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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.

Ephrem Kibru Melese, Menen Ayalew Shibeshi, Sadik Taju Sherief Department of Ophthalmology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Sadik Taju Sherief, Department of Ophthalmology, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia, Email goge4000@yahoo.comPurpose: A community-based study was conducted to determine the prevalence and sociodemographic factors of pseudoexfoliation syndrome among adults in Southern Ethiopia.Patients and Methods: A community-based cross-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 intraocular pressure measurement using Tono-Pen. Pseudoexfoliation was diagnosed on slit-lamp examination 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 was 12.0% (95% confidence interval: 9.7– 14.3%). The mean age of pseudoexfoliation cases 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 pseudoexfoliation was found to be 20.65 ± 5.15 mmHg, while it was 15.0 ± 2.3 mmHg for those without pseudoexfoliation. The difference between the two populations was found to be statistically significant (P < 0.05).Conclusion: The prevalence of pseudoexfoliation in eyes of people in Southern Ethiopia appears greater than that reported in other places of Africa and Asia. Pseudoexfoliation occurs at a relatively younger age in our population. Increasing age is associated with the presence of pseudoexfoliation, and pseudoexfoliation in turn is associated with higher intraocular pressure.Keywords: pseudoexfoliation, intraocular pressure, glaucoma, rural community

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.

Background/Objectives Retinoblastoma is a common childhood intraocular malignancy, the bilateral form of which most commonly results from a de novo germline pathogenic variant in the RB1 gene. Both advanced maternal age and decreasing birth order are known to increase the risk of de novo germline pathogenic variants, while the influence of national wealth is understudied. This cohort study aimed to retrospectively observe whether these factors influence the ratio of bilateral retinoblastoma cases compared to unilateral retinoblastoma, thereby inferring an influence on the development of de novo germline pathogenic variants in RB1. Subjects/Methods Data from 688 patients from 11 centres in 10 countries were analysed using a series of statistical methods. Results No associations were found between advanced maternal age, birth order or GDP per capita and the ratio of bilateral to unilateral retinoblastoma cases (p values = 0.534, 0.201, 0.067, respectively), indicating that these factors do not contribute to the development of a de novo pathogenic variant. Conclusions Despite a lack of a definitive control group and genetic testing, this study demonstrates that advanced maternal age, birth order or GDP per capita do not influence the risk of developing a bilateral retinoblastoma.

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.

Simple Summary Breastfeeding has been shown to lower the risk of oncogenesis in many pediatric cancers, with longer periods of breastfeeding having the most protective effect. However, an association has not yet been determined for the consequence or benefit of breastfeeding in retinoblastoma (RB), the most common intraocular malignancy of childhood affecting 8000 children worldwide each year. Herein, we aimed to understand the role of breastfeeding in the severity of development of nonhereditary RB, specifically its relationship to age at diagnosis, ocular prognosis, and extraocular involvement. Our analysis of 344 patients indicated that neither breastfeeding nor formula feeding was associated with differences in age at diagnosis, ocular prognosis, or extraocular involvement. More research elucidating the factors affecting the development of RB is warranted both to understand the pathophysiology of tumor development and to develop clinical recommendations for preventive care. Abstract The protective effects of breastfeeding on various childhood malignancies have been established but an association has not yet been determined for retinoblastoma (RB). We aimed to further investigate the role of breastfeeding in the severity of nonhereditary RB development, assessing relationship to (1) age at diagnosis, (2) ocular prognosis, measured by International Intraocular RB Classification (IIRC) or Intraocular Classification of RB (ICRB) group and success of eye salvage, and (3) extraocular involvement. Analyses were performed on a global dataset subgroup of 344 RB patients whose legal guardian(s) consented to answer a neonatal questionnaire. Patients with undetermined or mixed feeding history, family history of RB, or sporadic bilateral RB were excluded. There was no statistically significant difference between breastfed and formula-fed groups in (1) age at diagnosis (p = 0.20), (2) ocular prognosis measures of IIRC/ICRB group (p = 0.62) and success of eye salvage (p = 0.16), or (3) extraocular involvement shown by International Retinoblastoma Staging System (IRSS) at presentation (p = 0.74), lymph node involvement (p = 0.20), and distant metastases (p = 0.37). This study suggests that breastfeeding neither impacts the sporadic development nor is associated with a decrease in the severity of nonhereditary RB as measured by age at diagnosis, stage of disease, ocular prognosis, and extraocular spread. A further exploration into the impact of diet on children who develop RB is warranted.

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.

Simple Summary The authors aimed to determine the lag time between onset of symptoms and diagnosis of retinoblastoma in countries based on their national-income and analyse its effect on the outcomes. Based on analysis of 692 retinoblastoma patients from 11 treatment centres in 10 countries, there was a statistically significant difference in the lag time between onset of symptoms and diagnosis of retinoblastoma based on country income level. This difference in the lag time between different countries results in varied outcomes across patients. Shorter lag time results in better chances of eye and patient survival. Abstract Background: The relationship between lag time and outcomes in retinoblastoma (RB) is unclear. In this study, we aimed to study the effect of lag time between onset of symptoms and diagnosis of retinoblastoma (RB) in countries based on their national-income and analyse its effect on the outcomes. Methods: We performed a prospective study of 692 patients from 11 RB centres in 10 countries from 1 January 2019 to 31 December 2019. Results: The following factors were significantly different among different countries based on national-income level: age at diagnosis of RB (p = 0.001), distance from home to nearest primary healthcare centre (p = 0.03) and mean lag time between detection of first symptom to visit to RB treatment centre (p = 0.0007). After adjusting for country income, increased lag time between onset of symptoms and diagnosis of RB was associated with higher chances of an advanced tumour at presentation (p < 0.001), higher chances of high-risk histopathology features (p = 0.003), regional lymph node metastasis (p < 0.001), systemic metastasis (p < 0.001) and death (p < 0.001). Conclusions: There is a significant difference in the lag time between onset of signs and symptoms and referral to an RB treatment centre among countries based on national income resulting in significant differences in the presenting features and clinical outcomes.

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.