Childhood vision impairment and refractive error in Zimbabwe: A hospital-based retrospective study

BACKGROUND: The objective of this study was to determine the causes and distribution of vision impairment and refractive error among children in Zimbabwe.METHODS: A hospital-based retrospective cross-sectional study was conducted among children (3-16) who attended the Eye Institute, Harare, Zimbabwe, from January 2010 to December 2020. Patients’ records were collated, and variables such as visual acuity, ocular morbidities, and vision impairment were analysed.RESULTS: During this time, 1038 children with mean age of 10.63 ± 3.54 years visited the facility. The majority of them were males (53.2%). Prior to treatment, 9.9% of the children had vision impairment which reduced to 3.5% after intervention. Uncorrected refractive error accounted for the majority of vision impairment (67.0%), followed by keratoconus (7.8%), corneal opacity/ulceration (6.8%), and amblyopia (6.8%), among other conditions. Astigmatism (60.6%) was the most prevalent type of refractive error followed by myopia (37.5%).CONCLUSION: The prevalence of childhood vision impairment is higher than that found in similar hospital-based studies conducted in Africa. The most common reason for childhood vision impairment was uncorrected refractive error

The Association of Central Corneal Thickness and Intraocular Pressure Measures by Non-Contact Tonometry and Goldmann Applanation Tonometry among Glaucoma Patients.

BACKGROUND፡ The aim of this study was to determine whether Central Corneal Thickness (CCT) is associated with intraocular pressure measurement (IOP) with a Non-contact tonometer and the Goldmann applanation tonometer in glaucoma patients.MATERIALS AND METHODS: The study involved two hundred and thirty-two eyes of clinically diagnosed glaucoma patients receiving care at a referral facility. IOP measurements were obtained using both the Non-Contact Tonometer (NCT) and Goldmann Applanation Tonometer (GAT). The association between age, ethnicity, and CCT, as well as CCT on the measures of NCT and GAT, were analyzed.RESULTS: There were 64(55.2%) males and 52 (44.8%) females and their ages ranged from 18 to 85 years (mean age = 47.72; SD ±15.75 years). There was a weak positive correlation between the CCT and NCT findings in the right eye (r = 0.19, n = 116, p < 0.05) and in the left eye (r = 0.25, n = 116, p < 0.05). However, there was no correlation between CCT and GAT measurements. Age had a significant correlation with CCT while gender and ethnicity had no significant correlation.CONCLUSION: The study found a significant association between CCT and NCT. However, there was no significant association between CCT and GAT. CCT had an association with age but independent of gender and ethnicity since there was no significant relationship between these variables

Comparison of the Outcomes of Manual Small Incision Cataract Surgery (MSICS) and Phacoemulsification (PHACO) in Ghana

Background: The growing middle-class population of Ghana has seen more people being employed in visually demanding occupations  and hence there is an increased desire for quality post-cataract surgical visual outcomes. This study aimed at comparing the outcomes of manual small incision cataract surgery (MSICS) and phacoemulsification (PHACO) among Ghanaians. Methods: This was a retrospective cross-sectional study in which records of patients who underwent MSCIS or phacoemulsification by the same surgeon were reviewed. Results: Medical records of 248 eyes were reviewed, out of which 132 underwent PHACO and 116 had MSICS. A significant number of the  PHACO group had good (6/6–6/18) uncorrected visual acuity (UCVA) compared to the MSICS group at 1–2 weeks follow-up (p = 0.003) and 4–6 weeks follow-up (p = 0.002). MSICS resulted in a higher total astigmatic change compared to PHACO (p < 0.001). The PHACO grouphad a higher number of postoperative complications compared with the MSICS group (p <0.001). Postoperative borderline and poor  uncorrected visual acuity were associated with age, total astigmatic change, and postoperative complications. Conclusion: The postoperative UCVA outcomes at 4–6 weeks’ follow-up indicates that PHACO resulted in noticeably less spectacle dependency when compared to MSICS

Development and Validation of the Minnesota Low Vision Reading Test (MNRead) Acuity Chart for the Asante Twi Language

Aim: To design and validate a MNREAD Asante Twi version reading chart, to aid in the assessment of near visual acuity of natives Ghanaians. Methods: Cross-sectional and experimental designs were employed in phases I and II respectively of this study. The chart was developed using 20 transited pupils in class four in the Kumasi metropolis in phase I and validated in a clinical setting at the Manhyia District Hospital, Kumasi, using students in phase II. Results: A total of 100 participants (mean age; 22.19 \ub1 1.61 years) were involved in the second phase of this study. A Pearson product-moment correlation coefficient was computed to assess the relationship between MNREAD Asante Twi charts logMAR scores in both eyes. The MNREAD-Asante Twi acuity charts had very strong correlations (r = 0.94, p < 0.001) for MNREAD set 1A (black on white background) scores and MNREAD set 2A (black on white background) for acuity scores. Correlation between MNREAD set 1B (white on black background) scores and MNREAD set 2B (white on black background) scores was r = 0.95, p < 0.001. Conclusion: MNREAD Asante Twi reading chart will enhance the measurement of near visual function in native Ghanaians

Clinical and sociodemographic characteristics of glaucoma patients at a tertiary referral facility in Zimbabwe

PurposeTo evaluate the clinical and socio-demographic profile of patients living with glaucoma and receiving care in a tertiary eye center in Zimbabwe.MethodA hospital-based retrospective study of clinical records of glaucoma patients from January 2014 to December 2018. The study involved collating demographic information of patients, visual acuities, (VA) intraocular pressure, (IOP), cup-to-disc ratios, (CDRs), average retinal nerve fibers thickness, (RNFL), cup volume, cup-to-disc area, vertical cup-to-disc ratio, (VCDR), rim area, disc area, glaucoma hemifield test, visual field indices and the management of glaucoma.ResultsNine thousand one hundred and eighty-five (9,185) folders were retrieved. Out of these, 432 (4.7%) qualified for the study and were analyzed. There were 267 (61.8%) males and 165 (38.2%) females. The mean age (± Standard deviation, SD) of the patients was 62.66 ± 15.94 years, (range 10 - 110 years). The means visual acuity (VA): OD =1.30 ± 1.06 Logarithm of the Minimum Angle of Resolution, (logMAR), OS = 1.33 ± 1.06 logMAR; IOP: OD = 29.51 ± 12.89 mmHg, OS: 29.17 ± 12.59 mmHg; CDRs: OD = 0.91 ± 0.14 D, OS = 0.92 ± 0.14 D; and the average RNFL thickness was 72.76 ± 18.26 µm and 71.24 ± 23.17 µm in the right and left eye respectively. The mainstay of treatment was medication only. ConclusionThere were more males than females receiving glaucoma care at the tertiary level. Glaucoma cases included juveniles but the mean age was mostly the elderly. It was characterized by high IOPs, large CDRs, and thin RNFL suggestive of late presentation

Prevalence and causes of visual impairment amongst hearing impaired school-going children in sub-Saharan Africa: a scoping review

Background: Learners living with hearing impairment are at a higher risk of visual impairment. Purpose: To summarise relevant literature investigating the prevalence and causes of visual impairment amongst learners living with hearing impairment in sub-Saharan Africa. Methods: A search of nine databases and the reference lists of retrieved studies were conducted using the standard methodology for scoping reviews as described in the PRISMA statement. The databases were MEDLINE, PubMed, EMBASE, the Cochrane Library, Global Health, OVID, Google Scholar, Web of Science, and Science Direct. A scoping review of articles published in the English language from 2000 to 2020 was conducted while considering the study design, sub-Saharan Africa, and school for the deaf. Descriptive statistics was used to analyse the data. Results: The initial search retrieved eight studies, seven of which met the set inclusion criteria. All seven studies included employed a cross-sectional design. The prevalence of visual impairment ranged from 2.2-34.6% with the major cause being uncorrected refractive error (7.9-73.26%). The most common type of refractive error was myopia (42.2%) followed by hyperopia (28.6%) and astigmatism (28.6%). Conclusion: This review has demonstrated that there is a paucity of high-quality and well-designed studies that have investigated the prevalence and causes of visual impairment amongst hearing-impaired children in sub-Saharan Africa suggesting the need for further research in this area. Keywords: Visual impairment; prevalence; Africa; hearing impairment; ocular morbidity

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Epidemiology and clinical presentation of glaucoma in a referral facility in Ghana: Any lessons for public health intervention?

The purpose of this study was to evaluate the epidemiological and clinical profile of patients living with glaucoma and receiving care in a tertiary eye center in Ghana. This was a hospital-based retrospective study of clinical records of glaucoma patients from January 2010 to December 2019. The study involved collating demographic information of patients, clinical presentation, and the management of glaucoma. A total of nineteen thousand (19,000) charts were retrieved from the eye center's archives. Out of these, 660 (3.5%) records of patients qualified for the study and were analyzed. There were 398 (60.3%) males and 262 (39.7%) females. Their ages ranged from 9 to 86 years (mean age = 47.30; SD ± 16.86 years). The averages of ocular parameters of 1,320 eyes (660 patients) were visual acuity = 0.26 ± 0.55 logMAR; intraocular pressure: 17.31 ± 6.11 mmHg; cup-to-disc ratios: 0.67 ± 0.17 D; and the average retinal nerve fibers thickness was 95.03 ± 21.74 μm. The mainstay of treatment was the sole use of medication. Males were the major group receiving glaucoma care at the tertiary level. Glaucoma cases included juveniles but the mean age suggests most were of adult-onset. Socio-demographic characteristics affected the diagnosis and management of glaucoma among patients receiving care at a referral center. Public health, stakeholders, and policymakers' interventions can help identify individuals with glaucoma

Comparative assessment of the Goldmann applanation and noncontact tonometers in intraocular pressure measurements in a sample of glaucoma patients in the Cape Coast Metropolis, Ghana

Objectives: The objective of the study was to explore the usage of the Goldmann applanation tonometry and noncontact tonometry interchangeably in the measurement of intraocular pressure (IOP) in glaucoma patients. Materials and Methods: The study involved 441 clinically diagnosed glaucoma patients receiving care at a referral facility. IOP measurements were obtained using both the Noncontact tonometer and Goldmann applanation tonometer The repeatability of the measures was analyzed by comparing the repeated measures of the devices using paired t‑test and calculating the correlation coefficient. A Bland–Altman analysis was used to determine the limits of agreement between the two procedures. Results: There were 271 (61.5%) males and 170 (38.5%) females and their age ranged from 18 to 73 years (mean age = 49.37; standard deviation ± 14.81 years). The findings of the study showed significantly lower readings (P < 0.001) of the GAT (right eye = 17.40 ± 7.48 mmHg; left eye = 16.80 ± 7.49 mmHg) compared to the NCT (right eye = 20.15 ± 8.30 mmHg; left eye = 19.74 ± 8.31 mmHg). There was a strong positive correlation between the GAT and NCT findings in the right eye (r = 0.871, n = 441, P < 0.001) and in the left eye (r = 0.887, n = 441, P < 0.001). There was a wide limit of agreement between NCT and GAT measurements. Conclusion: There was statistically significant higher measures obtained with NCT than the GAT but did not exceed the allowable inter‑device difference. There was a strong positive correlation between GAT and NCT measurements. However, it is strongly recommended that these devices are not used interchangeably in the monitoring of IOP in glaucoma due to the wide range of limits of agreement

Ocular trauma among patients attending a tertiary teaching hospital in Zimbabwe.

PurposeTo investigate the trends, prevalence and distribution of ocular trauma in a Zimbabwean Tertiary Teaching Hospital (Parirenyatwa).MethodA hospital-based retrospective cross-sectional study was conducted at the Parirenyatwa Group of Hospitals, Sekuru Kaguvi Eye Department in Harare, Zimbabwe, to review medical records of patients with ocular trauma visiting for treatment at the outpatient department between January 2017 and December 2021. Information on patients' demographics, presenting visual acuity, type of ocular trauma, and the number of eyes affected were collected and analysed using descriptive and inferential statistics.ResultsA total of 863 patients (1007 eyes) were identified to have experienced ocular trauma of one kind or another, with the youth (18-35 years) reporting with most cases (331, 38.4%). About 71.2% of patients were classified as having open-globe injuries and of that number, 90% were caused by blunt trauma, while the rest were caused by penetrating, intraocular, and perforating injuries. Patients with open-globe injuries were about 10 times more likely to develop blindness than those with closed-globe injuries after adjusting for age and gender, and this was statistically significant (ARR = 9.65, 95% CI: 5.53-16.84, p ConclusionThere is a high prevalence of open-globe injuries in Zimbabwe with blunt trauma being the most significant cause. This suggests the need to promote and intensify public eye health awareness and sensitisation on safety strategies for the prevention of ocular trauma throughout the country