N igerian Journal of Ophthalmology 2011; 19(1): 19-24 Ocular Co-morbidity in Patients with Refractive Errors in Nigeria BO Adegbehingbe FWA CS, O Adeoye FWA CS, BA Adewara M BBS Ophthalmology Unit, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife 1-4 ABSTRACT a high proportion of patients attend ing ophthalm ic clinics. Refractive errors can be easily d iagnosed , m easured and Purpose: To d eterm ine the pattern and prevalence of other corrected w ith spectacles or other refractive corrections to ocular problem s seen in patients w ith refractive errors attain normal vision. H ow ever, non correction or inad equate in a N igerian teaching hospital. correction of refractive errors becom es a m ajor cause of low Methods: A retrospective hospital-based review of all vision and even blind ness. Globally, there are 8 m illion consecutive patients w ho presented w ith signs and people w ho are blind and 153 m illion w ith visual sym ptom s of refractive errors at the Obafem i Aw olow o im pairm ent (presenting visual acuity <6/ 18 in the better University Teaching H ospitals Com plex betw een 1st eye) d ue to uncorrected refractive errors; this exclud es January 2007 and 31st August 2007. Patients w ho had a presbyopia.5 Poor visual outcom e in patients w ith refractive d iagnosis of refractive error and su bsequently had errors could be in part d ue to other associated ocular d etailed eye exam ination w ere includ ed in this stud y. m orbid ity, though som e patients w ith co-existing ocular Data w as retrieved from the patients’ clinical record s m orbid ity m ay still attain norm al vision. and analyzed w ith SPSS version 15. Stud ies by various researchers have show n relationships Results: Out of 724 new patients seen w ithin the stud y betw een refractive error and other ocular m orbid ities such 6 7 8 period , 235 had refractive errors (93 m ales and 142 as cataract, , glaucoma, and allergic conjunctivitis. Detailed fem ales). Patients’ ages ranged betw een 7 and 74 years assessm ents of ind ivid uals w ho have refractive errors w ith a m ean of 30.5+/ - 4.6 years. In m ore than half provid e an opportunity for id entifying other potentially co- (54%) of the patients, associated ocular co-m orbid ities existing blind ing cond itions before they cause visual loss. w ere d ocum ented . The vision-im p airing d iseases The consultation of ‘road -sid e d ispensers’ by m ost patients d ocum ented m orbid ities in 56 (44.1) patients w ere in d eveloping countries and lack of d etailed ocular cataract 26 (20.5%), glaucom a 20 (15.8%), d iabetic exam ination by optom etrists and opticians in these m aculopathy 3 (2.7%), am blyopia, corneal opacities and com m unities has rem ained one of the m ain challenges to the CMV retinitis. N on vision-im p airing d isord ers correction of refractive errors and p ossible id entification of d ocum ented w ere conjunctivitis, 49 (38.6%); pterygium other co-m orbid ities. The m ajority of patients also 6 (4.7%), chalazion 5 (3.9%), hypertensive retinopathy 4 circum vent the services of eye care professionals and (3.1%), d ry eyes and episcleritis. Im m ature cataract w as consult non-qualified personnel for a num ber of reasons, 9 responsible for about 2/ 3 of cases w ith poor corrected includ ing the belief of ‘cost savings’. Patients in these visual acuity d ocum ented in a large proportion of the categories w ill au tom atically m iss d etailed an d patients 26 (11.1%). com prehensive review by op hthalm ologists and as such, som e asym ptom atic ocular cond itions such as glaucom a (a Conclusion: Patients w ith refractive errors need d etailed m ajor cause of irreversible blind ness) m ay not be d iagnosed ocular exam ination for early d etection of other co- early enough for prom pt treatm ent. It has been w ell m orbid ities w hich m ay significantly affect vision and d ocum ented that patients w ho require frequent change of lead to avoid able blind ness and visual im pairm ent. sp ectacles m ay actually be suffering from other ocular d iseases, especially glaucom a. Key w ords: refractive errors, ocular co-m orbid ity, This stud y w as und ertaken to assess the frequency of glaucom a, visual im pairm ent, blind ness patients that seem ingly present w ith refractive errors but actually have other eye diseases. The aim w as to d eterm ine the pattern and prevalence of other ocular co-m orbid ities INTRODUCTION su ch as glau com a, ocu lar hyp ertension, cataract, hypertensive retinopathy, d iabetic retinopathy, and other Refractive errors (myopia, hyperm etropia, astigm atism and eye d isord ers in patients w ith refractive error in a tertiary presbyopia) affect a large proportion of people of all ages eye care centre. This w ill assist in provid ing inform ation and gend er. Patients w ith refractive errors (RE) account for Correspondence: Dr Bernice O Ad egbehingbe, Op hthalm ology Unit, Dep artm ent of Su rgery, Facu lty of Clinical Sciences, Obafem i Aw olow o University, Ile-Ife • E-m ail: [email protected] k BO A degbehingbe, O A deoye, BA A dewara w hich can be useful for early d etection of eye d iseases and Data w as im puted and analyzed u sing the SPSS version eye health planning. 15. The m ean and stand ard d eviations (SD) for patients’ age w ere calculated . Variables w ere related using chi square and METHODOLOGY tests for statistical significance w ere d one using the Welch's t test. A P value of less than 0.05 w as consid ered significant. A retrospective non-com parative hospital-based review of all consecutive patients w ho had prim ary d iagnosis as refractive error at the Obafem i Aw olow o University RESULTS Teaching H ospitals Com plex betw een 1st January 2007 and A total of 724 new patients w ere seen over the stud y period . 31st August 2007 w as cond ucted . The protocol for this stud y Of these 235 (32.5%) had a prim ary d iagnosis of refractive w as approved by the hospital research and ethics errors. Patients’ ages ranged betw een 7 - 74 yrs w ith a m ean com m ittee. of 30.5 + 4.6 yrs. A largest num ber of patients, 120 (51.1%), Inclusion criteria com prised patients of all ages w ho w ere betw een ages 10 and 30 years, w hile 57 (24.3%) w ere presented w ith vision of < N 8 for near or < 6/ 12 for child ren (</ =16yrs). There w ere 142 patients below the age d istance. Distant visual acuity in all subjects w as im proved of 40 years w hile 93 w ere over 40 years. There w ere m ore w ith a Pin H ole and refraction by at least tw o lines on the fem ales, 142 (60.4%) than m ales. Age range and sex Snellen’s chart. Includ ed in this stud y w ere patients in d istribution of patients w ith refractive errors w ere as w hom refractive errors w ere associated w ith other ocular or d epicted in table 1. system ic d isease such as cataract, glaucom a, corneal scars, d iabetes, m aculopathy, keratoconus, chalazion, m arginal Table 1. Sex and age range of patients with refractive errors corneal d egenerations, pterygium or previous ocular Age Range Sex Total (%) surgery or d rugs that could cause shifts in refractive error.. Male (%) Female (%) Exclu d ed from the stud y w ere those patients w ho had no im provem ent in their visual acuity w ith refraction. 1-9 5 (2.1) 4 (1.7) 9 (3.8) Data collected on the patients includ ed d em ographics 10-19 19 (8.1) 40 (17.0) 59 (25.1) such as patients’ age, sex, occupation and level of ed ucation. 20-29 26 (11.1) 35 (14.9) 61 (26.0) Others w ere presenting ocular sym ptom s and signs, 30-39 4 (1.7) 9 (3.8) 13 (5.5) presenting visual acuity (w ith or w ithout Pin H ole test), 40-49 12 (5.1) 26 (11.1) 38 (16.2) d rug and past m ed ical history. Intraocular pressure, d ilated fund uscopy and d etailed eye exam inations w ere carried out 50-59 14 (6.0) 15 (6.4) 29 (12.4) by a consultant ophthalm ologist. Refraction m easured w ith 60-69 11 (4.6) 10 (4.3) 21 (8.9) retinoscopy accom panied w ith subjective testing w as d one 70-79 2 (0.8) 3 (1.3) 5 (2.1) by an optom etrist. Total 93 (39.5) 142 (60.5) 235 (100) Glaucom a d am age w as d efined as reprod u cible glaucom atous visual field d efects w ith the H um phrey Full Threshold 24-2 program m e w ith or w ithout elevated intra- More than half of the patients, 127 (54%) had other ocular pressure in association w ith characteristic optic nerve associated causes of ocular co-m orbid ity (table 2).