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Introduction Retinoblastoma is the most frequent intraocular malignancy of the eye in children, occurring in early childhood. Based on global estimates, Ethiopia is expected to observe over 200 new retinoblastoma cases per year, however without a cancer registry, this number is difficult to confirm. Therefore, the goal of the study was to determine the incidence and geographic distribution of retinoblastoma in Ethiopia. Methods A retrospective medical chart review of clinically diagnosed new retinoblastoma patients between January 1, 2017 - December 31, 2020, in four public Ethiopian tertiary hospitals was performed. The incidence of retinoblastoma was calculated by a birth-cohort analysis. Results There were 221 retinoblastoma patients observed in the study period. The incidence of retinoblastoma was found to be 1 in 52,156 live births. Incidence varied among different regions of Ethiopia. Conclusion The incidence of retinoblastoma observed in this study is likely an underestimate. It is possible that patients were undercounted because they were seen outside of the 4 main retinoblastoma treatment facilities included in this facility, or they experienced barriers to accessing care. Our study suggests a need for a nationwide retinoblastoma registry and more retinoblastoma treatment centers in the country.

Background Increased lag time between the onset of symptoms and treatment of retinoblastoma (RB) is one of the factors contributing to delay in diagnosis. The aim of this study was to understand the referral patterns and lag times for RB patients who were treated at Menelik II Hospital in Addis Ababa, Ethiopia. Method A single-center, cross- sectional study was conducted in January 2018. All new patients with a confirmed RB diagnosis who had presented to Menelik II Hospital from May 2015 to May 2017 were eligible. A questionnaire developed by the research team was administered to the patient’s caregiver by phone. Results Thirty-eight patients were included in the study and completed the phone survey. Twenty-nine patients (76.3%) delayed seeing a health care provider for ≥ 3 months from the onset of symptoms, with the most common reason being the belief that it was not a problem (96.5%), followed by 73% saying it was too expensive. The majority of patients (37/38, 97.4%) visited at least 1 additional health care facility prior to reaching a RB treatment facility. The mean overall lag time from noticing the first symptom to treatment was 14.31 (range 0.25–62.25) months. Conclusion Lack of knowledge and cost are major barriers to patients first seeking care for RB symptoms. Cost and travel distance are major barriers to seeing referred providers and receiving definitive treatment. Delays in care may be alleviated by public education, early screening, and public assistance programs.

Introduction: The presenting symptoms of retinoblastoma in Ethiopia, as well as their relationship to the stage of the disease, are poorly understood, but they could be important as background knowledge for creating early detection initiatives. This study aimed to describe the clinical and histopathological characteristics of retinoblastoma among Ethiopian patients. Methods: A hospital-based cross-sectional analysis of all children with newly diagnosed retinoblastoma during the study period of May 2015 to December 2019, inclusive, who presented to a tertiary referral center during were included. Demographic, clinical, and histological characteristics were collected and descriptive statistics were done using SPSS Version 20.0 software. Results: A total of 217 patients (unilateral 84.3%, bilateral 15.7%) were studied. The median age at presentation was 29 months (34 months vs. 19.5 months in unilateral and bilateral cases, respectively, p < 0.001). Among all patients, 57.8% were male. Leukocoria was the most common presenting sign (37.3%) and followed by fungating mass (31.8%). Tumors were extraocular in 40.1% of cases. From the intraocular cases, 73.3% were advanced International Intraocular Retinoblastoma Classification Group D or E disease. Sixty-two (54.4%) of the eyes had high-risk pathological features. The median lag time was significantly shorter for intraocular versus extraocular cases (5 months vs. 12 months, respectively, p < 0.001). Conclusion: Our results show that the majority of Ethiopian children with retinoblastoma have delayed presentation and late stage at diagnosis. This suggests that national health promotion campaigns to increase public knowledge on the presenting signs of retinoblastoma may be critical to achieving early diagnosis. Furthermore, the development of standard management guidelines informed by this study will be helpful in managing the complex and advanced cases currently observed.

This study explored the lived experience of parents of children with retinoblastoma.A phenomenological qualitative study design was used, and a purposive sampling technique to recruit parents of children with retinoblastoma. Semi-structured interviews were conducted to document the lived experience of participants, who were asked to narrate their experiences caring for a child with retinoblastoma, thinking back to the day they learned about their child's condition, as well as their thoughts about the future. The interviews were conducted in Amharic and Oromo language, and audio recordings were transcribed and translated to English. Data were analyzed using thematic analysis.Thirteen parents (seven mothers, six fathers) participated in the study. Collectively, the children of the participants represented all the stages of the retinoblastoma journey (i.e., diagnosis, treatment, remission, and recurrence). Five major themes emerged from the thematic data analysis: (a) reactions when learning the child's condition; (b) receiving health care; (c) costs of caregiving; (d) support; and (e) uncertainties.The lived experiences of parents of children with retinoblastoma revealed a significant mental health and psychosocial burden. The sources of mental distress were found to be complex and varied. Holistic care for retinoblastoma should include programs that address the biopsychosocial needs of caregivers.

Objective To investigate in a large global sample of patients with retinoblastoma whether sex predilection exists for this childhood eye cancer. Methods A cross-sectional analysis including 4351 treatment-naive retinoblastoma patients from 153 countries who presented to 278 treatment centers across the world in 2017. The sex ratio (male/female) in the sample was compared to the sex ratio at birth by means of a two-sided proportions test at global level, country economic grouping, continent, and for selected countries. Results For the entire sample, the mean retinoblastoma sex ratio, 1.20, was higher than the weighted global sex ratio at birth, 1.07 (p n = 1940), 1.23 vs. 1.07 (p = 0.019); Asia (n = 2276), 1.28 vs. 1.06 (p n = 558), 1.52 vs. 1.11 (p = 0.008). Sensitivity analysis, excluding data from India, showed that differences remained significant for the remaining sample (χ2 = 6.925, corrected p = 0.025) and for Asia (χ2 = 5.084, corrected p = 0.036). Excluding data from Asia, differences for the remaining sample were nonsignificant (χ2 = 2.205, p = 0.14). Conclusions No proof of sex predilection in retinoblastoma was found in the present study, which is estimated to include over half of new retinoblastoma patients worldwide in 2017. A high male to female ratio in Asian countries, India in specific, which may have had an impact on global-level analysis, is likely due to gender discrimination in access to care in these countries, rather than a biological difference between sexes.

BackgroundRates of care abandonment for retinoblastoma (RB) demonstrate significant geographical variation; however, other variables that place a patient at risk of abandoning care remain unclear. This study aims to identify the risk factors for care abandonment across a multinational set of patients.MethodsA prospective, observational study of 692 patients from 11 RB centres in 10 countries was conducted from 1 January 2019 to 31 December 2019. Multivariate logistic regression was used to identify risk factors associated with higher rates of care abandonment.ResultsLogistic regression showed a higher risk of abandoning care based on country (high-risk countries include Bangladesh (OR=18.1), Pakistan (OR=45.5) and Peru (OR=9.23), pConclusionCountry, advanced disease and female sex were all associated with higher rates of abandonment. In this analysis, enucleation as the primary treatment was not associated with abandonment. Further research investigating cultural barriers can enable the building of targeted retention strategies unique to each country.

Objective To assess the effect of the 45-minute diagnostic occlusion test (DOT) on the measured esodeviation in patients with acquired esotropia. Methods After the routine ophthalmic examination, 67 patients with acquired esotropia were randomly assigned to either the patch group (37 subjects) or the control group (30 subjects). For both groups the mean distance and near deviations before and after 45 minutes were compared. Results The mean pre- and post-DOT measurement at distant target for the patch group was an esodeviation of 6.7 ± 7.5 prism diopters (PD) and 13.2 ± 11.7 PD, respectively. The 45-minute DOT induced an average increase of the esotropia of 6.4 ± 5.9 PD in the patch group (p = 0.0001). For the control group, the first and second mean measurement were similar, 9.2 ± 7.6 PD and 9.1 ± 6.5 PD, respectively (p = 0.103). The mean pre- and post-DOT esodeviation at near distance for the patch group were 10.1 ± 10.1 PD and 18.7 ± 13.7 PD (p = 0.001). Following the DOT, >5 PD change was noted in 26 (70.1%) from a near distance target (p = 0.001). For the control group, the mean near first and second measurements were 13.9 PD and 15.0 PD, respectively. Conclusion Performing DOT in acquired esodeviations may help to reveal the full deviation and ultimately decrease the risk of surgical undercorrection by eliminating tonic fusional divergence. The DOT can be applied clinically for acquired esotopia to accurately measure the angle of deviation.

Background: Bilateral cataract is a significant cause of blindness in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia. Methods: A Google Forms mobile phone questionnaire was emailed to nine ophthalmologists known to perform cataract surgery in young children.Results: All nine responded. All but one had received either 12- or 3-5-month’s training in pediatric ophthalmology with hands-on surgical training. The other surgeon had received informal training from an experienced colleague and visiting ophthalmologists. Five worked in the capital, Addis Ababa, and they worked in six public referral hospitals and one private center. Over 12 months (2017-2018) 508 children underwent surgery; 84 (17%) children had bilateral and 424 (83%) had unilateral cataract, mainly following trauma (mean 66 (range 18-145 standard deviation (SD) ±47) eyes/surgeon). There were substantially fewer surgeons per million population (nine for 115 million population) than recommended by the World Health Organization and they were unevenly distributed across the country.Methylcellulose and rigid intraocular lenses were generally available but less than 50% of facilities had a sharp vitrectomy cutter and cohesive viscoelastic. Mean travel time outside Addis Ababa to a facility offering pediatric cataract surgery was 10 hours. Conclusion: Despite the high number of cases per surgeon, the output for bilateral cataracts was far lower than required. More well-equipped ophthalmologists trained in pediatric cataract surgery are urgently required, with deployment to under-served areas.

Background: Clinical studies in the hospital settings using patients having ocular morbidities have shown a high prevalence of pseudoexfoliation (PXF) in Ethiopia. With this information in mind community based study was conducted to determine prevalence and socio demographic factors of pseudoexfoliation syndrome among adults in Southern Ethiopia.Methods: A community based Crosse sectional study was conducted among subjects aged 40 years or older. Subjects underwent standardized examination, including portable slit lamp biomicroscopy before and after pupillary dilatation, and IOP measurement using Tono-Pen. Pseudoexfoliation was diagnosed on slit lamp exam by the presence of white dandruff-like material on the pupillary margin and/or on the anterior lens capsule of one or both eyes. Results: Among 760 participants, the prevalence of Pseudoexfoliation(PXF) was 12.0% (95% confidence interval, 9.7%-14.3%). The mean age was 63.9 years (SD 9.96, age range 40-90 years). The prevalence increased with increasing age, with 26.9% of those 60 or older affected. Slightly higher proportion of males (12.4%) were found to have Pseudoexfoliation in either of the eyes than females (11.6%) which was not statistically significant (p=0.738). Mean IOP in subjects with PXF was found to be 20.65 + 5.15 mmHg, while it was 15.0 + 2.3mmHg for those without PXF. The difference between the two populations was found to be statistically significant (PConclusions: The prevalence of PXF in eyes of people in Southern Ethiopia appears greater than that reported in other places of Africa and Asia. PXF occurs at a relatively younger age in our population. Increasing age is associated with the presence of PXF, and PXF in turn is associated with high IOP.

BackgroundThe travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.MethodsA cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.ResultsCapture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI −12.4 to −5.4, pConclusionsFewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.

Clinical studies in the hospital settings using patients having ocular morbidities have shown a high prevalence of pseudoexfoliation (PXF) in Ethiopia. With this information in mind community based study was conducted to determine age and sex-specific prevalence of pseudoexfoliation syndrome (PXF) and its relationship with some ophthalmological variables.Objective To determine the prevalence and clinical features of pseudoexfoliation among adults in kebena woreda of Gurage zone, SNNPR, Ethiopia.Design Random cross-sectional samples of adult population aged 40 years or older in the community of the district.Methods A total of 760 subjects aged 40 years or older underwent standardized examination, including portable slit lamp biomicroscopy before and after pupillary dilatation, and IOP measurement using Tono-Pen. PXF was diagnosed on slit lamp exam by the presence of white dandruff-like material on the pupillary margin and/or on the anterior lens capsule of one or both eyes.Results Among 760 participants, the prevalence of PXF was 12.0% (95% confidence interval, 9.7%-14.3%). The mean age was 63.9 years (SD 9.96, age range 40-90 years). Fifty six percent were found to have bilateral PXF. The prevalence increased with increasing age, with 26.9% of those 60 or older affected. Slightly higher proportion of males (12.4%) were found to have pseudoexfoliation in either of the eyes than females (11.6%) which was not statistically significant (p=0.738). Mean IOP in subjects with PXF was found to be 20.65 + 5.15 mmHg, while it was 15.0 + 2.3mmHg for those without PXF. The difference between the two populations was found to be statistically significant (P

Purpose: We aimed to estimate the prevalence of trachoma in each district (“woreda”) of Tigray Region, Ethiopia. Methods: We conducted 11 cross-sectional community-based surveys in evaluation units covering 34 rural woredas from January to March 2013 using the standardized methodology developed for the Global Trachoma Mapping Project. Results: Teams visited 8034 households in 275 villages. A total of 28,581 consenting individuals were examined, 16,163 (56.7%) of whom were female. The region-wide adjusted trichiasis prevalence was 1.7% in those aged 15 years and older. All evaluation units mapped had a trichiasis prevalence over the World Health Organization elimination threshold of 0.2% in people aged 15 years and older. The region-wide adjusted prevalence of the clinical sign trachomatous inflammation – follicular (TF) in children aged 1–9 years was 26.1%. A total 10 evaluation units, covering 31 woredas, with a combined rural population of 4.3 million inhabitants, had a prevalence of TF ≥10%, and require full implementation of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement) for at least 3 years before impact surveys are undertaken. Of these, four evaluation units, covering 12 woredas, with a combined rural population of 1.7 million inhabitants, had a TF prevalence ≥30%. Conclusion: Both active trachoma and trichiasis are public health problems in Tigray, which needs urgent implementation of the full SAFE strategy.