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The need to highlight the dangers to the eye and visual status in couching has become necessary in order to discourage its patronage. This was a bi-center clinic-based prospective descriptive study about new cases of couched eyes which were seen over a two-year period. Oral interviews, eye examinations, refractions, and perimetry tests were used to obtain the information. SPSS version 16 was used for the descriptive analysis. Twenty-five patients and 30 eyes of 15 (60%) males and 10 (40%) females were studied. The age range was 34-90 years with a mean age of 67.87 years (SD 11.27). Presenting versus (vs) corrected visual acuity (VA) for normal vision was 6.7% vs 23.3%, visual impairment was 16.7% vs 26.3%, and blindness was 76.7% vs 50. %. A significant number still remained blind after corrections ( P = 0.014). The most common presenting complaint was “poor/ blurred vision” in 24 (80.4%) and the most frequent duration of couching before presentation was 7-12 months (46.7%). Subjects with a cup:disc ratio > 0.6 had intraocular pressures (IOPs) of > 21 mmHg, and 50% of those patients had IOP > 40 mmHg ( P = 0.001). Glaucoma (13.3%) and corneal opacity/retinal detachment/couching maculopathy/optic atrophy (10%) were the most common complications. Couching causes visually-disabling complications, and is therefore strongly condemned. Increasing public awareness and putting a policy in place for affordable and accessible cataract services in government hospitals would gradually phase out its patronage. [ABSTRACT FROM AUTHOR]

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The Keeler Pulsair EasyEye non-contact tonometer (NCT) was introduced into practice at Rachel Eye Center Abuja, Nigeria, where the patients are indigenous Africans. This was compared to the ‘gold standard’ Goldmann applanation tonometer (GAT) to determine if the instrument was accurate in Africans, with particular reference to the influence of central corneal thickness (CCT). Patients and methods:  174 eyes of 88 patients were analysed. Pachymetry was performed using Sonomed PacScan AP300, and GAT with the Haag Streit R-900. Pachymetric corrections of NCT (NCTc) and GAT (GATc) were carried out with the Sonomed algorithm. Pearson’s correlation r, linear regression analysis, Student t-test and Bland–Altman analysis were used to compare the instruments. Results:  Mean NCT readings were similar (17.36 mmHg) to mean GAT (17.42 mmHg; p = 0.769). GAT/NCT correlation coefficient, r, was 0.883 as compared with 0.868 for GATc/NCTc. The linear regression equation was GAT = 2.79 + 0.84*NCT ( r2 = 0.78). Forty-five per cent of differences were within 1 mmHg, while 79% were within 3 mmHg. This was similar to findings in some studies on Caucasians. Bland–Altman analysis however suggested that the spread of differences was wider than in those studies. Outliers (differences more than 5 mmHg) sometimes reflected difficulties encountered with GAT in routine practice. Mean CCT was 537.9 μm, (S.D. 38.4, 95% confidence interval 532.1–543.7 μm) and CCT appeared lower than in Caucasians. Both GAT and NCT IOP tended to rise with increasing CCT but NCT had a greater tendency to do so. Regression analysis suggested that NCT IOP increased by 0.6 mmHg for every 10 μm increase in CCT, compared to 0.4 mmHg for GAT. Thirty-eight per cent of the patients preferred NCT as opposed to 25% GAT. Conclusions:  The Keeler Pulsair EasyEye gives reliable measurements of IOP in African eyes but is significantly affected by CCT. Particularly in borderline cases where management decisions have to be taken, it may be necessary to have pachymetric corrections based on an NCT algorithm, which appears steeper than the GAT algorithm. [ABSTRACT FROM AUTHOR]