1
|
Garba F, Kyari F, Nolan W, Burton MJ, Gordon I, Evans JR, Hu VH. Portable devices for diagnosis and monitoring of glaucoma: a scoping review protocol. BMJ Open 2024; 14:e082375. [PMID: 38471693 PMCID: PMC10936509 DOI: 10.1136/bmjopen-2023-082375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Glaucoma is the leading cause of irreversible blindness in the world. The need to diagnose glaucoma early in its natural history before extensive sight loss occurs cannot be overemphasised. However, glaucoma is largely asymptomatic in the early stages of the disease making it complex to diagnose clinically and requires the support of technology. The objective of this scoping review is to determine the nature and extent of the evidence for use of portable devices in the diagnosis of glaucoma. METHODS We will consider studies conducted in all healthcare settings using portable devices for the detection of all type of adult glaucoma. We will also include any systematic reviews or scoping reviews, which relate to this topic. Searches will be conducted in MEDLINE, Embase, CENTRAL on the Cochrane Library and Global Health databases, from their inception to the present. Reference lists from publications identified in the searches will also be reviewed. Two authors will independently screen titles and abstracts, followed by full-text screening to assess studies for inclusion. Any disagreements will be discussed and resolved with a third author. Tables accompanied by narrative descriptions will be employed to discuss results and show how it relates to review questions. ETHICS AND DISSEMINATION Ethical approval is not required in this review. Only published and publicly accessible data will be used. We will publish our findings in an open-access, peer-reviewed journal and develop an accessible summary of results and recommendations.
Collapse
Affiliation(s)
- Farouk Garba
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
- Department of Ophthalmology, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Fatima Kyari
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
- Department of Ophthalmology, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Winifred Nolan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
- NHIR Biomedical Reserach Centre, Moorfields and UCL Institute of Ophthalmology, London, UK
| | - Matthew J Burton
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
| | - Iris Gordon
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
| | - Jennifer R Evans
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
| | - Victor H Hu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, International Centre for Eye Health, London, UK
| |
Collapse
|
2
|
Eze U, Yeye-Agba O, Obasuyi O, Danagundi M, of the OB. The world is bright, save your sight: Why you should take your eye checks serious. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_203_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
3
|
Selective laser trabeculoplasty versus 0·5% timolol eye drops in the management of glaucoma in Tanzania. THE LANCET GLOBAL HEALTH 2021; 9:e1489-e1490. [DOI: 10.1016/s2214-109x(21)00402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
|
4
|
Mukwanseke E, Kilangalanga J, Lutete F, Hopkins A, Guthoff RF, Frech S. Ocular Morbidity-A Critical Analysis to Improve Outpatient Services in an Eye Department in a Sub-Saharan Megacity. J Clin Med 2021; 10:jcm10173791. [PMID: 34501238 PMCID: PMC8432205 DOI: 10.3390/jcm10173791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to analyse outpatient services in an ophthalmic clinic of a church-run hospital providing secondary level care in an African megacity, paying special attention to the poorest users of the services. The range of examination was reviewed from 500 patient records of all ages consecutively chosen on random days attending the outpatient department for the first time in order to optimize workflow and to analyse the offered treatment modalities. Mean age was 41.9 ± 21.9 years, and 53.6% of the patients were female. Of the patients, 74.8% presented with visual impairment. The most frequent findings were refractive errors (35.8%), presbyopia (21.2%), allergic conjunctivitis (14.0%), cataract (13.2%) and glaucoma (6.4%). Patient management consisted of optical treatment (49.6%), surgery (11.4%) and medical treatment (39.0%). These results show the importance of the demand in refractive services and the need to train specific service providers. Knowing the frequencies of common conditions enables more appropriate diagnostic and treatment strategies, e.g., the importance of refractive errors, and should lead to improvements in training, staffing, therapeutics and patient outcomes. This approach can be applied to many other outpatient services and should be evaluated in light of the city’s impoverished health outreach and educational situation.
Collapse
Affiliation(s)
- Edith Mukwanseke
- Centre de Formation Ophtalmologique Pour l’Afrique Centrale, Eye Department, Saint Joseph’s Hospital, Kinshasa P.O. Box 322, Democratic Republic of the Congo; (E.M.); (J.K.); (F.L.)
| | - Janvier Kilangalanga
- Centre de Formation Ophtalmologique Pour l’Afrique Centrale, Eye Department, Saint Joseph’s Hospital, Kinshasa P.O. Box 322, Democratic Republic of the Congo; (E.M.); (J.K.); (F.L.)
| | - Flavien Lutete
- Centre de Formation Ophtalmologique Pour l’Afrique Centrale, Eye Department, Saint Joseph’s Hospital, Kinshasa P.O. Box 322, Democratic Republic of the Congo; (E.M.); (J.K.); (F.L.)
| | - Adrian Hopkins
- National Programme for Eye Health and Vision, Kinshasa P.O. Box 322, Democratic Republic of the Congo;
| | - Rudolf F. Guthoff
- Department of Ophthalmology, Rostock University Medical Centre, 18057 Rostock, Germany;
| | - Stefanie Frech
- Department of Ophthalmology, Rostock University Medical Centre, 18057 Rostock, Germany;
- Correspondence:
| |
Collapse
|
5
|
Ophthalmology training in sub-Saharan Africa: a scoping review. Eye (Lond) 2020; 35:1066-1083. [PMID: 33323984 DOI: 10.1038/s41433-020-01335-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 11/08/2022] Open
Abstract
Sub-Saharan Africa is home to 12% of the global population, and 4.3 million are blind and over 15 million are visually impaired. There are only 2.5 ophthalmologists per million people in SSA. Training of ophthalmologists is critical. We designed a systematic literature review protocol, searched MEDLINE Ovid and Embase OVID on 1 August 2019 and limited these searches to the year 2000 onwards. We also searched Google Scholar and websites of ophthalmic institutions for additional information. We include a total of 49 references in this review and used a narrative approach to synthesise the results. There are 56 training institutions for ophthalmologists in eleven Anglophone, eleven Francophone, and two Lusophone SSA countries. The median duration of ophthalmology training programmes was 4 years. Most curricula have been regionally standardised. National, regional and international collaborations are a key feature to ophthalmology training in more than half of ophthalmology training programmes. There is a drive, although perhaps not always evidence-based, for sub-specialisation in the region. Available published scientific data on ophthalmic medical and surgical training in SSA is sparse, especially for Francophone and Lusophone countries. However, through a broad scoping review strategy it has been possible to obtain a valuable and detailed view of ophthalmology training in SSA. Training of ophthalmologists is a complex and multi-faceted task. There are challenges in appropriate selection, capacity, and funding of available training institutions. Numerous learning outcomes demand curriculum, time, faculty, support, and appropriate assessment. There are opportunities provided by modern training approaches. Partnership is key.
Collapse
|
6
|
West Indies Glaucoma Laser Study (WIGLS) 3. Anterior Chamber Inflammation Following Selective Laser Trabeculoplasty in Afro-Caribbeans with Open-angle Glaucoma. J Glaucoma 2020; 28:622-625. [PMID: 30921277 DOI: 10.1097/ijg.0000000000001250] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PRECIS In the absence of prophylactic anti-inflammatory therapy, anterior chamber inflammation (characterized by cells and less commonly flare) is minimal and transient after selective laser trabeculoplasty in Afro-Caribbean glaucoma patients. PURPOSE The purpose of this study was to characterize the prevalence, severity, and duration of anterior chamber inflammation (cells and flare) following selective laser trabeculoplasty (SLT) in Afro-Caribbean eyes with primary open-angle glaucoma (POAG). METHODS In total 144 eyes of 72 POAG patients underwent first-time 360-degree SLT treatment following washout of all topical medications in the prospective West Indies Glaucoma Laser Study. No anti-inflammatory therapy was used post-SLT. Anterior chamber cells and flare were characterized pre-SLT after medication washout, and 1 week, 6 weeks, and 3, 6, 9 and 12 months post-SLT using the standardized methodology described by the Society for Uveitis Nomenclature (SUN) in which cells and flare are each graded on a scale of 0-4+ using specific slit-lamp settings. RESULTS Mean cell scores in both right and left eyes rose significantly (P<0.0001) from baseline to week 1 after SLT before returning to baseline values at all subsequent time points. Mean flare scores in right eyes (P=0.0185) but not left eyes (P=0.1816) rose from baseline to week 1 after SLT before returning to baseline values at all subsequent time points. Cells appeared in 40.3% of eyes and flare appeared in 9.7% of eyes after SLT. One subject developed bilateral symptomatic anterior iritis one day postoperatively and reported a previously undisclosed history of recurrent iritis; the iritis resolved with topical steroid therapy. CONCLUSIONS SLT in Afro-Caribbean people with POAG is associated with mild, short-lived and self-limited anterior chamber inflammation. Routine anti-inflammatory therapy to suppress posttreatment inflammation after SLT is unnecessary in this population.
Collapse
|
7
|
Glaucoma Features in an East African Population: A 6-Year Cohort Study of Older Adults in Nakuru, Kenya. J Glaucoma 2019; 27:455-463. [PMID: 29557831 DOI: 10.1097/ijg.0000000000000941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Glaucoma is a leading cause of blindness in people of African descent. Minimal data is available from African population-based cohort studies. The primary aims of this study were to describe the normative distribution of glaucoma features to enable glaucoma classification and to assess risk factors for those with glaucoma at follow-up among people aged 50 years and above in Kenya. MATERIALS AND METHODS Random cluster sampling with probability proportionate to size was used to select a representative cross-sectional sample of adults aged 50 years and above in 2007 to 2008 in Nakuru District, Kenya. A 6-year follow-up was undertaken in 2013 to 2014. Comprehensive ophthalmic examination included visual acuity, digital retinal photography, visual fields, intraocular pressure, optical coherence tomography, and independent grading of optic nerve images. We report glaucoma features, prevalence and predictors for glaucoma based on the International Society for Geographical & Epidemiological Ophthalmology (ISGEO) criteria. Measures were estimated using a Poisson regression model and including inverse-probability weighting for loss to follow-up. RESULTS At baseline, 4414 participants aged 50 years and above underwent examination. Anterior chamber optical coherence tomography findings: mean anterior chamber angle of 36.6 degrees, mean central corneal thickness of 508.1 μm and a mean anterior chamber depth of 2.67 mm. A total of 2171 participants were examined at follow-up. The vertical cup to disc ratio distribution was 0.7 and 0.8 at the 97.5th and 99.5th percentiles, respectively. A total of 88 (4.3%, 95% confidence interval, 3.5%-5.9%) of participants at follow-up had glaucoma consistent with ISGEO criteria. A relative afferent pupillary defect and raised intraocular pressure were associated with the diagnosis. CONCLUSIONS Glaucoma is a public health challenge in low-resource settings. Research into testing and treatment modalities in Africa is needed.
Collapse
|
8
|
Muhammad N, Adamu MD, Mpyet C, Bounce C, Maishanu NM, Jabo AM, Rabiu MM, Bascaran C, Isiyaku S, Foster A. Impact of a 10-Year Eye Care Program in Sokoto, Nigeria: Changing Pattern of Prevalence and Causes of Blindness and Visual Impairment. Middle East Afr J Ophthalmol 2019; 26:101-106. [PMID: 31543668 PMCID: PMC6737780 DOI: 10.4103/meajo.meajo_113_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: This study was undertaken to ascertain the current magnitude and causes of blindness and visual impairment in persons aged 50 years and over and to assess the impact of a 10-year eye care program in Sokoto State, Nigeria. METHODS: A rapid assessment of avoidable blindness (RAAB) survey (in persons 50 years and over) was conducted in 2016. Participants were selected in Wurno health zone using a two-stage cluster randomized sampling with probability proportional to size. Operational definitions were based on RAAB and World Health Organization eye examination record definitions. Eye care program documents were reviewed and data from a baseline survey undertaken in 2005 were reanalyzed. RESULTS: A response of 89.1% (2405 of 2700 participants) was obtained in the 2016 survey. With available correction, the unadjusted prevalence of blindness was 7.7% (95% confidence interval [CI]: 6.4, 8.9). The odds of blindness were 1.8 times higher in females than males (95% CI: 1.3, 2.4; P < 0.001). Major causes of blindness were cataract (48.9%) corneal disease (20.1%), glaucoma (10.3%), and uncorrected refractive error/aphakia (8.7%). The age- and sex-adjusted prevalence of blindness has declined from 11.6% (95% CI: 7.4, 17.0) in 2005 to 6.8% (95% CI: 5.6, 8.0%) in 2016. CONCLUSION: The blindness prevalence is high, and the major causes are avoidable in the health zone. The findings suggest that investments in the program over the last 10 years might have led to almost a halving in the prevalence of blindness in th e population. However, the small sample size of persons 50+ years from Wurno zone in the 2005 survey necessitate caution when comparing the 2005 and the 2016 surveys.
Collapse
Affiliation(s)
- Nasiru Muhammad
- Department of Ophthalmology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Mohammed D Adamu
- Department of Ophthalmology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria.,Sightsavers Nigeria Office, Kaduna, Nigeria.,Division of Ophthalmology, Kilimanjaro Centre for Community Ophthalmology International, University of Cape Town, Cape Town, South Africa
| | - Catey Bounce
- Department of Primary Care and Public Health Sciences, King's College, London, United Kingdom
| | - Nuhu M Maishanu
- Sokoto State Eye Health Programme, Ministry of Health, Sokoto, Nigeria
| | | | | | - Covadonga Bascaran
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Allen Foster
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
9
|
Realini T, Olawoye O, Kizor-Akaraiwe N, Manji S, Sit A. The Rationale for Selective Laser Trabeculoplasty in Africa. Asia Pac J Ophthalmol (Phila) 2018; 7:387-393. [PMID: 30484574 DOI: 10.22608/apo.2018271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Glaucoma is the leading cause of irreversible blindness in Africa. The condition is treatable but not curable. There are numerous obstacles to glaucoma care in Africa, including availability, accessibility and affordability of treatments, as well as medication nonadherence among patients. Medical therapy is costly relative to the average income in Africa and it requires daily self-dosing by patients. Surgery is of limited availability in many regions in Africa, and a high proportion of patients refuse surgery because it is expensive. Selective laser trabeculoplasty (SLT) proves to be a favorable alternative to medical or surgical care, as it is highly effective and safe in people of African descent, more cost-effective than medical therapy, quick and easy to perform, and portable. The procedure also requires no postoperative care, thus obviates the issue of nonadherence. In uncontrolled studies, SLT has a high response rate and it lowers intraocular pressure by 30% to 40%, which exceeds the goal in international guidelines for initial therapies. The African Glaucoma Consortium (AGC), a member-driven stakeholder collective, has been formed in part to develop the infrastructure for continent-wide improvements in glaucoma care. It embraces SLT as a potential key tool in their development plans. The mission of AGC includes improving clinical care by educating existing and new health care professionals to expand the provider network, by conducting trials to identify optimal care strategies for glaucoma in Africa, and by facilitating the development of an integrated network of Centers of Excellence to bring SLT and other crucial glaucoma therapies to communities throughout Africa.
Collapse
Affiliation(s)
- Tony Realini
- West Virginia University Eye Institute, Morgantown, WV
| | - Olusola Olawoye
- Department of Ophthalmology, College of Medicine, University of Ibadan, Nigeria
| | | | - Selina Manji
- Global Health Program, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|