Optometry

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The epidemiology of ocular injuries among patients presenting to provincial hospitals in KwaZulu-Natal, South Africa.
Sukati, Velibanti Nhlanhla.; Hansraj, Rekha.
Purpose: Ocular injuries are increasingly becoming the permanent cause of visual blindness (Mufti et al, 2004). Most of the previous studies in this area are done in countries outside the African context. A limited number of general surveys in ocular trauma appear in the ophthalmic literature in South Africa. The purpose of this study was to provide epidemiological data on ocular injuries among patients utilising the provincial hospitals eye services in KwaZulu-Natal, South Africa. Methods: A quantitative retrospective study design was carried out by collecting data on 660 patient’s record cards with ocular injuries presenting to four selected provincial eye care clinics for a four year period (January 2005-December 2008). Using a data sheet devised for capturing of the information, the following data was retrieved: (i) demographics details, (ii) place of trauma (iii) nature of trauma, (iv) type of injury, (v) management and (vi) visual outcomes following primary eye care. All patients who presented to the eye clinics with ocular injuries within the specified four years, both genders, all race groups and all age groups were included in the study. Results: There were 440 patients’ records reviewed at rural hospitals and 220 at urban hospitals. Males were more likely than females to have ever experienced an eye injury (72.3% versus 27.7%, respectively) and urban males were more likely than rural males to incur an eye injury (79.1% versus 68.9%, respectively). The Black population has a higher prevalence of ocular injuries than other race groups: Blacks 93.8% followed by Indians 3.9%, Coloureds 2% and the least in Whites 0.3%. Over one-third of all the patients were between 21 and 30 years old with second highest percentage of patients being in the age category of 31 to 40 years. A significant percentage of patients were children (13.8%) up to the age of 12 years. Open globe injuries were more frequent (56.2%) than closed globe injuries (43.8%). Blunt trauma/contusion was the most frequent type of injury (35.2%). More than half of patients (50.9%) had associated ocular signs with the predominance of haemorrhages (15.9%). The majority of the patients presenting with ocular signs had incurred blunt trauma (54%). Only 3.5% of all injuries were bilateral and 96.5% were unilateral. Solid objects were responsible for more than half of the injuries (54.4%) occurring either in the home or at work, followed by assaults (24.3%) and chemical burns (6.2%). Three percent of patients’ records (n=17) had substance (alcohol) abuse documented. The home accounted for the majority of the eye injuries (60.6%) followed by the social environment (15.2%), workplace or industry (13.6%), commercial workplace and agriculture had the same number of injuries (4.1%) and sports or leisure facilities (2.4%). The home remained the single most frequent place for an injury to occur across all age groups, highest in the 21 to 30 age group (26.8%, n=107) followed by 21.3% (n=85) in the 0 to 12 age group. Thirty patients (4.5%) required surgical intervention at initial presentation. Three hundred and forty patients (51.5%) returned for follow up examination. Only 9 (9.2%) patients with initial poor vision (<6/60) achieved 6/12 or better visual acuity after treatment. In 17 (38.6%) patients, visual acuity remained the same as initial visual acuity (6/15-6/60) and got worse in 5 (7.8%) patients (<6/60). Twenty six (59.1%) patients achieved between 6/15-6/60 vision after presenting with poor vision and 59 (92.2%) remained with poor vision after treatment. Conclusion: Ocular trauma is a relatively common problem in the province of KwaZulu-Natal, occurring most frequently in young adults and males warranting presentation to the eye casualty department for treatment. Ocular trauma is usually unilateral, but can also be bilateral and this remains a significant major public health problem. People engaged in agriculture, in industry, in the home, in the social environment, in sports and people living in rural communities are at highest risk. This warrants specific, targeted, prevention measures to be put in place to minimize the incidence of visually damaging trauma.
Ocular health of cocoa farmers in Ghana : an assessment and intervention study.
Boadi-Kusi, Samuel Bert.; Hansraj, Rekha.; Mashige, Khathutshelo Percy.
Background: Cocoa farmers are known to face a lot of ocular health hazards such as chemicals, ultraviolet radiations, farm equipment, plants, dust and allergens among others in the field of work. This study sought to examine and understand the factors that affect the ocular health of cocoa farmers in Ghana in order to improve their knowledge and awareness on ocular health and safety practices through a training intervention. Methods: The study employed two quantitative approaches: a cross-sectional survey and a quasi- experimental pre-post-test study design. The cross-sectional study involved administration of a questionnaire and conducting a comprehensive eye examination among participants, while the pre-post-test study used a structured questionnaire to gather baseline knowledge and post training knowledge on ocular health and safety practices among the participants to establish a change. A multistage random sampling approach was used to select participants from four cocoa growing districts of Ghana. Results: Five hundred and fifty-six, out of the 576, who were recruited for the first phase of the study, met the inclusion criteria, giving an eligibility rate of 96.5%. The participants consisted of 359 (64.6%) males and 197 (35.4%) females with a mean age of 54.9 years (± 11.2). Educational attainment among the participants was low, with 142 (25.5%) having had no formal education. Participants spent an average of 33.3 (±13.4) hours per week on the farm, with males spending more time 35.3 (±13.9) than females 29.6 (± 11.8) (p<0.001) and also spent more hours on the farm than females (p<0.001). Participants reported poor distance and near vision, itching/redness, pain and tearing as major complaints. Anterior eye conditions recorded included pterygium 23.7% (CI: 20.3-27.5), allergic conjunctivitis 9.7% (CI: 7.4 - 12.5) and corneal scar/opacity 6.1% (CI: 4.3 - 8.4). Other conditions included cataract 25.5% (CI: 22.0-29.3), glaucoma 15.8 (CI: 12.9 - 19.1) and macular disorders 4.9% (CI: 3.2 - 7.0). Posterior segment conditions and uncorrected refractive errors (67.6%) were the major causes of moderate and severe visual impairment (MSVI) (16.7%) and legal blindness (4.9%) among the population studied. Presbyopia was present in 83.1% (CI: 79.7 - 86.1) of the participants. The rate of ocular injuries was 143/12 854.5 worker years or 11.3/1 000 worker years (95% CI: 9.4 - 31.0), which led to a lost work time injuries of 137 injuries/ 12 854.5 worker years or 37.3/1000 worker years (95% CI: 34.1- 40.8) and were predominantly in males. Blunt injuries from plants/branches and chemical injuries were mostly reported. Only 34 (6.1%) reported using ocular protection. Barriers to use of ocular protection included non availability of the equipment, lack of funds and ignorance or lack of training. More than half of the participants (52.4%) had never seen an eye care practitioner, while 25% reported seeking eye care within the last one year preceding the study. Those who were registered with the National Health Insurance Scheme were more likely to attend a hospital/clinic for eye care services (OR = 3.93, 1.40 - 11.06, p = 0.009). Barriers to utilization of eye facilities included lack of funds, long distance to facility and long waiting time at eye facilities. Two hundred participants enrolled for the quasi-experimented pre-post-tested study, and had varied opinions on ocular health and safety practices on the farm. They demonstrated a good knowledge on the ocular hazards they face at work, although most were unaware of the effect of some of the hazards on the eye. Farmers also had a poor knowledge on ocular protection but a fair knowledge on first aid for ocular emergencies. Participants improved their knowledge scores (overall 40 points) on ocular health and safety practices from a pre- median score of 172 (IQR: 164 - 177.5) to 212 (IQR: 206 - 219.5) following the pre- and postevaluation of the training intervention. Conclusions: Eye disorders are prevalent among cocoa farmers in Ghana. Farmers are engaged in improper ocular health and safety practices on the farm. They also make insufficient use of appropriate protective eye devices and health services. The study demonstrated that, with an ocular health intervention, cocoa farmers can improve on their knowledge and awareness level on ocular health and safety practices which may be of benefit to the farmer, employers and the national economy.
Prevalence and distribution of visual impairment, refractive error and their impact on quality of life among school-going children aged 6-18 years in Sekhukhune District (Limpopo), South Africa.
(2020) Magakwe, Tshubelela Sello Simon.; Xulu-Kasaba, Zamadonda Nokuthula Queen.; Hansraj, Rekha.
Background: Refractive error (RE) and visual impairment (VI) remain major problems affecting school going children worldwide and impacting their quality of life. Aim: To determine the prevalence and distribution of RE and VI, and their impact on quality of life (QoL) of school-going children. Setting: This school-based study was conducted on school-going children residing within the borders of greater Sekhukhune district, Limpopo (South Africa). Methods: A multistage random sampling method was used to select schoolchildren aged between 6 and 18 years from Grades R to 12. A total of 400 learners where invited to participate in this study and 326 (81.5% [95% CI, 77.7-85.3]) learners underwent an eye examination. The examination assessed unaided and aided visual acuity using a LogMAR chart, binocular motor function, autorefraction under cycloplegia, media and fundus examination, and QoL measured with the National Eye Institute visual function questionnaire (NEI-VFQ-25). Results: The prevalence of uncorrected, presenting and best corrected visual acuity of 0.30 or worse in the better eye was 12.3% (95% CI, 8.7-15.8), 12.3% (95% CI, 8.7-15.8) and 2.1% (95% CI, 0.6-3.7) respectively. Refractive error accounted for 81% of all causes of VI. Myopia was the most prevalent RE (50.7% [ 95% CI, 38.8-62.7] ), followed by astigmatism (36% [95% CI, 24.3-47.3]), and hypermetropia (13.6% [95% CI, 5.30-21.6] ). There was no significant difference in the prevalence of RE and VI between males (50.7% [95% CI, 38.8-62.7]) and females (49.3% [95% CI, 37.3-61.2]). Refractive error and VI were highest among children aged between 14 and 18 years. Moreover, the highest prevalence of RE was observed in Grades 9 to 12 learners (46.3% [95% CI, 34.3-58.2]). Children with RE and or VI scored low on NEI-VFQ-25. Conclusion: The prevalence of RE and VI among schoolchildren in greater Sekhukhune district was high. This calls for attention from policymakers and all stakeholders responsible for eye care to devise strategies to address these conditions as they decrease the children’s QoL.
Validation of selected iPhone optometric screening applications in vision screening.
(2020) Moodley, Therisha.; Hansraj, Rekha.; Govender-Poonsamy, Pirindhavellie.
Introduction: There has been an unprecedent increase in the use of mobile technology to provide health care services. The eye care industry has also adopted the use of these innovative smart-technology devices to provide rapid, convenient and less time-consuming eye screenings through the use of applications (apps) however, the accuracy and reliability of these tests have not been fully established. Aim: To determine if the selected smartphone apps have comparable results to their equivalent standard clinical optometric tests. Method: The study employed a comparative research design that compared the results of two each, smartphone distance visual acuity (DVA), contrast sensitivity and astigmatism apps to the results provided by the standard Snellen DVA chart, Pelli-Robson chart and JCC test, respectively. A total of 113 participants were recruited using convenience sampling. The results were analyzed and the Wilcoxon Signed ranked test was used to assess for any comparisons. Results: The median DVA as determined by the Snellen test and both VA apps were found to be exactly the same (0.63) for both the right and left eyes. More participants passed the CS test with the smartphone apps as compared to the standard Pelli-Robson test. Statistically significant (p<0.001) lower percentages of participants were detected as having astigmatism by both smartphone apps when compared to standard clinical testing. Conclusion: The Kay iSight professional (paid) and Pocket Eye Exam (free) VA app testing, overall, showed promising results as they produced results similar to the standard Snellen test. Both the CS smartphone apps overestimated the results and both astigmatism apps significantly underestimated the number of participants with astigmatism. These apps therefore failed in providing accurate screenings results and need to be further modified before it can be used as a screening device. However, due to the lack of literature more studies need to be done before these devices can be used for home screenings or clinical use.

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Browsing Optometry by Author "Hansraj, Rekha."