Background: Uncorrected presbyopia and its impact on the quality of life was performed as part of a community research towards strengthening the provision of optical services for Sagamu Local Government Area of Ogun State, Nigeria. Aim: To determine the effect of uncorrected presbyopia on the quality of life of adults of 30 years old and above in Sagamu, Southwest, Nigeria. Setting: This study consisted of the permanent resident adults of the town and village settlements within the local government. Methods: Examination of respondents included distance visual acuity measurement with or without pinhole at 6 metres using the Snellen’s chart. Near assessment was performed at 40 centimetres with the distance correction in place if required. The semi-structured questionnaire which contained demographics and near-vision task difficulties, et cetera, was administered. Ethical approval was obtained. The data were entered and analysed using Statistical Package for Social Sciences version 16 statistical software. Results: The study showed that presbyopes significantly reported not being satisfied with near-vision (p = 0.0001) and requiring help because of near-vision problems (p = 0.0004) more than non-presbyopes. The most difficult presbyopic activities were reading, writing, sorting grains, threading needle, cutting fingernails and recognising small objects. All were statistically significant (each with p ≤ 0.0001). Conclusion: The impact of reduced near vision on the quality of life in Sagamu, Nigeria, is striking and similar to findings around the world. So, any optical services plan for the local government area has to include presbyopic corrections.

Background: The university-based low vision clinic is one of the few low vision clinics in South Africa.Aim: To describe demographic and clinical profiles of patients who attended this clinic from 2010 to 2017.Setting: The university low vision clinic, South Africa.Methods: The record cards of all patients seen at the low vision clinic over 8 years were examined and the following information was extracted: age, gender, presenting visual acuity (VA), VA following low vision assessment, cause of visual impairment and types of low vision devices recommended.Results: A total of 621 patients were examined, comprising 45.1% males and 55.9% females aged 36.0 ± 18.2 years (range: 4–93 years). Many of these patients (33.7%) had presenting VA worse than 1.3 logarithm of the Minimum Angle of Resolution (logMAR) ( 6/120) at 4 m in the better eye, and 196 (31.6%) had presenting VA of worse than 1.3 logMAR at near distance. Following optical low vision assessment, 62.4% had distance VA of 0.9 LogMAR (6/48) to −0.2 logMAR (6/3.8) and 58.4% had near VA of 0.9 logMAR (6/48) to −0.2 logMAR (6/3.8). Albinism (22.7%), unknown causes (18.2%), cataract (15.5%) and macular diseases (12.2%) were the most common causes of low vision. Amblyopia (80.7%) was the most common cause of low vision in patients aged 20 years and younger, followed by albinism (68.1%) and corneal diseases (41%). Cataract (78.1%), macular diseases (64.4%) and glaucoma (55.9%) were the most common causes of low vision in patients aged more than 60 years. Telescopes (33.8%) were the most commonly recommended form of intervention, followed by magnifiers (29.6%) and protective measures (24.5%).Conclusion: Albinism, cataract and macular diseases are the predominant causes of low vision in patients attending this low vision clinic. There was a significant improvement in VA after low-vision assessment, particularly for patients with presenting VA of better than 1.3 logMAR (6/120).

Background: Without appropriate interventions, simple or low myopia can progressively get worse and lead to high myopia. Patients with high myopia are at a greater risk of developing retinal detachment, myopic macular degeneration, glaucoma and eventual blindness in some cases, and hence the reason for the global call for myopia control. Consequently, myopia in the 21st century is not only treated as a refractive error but an ocular disorder with potential negative consequences. Myopia control strategies include optical, pharmacological and behavioural methods. In this report, the effectiveness of optical methods of myopia control was reviewed. Aim: The aim of the review is to evaluate and summarise existing knowledge on myopia control and provide recommendations to guide future studies. Method: The review was conducted using online search engines including PubMed and Google Scholar. Articles published between 2000 and 2019 were included. Results: For the optical methods of myopia control, under-correction has been found to be largely ineffective. However, a recent study shows that myopic children without correction had slower myopia progression (−0.75 D) than fully corrected children (−1.04 D) indicating a 28% reduction. Evidence from various studies indicates that bifocals and progressive addition lenses are not as effective as soft dual focus contact lenses or extended depth of focus contact lenses. Clinical trials indicate that single vision rigid gas permeable lenses did not slow myopic progression. Peripheral defocus lenses and orthokeratology were found to be approximately 50% effective across studies reviewed. Conclusion: Peripheral defocus lenses and multifocal contact lens designs offer the most effective myopia control. Orthokeratology is equally effective but future designs should consider ways of minimising risks of complications with lens wear. More studies would be needed to better understand how under-corrected myopic eyes tend to progress faster, whereas myopic eyes without correction tend to progress slower. A holistic approach and combination of methods may offer the best form of myopia control in the 21st century considering the increase in near work activities and use of digital devices among the most vulnerable groups.

Background: Canalicular lacerations cause significant morbidity if unrepaired and may be associated with serious ocular injuries. Few studies describe the causes of these injuries, and none of these were conducted in Southern Africa. Aim: The aim of this study was to describe the incidence of canalicular lacerations in terms of their causes, associated ocular injuries and management at St John Eye Hospital. Setting: St John Eye Hospital, Soweto, Gauteng Province, South Africa. Methods: This was a prospective descriptive study of all patients presenting with canalicular lacerations at St John Eye Hospital over a 7-month period. Data were collected from the patient files and analysed using descriptive statistics. Results: Seventy-eight patients presented at St John Eye Hospital with lid lacerations. Of these 78 patients, 26 (33.3%) had canalicular involvement. There was only mild male preponderance. The median age was 34 years. The most common cause of injury was assault (58%) usually involving a knife. There were associated ocular injuries in 35% of the patients. Globe rupture was relatively common (8%). All patients received lid repair under general anaesthetic. Additional surgical procedures were performed in 19%. The median duration of surgery was 103 minutes. Canalicular repair consumed 100 min of operating time per week. Conclusion: This study demonstrates that canalicular lacerations are relatively common at St John Eye Hospital. These are disproportionately caused by assault and more often associated with serious ocular injuries. This places considerable burden on already limited theatre resources and may be of particular relevance in the South African setting.

Background: Keratoconus, a corneal ectasia associated with thickness and structural changes, has been reported to co-exist with posterior segment ocular conditions. However, very few studies have reported on macular thicknesses in individuals with keratoconus.Aim: The aim of this study was to investigate macular thicknesses in participants with keratoconus.Setting: This study was conducted at the University of KwaZulu-Natal (UKZN).Methods: A comparative cross-sectional research design was used. The sample consisted of 88 participants with 44 each in the control and keratoconus (15, 11 and 18 with mild, moderate and severe keratoconus, respectively) groups. Macular thicknesses were obtained with the Fourier-domain Optovue iVue100 optical coherence tomographer using the nine Early Treatment Diabetic Retinopathy Study sectors. Data were analysed using descriptive and inferential statistics.Results: Overall, the mean macular thicknesses were comparable among the control and three keratoconus groups (p ≥ 0.199). The mean central foveal thickness was greater in the severe keratoconus group (259 µm) than the other three study groups that showed similar measurements (247 µm – 248 µm). The central fovea was thinnest followed by the perifovea and parafovea in all four study groups. The mean thickness in the nasal and temporal quadrants of the parafovea and perifovea was thickest and thinnest, respectively, in all four study groups.Conclusion: Macular thicknesses via optical coherence tomography in individuals with keratoconus and controls are similar with thickness differences that are clinically insignificant. Consequently, macular thicknesses should be included in the preoperative assessment of individuals with keratoconus awaiting corneal transplantation to assess the integrity of the retina prior to surgery.

Background: Uncorrected refractive error could negatively affect learning and academic performance, there is still inadequate information for planning school health.Aim: To determine the proportion of students with vision impairment because of uncorrected refractive error, and prevalent types among learners aged 10–18 years.Setting: The study site included two of 18 local government areas of the Cross River State in Nigeria, with 23 public and mission secondary schools.Methods: A two-stage cluster sampling method was used to enrol 4241 study participants from eight selected secondary schools.Results: The prevalence of vision impairment (presenting visual acuity worse than 6/12) was 7.9% (95% confidence interval [CI]: 7.17% – 8.6%). The prevalence of vision impairment because of refractive error was 7.2% (95% CI: 6.41% – 7.96%) in the better eye. Astigmatism was the predominant type of refractive error with a prevalence of 4.2% (95% CI: 3.6% – 4.8%), followed by myopia (1.72%; 95% CI: 1.3% – 2.1%) and hyperopia (1.3%; 95% CI: 0.9% – 1.6%). There were statistically significant differences in proportions of female participants who presented with myopic astigmatism (30.8%; p 0.012). Statistically significant difference in proportions was found in older (33.3%; p 0.0004) and male (29.6%; p 0.0003) participants who presented with hyperopic astigmatism compared to younger and female participants, respectively. Myopia accounted for 4.8% (95% CI: 4.2% – 5.5%) and was significantly higher in female participants (5.5%; p 0.033).Conclusion: Refractive error was the major cause of vision impairment and myopic astigmatism was the predominant type of refractive error among secondary school children in Calabar.

Background: Corneal astigmatism and central corneal thickness are important clinical parameters for cataract surgery and glaucoma, respectively. There is very little research on the central corneal thickness and the prevalence and pattern of corneal astigmatism in black South Africans. Aim: The aim of this study was to analyse the corneal astigmatism and central corneal thickness of a large population of black South Africans awaiting cataract surgery. Setting: The study was conducted at St John Eye Hospital, Soweto, South Africa. Methods: This was a cross-sectional study of a database of adult black patients awaiting cataract surgery. Biometric data was captured using Sheimpflug Imaging (Nidek AL-Scan). Steep corneas (K readings of more than 48 D) or abnormally thin or thick corneas (central corneal thickness [CCT] 650 μ m) were excluded from the study. Results: A total of 3231 eyes of 1713 patients were included in this study. Patient ages ranged from 18 to 99 years with a median age of 67 years (interquartile range [IQR] 57–75 years). There were more females ( n = 1064) than males ( n = 649). The median central corneal thickness was 494 μ m (IQR 473 μ m–516 μ m). The median corneal astigmatism was 0.92 dioptres (IQR 0.55–1.43 dioptres). A large proportion (45%) of our study sample patients had 1 dioptre or more of corneal astigmatism. Conclusion: This analysis of corneal biometric data revealed that a large proportion of black South African patients awaiting cataract surgery have thin corneas and visually significant corneal astigmatism.

Background: International and African rights instruments stipulate that children have the right to access quality general and eye health care. Lack of access to quality eye care can have a significant negative impact on the child, family and society in general.Aim: To determine the knowledge and practices of eye care professionals about the availability and accessibility of child eye care services in the public sector in Swaziland.Setting: The study was conducted in Swaziland.Methods: This was a quantitative study design, and 15 public eye health professionals completed and returned the Questionnaire for Eye Health Professionals (QEHP).Results: Thirteen (86.7%) eye health practitioners reported that both standard practice guidelines and paediatric national guidelines for ophthalmic services were unavailable. The majority (66.7%) identified cost and unawareness of available services by parents as the most common barrier to accessing eye care services. Nine (60%) felt that they were less informed about eye health problems and 6 (40%) reported being well informed. Eight (53.3%) respondents indicated that there were no outreach programmes and 7 (46.7%) reported that their clinics offered these services. Thirteen (86.7%) eye health practitioners indicated that they were not part of teachers’ training for supporting visually impaired children, while 2 (13%) reported that they were.Conclusion: Formulation of guidelines to support eye health care service delivery in Swaziland is essential in order to improve availability, accessibility, affordability and effectiveness in the public health system.

Background: Vision screenings are important in identifying visual anomalies likely to disrupt the physical, intellectual, social and emotional development of children. School health services globally include vision screenings, complementing a variety of associated screening services.Aim: This review article provides evidence for content, provision and efficacy of the vision screening services for children of school-going age and reports on the current practice of children’s vision screenings worldwide including in South Africa.Methods: Studies were identified from PubMed, Ebscohost and Science Direct with the search terms utilised during the selection of electronic articles and journals for the review. The target population includes children of school-going age from 6 to 19 years without previously known conditions associated with visual anomalies and learning-related problems. The quality of vision screening programmes and policies for the school-going age children in different countries were evaluated using Wilson and Jungner criteria.1Results: Vision screening programmes worldwide appear to support comprehensive vision screening methods among pre-schoolers (from birth to ≤ 6 years vs. children of school-going age). The development of vision screening procedures in some countries in the United States of America (USA) was found to be grounded on epidemiologic findings and principles. These may have contributed towards the formulation of national vision screening guidelines for pre-schoolers that supported the detection of amblyopia and its associated conditions such as strabismus, anisometropia and myopia. School-going children’s vision screenings are not supported worldwide as research has shown that there is lack of benefits for detecting other visual anomalies such as vergence and accommodative dysfunctions. This is despite evidence provided by the literature reviewed that an association exists between prevalent accommodation and vergence dysfunctions including poor ocular motilities and poor near-vision, among children of school-going age with poor academic performance.Conclusion: The guidelines worldwide support school vision screenings, especially for the pre-schoolers by the school health nurses, with other programs having considered the teachers, optometrists or orthoptists as the appropriate personnel to conduct the school vision screenings. There is still a need for the effectiveness of the school vision-screening programmes to be investigated related to the importance of detecting convergence and accommodative dysfunctions for the school going age children.

This article presents a case of ethambutol toxic optic neuropathy determined during the routine optometric examination of a 66-year-old man. Ethambutol is an established drug for the treatment of tuberculosis, but has significant side effects, notably optic neuropathy. The prognosis for vision restoration is unpredictable, with the possibility of permanent vision loss. Treatment cessation is the only option to limit ocular damage; therefore, the early recognition of ethambutol optic neuropathy by optometrists is essential.