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Adedayo O Adio,1 Alfred A Onua21University Of Port Harcourt Teaching Hospital, 2Braithwaite Memorial Specialist Hospital, Port Harcourt, Rivers State, NigeriaBackground: Primary open angle glaucoma is reported to blind 150,000 people in the Nigerian population and over 7000 in Rivers State, and requires constant follow-up. Compliance is a challenge, given that most inhabitants live below the poverty line. This study was performed to determine how Nigerian patients are affected economically by the disease.Methods: Consecutive adult patients attending the eye clinic of the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria, with a diagnosis of primary open angle glaucoma and on outpatient antiglaucoma treatment in the first 6 months of 2006, were recruited for the study. The lowest paid government worker was on USD50 (N7500.00) per month and the gross domestic product per capita was USD1150 for the period under review.Results: We enrolled 120 consecutive patients of mean age 52.7 ± 10.4 years, with a male to female ratio of 2:3. The most common occupations were in the civil service (n = 56, 46.7%). All participants were on topical antiglaucoma treatment. The average cost of medical antiglaucoma medication was N6000 (USD40) per month. Computed to include indirect costs, including medical laboratory tests, transportation, and care by patient escorts, an average sum of USD105.4 (N15,810) was spent by each patient per month. Most of the patients (73.3%) were responsible for their own treatment costs. No patient accepted the cheaper option of surgery (USD275.4, N41,310). Eighty of the patients (66.7%) visited our eye clinic monthly. Direct and indirect loss to the economy was USD3,064587 per annum from those already blind. This was in addition to the USD 4.1 million being spent yearly on medical treatment by those who were visually impaired by glaucoma.Conclusion: Middle-income earners spent over 50% of their monthly income and low-income earners spend all their monthly earnings on treatment for glaucoma. This situation often resulted in noncompliance with treatment and hospital follow-up visits. To reduce the economic burden of glaucoma, trabeculectomy performed by experienced surgeons should be offered as first-line treatment for glaucoma in this country, rather than medical therapy.Keywords: economic burden, chronic glaucoma, blindness, Rivers State, Nigeria

Adedayo Omobolanle Adio,1 Samuel Otabor Wajuihian21University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria; 2Department of Optometry, University of KwaZulu-Natal, Durban, South AfricaAim: The aim of this study was to provide a profile of oculo-visual anomalies in children with Down syndrome (DS) in Port Harcourt, Nigeria.Methods: This comparative study assessed the visual functions of 120 children (42 DS and 78 developmentally normal children). The visual functions evaluated and the techniques used were: visual acuity (Snellen illiterate chart and Lea picture charts), refraction (static retinoscopy with cyclopegia), ocular alignment (cover test), near point of convergence (pen and rule), and external examinations and fundoscopy.Results: A total of 42 children with DS (22 males, 20 females, mean age 11.43 ± 6.041 years) and control group of 78 normal children (36 females, 42 males) with mean age 6.63 ± 1.98 years were examined. Of the 42 DS children, visual acuity was less than 6/18 in eight and one of the DS and control groups, respectively. Visual acuity could not be checked conventionally in eleven participants from the DS group due to poor response. The main findings were: DS compared to control group showed refractive errors of 76.2% (half of which was from myopia) vs 14.1% (only 10% due to myopia). There was a statistically significant difference in total refractive errors between the Down syndrome group and the control group (P = 0.001, Χ2 = 18.29). Strabismus was 9.5% (75% esotropia) vs 0%, and there was a statistically significant difference (P = 0.001, Χ2 = 5.01), nystagmus was 4.8% v 0%, conjunctivitis 19.05% vs 8.97%, and keratitis 7.14% vs 0%, which was statistically significant (P = 0.05, Χ2 = 2.90).Conclusion: Refractive errors were prevalent in a sample of children with DS in Port Harcourt, Nigeria, whereas the prevalence of ocular diseases was low when compared to age-matched control participants. This study highlights the need for ophthalmic care in children with DS. Routine eye care such as the use of spectacles when necessary is recommended for people with DS at all ages to improve their educational and social needs as well as overall quality of life.Keywords: Down syndrome, refractive errors, strabismus, ocular diseases

Purpose: Large-angle horizontal ocular deviations will commonly require bilateral surgery to correct the primary ocular deviation. However, considering the need for full correction with one surgical procedure and patients' reluctance to be operated on the good eye, such large horizontal ocular deviations may be managed with true muscle transplantation. The authors present a case series of patients who underwent this procedure and develop a surgical table to guide management., Methods: Patients with horizontal squints measuring 80 prism diopters (PD) or larger in all age groups who underwent extraocular muscle transplantation surgery between January 2019 and June 2022 in Nigeria were included. Preoperative deviation of the squint, sensory evaluation, surgical dosage, and outcomes were documented. Part of the resected muscle was transplanted to give additional recession in the antagonist muscle. Success was defined as deviation corrected by 60% or more or postoperative ocular alignment within 10 PD or less, six weeks postoperatively., Results: Fourteen patients with extra-large-angle strabismus were operated. Male/female ratio was 0.6:1. Mean preoperative deviation of 89.6 ± 9.3 collapsed to 6.6 ± 1.8 PD at six weeks and continued to improve to a mean deviation of 2.5 PD at six months postoperatively. When the subgroup of patients who were < 18 years were analyzed, the outcome was equally successful; preoperative deviation of 89.4 PD collapsed to 1.4 PD, six months postoperatively. There were equal success rates when those with sensory strabismus were compared with those with binocular vision; preoperative deviation of 92.5 PD in the sensory group and 88.5 PD in the binocular group collapsed to 5.9 PD and 1 PD, respectively, six months after surgery., Conclusion: A viable alternative for treating extra-large-angle strabismus in adults and children in developing countries was described with good postoperative outcome. In addition, a new expanded surgical dosage table for muscle transplantation surgery corrections of up to 130 PD was developed., Competing Interests: None., (Copyright © 2024 Adio et al.)

A call to the governments of developing countries that parents of visually impaired, all eyecare workers especially ophthalmologists including all schools where visually impaired people are being educated, to see the advantage of proper screening and continuous eyecare of individuals who present to these schools/rehabilitation centers by qualified eyecare personnel as well as have proper knowledge of where such rehabilitative services are available by those who should knowthe eyecare workers. The specific role of the ophthalmologist is highlighted., Competing Interests: The authors declare that no competing interest exists., (Copyright © 2023 by West African Journal of Medicine.)

Digital eye strain (DES) or computer vision syndrome (CVS) is a phenomenon linked to ever increasing digital screen use globally, affecting a large number of individuals. Recognizing causative and alleviating factors of DES may help establish appropriate policies. We aimed to review factors that aggravate or alleviate DES symptoms in young, i.e. pre-presbyopic (< 40 years old), digital device users. We searched PubMed, Scopus, EMBASE, Cochrane, Trip Database, and grey literature up to 1st July 2021. Among a plethora of studies with heterogeneous diagnostic criteria for DES, we only included those using a validated questionnaire for the diagnosis and evaluating associated factors in young subjects. Relevant data were extracted, risk of bias assessment of the included studies and GRADE evaluation of each outcome were performed. Ten studies were included (five interventional, five observational) involving 2365 participants. Evidence coming from studies with moderate risk of bias suggested that blue-blocking filters do not appear to prevent DES (2 studies, 130 participants), while use of screens for > 4-5 h/day (2 studies, 461 participants) and poor ergonomic parameters during screen use (1 study, 200 participants) are associated with higher DES symptoms' score. GRADE evaluation for the outcomes of blue-blocking filters and duration of screen use showed low to moderate quality of evidence. It appears advisable to optimize ergonomic parameters and restrict screen use duration, for minimizing DES symptoms. Health professionals and policy makers may consider recommending such practices for digital screen users at work or leisure. There is no evidence for use of blue-blocking filters., Competing Interests: Declaration of Competing Interest Prof. Ken K. Nischal has the following financial disclosures Santen Inc., Graybug, Essilor and Ocumension none of which is relevant to this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Blind individuals whether from birth or after being sighted for different periods of their lives constitute about 1% of the Nigerian population. These are individuals who can meaningfully contribute to the growth and development of society if properly guided. However, the traditional way of thinking within the society they find themselves in contributes to their lack of productivity. From birth to adulthood, they need to be guided and consciously prepared for independence. This is not yet widely obtainable in Nigerian society and other developing societies and generally may result in rejection, neglect, and high mortality rates in those affected with the majority unemployed sometimes for up to 10-15 years. It is imperative to offer comprehensive rehabilitation services that can assist this group of individuals to assert/reassert control and independence by designing a program tailored to meet their individual needs (not forgetting those who become blind as adults). A regional center, The Lens Rehabilitation center for the blind and severely visually impaired (TLEC ReHab Nig) located in Port Harcourt, Nigeria has put together a comprehensive program to ensure all round preparedness for independent, productive and fruitful living for persons living with blindness in line with best practices. This is an initial report on the outcome., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2023 by West African Journal of Medicine.)

Introduction: Microvascular remodelling is a symptom of cardiovascular disease. Despite the mechanical environment being recognized as a major contributor to the remodelling process, it is currently only understood in a rudimentary way., Objective: A morphological and mechanical evaluation of the resistance vasculature in health and diabetes mellitus., Methods: The cells and extracellular matrix of human subcutaneous resistance arteries from abdominal fat biopsies were imaged using two-photon fluorescence and second harmonic generation at varying transmural pressure. The results informed a two-layer mechanical model., Results: Diabetic resistance arteries reduced in wall area as pressure was increased. This was attributed to the presence of thick, straight collagen fibre bundles that braced the outer wall. The abnormal mechanical environment caused the internal elastic lamina and endothelial and vascular smooth muscle cell arrangements to twist., Conclusions: Our results suggest diabetic microvascular remodelling is likely to be stress-driven, comprising at least 2 stages: (1) Laying down of adventitial bracing fibres that limit outward distension, and (2) Deposition of additional collagen in the media, likely due to the significantly altered mechanical environment. This work represents a step towards elucidating the local stress environment of cells, which is crucial to build accurate models of mechanotransduction in disease., (© 2021 The Author(s) Published by S. Karger AG, Basel.)

Objectives: Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria., Design: Descriptive case study., Setting: Neonatal intensive care units in Nigeria., Participants: Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria)., Methods and Analysis: A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision., Results: In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems., Conclusion: ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The benefit of enhanced shear stress to the vascular endothelium has been well-documented in conduit arteries but is less understood in skin microcirculation. The aim of this study was to provide physiological evidence of the vascular changes in skin microcirculation induced by intermittent pneumatic compression (IPC) of 1 s cuff inflation (130 mmHg) every 20 s to the palm of the hand for 30 min. The oxygenation and hemodynamics of dorsal mid-phalangeal finger skin microcirculation were assessed by laser Doppler fluximetry and reflectance spectroscopy before, during, and after IPC in 15 young (18-39 years old) and 39 older (40-80 years old) controls and 32 older subjects with type 2 diabetes mellitus. Each individual cuff inflation induced: 1 ) brief surge in flux immediately after cuff deflation followed by 2 ) transitory reduction in blood oxygen for ∼4 s, and 3 ) a second increase in perfusion and oxygenation of the microcirculation peaking ∼11 s after cuff deflation in all subject groups. With no significant change in blood volume observed by reflectance spectroscopy, despite the increased shear stress at the observed site, this second peak in flux and blood oxygen suggests a delayed vasoactive response upstream inducing increased arterial influx in the microcirculation that was higher in older controls and subjects with diabetes compared to young controls ( P < 0.001, P < 0.001, respectively) and achieving maximum capillary recruitment in all subject groups. Transitory hypoxic stimuli with conducted vasodilation may be a mechanism through which IPC enhances capillary perfusion in skin microcirculation independent of age and type 2 diabetes mellitus. NEW & NOTEWORTHY This study demonstrates that hand intermittent pneumatic compression evokes transitory hypoxic stimuli in distal finger skin microcirculation inducing vasodilation of arterial inflow vessels, enhanced perfusion, and maximum capillary recruitment in young and older subjects and older subjects with type 2 diabetes mellitus. Enhanced shear stress in the microcirculation did not appear to induce local skin vasodilation.

Vascular diseases such as diabetes and hypertension cause changes to the vasculature that can lead to vessel stiffening and the loss of vasoactivity. The microstructural bases of these changes are not presently fully understood. We present a new methodology for stain-free visualization, at a microscopic scale, of the morphology of the main passive components of the walls of unfixed resistance arteries and their response to changes in transmural pressure. Human resistance arteries were dissected from subcutaneous fat biopsies, mounted on a perfusion myograph, and imaged at varying transmural pressures using a multimodal nonlinear microscope. High-resolution three-dimensional images of elastic fibers, collagen, and cell nuclei were constructed. The honeycomb structure of the elastic fibers comprising the internal elastic layer became visible at a transmural pressure of 30 mmHg. The adventitia, comprising wavy collagen fibers punctuated by straight elastic fibers, thinned under pressure as the collagen network straightened and pulled taut. Quantitative measurements of fiber orientation were made as a function of pressure. A multilayer analytical model was used to calculate the stiffness and stress in each layer. The adventitia was calculated to be up to 10 times as stiff as the media and experienced up to 8 times the stress, depending on lumen diameter. This work reveals that pressure-induced reorganization of fibrous proteins gives rise to very high local strain fields and highlights the unique mechanical roles of both fibrous networks. It thereby provides a basis for understanding the micromechanical significance of structural changes that occur with age and disease., (Copyright © 2016 the American Physiological Society.)

Purpose. With many preterm babies now surviving as a result of improvement in neonatal care in Nigeria, the incidence of visual impairment/blindness as a result of retinopathy of prematurity (ROP) may rise. We describe our findings after screening starts for the first time in a 15-year-old special care baby unit so as to establish the incidence and risk factors for developing ROP. Methods. A prospective study carried out at the Special Care Baby Unit (SCBU) and Pediatric Outpatient Clinics of the University of Port Harcourt Teaching Hospital between January 1 and October 31, 2012. Fifty-three preterm babies (of 550 neonates admitted within the study period) delivered before 32 completed weeks and weighing less than 1500 g were included in the study following informed consent and the main outcome measure was the development of any stage of ROP. Results. Mean gestational age at birth was 28.98 ± 1.38 weeks. Mean birth weight was 1411 ± 128 g. Out of 550 babies admitted at SCBU, 87 of 100 preterms survived with 53 included in study. Twenty-five (47.2%) had different degrees of ROP with prevalence found to be 47.2%. Prevalence was higher (75%) in babies weighing <1300 g and those delivered before 30-week gestation (58%). Twenty-one (84%) had stage 1 no plus disease and 3 (12%) had stage 2 no plus disease. Only 1 (4%) had threshold disease in Zone 1. None had disease at stage 4 or 5 or AP-ROP. Receiving supplemental oxygen (χ (2) = 6.17; P = 0.01), presence of sepsis (χ (2) = 7.47; P = 0.006), multiple blood transfusions (χ (2) = 5.11; P = 0.02), and delivery by caesarian section (χ (2) = 4.22; P = 0.04) were significantly associated with development of ROP. There were no significant differences with gender, apneic spells, jaundice, or phototherapy. Conclusions and Relevance. All live infants with ROP were noted to regress spontaneously in this study. Though it may not be cost effective to acquire treatment facilities at the moment (the only child with treatable disease died), facilities for screening preterm infants displaying high risk features may be essential as smaller babies are saved.

Background: The impact of low vision (visual impairment categories 1 and 2) is felt more in developing countries of the world due to the problems of access to effective eye care. In severe cases it leads to social problems with economic implications. When children are involved, learning is affected leading to dependence even when they become adults and the community also suffers from this. Effective care, more often than not, brings about cure in some cases but unfortunately, access to this care is denied for reasons ranging from ignorance and harmful traditional practices to lack of commitment by governments., Objective: To determine the prevalence and causes of low vision in some farming communities in South-South Nigeria in order to proffer solution on its prevention and possible management., Methods: A cross-sectional, population based, multistage survey was carried out between the 8th of September and 20th of October, 2007 to determine the burden of low vision. Households were picked from seven villages selected from seven communities by random sampling in Ikwerre Local Government Area of Rivers State. Basic eye examination involving visual acuity assessment, pen torch examination, funduscopy and intraocular pressure measurement was done. Refraction was manually done and high plus (+8 to + 10) lenses used for aphakics. Visual field was assessed using confrontation method. Data was recorded with World Health Organization Prevention of Blindness (WHO/PBL) form., Results: A total of 754 males and 759 females were examined, giving a male to female ratio (M: F) of approximately 1:1. The prevalence of low vision was 5.5% (category 1: moderate visual impairment = 4.1% and category 2: severe visual impairment = 1.4%). There were more females (51.8%) with low vision than males (48.2%) most of them being more than 50 years old. No child below 10 years had low vision though those between 10-19 years made up 1.78% of all case of low vision. The commonest causes of low vision were refractive error (50.6%), cataract and aphakia (26.5%), glaucoma (8.5%), optic atrophy (8.5%), while others contributed 10%., Conclusion: The management of low vision should target vulnerable groups (females and those > 50 years) through effective planning and implementation of programs for prevention ofblindness, outreach programs for enlightenment about causes and the use of low vision aids, making treatment affordable, training of health personnel on basic eye care and establishment of a functional state program for blindness prevention.

Background: A review of pediatric cases seen over one year in the eye clinic of the University of Port Harcourt teaching hospital, Rivers state is presented., Aim: To ascertain the different diagnoses made in children who attend the eye clinic and the most common with a view to establish guidelines for equipping a functional pediatric ophthalmic clinic to address the problems if any., Methodology: Records of all patients aged 0-18 years who attended the clinic in the year 2004 were extracted from the outpatient register. The information was analyzed manually with a simple scientific calculator., Results: Atotal number of 846 pediatric patients were seen in the one year period under review. Newly diagnosed patients were 671 in number. Male female ratio was 1:1.07. The largest number of patients seen was between the ages of 13-18 years (n = 320). Refractive error was the most common condition seen with 248 diagnosed with the condition and a percentage of(28.95%) of the total number of patients seen. Vernal conjunctivitis followed with a percentage of 17.96% (n=152). Sixty-two (7.33%) were diagnosed with iritis while 52 were diagnosed to have cataract (6.15%). Thirty-five had glaucoma as the primary diagnosis (4.14%) while 14 children presented with conjunctivitis (1.65%). Other patients had pterygium (n=9, 1.06%), chalazion (n=4, 0.47%) and corneal opacity (n=6, 0.71%). The patients with refractive error and vernal conjunctivitis were mainly girls 56.5% and 25% respectively. Glaucoma mainly affected boys (57.1%) Cataracts were mainly seen in girls (53.8%)., Conclusion: The commonest causes of childhood ocular morbidity in this study were refractive error and allergic conjunctivitis accounting for almost 50% of pediatric patients presenting at the ophthalmology clinic of UPTH. These require prompt pediatric ophthalmic consultation for effective treatment and prevention of avoidable sequelae. Therefore facilities need to be made available to adequately detect these conditions early particularly for refractive errors before amblyopia develops through training of teachers in all schools and public awareness campaigns. It may be important to ensure that legislation be passed to ensure compulsory eye checks before parents enroll their wards in school.

Background: Old people's home is a relatively new experience in Nigeria. Data on the pattern of ocular morbidity among inmates are examined with the aim of making suitable recommendations., Method: An old people's home in Port Harcourt was the site of this survey carried out in February 2004. The following data was collected from all inmates-name, sex, age, length of stay, visual acuity, main cause of ocular morbidity, past medical history. Intraocular pressure was measured as indicated. Refractions were carried out on the spot., Results: The male to female ratio of the 20 inmates was 2:3. The age range was from 70-105 years with a mean of 85 years, 7 months +/- 12.14 (SD). The mean duration of stay was 7 years with 50% staying there less than 5 years. 60% had associated systemic illnesses. 85% had visual acuity of less than 3/60 in the better eye. Cataract was the cause of 40% of the ocular morbidity and also caused 57% of the blindness., Conclusion: This study emphasizes the need for regular check up of our geriatric population to enable early detection of ocular health problems and thus prevent avoidable disability and dependency. Social support and health insurance could also improve outcome and uptake of treatment options.