients.<br><strong>Design:</strong> Mixed-method study.<br><br><strong>Settings:</strong> Harare Central Hospital Eye Unit, Zimbabwe.<br><br><strong>Subjects:</strong> A convenience sample of 30 eligible adult patients who had come for eye care at the outpatients’<br>department and 18 health care providers.<br><br><strong>Methods:</strong> This study was conducted as the first phase of a two-phase broader study. We held five focus groups<br>with patients and doctors separately and twelve in-depth key informant interviews with nurses. Participants<br>were asked to identify attributes of the care process they regarded as leading to satisfying eye care. We recorded<br>full details and used a tallying method to record frequencies. We then ranked and identified key attributes, with<br>the top three attributes regarded as the most important.<br><strong><br>Results:</strong> The study developed nine attributes from health providers and seven attributes from health users.<br>The most important attributes for health providers were the availability of drugs, good staff attitude and the<br>availability of equipment. Patients prioritised good staff attitude, adequate information and the availability of<br>doctors. All the attributes mentioned by health users were mentioned by health providers but ranked differently.<br><strong><br>Conclusion:</strong> Both clinical and nonclinical attributes of care were considered by health providers and health<br>users. Overall, attributes that were important to patients were linked to interpersonal relations (attitudes,<br>communication, availability of, and access to doctors). Health providers’ preferences were mostly clinical (drugs<br>and equipment). Acknowledging these differences in perspectives may help policymakers when designing<br>frameworks for quality health services.</p> Kawome MM, Shamu S, Masanganise R Copyright (c) 2023 Kawome MM, Shamu S, Masanganise R Wed, 19 Apr 2023 00:00:00 -0400 Sensitivity and specificity of McMonnies Questionnaire in diagnosing dry eye syndrome among patients aged 40 years and above in Uganda <p><strong>Objective:</strong> To evaluate the sensitivity and specificity of McMonnies Questionnaire (MQ) as a screening tool for<br>Dry Eye Syndrome (DES) among patients aged 40 years and above attending Ruharo Eye Centre (REC).</p> <p><strong>Design:</strong> This was a cross-sectional hospital-based study.</p> <p><strong>Methods:</strong> The study was conducted during the months of September to December 2017. Both males (76) and<br>females (91) who were aged 40 years and above using convenient sampling were included. All participants were<br>screened for DES using McMonnies Questionnaire after which assessment for the signs of DES using Schirmer<br>I, TBUT and Rose Bengal tests were done. We entered data into Excel and exported into Stata 13.0 for analysis.</p> <p><strong>Results:</strong> A total of 167 patients were enrolled, 91 (54.49%) were females. The female to male ratio was 1.2:1. The<br>median age of the patients was 63 years (IQR: 54-72, range: 40-94). The median Schirmer I, TBUT and MQ scores<br>were 14 mm (IQR: 5-22, range: 1-35), 6.67 seconds (IQR: 3.33-17, range: 1-34.33) and 12 (IQR: 9-17 range of 2-27).<br>The prevalence of DES was 68%. The sensitivity and specificity of McMonnies Questionnaire in diagnosing DES<br>were 81.6% (95% CI, 73.2 - 88.2) and 39.6% (95% CI, 26.5 - 54) respectively.</p> <p><strong>Conclusion:</strong> The McMonnies Questionnaire had a high sensitivity (81.3%)but low specificity (36.9%) in diagnosing<br>DES. Therefore, when such a test is negative, it is good for ruling out DES but not suitable for identifying<br>people at risk of the disease.</p> Atto G, Twinamasiko A, Arunga S Copyright (c) 2023 Atto G, Twinamasiko A, Arunga S Tue, 18 Apr 2023 00:00:00 -0400 Glaucoma awareness in Sub Saharan Africa region: Review and strategies <p>There is low level of awareness on glaucoma among the public in the region and there is a need for more research.<br>Raising glaucoma awareness has multiple impacts that ultimately contribute to early detection, management<br>and avoiding blindness due to the disease. There are various strategies for raising awareness on glaucoma and<br>the experience in Ethiopia has shown the importance of raising glaucoma awareness in terms of early detection<br>of disease, compliance to glaucoma management, acceptance of surgery, mobilizing stakeholders, and getting<br>due attention to glaucoma as a public health problem.</p> Gessesse GW, Mulugeta A, Giorgis AT, Ayele FA Copyright (c) 2023 Gessesse GW, Mulugeta A, Giorgis AT, Ayele FA Wed, 19 Apr 2023 00:00:00 -0400 From strabismus to pseudo-strabismus and familial exudative vitreoretinopathy, a clinical journey of phenotypically identic twins with symmetric ocular features <p>Familial Exudative Vitreoretinopathy (FEVR) is a rare genetic condition and several genes have been identified.<br>Clinically, it can cause macular dragging and therefore pseudo-strabismus or exudative or tractional retinal<br>detachment leading to loss of vision in severe cases. Other symptoms including refractive error, cataract and<br>glaucoma have been documented. The main differential diagnosis remains retinopathy of prematurity. We<br>report two phenotypically identic twins that were seen in a lower level hospital and diagnosed with strabismus<br>presumed to be secondary to myopia. A multidisciplinary team including optometrist, paediatric and vitreoretinal<br>ophthalmologists re-examined the twins and found eccentric fixation and features of FEVR on fundoscopy<br>and angiography. There was a high chance that the twins would have been managed only with spectacles<br>missing the opportunity to be followed up for a more severe vitreoretinal proliferative disease. This case report<br>underlines the genetic basis of the disease with symmetrical and equally distributed myopia, macular dragging<br>and subsequent pseudo-strabismus and FEVR angiographic features. A multidisciplinary team-work was of<br>utmost importance. Beside refractive error correction, the twins also benefited from laser photocoagulation to<br>the avascular retinae to prevent further progress of the proliferative vitreoretinopathy. A good clinical history is<br>enough to rule out retinopathy of prematurity and focus on other causes of retinal fibrovascular membranes in<br>the pediatric population. The fluorescein angiography can be decisive in the clinical setting while genotyping is<br>essential for genetic counseling. Clinicians in low income countries may depend solely on a good clinical history<br>and examination but a high index of suspicion in presence of clinical features of FEVR is key.</p> Pathan AH, Niyonzima JC, Sazzad Iftekhar QS Copyright (c) 2023 Pathan AH, Niyonzima JC, Sazzad Iftekhar QS Wed, 19 Apr 2023 00:00:00 -0400 Characteristics of babies referred to a tertiary eye hospital of Bangladesh for retinopathy of prematurity screening and management, a database analysis <p><strong>Background:</strong> IspahaniIslamia Eye Institute and Hospital (IIEIH) is a not for profit hospital and a leading Retinopathy<br>of Prematurity (ROP) screening center in Bangladesh.</p> <p><br><strong>Objective:</strong> The study had an aim to analyze the characteristics of referred babies and identify possible bottlenecks<br>in the referral system.</p> <p><br><strong>Methods:</strong> Electronic records of babies referred to IIEIH for a period of three years (2016-2018) were analyzed<br>retrospectively. All the babies registered in the electronic file were screened by any of the three consultants with<br>a keen interest in ROP. Variables of interest were ROP stage, gestational age, birth weight, time to screening, referring<br>institution and treatment modalities (laser, Anti-VEGF, retina surgery or combination). Data was exported<br>to SPSS version 23 for Mac for descriptive and correlation analysis. A P-value of less than 0.05 was considered<br>statistically significant.</p> <p><br><strong>Results:</strong> Eight hundred and eighty seven babies with ROP stage 1 or above were registered over the 3 years<br>period, a large majority were referred mostly by neighbouring private institutions (75%), 60% of babies were<br>moderate pre-terms according to WHO classification, the mean birth weight was 1563±397.1 grams. ROP stage<br>2 was dominant (37%) and 61% of any stage ROP babies had at least one treatment modality. There was an obvious<br>delay in screening since only 55% of babies were screened within a period of less than 8 weeks. The younger<br>the gestational age and the lower the birth weight, the higher the risk of presenting with ROP with advanced<br>stage. (P-value&lt;0.001).</p> <p><br><strong>Conclusions:</strong> The majority of babies with ROP came from private institutions and more than half of them needed<br>at least one treatment modality. The delay in screening was a key bottleneck and needs to be addressed. We<br>recommend more NICUS and more ROP services in public hospitals</p> Niyonzima JC, Nahar N, Chowdhury M, Kumar SD, Rahman M Copyright (c) 2023 Niyonzima JC, Nahar N, Chowdhury M, Kumar SD, Rahman M Wed, 19 Apr 2023 00:00:00 -0400 Diabetic retinopathy screening program in Southwestern Uganda <p><strong>Objectives:</strong> Between 2019 and 2045, the prevalence of Diabetes Mellitus (DM) will double; associated with<br>this, the burden of Diabetic Retinopathy (DR) is also expected to increase, especially in low-resourced settings.<br>To prevent avoidable visual impairment and blindness, early detection through screening and early treatment<br>are necessary. To enable access to these services, we developed the Lions Diabetic Retinopathy Project for<br>southwestern Uganda to serve the region including 17 Districts with eight million inhabitants.<br><strong><br>Methods:</strong> A three-pronged strategy for mass screenings levering the existing general health system and<br>opportunistic screening of higher-risk population. Capacity building involved training a vitreoretinal surgeon<br>and allied eye care providers, installing critical infrastructure at the referral eye hospital, and acquiring equipment<br>for primary health centres.<br><br><strong>Results:</strong> In 1.5 years, 60 DR screening camps were implemented; this led to screening of 9,991 high risk<br>individuals for DM and 5,730 DM patients for DR. We referred 1,218 individuals with DR for further management<br>at the referral eye hospital, but only 220 (18%) attended referral. The main barrier for not attending referral<br>was long travel distance and the associated direct and indirect costs. Human resources trained included 34<br>ophthalmic nurses, five midlevel providers, and one vitreoretinal surgeon. Major equipment acquired included<br>a vitrectomy system, an outreach vehicle, and non-mydriatic fundus cameras.<br><strong><br>Conclusions:</strong> DR screening can be implemented in a resource-limited setting by integrating with the general<br>primary healthcare system. However, geographic barriers stymie delivery of therapeutic services and we need<br>to establish models to bring these services closer to areas with poorer access.</p> Arunga S, Tran T, Tusingwire P, Kwaga T, Kanji R, Kageni R, Hortense LN Ruvuma S, Twinamasiko A, Kakuhikire B, Kataate B, Kilberg K, Gibbs G, Kakinda M, Harrie R, Onyango J Copyright (c) 2023 Arunga S, Tran T, Tusingwire P, Kwaga T, Kanji R, Kageni R, Hortense LN Ruvuma S, Twinamasiko A, Kakuhikire B, Kataate B, Kilberg K, Gibbs G, Kakinda M, Harrie R, Onyango J Wed, 19 Apr 2023 00:00:00 -0400 Concurrent retinoblastoma and morning glory disc anomaly in a 9 month old baby: a case report <p>Concurrent occurrence of retinoblastoma and other ocular anomalies is rare. Appearance of leukocoria in the<br>other eye usually signals bilateral disease although this is not always the case. This emphasises the need of<br>careful examination always. We present a case of retinoblastoma and morning glory disc anomaly in a baby.<br>Both conditions had leukocoria in each eye, which was noted at different stages of the clinical evaluation.<br>Although our patient did not have other associated features, this scenario requires distinct multi- disciplinary<br>approach for management of each of the conditions and any accompanying clinical disorders.</p> Nyabuga B, Njambi L, Kimani K Copyright (c) 2023 Nyabuga B, Njambi L, Kimani K Wed, 19 Apr 2023 00:00:00 -0400 Argon laser for subhyaloid retinal haemorrhage: a case report <p>To present a case of severe pre-retinal haemorrhage that was treated with Argon laser posterior hyaloidotomy.<br>A 30-year-old female, non-diabetic and non-hypertensive patient presented with sudden painless loss of vision<br>in the left eye and no history of trauma. Her vision was counting fingers in that eye. Retinal imaging showed<br>severe pre-retinal haemorrhage over the macular area. Argon laser posterior hyaloidotomy was immediately<br>performed. Blood drained inferiorly into the vitreous cavity with clearance of the premacular area. Her vision<br>improved to 6/9 within 30 minutes. Neglect of early intervention for preretinal haemorrhage with the Argon<br>laser leads to complications such as vision loss and prolonged time for visual recovery. Argon laser hyaloidotomy<br>is a viable option for prompt vision recovery.</p> Kanji R, Ruvuma S, Kwaga T, Wiaffe G, Soliman A, Tuswingwire P, Arunga S Copyright (c) 2023 Kanji R, Ruvuma S, Kwaga T, Wiaffe G, Soliman A, Tuswingwire P, Arunga S Wed, 19 Apr 2023 00:00:00 -0400 Factors associated with poor presenting vision among patients with microbial keratitis In Uganda <p><strong>Objective:</strong> To determine factors associated with poor presenting vision among patients with microbial keratitis<br>in Uganda.<br><strong><br>Design:</strong> Retrospective audit study.<br><br><strong>Methods:</strong> This was a study of patients presenting with microbial keratitis at the two main eye units in Southern<br>Uganda in the year 2015. Information on time to presentation, treatment history, use of traditional eye medicine,<br>trauma and presenting final visual acuity was collected. Factors associated with a poor presenting vision in a<br>regression model were analysed.<br><br><strong>Results:</strong> There were 273 cases during the year 2015. The median presentation time was 7 days from onset<br>(IQR 2-21, total range 0-366 days). Trauma was reported in 59/88 (67%) patients and 69/162 (43%) reported<br>using traditional eye medicine. Visual acuity was reported in only 216/273 cases at presention. Visual acuity at<br>presentation of less than 6/60 (severe visual impairment) was strongly associated with the use of traditional eye<br>medicine (OR 5.13, 95%CI 2.17–12.1, p=0.001) and distance from the eye hospital (OR 1.02, 95% CI 1.01-1.03,<br>p=0.002).<br><strong><br>Conclusion:</strong> This audit highlighted the role of use of traditional eye medicine and long distance from the eye<br>hospital in contributing to poor presentation among patients with microbial keratitis in Uganda.</p> Arunga S, Atto G, Ayebazibwe B, Onyango J, Macleod D, Hu VH, Burton MJ Copyright (c) 2023 Arunga S, Atto G, Ayebazibwe B, Onyango J, Macleod D, Hu VH, Burton MJ Wed, 19 Apr 2023 00:00:00 -0400 Bilateral eyelid Kaposi’s sarcoma: a case report <p>Kaposi’s Sarcoma (KS) is a generalized angio-sarcoma caused by the Human Herpes Virus type 8 (HHV-8).<br>Infection by the Human Immunodeficiency Virus (HIV) has been shown to predispose to the development of<br>KS. The commonest location of KS lesions include the skin of the lower limbs, hard palate and gastrointestinal<br>system, lymph nodes and lungs. The occurrence of KS on the eye is considered rare. We report a case of a 45 year<br>old HIV positive female patient who presented with bilateral eyelid KS as the first manifestation of systemic KS.<br>Excisional biopsies were done on both eyelids. The histology showed fascicles of spindle cells and extravasation<br>of red blood cells. A histological diagnosis of bilateral eyelid KS was made.</p> Saiko M, Agrippa FM, Rudo MM Copyright (c) 2023 Saiko M, Agrippa FM, Rudo MM Wed, 19 Apr 2023 00:00:00 -0400 Review of outcome of horizontal childhood strabismus surgery at Kenyatta National Hospital and Kikuyu Eye Unit <p><strong>Background:</strong> With early management of strabismus, improved visual acuity and better cosmetic outcomes<br>can be achieved. Strabismus surgery aims to improve the cosmetic appearance of the eyes and eventually<br>reduce the negative psycho-social impact, possibly restore Binocular Single Vision (BSV) and centralize or<br>expand the field of BSV hence this study is of importance to determine whether we are achieving the aims<br>of surgery.<br><br><strong>Objectives:</strong> The aim of this study was to determine the outcome of horizontal childhood strabismus surgery<br>at Kenyatta National Hospital (KNH) and Kikuyu Eye Unit (KEU).<br><strong><br>Methods:</strong> A retrospective case series was carried out targeting children who underwent strabismus surgery.<br><br><strong>Results:</strong> A total of 199 children (0 – 15 years) who had corrective strabismus surgery from June 2008 to June<br>2013, of whom 122/199 (61.3%) completed the 2-3 month follow-up. Forty one out of ninety (45.6%) cases<br>of esotropia and 19/32 (59.4%) cases of exotropia had a good outcome, while the poor outcome was 15/90<br>(16.7%) and 2/32 (6.3%), respectively. Bilateral medial rectus recession for esotropia had 12/34 (35.3%) good<br>outcome and 6/34 (17.6%) poor outcome, while recess-resect procedure for esotropia had 27/53 (50.9%)<br>good and 9/53 (17%) poor outcome. Bilateral lateral rectus recession for exotropia had 4/9 (44.4%) good and<br>1/9 (11.1%) poor outcome, while for recess-resect procedure for exotropia had 15/23 (65.2%) good and 1/23<br>(4.3%) poor outcome.<br><strong><br>Conclusions:</strong> The most common type of paediatric strabismus was esotropia. Most common surgery<br>performed was a recess-resect procedure for all types of tropia. Surgical success rate was generally good.</p> Fazal AF, Kimani K, Nyamori J, Mundia D Copyright (c) 2023 Fazal AF, Kimani K, Nyamori J, Mundia D Wed, 19 Apr 2023 00:00:00 -0400 Psychological experiences of adult patients with blindness secondary to glaucoma at Lions Sight First Eye Hospital in Blantyre, Malawi <p><strong>Background:</strong> Glaucoma is the second leading cause of blindness in the world. Blindness secondary to<br>glaucoma is irreversible, and thus people experience lifelong blindness once they develop blindness from<br>glaucoma. Currently, there is lack of literature regarding psychological experiences of patients living with<br>blindness secondary to glaucoma in Africa.<br><br><strong>Objective:</strong> To explore psychological experiences of adult patients with blindness secondary to glaucoma.<br><br><strong>Method:</strong> A hospital based qualitative study at a tertiary government eye hospital was done among adult<br>patients who presented with blindness secondary to glaucoma. Selection of participants was done by<br>purposive sampling and individual in-depth interviews were used to collect data among study participants<br>until data saturation. Data was analyzed using content analysis.<br><br><strong>Results:</strong> Eight adult patients (7 men and 1 woman) with blindness secondary to glaucoma were interviewed.<br>Patients with glaucoma experienced psychological distress and depression due to unemployment, lack<br>of basic needs and worries related to unaccomplished family obligations. The patients felt restricted in<br>performing activities of daily living which consequently overburden their caregivers.<br><br><strong>Conclusion:</strong> This study has shown that adult patients who are blind from glaucoma experience challenging<br>mental health problems. There is a need for integration of psychosocial care into the management of patients<br>with blindness secondary to glaucoma.</p> Chilonga FS, Kayange PC, Manda CS, Zungu TL, Masulani-Mwale C Copyright (c) 2023 Chilonga FS, Kayange PC, Manda CS, Zungu TL, Masulani-Mwale C Wed, 19 Apr 2023 00:00:00 -0400 Solitary retinocytoma in a seven year old boy <p>Retinal astrocytoma is a rare benign tumour of astrocytes in the neurosensory retina. Detection usually occurs in childhood or adolescence. In this age group the diagnosis of solitary cases can be challenging as they may mimick retinoblastoma. However, there are cases that have been diagnosed in adulthood. In this case report, a seven year old boy presented with long standing history of leukocoria. The discussion highlights the management and distinguishing features with other causes of leukocoria.</p> Wanyonyi M, Njambi L, Kimani K, Gachago M, Njuguna M Copyright (c) 2023 Wanyonyi M, Njambi L, Kimani K, Gachago M, Njuguna M Wed, 19 Apr 2023 00:00:00 -0400 Review of ocular trauma in Tamale Teaching Hospital, Tamale, Ghana <p><strong>Objective:</strong> To establish the epidemiologic characteristics, referral pattern, interventions, visual outcomes and complications resulting in visual impairment/blindness among ocular trauma patients in Tamale Teaching Hospital (TTH) Eye Clinic, Tamale, Ghana.<br><br><strong>Materials and Methods:</strong> This was a retrospective hospital-based case series in which all new patients of all ages with various eye conditions from 1st January to 31st December 2010 were reviewed from the outpatient/inpatient record books and the sex and age recorded. The files/ folders of patients with ocular trauma were selected and retrieved. The epidemiological characteristics, referral pattern, interventions, visual outcomes and complications resulting in visual impairment/blindness among ocular trauma patients were analysed.<br><br><strong>Results:</strong> A total of 2,027 records of new patients with various eye conditions were retrieved. Three hundred and sixty one (377 eyes) new ocular trauma patients’ files/ folders were analyzed. The Male: Female ratio was 1:1.1 (p=0.09) for all new patients with various eye conditions whilst it was 1.8:1 (p&lt;0.01) for new ocular trauma patients. Ocular trauma patients were younger than general patients with 20 – 29 years age group having most new patients (27.4%) compared with the over 49 years age group for other new cases (23.4%). Approximately 68.4% of the ocular trauma patients were seen at TTH without a referral. Conjunctival lesions were the commonest finding affecting 124(32.9%) of the ocular trauma patients. The majority of patients 88.1% sustained closed globe trauma, 8.3% had adnexal trauma whilst 3.6% had open globe trauma. The commonest intervention rendered was medical treatment alone to 64.4% of the patients. By the WHO classification, majority 67.4% of traumatized eyes had normal vision, 13.9% were visually impaired and 18.7% were blind. Thus, 110 (32.6%) were visually impaired/ blind in the traumatized eye. The commonest complications resulting in visual impairment/ blindness were corneal opacities/ scars in 33(30.0%) cases.<br><br><strong>Conclusion:</strong> Majority of ocular trauma patients presented with minor injuries which healed without complications. However, ocular trauma was a major cause of monocular blindness and visual impairment. Ocular trauma also tended to affect a younger age group and especially males compared to other eye diseases.</p> Bonsaana GB, Nyenze EM, Ilako DR, Wanye S Copyright (c) 2023 Bonsaana GB, Nyenze EM, Ilako DR, Wanye S Wed, 19 Apr 2023 00:00:00 -0400 Refractive errors among school children in Addis Ababa, Ethiopia <p><strong>Objective:</strong> To determine the prevalence of refractive errors among school children aged 6-18 years in the city of Addis Ababa, Ethiopia.<br><br><strong>Methods:</strong> A cross sectional study of refractive errors examined 1800 students in four randomly selected elementary schools during March, 2014. Subjects were selected by multistage random sampling. The children were examined by a team of ophthalmic nurses, optometrists and an ophthalmologist who performed visual acuity testing, cycloplegic refraction and slit lamp examination. Visual impairment was defined as V/A &lt; 6/12.<br><br><strong>Results:</strong> A total of 1800 (695 boys and 1105 girls) students were included in the study with a response rate of 99.4%. Refractive errors in either eye were 71 (4.0%) (95% CI 3.9-4.0). Of these myopia &lt; 1.oD was found to be higher 19 (26.7%) cases followed by astigmatism &gt;+ − 1.5D in 12 (17%) cases. Being female and the presence of other eye diseases increases the odds of refractive error.<br><br><strong>Conclusion and recommendation:</strong> The prevalence of refractive errors in school children is significant in Addis Ababa, highlighting the need for school screening and optical intervention programs.</p> Nebiyat K, Alemayehu W, Tigist SW Copyright (c) 2023 Nebiyat K, Alemayehu W, Tigist SW Wed, 19 Apr 2023 00:00:00 -0400 Prevalence of dry eye syndrome in diabetic patients attending Kenyatta National Hospital, Kenya <p><strong>Objective:</strong> To determine prevalence and ocular findings of dry eye syndrome in adult diabetic patients at Kenyatta National Hospital (KNH) in Kenya.<br><br><strong>Methods:</strong> A descriptive cross sectional study that was carried out among diabetic patients attending diabetic outpatient clinic and diabetic eye clinic at the KNH during October 2013-May 2014. All diabetic patients aged 18 years and over were requested to participate. Data on demographic profile, symptomatology, duration of diabetes and medication use of participants was documented. They were subsequently examined and underwent non-invasive tests to determine presence of dry eye syndrome (DES). Data collected was analyzed using the Statistical Package for Social Scientists (SPSS) version 21.0. Descriptive statistics such as frequencies, tables, mode, median and mean were used to summarize the data. Relationship between frequency, presence of dry eye syndrome and age, sex, duration of diabetes was assessed.<br><br><strong>Results:</strong> Prevalence of DES was 49.8% (CI 0.001-0.568), was more common among females (M:F 1:2.2) and increased with age (p=0.001, peak age 56-65 years) and duration of diabetes (p=0.000454, peak duration after 15-19 years). There was significant association between DES and symptomatology (p&lt;0.00001) , but not between DES and ocular signs (p=0.81) nor DES and TBUT (P=0.082) nor DES and Schirmer test (p=0.454).<br><br><strong>Conclusion and recommendation:</strong> There is high prevalence of DES among diabetics. Greater emphasis should be placed on symptoms when making a diagnosis of DES.</p> Ogundo C, Ilako D, Maina J Copyright (c) 2023 Ogundo C, Ilako D, Maina J Wed, 19 Apr 2023 00:00:00 -0400 Patients’ satisfaction with outreach eye care service provided in South West Ethiopia <p><strong>Background:</strong> Nowadays, assessing patient satisfaction is an integral part of monitoring and evaluation of health service delivery and quality assurance. Patient satisfaction with the outreach based eye care service in Ethiopia has not been studied.<br><br><strong>Objective:</strong> This study was conducted to determine the overall patient satisfaction and its factors and predictors in Southwest Ethiopia.<br><br><strong>Methods:</strong> A cross-sectional study was conducted on 411 sampled ophthalmic patients who received eye care service during regular ophthalmic outreach programs of Jimma University from January-December, 2013. Overall patient satisfaction was measured using a validated patient satisfaction questionnaire (PSQ-18). The physical facility of the outreach sites were assessed by complementary questions. Mean satisfaction scores were calculated and compared among variables using ANOVA test. Multivariate analysis and linear regression models were tested and were considered significant if P&lt;0.05.<br><br><strong>Results:</strong> Majority, 402(97.8%) of the study subjects were satisfied and the overall mean satisfaction score of the study subjects was 4.7(SD±0.5) out of 5. This was statistically different among subgroups of age (P=0.000), education level (P=0.007) and occupation type (P=0.000) but not with sex (P=0.393), religion (P=0.059) and marital status (P=0.124). Age was the only independent factor for the overall satisfaction (P=0.007). Among components of patient satisfaction, the highest mean was in communication 4.63(SD±0.6) followed by technical quality of health care providers 4.60(SD±0.6). The interpersonal manner of health care providers had the lowest mean score 3.3(SD±1.6). Each of the components (technical quality, interpersonal manner, communication, financial aspect, time spent with care providers, accessibility and convenience, physical facility) were significantly associated with overall satisfaction (P&lt;0.05). All these components except physical facility and financial aspect were significant linear predictors of overall satisfaction.<br><br><strong>Conclusion:</strong> The overall patient satisfaction to the regular outreach eye care services was very high. Jimma University should therefore continue the program while improving on each domain of satisfaction measures with the focus on interpersonal manner and accessibility and convenience.</p> Yeshigeta GB, Aemero AM, Tsedeke AA Copyright (c) 2023 Yeshigeta GB, Aemero AM, Tsedeke AA Wed, 19 Apr 2023 00:00:00 -0400 Ocular manifestations among HIV/AIDS patients; a case of Muhimbili National Hospital, Tanzania <p><strong>Objective:</strong> About 70-80% of HIV/AIDS patients develop an ocular complication at some point of their illness, at times causing blindness, ocular damage and even death. This study was conducted to determine the pattern of ocular manifestations of HIV/AIDS and their relationship to Highly-Active-Anti-Retroviral-Therapy and CD4+Tcells-count among HIV/AIDS patients at Muhimbili National Hospital.<br><br><strong>Methods:</strong> Cross-sectional study among 296 systematically sampled HIV/AIDS patients. Data collection was by history taking, clinical examination, laboratory investigations and review of case notes. Analysis was aided by using SPSS version 17 software. Inferential statistics was performed and a p&lt;0.05 was considered significant.<br><br><strong>Results:</strong> Of the 296 patients, 165(56%) were females. About 153(51.7%) patients were using Highly-Active-Anti-Retroviral-Therapy, 164(55.4%) and 66(20.3%) had CD4+Tcells-counts of &gt;350cells/μL and &lt;200cell/mm3 respectively. Ocular manifestations affected 124/296 (41.9%) patients. The prevalence of ocular manifestations was significantly higher among those not on Highly-Active-Anti-Retroviral-Therapy (67.1% vs 18.3%, x2=66.79, p&lt;0.01) and among patients with CD4+Tcells-count &lt;200cells/μL (73.3% vs 29.9%, x2=34.1, p&lt;0.05). The commonest manifestations among 592 eyes were optic atrophy 5.4(9.1%), cataract 25(4.2%), keratitis 23(3.8%), HIV-retinopathy 21(3.5%) and squamous cell carcinoma of the conjunctiva 16(2.7%).<br><br><strong>Conclusion:</strong> Despite introduction of HAART, the prevalence of ocular manifestations in Dar-es-Salaam is still high. Further research on optic nerve disorders; awareness creation to inform patients, health personnel and the community; and to screen HIV patients for ocular manifestations are recommended.</p> Yusufali ME, Mafwiri MM, Sanyiwa AJ, Kisimbi SJ, Muhina C, Mosenene S, Sirili N Copyright (c) 2023 Yusufali ME, Mafwiri MM, Sanyiwa AJ, Kisimbi SJ, Muhina C, Mosenene S, Sirili N Wed, 19 Apr 2023 00:00:00 -0400 Magnitude of delay in presentation and management of retinoblastoma patients at the Kenyatta National Hospital, Kenya <p><strong>Background:</strong> Retinoblastoma is the commonest intraocular childhood malignancy in the world and is curable when detected early. Delay in presentation and management is seen as a major contributor affecting outcome.</p> <p><strong>Objective:</strong> To determine the magnitude of delay in the presentation and management of retinoblastoma patients at the Kenyatta National Hospital.</p> <p><br><strong>Methodology:</strong> A cross sectional hospital based study done from November 2012 to April 2014 at the Kenyatta National Hospital. Data was collected using a semi structured questionnaire from the parents/guardians of retinoblastoma patients who gave consent.</p> <p><br><strong>Results:</strong> Ninety-one parents/guardians of 64 patients participated. Sixty point nine percent took more than 5 months from onset of symptoms to presentation at the referral centre while 46.1% took more than 1 month from onset of symptoms to first visit to a health facility. Ten point nine percent of patients took more than 2 weeks before starting definitive management at the referral centre.</p> <p><br><strong>Conclusions:</strong> Majority of the patients presented late to the referral centre while most of the health care providers referred the patients early. Augmentation of public awareness on retinoblastoma would make the primary caregivers more aware of early symptoms of the disease.</p> Makite I, Kimani K, Njuguna M Copyright (c) 2023 Makite I, Kimani K, Njuguna M Wed, 19 Apr 2023 00:00:00 -0400 Incidence of neonatal conjunctivitis at Mbarara Regional Referral Hospital, South Western Uganda <p><strong>Objective:</strong> To determine cumulative incidence of neonatal conjunctivitis (NC) in babies delivered at Mbarara Regional Referral Hospital (MRRH), establish the responsible microorganisms and their sensitivity to available antibiotics and determine factors associated with neonatal conjunctivitis among these babies.</p> <p><strong>Methods:</strong> A prospective cohort study where babies delivered at MRRH whose mothers stayed in Mbarara municipality were recruited within 24 hours after birth and weekly follow up was done until the occurrence of NC, or lost to follow up or administrative censoring at 28 days. Neonates who developed conjunctivitis had a conjunctival swab taken for microbiology.</p> <p><strong>Results:</strong> Out of 438 babies recruited, 45 (10.3%) were lost to follow up while 49 (11.2%, 95% CI 8.4 – 14.5) developed neonatal conjunctivitis by 28 days. Isolated pathogens were Staphylococcus aureus 23 (67.65%), Klebsiella pneumoniae 7 (20.59%), Neisseria gonorrhoeae 3 (8.82%) and Streptococcus pyogenes 1(2.94%). In 15 (30.6%) of 49 cultures done there was no growth. Isolates tested had only 18% sensitivity to tetracycline. However there was 100% sensitivity to gentamycin and oxacillin, while slightly lower sensitivity was achieved for ceftriaxone (76%), ciprofloxacin (68%) and chloramphenical (61%). Not receiving prophylaxis within 24 hours after birth [adjusted OR 4.85 CI (1.17 – 20.19)] and neonatal admission to Neonatal Intensive Care Unit (NICU) after delivery [adjusted OR 6.03 CI (1.09 – 33.32)] were independently associated with higher odds of developing NC.</p> <p><strong>Conclusions:</strong> The incidence of NC was unexpectedly high. Admission to NICU and lack of prophylaxis within 24 hours were risk factors for developing NC.<br><br><strong>Key words:</strong> Neonatal, Conjunctivitis, Cohort, Incidence</p> Ayebazibwe B, Twinamasko, A Waddell K Copyright (c) 2023 Ayebazibwe B, Twinamasko, A Waddell K Wed, 19 Apr 2023 00:00:00 -0400 A 5 year’s retrospective case series on the clinical profile and management of retinoblastoma at Maputo Central Hospital, Mozambique <p><strong>Background:</strong> Retinoblastoma is the commonest intraocular malignancy in childhood. The national<br>epidemiological characteristics of retinoblastoma in Mozambique are not clearly known. Early diagnosis<br>and appropriate treatment leads to a favourable outcome while a delayed diagnosis and inappropriate<br>treatment can be fatal.<br><br><strong>Objective:</strong> To determine the pattern of presentation and management of retinoblastoma patients at<br>Maputo Central Hospital during a 5 year period (1st January 2010 to 31st December 2014).<br>Methodology: The study was a retrospective case series carried out at Maputo Central Hospital<br>(Ophthalmology and Paediatric Oncology Services). Records of all retinoblastoma patients were retrieved<br>with the help of the specific file number. Demographic characteristics, clinical presentation, investigations<br>and management modalities of retinoblastoma patients were retrieved. Data was extracted and entered<br>into a structured questionnaire and analysed.<br><br><strong>Results:</strong> A total of 57 patients from 7 different provinces of Mozambique had clinical, histological or both<br>clinical and histological diagnosis of retinoblastoma. The overall mean age at presentation was 30.5 months<br>(CI 24.65 - 36.05) (SD 21.5); 82.4% of cases had unilateral retinoblastoma while 12.3% of cases had bilateral<br>(mean age at presentation was 30.2 months and 26.4 months respectively). The female: male ratio was<br>1.2:1. The main presenting complaint was white reflex (62.5%) followed by eye swelling (50%), eye redness<br>(40%) and poor vision (32.5%) while the main clinical signs were leukocoria (55%) followed by proptosis<br>(50%) and eye redness (27.5%). Out of the 51 eyes who had surgery: 96% did not have documentation<br>of the choroid and 98% of the scleral, but 54.9% of the eyes had optic nerve involovement, 33.3% had<br>resection margin involvement and 31.4% had periocular tissue involvement. The main modalities of<br>management were enucleation (93.9%), chemotherapy (24.5%) and exenteration (18%). The eligible<br>patients for chemotherapy were 67.7% but only 35.3% of the patients received chemotherapy.<br><br><strong>Conclusion:</strong> Many patients presented at older ages (with a mean age at presentation of 30.5 months) and<br>many presented late with advanced orbital disease. Majority of the patients had unilateral retinoblastoma.<br>Significant number of patients had optic nerve, resection margin and periocular tissue involvement noted<br>on histology. The main modalities of management were enucleation, exenteration and chemotherapy,<br>although there were no clear eligibility criteria for chemotherapy in retinoblastoma patients.</p> Dimande LSA, Ilako D, Nyenze EM, Zambujo Y Copyright (c) 2023 Dimande LSA, Ilako D, Nyenze EM, Zambujo Y Wed, 19 Apr 2023 00:00:00 -0400 Knowledge, attitude and practice of eye diseases in children among paediatricians in Kenya <p><strong>Objective:</strong> To assess knowledge, attitude and practice of childhood eye diseases among paediatricians working<br>in Kenya.<br><strong><br>Methods:</strong> The study was carried out among paediatricians working in the various hospitals and clinics in Kenya.<br>A semi structured questionnaire was distributed to consenting paediatricians for completion. Dependent<br>variables were knowledge attitude and practice. Independent variables were age, sex, duration and type of<br>practice. The data was analyzed using STATA. Level of knowledge was grouped according to Bloom’s original<br>cut-off points into good (&gt;80%), moderate (60-80%) and poor (&lt; 60%).<br><br><strong>Results:</strong> Out of the 125 paediatricians who responded, 69.6% had a level of knowledge classifiable as poor,<br>28.0% moderate and 2.4% good. The mean score of participants in this study was 58.20%. However participants<br>showed varied levels of knowledge in different subject matters. Sixty nine point six per cent of paediatricians carry<br>out eye examination in children, though this varied with each participant doing only the test they are familiar<br>with. Their referral of children with eye diseases to an ophthalmologist was found to be generally appropriate.<br>The attitudes of participants in the various subject areas raised were positive. Ninety nine point two per cent of<br>participants agreed that eye examination by paediatricians could help with early referral of retinoblastoma.<br><strong><br>Conclusion:</strong> The participants had poor level of knowledge of childhood eye diseases. However their attitude and<br>practice was generally positive. Their knowledge could be boosted with regular continuous medical education<br>on eye diseases.</p> Wanyama SP, Marco S, Kariuki MM Copyright (c) 2023 Wanyama SP, Marco S, Kariuki MM Wed, 19 Apr 2023 00:00:00 -0400 A randomized clinical trial comparing retrobulbar injection of absolute alcohol and chlorpromazine in managing painful blind eyes, Menelik II Hospital, Addis Ababa, Ethiopia <p><strong>Background:</strong> Many eye diseases may end up with a painful blind eye. Different management options<br>have been used to alleviate the pain and maintain the globe. Topical medications are frequently used as<br>conservative treatment. Retrobulbar injection of neurolytic agents like alcohol, chlorpromazine (CPZ) or<br>phenol are other medical options that can be considered.<br><br><strong>Objectives:</strong> Comparing the efficacy and safety of retrobulbar absolute alcohol with chlorpromazine<br>injection in the treatment of painful blind eyes.<br><br><strong>Methods:</strong> A double masked trial in which patients with painful blind eye, aged 18 years or above, were<br>randomized to receive either a retrobulbar injection of 2ml of absolute alcohol (96%) or 2ml of CPZ (25mg/<br>ml), both with 2ml of lidocaine (2%). Visual Analogue Scale (VAS) is used to objectively measure intensity<br>of pain and level of pain relief after the intervention.<br><br><strong>Results:</strong> A total of 84 eyes of 84 patients were injected with either absolute alcohol (n=43) or CPZ (n=41).<br>Thirty nine from alcohol group and 35 participants from the CPZ group appeared for third month followup<br>evaluation. Sixth month response was also evaluated in 30 and 26 participants from alcohol and CPZ<br>groups, respectively. The mean and standard deviation in VAS pain reduction was 57.9 mm (±32.17) in<br>the alcohol group and 55.4 mm (±31.26) in the CPZ group (P value= 0.734). Based on the improvement in<br>pain intensity 30 patients (79.6%) from absolute alcohol group and 28 patients (80.0%) from CPZ group<br>had significant pain relief after the 3rd month of injection. Statistically significant mean IOP reduction was<br>noted in CPZ group compared to the alcohol group: mean IOP (in mm Hg) reduction at 3rd month was<br>13.0 vs 2.5 (P-value 0.009). Immediately after the injection complications like burning sensation (20 vs 8),<br>ptosis (2 vs 0) and retrobulbar haemorrhage (0 vs 2) were noticed in alcohol and CPZ group respectively.<br>Lid swelling, external ophthalmoplegia, ptosis, chemosis and skin necrosis were the type of complications<br>observed later on. All the immediate and subsequent complications had resolved spontaneously.<br><br><strong>Conclusions and recommendation:</strong> Efficacy of pain reduction with retrobulbar injection of absolute<br>alcohol and chlorpromazine was comparable. The choice of retrobulbar injection between the two agents<br>also needs to consider availability and cost. Further study is required to evaluate long term efficacy and<br>safety.</p> Tadesse T, Abeba TG, Damji K Copyright (c) 2023 Tadesse T, Abeba TG, Damji K Wed, 19 Apr 2023 00:00:00 -0400 Health education and awareness about diabetic retinopathy among patients attending diabetic clinics in tertiary and regional hospitals in Tanzania <p><strong>Objective:</strong> To assess the level of diabetes education, diabetes eye-care delivery knowledge and awareness<br>about diabetic retinopathy among patients attending diabetes clinics in selected regional and tertiary<br>hospitals in Tanzania.<br><br><strong>Materials and Methods:</strong> A cross-sectional study was conducted in 6 regional and all 4 zonal tertiary referral<br>hospitals in Tanzania. A semi-structured questionnaire was administered to about 413 systematically<br>sampled patients to explore their demographics, diabetes health education, awareness about diabetic<br>retinopathy and eye-care, and challenges encountered when accessing diabetic eye care services.<br><br><strong>Results:</strong> A total of 413 patients were recruited. Seventy one (8.6%) patients were type-1, and 336 (81.3%)<br>type-2. Two hundred and fifty five (61.8%) had diabetes for 1-10 years. Three hundred and twenty two<br>(77.9%) had received diabetes education. Receiving diabetes education was significantly associated with<br>level of education (p&lt;0.0001), residential region (p&lt;0.0001) and occupational status (p&lt;0.007). Nurses<br>and doctors were the leading providers of diabetes education reported by 243 (75.5%) and 196 (47.5%)<br>patients. Radio, television, brochures/posters, relatives and friends were the least mentioned sources<br>of diabetes education. Education messages delivered were diabetic diet (390, 94.4%); control of: blood<br>sugar (226, 54.7%), blood-pressure (49, 12%); eye-care (62, 15%), feet-care (62,15%) and 45 (11%) exercise.<br>Twenty four (5.8%) patients were aware about the need for yearly eye examination. One hundred and<br>twenty three (29.8%) had previous eye examination. Shortage of staff in facilities providing diabetes-care;<br>inadequate drugs and equipment for monitoring blood sugar were the main challenges.<br><br><strong>Conclusions and recommendations:</strong> Although diabetes education is provided to most patients<br>attending diabetes clinics in Tanzania, patients have limited awareness about diabetic complications<br>in particular diabetic retinopathy including the need for yearly eye examination which would make<br>strategies to implement health promotion and prevention of diabetic retinopathy blindness difficulty.<br>Strategies to improve diabetes education are required.</p> Mafwiri MM, Mwakyusa N, Shilio B, Lutale JK Copyright (c) 2023 Mafwiri MM, Mwakyusa N, Shilio B, Lutale JK Wed, 19 Apr 2023 00:00:00 -0400 The clinical presentation and outcome of Mooren’s ulcer at Ruharo Eye Centre, Southwestern Uganda; a hospital based retrospective study <p><strong>Objective:</strong> To describe the clinical presentation, management, and treatment outcomes of Mooren’s ulcer<br>in Uganda.<br><br><strong>Methods:</strong> We reviewed records of all patients diagnosed with Mooren’s ulcer at Ruharo Eye Centre<br>from January 2013 to December 2015. We collected data from fifty-two patient charts on demographic<br>characteristics, history and presenting complaints, eye affected, clinical presentation, modes of medical<br>and surgical treatment, and post treatment visual acuity.<br><br><strong>Results:</strong> The median age was 24.5 years (IQR 16.5 years). The ratio of males to females was 8:1. Thirty two<br>(82.1%) patients presented with pain, 13 (33.3%) with redness, and 10 (25.7%) with tearing. Forty seven<br>(90.4%) patients had unilateral disease. Four (80%) of those with bilateral disease were aged 30 years and<br>above while one (20%) was below 30 years. Twenty nine (55.8%) of the patients received only medical<br>treatment and 23 (44.2%) received various forms of surgical management. Forty one (78.8%) still had<br>active ulceration on their last review date, 7 (13.5%) perforated after admission, 3 (5.8%) of the patients<br>were marked as healed on their last review date, and one (1.92%) was eviscerated. At the last follow up,<br>most patients ended with worse visual acuity (n=21, 40.4%) while 20 (38.5%) had no change and only 11<br>(21.2%) improved.<br><br><strong>Conclusion:</strong> This primary study provided background information on presentation of Mooren’s ulcer in<br>Uganda; our data indicated that younger males were the most affected group; severe disease occurred in<br>older patients.</p> Kavuma D, Arunga S Copyright (c) 2023 Kavuma D, Arunga S Wed, 19 Apr 2023 00:00:00 -0400 To what extent has Burundi achieved VISION 2020, “The Right to Sight” global initiative, targets for eye service delivery? <p><strong>Purpose:</strong> To assess the extent to which Vision 2020 eye care service delivery targets had been met in<br>Burundi by 2015.<br><br><strong>Methods:</strong> This was a descriptive cross-sectional study targeting District, Regional, and National Hospitals<br>in Burundi. A questionnaire was used to collect data on number and distribution of different cadres of eye<br>personnel. The recommendations of Vision 2020 were used to benchmark human resources as meeting,<br>exceeding or not meeting targets. A separate questionnaire was used to capture the number of cataract<br>surgeries conducted in the country.<br><br><strong>Results:</strong> In 2015, Burundi had 15 ophthalmologists (37.5% of the target), 33 ophthalmic clinical officers<br>(66.0% of the target) and 2 optometrists (5% of the target). The mean deficit for all cadres was 72.8%.<br>Eighty-percent of the ophthalmologists were based in Bujumbura. Four out of the 7 regions had no<br>ophthalmologist. Sixty-eight percent of eye care facilities belonged to the private sector. Seventy-five<br>percent of the facilities were in urban areas. The cataract surgical rate for the entire country was 138<br>surgeries per million populations per year.<br><br><strong>Conclusions:</strong> Burundi had not met the targets for human resources by 2015. Cataract surgery was very<br>low. Most of the eye care personnel and services were concentrated in the capital Bujumbura.</p> Niyonzima JC, Nyenze EM, Karimurio J, Kandeke L Copyright (c) 2023 Niyonzima JC, Nyenze EM, Karimurio J, Kandeke L Wed, 19 Apr 2023 00:00:00 -0400 Branch retinal vein occlusions: a review <p><strong>Introduction:</strong> Branch Retinal Vein Occlusion (BRVO) is the second most common retinal vascular disease with a<br>prevalence of 0.8%. The Branch Vein Occlusion Study was the first trial to show efficacy of treatment of macular<br>oedema in BRVO with grid laser which was considered the gold standard for several years. Since then several<br>other studies have been done on various classes of drugs and surgery and there are great strides that have<br>been made in enhancing the visual and anatomical outcome. In this review article, we did a pubmed search of<br>publications done over the years on the natural history of BRVO as well as the treatment options. The studies<br>included clinical trials, systematic reviews and case reports.<br><br><strong>Results:</strong> Currently anti-Vascular Endothelial Growth Factors (AntiVEGFs) appear to have the best outcomes in<br>terms of anatomical and visual recovery. Other therapies that have shown promise are the intravitreal steroids,<br>grid laser, antiVEGFs and steroids combined with lasers. Parsplana vitrectomy appears to be as efficacious as<br>antiVEGF but is very invasive and no good clinical trials have been done yet.<br><br><strong>Conclusion:</strong> Great strides have been made in improving the outcome of BRVO especially the macular oedema if<br>prompt and correct treatment is administered to the patient.</p> Gachago MM, Kibata AG Copyright (c) 2023 Gachago MM, Kibata AG Wed, 19 Apr 2023 00:00:00 -0400 Causes of severe visual impairement and blindness among children: a case of Mbarali District in Southern Tanzania <p><strong>Objective:</strong> To determine the anatomical causes and diagnosis leading to severe visual impairment and blindness<br>and explore their relationship to demographic characteristics among children in Mbarali district, Southern<br>Tanzania.<br><br><strong>Materials and methods:</strong> Key informants were trained on how to identify children with poor vision and other<br>ocular abnormalities. Key informants identified, listed and referred for examination children with poor vision,<br>white pupillary reflex, squint, and smaller and bigger than normal eyes. Children with a visual acuity of &lt;6/60<br>in the better eye were recruited for the study. Cycloplegic refraction, anterior and posterior segment and ocular<br>alignment examination were performed to ascertain the cause of Severe Visual Impairment (SVI) or Blindness<br>(BL).<br><br><strong>Results:</strong> Sixty six children had a visual acuity (VA) of &lt;6/60. Seventy percent were 5 years or more. The mean age<br>was 9.18(±4.42) (SD =4.42) years. Thirty five (53%) were females. Forty eight (72.7%) had SVI (VA&lt;6/60) while 18<br>(27.3%) were BL (VA&lt;3/60). Lens related conditions (27.3%), uncorrected refractive error (15.2%) and corneal<br>related disorders (13.6%) were the commonest causes of SVI/BL. Majority of children with lens related conditions<br>(72.2%), uncorrected refractive error and congenital glaucoma (75%) were females, while all 6 children with<br>cortical blindness were males. Lens related and cortical blindness conditions were commoner among under-five<br>than among older children (6/20, 30% vs 12/46, 26%) and (4/20,20% vs 2/46, 4%). Un-operated cataract was the<br>leading diagnosis causing SVI/BL. Only 4 patients were operated for cataract. There was only one patient with<br>phthisis-bulbi related to keratomalasia.<br><br><strong>Conclusion and Recommendations:</strong> Lens related conditions, specifically cataract was the leading cause of<br>SVI/BL. Recruitment of an eye-doctor at Mbarali District Hospital and establishment of tertiary eye services at<br>Mbeya Zonal Referral Hospital are recommended to enable identification, referral and comprehensive tertiary<br>management of children with eye conditions.</p> Mafwiri MM, Moshiro C, Mosenene S, Fakir A Copyright (c) 2023 Mafwiri MM, Moshiro C, Mosenene S, Fakir A Wed, 19 Apr 2023 00:00:00 -0400 Haemorrhagic retinal arterial macroaneursym: a case report <p>Retinal Arterial Macroaneurysms (RAMs) are acquired saccular or fusiform dilatations of the large branches of<br>retinal arteries, usually within the first three orders of bifurcation. RAMs are rare conditions and usually affect<br>hypertensive elderly women. In clinical practice, RAMs are frequently misdiagnosed as they masquerade<br>other retinal conditions. We present a case of haemorrhagic RAM which was initially misdiagnosed as vitreous<br>haemorrhages secondary to retinal vein occlusion or posterior vitreous detachment.</p> Kayange PC, Gandiwa M, Manda CS Copyright (c) 2023 Kayange PC, Gandiwa M, Manda CS Wed, 19 Apr 2023 00:00:00 -0400 Pattern of posterior segment injuries after ocular trauma at the vitreoretinal unit at Kikuyu Eye Unit, Kenya <p><strong>Background:</strong> Ocular trauma is a significant cause of monocular blindness worldwide. Eye injuries involving the<br>posterior segment have been a matter of concern particularly due to the related poor visual outcome. These injuries<br>require specialised intervention and follow up care to achieve best possible visual outcome.<br><br><strong>Objective:</strong> This study aimed to give baseline information on pattern of posterior segment eye injuries in the East Africa<br>set up.<br><br><strong>Design:</strong> Retrospective case series of eye injuries involving posterior segment treated at Kikuyu Eye Unit, a tertiary<br>referral eye hospital in Kenya between 1st January 2010 and 31st December 2014.<br>Results: One hundred and six eyes of 102 patients were reviewed, including 25 children. Seventy three patients (71.6%)<br>were male and majority were in the 31-40 years age group. The most known circumstance of injury was road traffic<br>accident in 9 (8.8%) patients. Metal was the most common agent causing these injuries in 15 (14.7%) eyes. Seventy nine<br>eyes (74.5%) had closed globe injuries. Retinal detachment and vitreous haemorrhage were the most common findings,<br>at 49 (46.2%) and 47 (44.3%) eyes respectively. Eighty nine eyes (84.0%) were blind at initial review with presenting<br>vision acuity &lt;3/60.<br><br><strong>Conclusion:</strong> Ocular injuries involving the posterior segment were most common in young males. Closed globe injuries<br>were the most common type of injuries (75%). Most eyes were blind at presentation indicating the severity of these<br>injuries and need for specialised intervention.</p> Nguyo GN, Jafferji S , Gachago M, Njuguna M Copyright (c) 2023 Nguyo GN, Jafferji S , Gachago M, Njuguna M Wed, 19 Apr 2023 00:00:00 -0400 Prevalence and pattern of manifest strabismus in paediatric patients at CCBRT, Dar es Salaam, Tanzania <p><strong>Background:</strong> Awareness on the magnitude of strabismus burden is crucial in preventing development of<br>amblyopia, restore binocularity, aid in development of stereopsis and improve treatments outcomes.<br>Objective: To determine the prevalence, and pattern of strabismus presentation in paediatric patients at<br>Comprehensive Community Based Rehabilitation in Tanzania (CCBRT).<br><strong><br>Design:</strong> Retrospective descriptive hospital based study.<br><strong><br>Subjects:</strong> Children aged 16 years and below presenting with strabismus at CCBRT between January 1, 2014 and<br>June 30, 2014.<br><strong><br>Methods:</strong> All strabismus coded files of patients below 16 years were identified from medical records. The data<br>collected included patients’ demographic data; age at onset of strabismus; visual acuity; characteristics of the<br>deviation; refractive status; binocular functions and amblyopia assessment; and relevant ocular and systemic<br>findings.<br><strong><br>Results:</strong> The prevalence of strabismus was 5.9%. Males were 49.1% and females 50.9%. Family history was<br>present in 3.3% of the patients. Most of the patients (61.8%) were below five years; average 4.6 years. A third of<br>the patients (32.5%) presented within one year of onset of strabismus; average duration 25.7 months. Systemic<br>and ocular co morbidities were present in 17.9% and 46.2% of the patients respectively. About half (47.9%),<br>had normal vision. Esotropia was the commonest deviation ( 63.3%); exotropia, 24% and hypertopia 2.8% . In<br>76.9% the strabismus was unilateral and alternating in 22.6%. Most of the deviations (42.9%) were between<br>30-50 prism dioptres. Hyperopia was in 51.7%; myopia in 14.4% and astigmatism 11.6% of the eyes. Amblyopia<br>was noted in 25.9% of the patients. Binocular single vision assessment was done in 14.1%; 62.5% had a negative<br>result.<br><strong><br>Conclusion:</strong> The prevalence of strabismus in this study was high at 5.9%. Esotropia was the commonest<br>deviation.</p> Njambi L, Rita O, Kazim D, Sonia V Copyright (c) 2023 Njambi L, Rita O, Kazim D, Sonia V Wed, 19 Apr 2023 00:00:00 -0400 Prevalence of strabismus and the outcomes of its management among children attending Ruharo Eye Center, South Western Uganda <p><strong>Background:</strong> Strabismus consists of any deviation of binocular alignment and is present in 2 to 4% of the<br>world’s child population. Strabismus can be both the cause and the effect of poor binocularity. When it appears<br>in the early years of life, strabismus may lead to states of sensorial adaptation such as retinoic correspondence<br>anomaly and amblyopia given that binocular single vision has a critical role in maintaining alignment. On the<br>other hand, if strabismus arises after binocular vision development, diplopia and image confusion appear, which<br>persist indefinitely or until motor alteration is corrected.<br><br><strong>Aim:</strong> To determine prevalence of strabismus and outcomes of its management among children attending<br>Ruharo Eye Center, South western, Uganda from January 2014 to December 2015.<br><br><strong>Methods:</strong> In this retrospective descriptive study, medical records of all strabismus patients aged below 16<br>years seen at Ruharo Eye Center, South western, Uganda from January 2014 to December 2015, were reviewed.<br>Information was collected on demographic characteristics, refractive errors, types of strabismus, management<br>and outcomes.<br><br><strong>Results:</strong> A total of 8,665 children were seen at REC during the period from January 2014 to December 2015. Of<br>these, 125 children had strabismus thus a prevalence of 1.4%. There were 56 males (44%) and 69 females (55%)<br>with mean age of 14 years, from 4 months to 15 years. Twenty nine children (23.2%) had amblyopia and eighty<br>six children (68.8%) had refractive errors of more than 0.5 diopter. Patients with hypermetropia were 45 (36.0%),<br>myopia 38 (30.4%) and astigmatism 3(2.4%). Esotropia accounted for 80% and exotropia 20% and both were the<br>common types. In our study, the management of strabismus cases included: glasses (30), eye patching (30) and<br>surgery (34). Of the 34 patients operated, post-operative alignment was achieved in 25 cases (73.53%) and under<br>correction occurring in 17.65%.<br><br><strong>Conclusion:</strong> The prevalence of paediatric strabismus at Ruharo Eye Center was 1.4%. The most common type of<br>paediatric strabismus in this study was esotropia. The surgical success rate was generally good.</p> Ntizahuvye S, Onyango J Copyright (c) 2023 Ntizahuvye S, Onyango J Wed, 19 Apr 2023 00:00:00 -0400 Solar retinopathy: a case report <p>A young woman presented with a history of poor vision both eyes after staring at the sun for approximately 5<br>minutes during a religious pilgrimage. Her vision was 6/12 at presentation. Fundoscopy revealed bilateral yellow<br>spots on the macular. Optical Coherence Tomography (OCT) scans revealed bilateral Retinal Pigment Epithelium<br>(RPE) damage. The patient was managed conservatively with full recovery of vision in 8 months.</p> Onyango O, Nyenze EM Copyright (c) 2023 Onyango O, Nyenze EM Wed, 19 Apr 2023 00:00:00 -0400 Developing a sustainable and scalable control programme for Retinopathy of Prematurity in Kenya: a health system perspective <p>Disease-control programmes have an important role to play in strengthening health systems to deliver the<br>interventions they recommend. In low and middle income countries, there is a shortfall in the coverage of<br>interventions for primary, secondary and tertiary interventions for the control of Retinopathy of Prematurity<br>(ROP)-related childhood blindness and visual impairment. We need strong health systems to ensure prevention,<br>timely diagnosis and access to effective care for ROP. If a health system strengthening approach is employed as<br>ROP interventions are being planned, health system issues that will affect implementation and outcomes can<br>be identified.</p> Mwangi N, Sitati S, Onyango O, Mundia D, Njambi L, Gachago M, Murila F, Nyamu G, Bitok M, Gichangi M for the Kenya ROP working group Copyright (c) 2023 Mwangi N, Sitati S, Onyango O, Mundia D, Njambi L, Gachago M, Murila F, Nyamu G, Bitok M, Gichangi M for the Kenya ROP working group Wed, 19 Apr 2023 00:00:00 -0400 Diabetic retinopathy among patients with type 2 diabetes mellitus at Moi Teaching and Referral Hospital, Eldoret, Kenya <p><strong>Background:</strong> Diabetic Retinopathy (DR) accounts for 5% of the 39 million causes of blindness occurring worldwide<br>and is estimated to contribute 3% of blindness in Kenya. Dyslipidemia, poor control of sugar, hypertension and<br>obesity increase the risk of DR in patients with diabetes. This study addresses the gap in information on the<br>magnitude of DR and its associated factors in patients with type 2 diabetes at Moi Teaching and Referral Hospital<br>(MTRH).<br><strong><br>Objectives:</strong> To determine the prevalence and severity of DR and its associated factors in patients with type 2<br>diabetes mellitus.<br><strong><br>Methods:</strong> This cross sectional study was conducted amongst patients with type 2 diabetes mellitus in MTRH.<br>Randomly selected participants underwent anthropometric, laboratory and visual acuity testing. Direct<br>ophthalmoscopy was used to assess DR and macula edema. Grading of DR was done using international clinical<br>diabetic retinopathy severity scale. A univariate and multivariate logistic regression model was used to assess<br>associations of the variables with DR.<br><strong><br>Results:</strong> Of the 329 participants enrolled, 187 (57%) were female with a mean age of 56.8 (10.99) years. One<br>hundred and three (31%) had diabetic retinopathy and 39 (12%) had diabetic macula edema. Mild to moderate<br>non proliferative diabetic retinopathy was the most prevalent grade at 79 (25%). One hundred and eighty<br>four (56%) of participants had hypertension (133/80; IQR 120/70-150/89) mmHg and 158 (48%) had glycated<br>haemoglobin between 7-10%. The median for the other assessed factors were as follows: duration of diabetes<br>5 (9) years, total cholesterol 4.6 (1.3) mmol/l and low density lipoprotein 3.0 (1.5) mmol/l. Increase in duration of<br>diabetes by 5 years {OR 2.02(95% CI 1.11-3.69); p 0.02}, glycated haemoglobin &gt; 6.5% {OR 2.13(95% CI 1.02-4.42);<br>p 0.04}, systolic hypertension &gt;160 mmHg {OR 1.02(95% CI 1.01-1.03); p 0.01} were associated with increased<br>risk of diabetic retinopathy while male gender and body mass index did not. Only 15% of the participants in this<br>study reported having had previous eye check-up.<br><br><strong>Conclusion:</strong> A third of patients with type 2 diabetes on follow up at MTRH have DR. Systolic hypertension,<br>increased duration of diabetes and high glycated haemoglobin were positively associated with increased risk of<br>developing DR</p> Musawa MS, Karoney MJ, Kwobah CM, Oduor C, Owino C Copyright (c) 2023 Musawa MS, Karoney MJ, Kwobah CM, Oduor C, Owino C Wed, 19 Apr 2023 00:00:00 -0400 Editorial: Conference scientific committees-what do they do? <p>Editorial: Conference scientific committees-what do they do?</p> Nyawira M, Mukuria M, Bitok M Copyright (c) 2023 Nyawira M, Mukuria M, Bitok M Wed, 19 Apr 2023 00:00:00 -0400 A toolkit for glaucoma management in Africa <p>Glaucoma is the leading cause of irreversible vision<br>impairment worldwide and the burden is largely in sub-<br>Saharan Africa (SSA) where about 4% of adults aged 40<br>years and above have the condition1. Clinic-based data<br>have increasingly shown younger adults presenting with<br>severe glaucoma.</p> JOECSA Copyright (c) 2023 JOECSA Wed, 19 Apr 2023 00:00:00 -0400 Introducing the new JOECSA editorial board <p>In this issue, we are pleased to introduce the new<br>JOECSA editorial board. The board was selected<br>following an elaborate process that took over one year.<br>It included a call for expression of interest from the<br>wider COECSA community, training of the new board<br>and updating of the submission and review systems.</p> JOECSA Copyright (c) 2023 JOECSA Wed, 19 Apr 2023 00:00:00 -0400 Strengthening eye health research output in the region <p>In this issue of the journal, we are pleased to announce<br>an exciting three-year partnership with ‘Eye’ Journal<br>team of the Royal College of Ophthalmologists<br>(RCOphth). This partnership is part of the VISION<br>2020 COECSA-RCOphth LINK partnership that has<br>been in existence for the last 10 years and has led<br>to development and strengthening of the COECSA<br>fellowship exam and examiner training, curriculum<br>development, ‘train the trainers’ and online CPD.</p> Arunga S, Nyenze EM, Wambiya V, Onyango J Copyright (c) 2023 Arunga S, Nyenze EM, Wambiya V, Onyango J Wed, 19 Apr 2023 00:00:00 -0400 Ophthalmology as a leader in innovation <p><em><strong>Introduction: Never a dull day in Ophthalmology<br></strong></em><br>It gives me great pleasure to write this article for I truly<br>believe that ophthalmology is one of the most exciting<br>branches of medicine as there is constant research<br>that leads to numerous innovations in technology,<br>pharmaceuticals and surgical techniques. However, for<br>one to fully appreciate this highly dynamic breed of<br>medicine one must have the innate desire to continuously<br>study, research, and learn new surgical techniques. Gone<br>are the days when we did our residency and coasted on<br>the knowledge obtained for the rest of our lives.<br>It gives me great pleasure to write this article for I truly<br>believe that ophthalmology is one of the most exciting<br>branches of medicine as there is constant research<br>that leads to numerous innovations in technology,<br>pharmaceuticals and surgical techniques. However, for<br>one to fully appreciate this highly dynamic breed of<br>medicine one must have the innate desire to continuously<br>study, research, and learn new surgical techniques. Gone<br>are the days when we did our residency and coasted on<br>the knowledge obtained for the rest of our lives.</p> Dr MM Gachago Copyright (c) 2023 Dr MM Gachago Wed, 19 Apr 2023 00:00:00 -0400 National guidelines for screening and management of retinopathy of prematurity in Kenya: an overview of the recommendations <p>Retinopathy of Prematurity (ROP) is a challenge to neonatology and ophthalmology, as it causes blindness<br>before the age of six months of age. In low and middle income countries, it is an upcoming epidemic and<br>important cause of childhood blindness. Guidelines in many developing countries are lacking. The objective<br>of the national guidelines for screening and management of ROP in Kenya is to improve the access, quality<br>and coverage of prevention, screening, treatment and follow-up in ROP services. In this article, we provide<br>an overview of the guidelines to facilitate their implementation by those providing care in new born units<br>and eye care services.</p> Sitati S, Mwangi N, Njambi L, Onyango O, Gachago M, Mundia D, Murila F Copyright (c) 2023 Sitati S, Mwangi N, Njambi L, Onyango O, Gachago M, Mundia D, Murila F Wed, 19 Apr 2023 00:00:00 -0400 Eye health in Kenya: 50 years on, what have we to show for it? <p>Eye health in Kenya: 50 years on, what have we to show for it?</p> JOECSA Copyright (c) 2023 JOECSA Wed, 19 Apr 2023 00:00:00 -0400 Outcomes of conjunctival flap in severe microbial keratitis <p><strong>Objectives:</strong> To describe the 3-month outcomes of conjunctival flap in managing severe Microbial Keratitis (MK).</p> <p><strong>Design:</strong> This was a prospective cohort study.<br>Setting: Patients were enrolled at two major eye hospitals in Mbarara, a major city in the Southwestern sub-region<br>of Uganda, over a one year period.</p> <p><strong>Subjects:</strong> Individuals of any age that met the case definition of severe microbial keratitis, in which perforation<br>occurred acutely or was impending.<br>Interventions: A complete Gunderson conjunctival flap was done in all suitable patients. Demographics, health<br>access, clinical, and microbiological data were recorded.<br>Main outcome measures: Statistical significance testing was done to assess predictors of evisceration at the<br>3-month follow-up time point.</p> <p><strong>Results:</strong> Among 57 patients (57 affected eyes), median age was 44 years (IQR 38, 60) and 47.4% were women.<br>Trauma was associated with 35.1% of cases. Median time to presentation was 23 days (IQR 12, 34). Etiology was<br>80.7% purely fungal pathogens, 10.5% mixed bacterial/fungal, and 8.8% undetermined. Mean infiltrate and epithelial<br>defect sizes were 7.2mm (SD 2.3) and 6.0mm (SD 2.5), respectively. Presenting visual acuity was &lt;3/60 in<br>78% of eyes. At 3-months, 19 eyes (34.5%, 95%CI 23.5-48.2) had improved best-corrected visual acuity, though 9<br>eyes required evisceration (15.8%, 95%CI 8.3-28.0). There were no clinically or statistically significant predictors<br>for evisceration at 3 months.</p> <p><strong>Conclusions:</strong> Conjunctival flap is a reasonable rescue procedure, especially if therapeutic penetrating keratoplasty<br>is an eventually feasible option. However, there are considerable risks of vision loss or lack of improvement<br>and eventual need for evisceration.</p> Tran T, Kanji R, Al-ramady A, Kintoki G, Onyango J, Leck A, Macleod D, Hu V, Burton M, Arunga S Copyright (c) 2023 Tran T, Kanji R, Al-ramady A, Kintoki G, Onyango J, Leck A, Macleod D, Hu V, Burton M, Arunga S Wed, 19 Apr 2023 00:00:00 -0400 Stand for action! Eye care and Sustainable Development Goals <p>Stand for action! Eye care and Sustainable Development Goals</p> JOECSA Copyright (c) 2023 JOECSA Wed, 19 Apr 2023 00:00:00 -0400 The COECSA research repository <p>We would like to introduce to you the proposed College of Ophthalmology of Eastern, Central and Southern Africa (COECSA) Research Repository, a digital archive that will contain various research papers done in the Eastern, Central and Southern Africa (ECSA) region, with a particular focus on Masters’ theses.</p> Arunga S, Bore M, Kavuma D, Nyatuga M Copyright (c) 2023 Arunga S, Bore M, Kavuma D, Nyatuga M Wed, 19 Apr 2023 00:00:00 -0400 Radio as an effective tool for community mobilisation for eye health programs, a case study of the Mbarara University of Science and Technology, Department of Ophthalmology outreach program to Ntungamo district, rural south-western Uganda <p><strong>Objective:</strong> To determine the most effective method of mobilizing the rural community to uptake cataract<br>outreach services in Ntungamo district, south western Uganda.<br><br><strong>Methods:</strong> This was a community based prospective survey conducted in Ntungamo district, rural south western<br>Uganda. Different methods were used to inform the local communities in the six sub regions in Ntungamo district<br>about an ongoing University outreach program. These included; local radio announcements, announcements<br>at places of worship, posters, word of mouth and referral from a previous outreach. One hundred and twenty<br>five respondents were randomly selected from a total of 600 people who turned up for the service and enrolled<br>into the study. Interviewer administered questionnnars were administered. The main interview question was<br>how respondents had received information about a cataract outreach service coming to their area. Results were<br>compiled and frequency tabulations were drawn.<br><br><strong>Results:</strong> The respondents reported that they received the information through radio announcements (85.6%),<br>by word of mouth (10%), by posters (2%) and by referral from previous outreach (1%). The results were consistent<br>across all the six sub regions in Ntungamo district.<br><br><strong>Conclusion:</strong> Radio announcements were the most effective method for mobilizing the community for uptake<br>of cataract outreach services.<br><br><strong>Recommendation:</strong> Radio</p> Arunga S, Twinamasiko A Copyright (c) 2023 Arunga S, Twinamasiko A Wed, 19 Apr 2023 00:00:00 -0400 Solar retinopathy following religious ritual ceremony: A case report from Blantyre, Malawi <p>Solar retinopathy is a retinal damage as a result of direct or indirect exposure to the solar radiation. It usually<br>occurs following direct viewing of an eclipse without adequate protective devices. It may also occur following<br>prolonged gazing at the sun, during sun bathing, and in patients with psychiatric disorders such as schizophrenia<br>or drug intoxication.<br>We discuss the clinical presentation, diagnosis and treatment of a 26 year old woman who developed solar<br>retinopathy after prolonged gazing at the sun during a religious ritual.</p> Gandiwa M, Manda CS, Kayange PC Copyright (c) 2023 Gandiwa M, Manda CS, Kayange PC Wed, 19 Apr 2023 00:00:00 -0400 Status of sub-specialization among practising ophthalmologists in Eastern Africa <p><strong>Objective:</strong> To establish the status of sub-specialization among practicing ophthalmologists in the Eastern Africa<br>region.</p> <p><br><strong>Design:</strong> This was a cross-sectional study.</p> <p><br><strong>Method:</strong> An analysis of data obtained from 65 practising ophthalmologists from six universities/teaching<br>hospitals in three countries within Eastern Africa.</p> <p><br><strong>Results:</strong> About a third (32%) of the practising ophthalmologists had sub-specialized while the rest (68%) had<br>not sub-specialized. Glaucoma had the highest number of sub-specialists while neuro-ophthalmology, uveitis<br>and ophthalmic pathology/tumour had none. About two-thirds (65.9%) of ophthalmologists who had not<br>sub-specialized indicated willingness to specialize subject to availability of opportunity and funding. Vitroretinal<br>surgery and anterior segment being the most preferred sub-specialties. India was cited as the main subspecialization<br>destination due to availability of sufficient hands-on training opportunities. The main barriers<br>to sub-specialization cited were lack of sufficient funding and inadequate opportunities for sub-specialization.<br>Lack of support in terms of equipment was seen as a major post-training challenge.</p> <p><br><strong>Conclusion:</strong> Majority of practising ophthalmologists had not sub-specialized mainly due to lack of sufficient<br>opportunities and funding. Although glaucoma is the area with many sub-specialists, vitro-retinal surgery<br>and anterior segment are emerging as the main preferred specialty area among ophthalmologists who had<br>not sub-specialized. Consequently, sustainable and demand driven funding and training opportunities for subspecialization<br>needs to be provided as a mechanism of raising sub-specialization profiles within the regions.</p> Kariuki M, Kithuka P, Irungu D , Koome G Copyright (c) 2023 Kariuki M, Kithuka P, Irungu D , Koome G Wed, 19 Apr 2023 00:00:00 -0400 Prevalence, risk factors and causes of visual impairment in patients with diabetes at Mbarara Regional Referral Hospital, South Western Uganda; A hospital based study <p><strong>Objective:</strong> To determine the prevalence, causes and risk factors to visual impairment among patients with<br>diabetes at Mbarara Regional Referral Hospital (MRRH) as a baseline pilot for developing diabetic retinopathy<br>treatment services.</p> <p><br><strong>Design:</strong> This was a descriptive cross sectional hospital based study conducted for a period of six months.<br>Methods: In a cross-sectional study done at Mbarara Regional Referral Hospital, 318 patients with diabetes aged<br>18 years and above were enrolled. Their visual acuity was determined. Those that had visual acuity of below<br>6/18 underwent a detailed ocular exam including refraction and a dilated fundoscopy to determine the cause<br>of visual impairment.</p> <p><br><strong>Results:</strong> The prevalence of visual impairment was 28.6% without correction, and 17% with correction. Cataract<br>was the commonest cause of visual impairment (34.5%) followed by refractive error (20.8%), glaucoma (16.8%)<br>and diabetic retinopathy (12.5%). Age was the only significant risk factor to visual impairment in this population.</p> <p><br><strong>Conclusion:</strong> The proportion of visual impairment was high and cataract was the commonest cause of visual<br>impairment in this population.</p> Seba EG, Arunga S, Bwonya BD, Twinamasiko A Copyright (c) 2023 Seba EG, Arunga S, Bwonya BD, Twinamasiko A Wed, 19 Apr 2023 00:00:00 -0400 Ocular surface disease among glaucoma patients in Ibadan, South-West Nigeria <p><strong>Objective:</strong> To study the frequency and severity of ocular surface disease among glaucoma patients attending<br>the Eye Clinic of the University College Hospital, Ibadan, Nigeria.<br><br><strong>Methods:</strong> A hospital-based, cross sectional study was carried out at the Eye Clinic of the University College<br>Hospital, Ibadan. After a detailed ocular examination, each respondent completed an Ocular Surface Disease<br>Index (OSDI) questionnaire and performed central visual field assessment. Participants were analyzed for the<br>effect of anti-glaucoma topical medications (all BAK-preserved) and glaucoma severity on ocular surface disease.</p> <p><br><strong>Results:</strong> A total of 122 consecutive glaucoma patients were studied. Males accounted for 45.1%. Increasing daily<br>drops of anti-glaucoma medication was significantly associated with increasing side effects such as redness,<br>stinging and peppery sensations (p &lt; 0.01). Eighty four patients representing 68.9% had some form of OSD using<br>the OSDI score. The OSDI scores and the number of patients with OSD significantly increased with increasing<br>glaucoma severity (p &lt; 0.01).</p> <p><br><strong>Conclusion:</strong> Ocular surface disease was found to be associated with glaucoma severity and use of BAK-preserved<br>topical anti-glaucoma medications.<br>Key words: Benzalkonium chloride, Glaucoma, Ibadan, Ocular surface disease</p> Sarimiye TF, Fasina O, Ashaye A, Bekibele C, Olawoye O Copyright (c) 2023 Sarimiye TF, Fasina O, Ashaye A, Bekibele C, Olawoye O Wed, 19 Apr 2023 00:00:00 -0400 Knowledge, attitude and practices among medical officers and diabetic patients regarding diabetic retinopathy in Ogun state of Nigeria <p><strong>Objective:</strong> To assess the knowledge, attitudes and practices regarding Diabetic Retinopathy (DR) among Medical<br>Officers (MO) and diabetic patients in Ogun State of Nigeria.</p> <p><br><strong>Design:</strong> This was a cross-sectional study.</p> <p><br><strong>Setting:</strong> Diabetic clinics based in three hospitals in Ogun state.</p> <p><br><strong>Methods:</strong> Medical officers in all the general hospitals were interviewed via telephone while one teaching hospital<br>and two state hospitals were randomly selected to conduct face-to-face interviews with diabetic patients. Data<br>obtained from these interviews was filled into a structured questionnaire.</p> <p><br><strong>Results:</strong> All the medical officers in the general hospitals were aware that DM affects the eyes while 43% believed<br>that diabetic patients need a monthly eye examination. About 36% examined the eyes of diabetic patients on<br>each visit. All medical officers would refer a diabetic with poor vision to an ophthalmologist. Majority (75%) of<br>the patients recruited were female. Fifty-one per cent of patients were not aware that diabetes affects the eyes<br>while only 35% had ever had a fundoscopy.</p> <p><br><strong>Conclusions:</strong> The medical officers in the general hospitals in the state are all aware that diabetes can cause DR<br>but don’t have eye clinics. Less than half of them (43%) screen for DR. Known diabetics are not having regular<br>eye examination.</p> Bogunjoko TJ Copyright (c) 2023 Bogunjoko TJ Wed, 19 Apr 2023 00:00:00 -0400 First JOECSA online only publication <p>Welcome to the first JOESCA edition that is available<br>only on the online version.</p> JOECSA Copyright (c) 2023 JOECSA Wed, 19 Apr 2023 00:00:00 -0400 Teams for better ophthalmology care <p>Teams for better ophthalmology care</p> JOECSA Copyright (c) 2023 JOECSA Wed, 19 Apr 2023 00:00:00 -0400