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Masters Degrees (Optometry)

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    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.
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    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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    Assessment of visual function amongst motor vehicle drivers in Maseru, Lesotho.
    (2021) Moledi, Zubeta.; Van Staden, Diane Beverly.
    Background: Driving is a primary mode of travel in many countries. It relies primarily on the function of vision to navigate roads and traffic safely. Ensuring good vision for motor vehicle drivers is therefore important to promote safety for all road users. Lesotho is a developing country, with road transportation central to the movement of people and goods within, and across the borders of the country. The absence of clear minimal requirements for visual function among holders of motor vehicle licences in Lesotho motivated this study. Aim: To assess the visual function of motor vehicle drivers in Maseru, Lesotho. Methods: A descriptive, mixed methods cross-sectional study employing systematic random sampling was conducted at the Traffic Department in Maseru, Lesotho. Active licensed drivers, both males and females, from 22–76 years of age participated in the study. Data was collected by means of key informant interviews, structured questionnaires and a comprehensive vision examination of all participants. Quantitative data was analysed using Strata version 14 software, while qualitative data was analysed descriptively. Results: The study included 460 licensed drivers with an overall mean age of 42.9 years, of which 64% (n=294) were men. One in five participants had not had an eye examination before obtaining their driving licence. Most participants (70.87%) had normal vision (6/9 or better) in the better-seeing eye, while 29.13% had visual acuity worse than 6/9 in the better-seeing eye. Among those with sub-normal vision, 29% had visual acuity ranging between 6/18 and 6/48 in the better-seeing eye. More than one third (39%) of participants had some form of refractive error, with myopia showing the highest distribution (46.46%), followed by astigmatism (32.96%) and hyperopia (24.59%). Of those with hyperopia, the majority (98%) were classified as having mild hyperopia (+0.50DS up to +2.00DS). Although myopia had the highest distribution, most cases were mild to moderate myopia (-0.50DS up to -5.75DS). The majority of participants (97.61%) passed the colour vision test, 53.70% achieved contrast sensitivity of up to 6/12 in the better eye and 99.6% achieved a measurement of 100 degrees for visual field test screening. Most participants did not wear spectacles when driving, with 37% of these having previously been advised to wear them based on identified need. Almost half (44%) of the participants reported to have been involved in road traffic accidents. Discussion: While most participants in this study presented with good vision for driving, it is concerning, that almost one in three (29%) had mild to moderate visual impairment and 39% had refractive error, yet they continued to drive without any form of refractive correction. Also, almost half of the participants (44%) had been involved in road traffic accidents, with almost one in five (19%) who had refractive error. It is possible that refractive error and visual impairment could have contributed to their involvement in road traffic accidents. The visual function findings in this study suggest that the Traffic Department in Lesotho should have guidelines on the minimum visual requirements for driving, as well as routine screening procedures. Conclusion: A significant proportion of the motor vehicle drivers in Lesotho have some form of compromised visual function, with many not undergoing an eye examination before obtaining a driver’s licence. If drivers are advised to have their eyes examined regularly, many visual function anomalies could be detected early and their vision corrected accordingly. The absence of effective screening methods for drivers in Lesotho could possibly be a contributor to the incidence of road traffic accidents in the country with the resultant negative socio-economic impacts.
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    A survey of traditional eye practices: a case study of the central region of Ghana.
    (2020) Enimah, Eugene Buah.; Nirghin, Urvashni.
    Background: Once one becomes dependent on the eyes, loss of vision can negatively impact person-social and psychological well-being with added financial constraints. Studies have shown that apart from attending the healthcare facilities to receive professional eye care, people also resort to other means to receive eye care, which sometimes have a harmful effect on the eye. Aim: This study sought to measure the prevalence, determinants, complications of traditional eye practices (use of TEM only, ophthalmic self-medication, and a combination of TEM and ophthalmic self-medication), and reasons for the non-use of professional eye care services among the Ghanaian populace. Methods: The study used a mixed-method convergent parallel study design to enroll 191 residents who were 18years old and above. The sampling method was based on the Expanded Program on Immunization survey technique. The data collection for this study included the administration of both closed and open-ended questionnaires, an interview, and an ophthalmic examination. The ophthalmic examination included the assessment of the visual integrity of the participants. Results: In total, 91.83% (n=191) participants were included in the study. The prevalence of the use of TEM was 9%, ophthalmic self-medication (7%), and a combination of TEM and ophthalmic self-medication (3%). Females were two times more likely to use TEM than male participants [χ2 (1) = 5.183, p = 0.023, (95% CI; 1.099 – 3.534)]. Other socio-demographic characteristics were not associated with traditional eye practices. The predominant TEM used was herbal medicine “Nyankwa O ye,” traditional concoction, and Kajal. The reasons for the use of TEM were; others benefitted from it (37.30%), belief in its potency (21.10%), and unsatisfactory orthodox treatment (15.50%). The major ocular complication recorded were glaucoma suspect (29.41%), refractive error (27.73%), other diagnoses (18.49%), and corneal scar (10.08%). Reasons for the non-use of professional eye care services were traditional eye practices were affordable, the eye clinics did not work on weekends, the potency of traditional eye practices, and others benefited from traditional eye practices. Conclusion: The factor that influences the use of TEMs at Asikuma Odoben Brakwa District was gender. The use of traditional eye practices should be discouraged due to its devastating consequences on the eyes.
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    An evaluation of the accuracy of the Moorfields Motion Displacement Test.
    (2020) Chetty, Keshia.; Loughman, James.; Naidoo, Kovin Shunmugam.; Govender-Poonsamy, Pirindhavellie.
    Introduction: Recent statistics report a global blind population of 32.4 million and 191 million people with vision impairment, of which more than 90% of the world’s visually impaired live in developing countries. Glaucoma, the third leading cause of blindness in Africa (after cataract), is responsible for approximately 15% of blindness in the continent, requiring early detection, but goes undiagnosed in developing countries because of lack of awareness of the disease and its effects. Screening methods are not always affordable and relatively inaccessible in most developing countries, posing a barrier to identifying people at risk of glaucoma blindness. The Humphrey’s Visual Field Analyser (HVFA), considered as the gold standard in assessing visual fields, is not suited to mass screening due to cost, portability, test time, physical testing requirements among other issues, thereby making it inconvenient for mass screening programmes. These shortcomings motivated the development of the Moorfield’s Motion Displacement Test (MMDT), a new portable visual field instrument, at the Moorfield’s Eye Hospital in London. Aim: To determine the agreement and sensitivity between the Humphrey’s Visual Field Analyser (HVFA) and the Moorfield’s Motion Displacement Test (MMDT). Methods: The study followed a comparative design based on simple random sampling, comprising two hundred and seven subjects. Of the total number of subjects included in the study, the glaucoma group comprised sixty-two subjects, whilst the control group comprised one hundred and forty-five subjects. A total of 293 eyes were included in the study, of which 94 eyes were glaucomatous (case) and 199 eyes were non-glaucomatous (control), of participants who were selected via chart review from two district hospitals in KwaZulu-Natal (KZN), South Africa; McCords Provincial Eye Hospital (case) and Prince Mshiyeni Memorial Hospital (control). Both eyes were tested using the HVFA and the MMDT instruments. All subjects were asked to complete a questionnaire prior to and after testing on both instruments. Results: Non-parametric tests were used because results were not normally distributed. The diagnostic accuracy of the MMDT was high in terms of test sensitivity (100%), but performed less well in terms of specificity (63.3% and 65.3%) for case and control participants respectively. Despite the low specificity, there was a high level of similarity and a faster testing time (for both groups) in detecting glaucomatous visual field defects on the MMDT compared with the HVFA. A significant number of participants (83.5 %) across the different race groups, preferred the MMDT over the HVFA, and found the use of the mouse over a push button to be easier (74.5% across all race groups). Majority of participants (80.5%) reported focusing on a central white dot seemed more comfortable than a central amber light and found anxiety levels reduced whilst using the MMDT. Conclusion: The high sensitivity and design advantages of the MMDT for population screening may help improve glaucoma case finding in the community, and thereby facilitate earlier treatment and better health outcomes for those affected. The specificity issue should be addressed, however, to avoid service delivery problems associated with unnecessary false positive referrals.
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    Visual function and quality of life in adolescents with visual impairment: a case study of the Arthur Blaxall School in Pietermaritzburg.
    (2018) Naipal, Shivani.; Rampersad, Nishanee.
    Background: Visual impairment (VI) may affect the lives of children, adolescents and adults although the effects of VI on the former two groups may be taken for granted as they account for less than half the population affected by VI. Affected children and adolescents may endure a lifetime of vision related difficulties that may affect their education, social interactions and possible future employment. Aim: To investigate visual function and quality of life (QoL) in adolescents with VI at the Arthur Blaxall School in Pietermaritzburg. Methods: This study followed a descriptive case study research design. Students registered at Arthur Blaxall School aged 10 years to 19 years were recruited using convenience sampling. Visual function was quantified by distance visual acuity (VA) and refractive error, contrast sensitivity, colour vision and central visual field. The QoL was assessed with the Cardiff Visual Ability Questionnaire for Children (CVAQC). Data were analysed using differential and inferential statistics. Results: The sample consisted of 70 participants with a mean age of 13.83 ± 2.28 years. The most common cause of VI was oculocutaneous albinism (OCA) followed by posterior segment disorders. The mean best-corrected VA ranged from 0.79 ± 0.16 logMAR to 0.91 ± 0.22 logMAR in the right, left and both eyes. Only 16 participants presented with spectacles and an additional 18 participants required spectacles following refraction. More than 40% of participants had moderate loss of contrast sensitivity in each eye. The majority of participants did not have any colour vision or central visual field defects. The mean visual ability score was −0.27 ± 0.74 log units, and the most difficult tasks were reading smallest print in textbooks and the board in the classroom for near and distance respectively. Participants with OCA had the best monocular best-corrected VA and contrast sensitivity. The most common colour vision defects among participants with anterior and posterior segment disorders were tritan and deutan colour vision defects respectively. Participants with anterior segment disorders had the poorest QoL while those with OCA had the best QoL. Conclusion: The results of this study showed that visual function varied among adolescents with VI. Furthermore, both visual function and QoL differed between each of the main causes of VI.
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    Impact of low vision on quality of life of patients with low vision visiting the low vision center of the Eastern Regional Hospital, Ghana.
    (2017) Adamptey, Beatrice.; Naidoo, Kovin Shunmugam.; Govender-Poonsamy, Pirindhavellie.
    Introduction: Low vision impacts quality of life and more so when the vision loss is severe. Persons living with low vision have reduced functionality and psychosocial well-being with the potential for high dependence on others in carrying out everyday activities. Decreased quality of life and psychosocial well-being affect both the individual and the community economically as the productive labour force is affected. Low vision may also increase morbidity and mortality. Although the relationship between low vision and quality of life has been extensively studied in other parts of the world, with documented evidence of the adverse effect of low vision on a person’s quality of life, very little has been done in Ghana to understand the specific setbacks and challenges low vision brings to the patients in spite of the fact that there are such patients living in the country for which reason a center has been set up to manage and treat them. Understanding specific vision and functional challenges is important in ensuring management that is tailored to the needs of patients with low vision. This study aims to investigate the impact of low vision on quality of life, and as well to establish the relationship between severity of vision loss and level of impact on quality of life of subjects with low vision visiting the low vision center of the Eastern Regional Hospital in Ghana. Method: A descriptive case control study involving 41 cases and 41 controls was conducted. The cases were stratified into three categories of low vision namely moderate, severe and profound. The National Eye Institute Visual Function Questionnaire (NEI VFQ-25) which consists of twenty five questions was used in the collection of data. Descriptive statistics and logistic regression analysis were conducted to determine associations between various variables. Results: Case subjects had statistically significantly lower quality of life compared to control subjects (cases, median=46.09, IQR= 30.84-66.00, n=41), (controls, median= 98.09, IQR=94.94-100.00-, n=41), p<0.001). The functional and psychosocial subscales (driving, near and distance activities, social function and mental health) produced the lowest quality of life scores. There was, however, no statistically significant difference in the ocular pain and discomfort subscale between cases and controls ((cases; median= 87.50, IQR= 71.88-100), (controls; median= 87.50, IQR= 87.50-100), p=0.098). Regression analysis showed no significant relationship between demographic profile and quality of life. Cases with profound low vision were 0.49 (95% CI= 0.46-0.71) times less likely to have good quality of life compared to subjects with normal vision. Quality of life worsened with decreasing vision Conclusion: Quality of life is impacted by low vision especially in areas of functionality and psychosocial well-being. The degree of impact of low vision on quality of life is influenced by the severity of vision loss. Incorporation of social support services counseling and rehabilitation protocols that focus on improving functionality may be a step in the right direction in assisting persons with low vision adapt to their vision loss and improve their quality of life.
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    Lifestyle and gender influence on the relationship between hypertension and intraocular pressure amongst the South Nigerian population.
    (2017) Igumbor, Brenda Avwerosuo.; Nirghin, Urvashni.
    Hypertension and increased intraocular pressure (IOP) have been considered to be detrimental to systemic and ocular health respectively. Untreated and prolonged increase in blood pressure (BP) has been linked to increase in IOP for some populations. Lifestyle factors such as cigarette smoking, alcohol intake, obesity, salt, fat, fruit and vegetable intake could have great influence on the relationship between hypertension and IOP. However, this has not been investigated. Aim: The aim of this study is to investigate the influence of gender and lifestyle factors on the relationship between hypertension and IOP amongst the South Nigerian population. Method: A total of 570 subjects between 20-70 years old were included in the study. Subjects were randomly selected from six approved eye hospitals within the South Nigerian region. The population was divided into two groups comprising of 285 normotensive and 285 hypertensive subjects. All subjects were presented with the information document. Only those with signed consent forms participated in the study. With each subjects, blood pressure, intraocular pressure, weight and height measurements were taken using the mercury sphygmomanometer, schiotz tonometer, measuring scale and measuring tape respectively. Thereafter, a lifestyle questionnaire about cigarette smoking, alcohol intake, obesity, salt, fat and fruit and vegetable intake were administered. Data was analyzed using the Statistical Packages for Social Sciences (Version 22), using Pearson correlation coefficient and Analysis of variance (ANOVA) Results: The percentage of male and female normotensive subjects were 33% (N=94) and 67% (N=191) respectively and served as control for the study. For the hypertensive subjects, 36.1% (N=103) were male and 63.9% (N=182) were female. The mean age was 42.31 ± 9.98 years old and 46.45 ± 10.23 years old for the normotensive and hypertensive subjects respectively. The mean IOP of the hypertensive male subjects was 21.22± 3.22 mmHg (RE) and 20.12 ± 2.62 mmHg (LE) and for the female subjects was 19.83 ± 3.75 mmHg (RE) and 18.98 ± 2.91 mmHg (LE). There was no correlation of lifestyle factors and gender on the relationship between HBP and IOP from the study. A correlation was however observed among the hypertensive subjects showing moderate correlation for SBP and DBP for IOP RE (0.375 and 0.297), respectively. A weak correlation was observed for SBP and DBP for IOP LE (0.241 and 0.204) respectively. The relationship between hypertension and IOP was statistically significant with p≤ 0.05. Conclusion: There was significant influence of gender on both hypertension and IOP for the RE and LE. Alcohol intake amongst all other lifestyle had influence on SBP, DBP and IOP RE and LE for hypertensive subjects.
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    Refractive errors, visual impairment and utilization of spectacles among primary school children in Onitsha, Anambra State, Nigeria.
    (2018) Ezinne, Ngozika Esther.; Mashige, Khathutshelo Percy.
    Aim: To establish the visual status and utilization of spectacles among primary school children in Onitsha, Anambra State, Nigeria. Methods: A stratified random cluster sampling procedure was used to select children aged 5- 15 years old from grades 1 to 6 in primary schools, with 1020 children in 102 clusters being enumerated, of whom 998 (97.8%) were examined. The examination included visual acuity, retinoscopy, auto-refraction under cycloplegia, and examination of the anterior segment, media and fundus. Results: The 998 children consisted of 554 (55.5%) females and 444 (44.5%) males, with their mean age being 9.01± 2.5 years. The prevalence of uncorrected, presenting and best corrected visual acuity of 20/40 or worse in the better eye was 9.7%, 7.7% and 1.3% respectively. Refractive error accounted for 86.6% of all causes of visual impairment (best corrected visual acuity of 20/40 or worse in the better eye). Myopia was the most prevalent refractive error (46.4%), followed by astigmatism (36.1%) and hyperopia (17.5%). Myopia (of at least −0.50 D) in one or both eyes was present in 46.4% of the children when measured with retinoscopy, and 49.5% when measured with auto-refraction. Astigmatism (of –0.50DC or less) was present in 36.1% of the children when with retinoscopy and auto-refraction. Hyperopia (+2.00D or more) in at least one eye was present in 21.6% of children with auto-refraction and 17.5% with retinoscopy. Refractive error and visual impairment were significantly more prevalent in females than in males (P = 0.04).Refractive error was highest among children 11−13 year old, while visual impairment was highest among children 5−7 years old. The rate of wearing spectacles among children with visual acuity of 20/40 or worse in one or both eyes was 20.6%. The major reason for non-compliance with spectacle wear among the children was disapproval from their parents. Conclusion: The prevalence of refractive error and visual impairment among primary school children in Onitsha was high while spectacle utilization rate was low. This highlights the need for services and strategies to address refractive error, visual impairment and compliance with spectacle utilization in this region.
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    The availability and accessibility of low vision services in Ashanti and Brong Ahafo Regions of Ghana.
    (2018) Kyeremeh, Sylvester.; Mashige, Khathutshelo Percy.
    Background: The prevalence of low vision on the African continent is generally high and varies across and within countries, as well as in people of different socioeconomic status. While regional studies on the prevalence of blindness and low vision in Ghana have been conducted, there is a lack of information on the availability and accessibility of low vision services in these regions. The aim of the study was to assess the availability and accessibility of low vision services in the Ashanti and Brong Ahafo regions of Ghana. Methods: This was a descriptive, quantitative, cross-sectional study design. Hand-delivered semi-structured questionnaires were used to collect information from eye care professionals selected from 58 eye care facilities within the Ashanti and Brong Ahafo regions of Ghana. In addition, face-to-face interviews were conducted with 29 low vision patients from the same regions. Results: Forty-four eye care facilities from the Ashanti region and 10 from the Brong Ahafo region responded to the questionnaire, giving an overall response rate of 93%. A total of 29 patients including 16 males and 13 females with a mean age of 33.79±17.42 years were interviewed from four different eye care facilities. Out of 50 eye care facilities who reported that they had low vision patients attending their clinics, 33 (66%) did not provide low vision services and 17 (34%) offered some form of this service. Eleven out of 15 (73.3%) patients reported that it was either difficult or very difficult to acquire optical low vision devices while 10 (83.3%) out of 12 patients reported the same about non-optical low vision devices. Of the 15 patients who responded to the questions on where they obtained their optical devices, 7 (47%) reported that they were donated to them, 2 (13%) obtained them from the market while 6 (40%) reported getting their devices from the hospitals or eye care facilities. For non-optical devices, the patients reported obtaining them from the market 5 (31%) and through donations 5 (31%). Others obtained them from the society for the blind 2 (15%), hospitals or eye clinics 2 (15%) and a resource centre 1 (8%). Barriers to the provision and uptake of low vision services included the lack of testing equipment, lack of assistive devices and high cost of services. Conclusions: Availability and accessibility of low vision services are limited in the Ashanti and Brong Ahafo regions. These findings should help to inform interventions to make low vision services available and accessible as well as to overcome the barriers to providing and utilising these services to minimise the impact of visual impairment.
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    Prevalence and risk factors for Myopia among school children in Aba, Nigeria.
    (2015) Atowa, Uchenna Chigozirim.; Munsamy, Alvin Jeffrey.; Wajuihian, Samuel Otabor.
    Abstract available in PDF file.
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    Patterns of contact lens prescribing in KwaZulu-Natal.
    (2015) Moodley, Veni.; Khan, Naimah Ebrahim.
    Master of Medical Science in Optometry. University of KwaZulu-Natal, Durban 2015.
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    Recruitment and retention of optometrists in the public sector of KwaZulu-Natal.
    Ramson, Prasidh.; Naidoo, Kovin Shunmugam.
    Introduction With Africa sharing just under a quarter of the world’s disease burden, there is a limited and disparate distribution of health workers to meet this challenge. In public sector optometry, the situation is no different from the sub-Saharan scenario. In South Africa, there is a vibrant private sector catering for the privileged few while there is a paucity of optometrists serving the larger public sector. KwaZulu-Natal is one of the most densely populated provinces and home to several of the poorest districts in South Africa. Despite an optometry school in the province, and with the lack of compulsory community service for new graduates, there is still a dire need for optometrists to serve in the public sector. Recruitment of appropriate health workers takes into account demographic, educational and socio-economic factors, while retention requires the input of several financial and non-financial components to keep staff motivated and productive. Aim The aim of this study was to investigate recruitment and retention elements that would appeal to and retain present and future optometrists in the public sector. Methods A cross sectional methodology, gathering both quantitative and qualitative data, was used. All public sector optometrists and district co-ordinators in KwaZulu-Natal province were contacted, with an 80% (41 out of 51) and 75% (9 out of 12) response rate received respectively. For optometrists and district co-ordinators, a questionnaire containing demographic, recruitment, retention and open ended questions was distributed by post, fax, email and online survey. For both groups, telephonic interviews were conducted using semi-structured techniques, allowing for triangulation of quantitative responses. Frequency distributions, Fisher’s exact test and Odds ratios were used to describe associations between demographic data and recruitment and retention queries. Qualitative responses were recorded, transcribed and then coded for recurring themes. Results The present public sector optometry workforce comprises mainly young (73%), Black (70%), females (66%). They chose to work in the public sector to ‘make a difference’, and was also attracted by ‘good working hours’ and ‘job security’. Fifty three percent of the sample chose to work in the public sector due to a study bursary, for which there was a statistically significant association for race (p = 0.01), gender (p = 0.05), and background origin (p = 0.05). To aid their retention in public service: improved salaries, career progression, recognition by supervisors, improved management relations and improved equipment was highest ranked. From the district co-ordinator’s perspective, recognition, improved salaries, career progression and improved equipment and infrastructure are imperative to retain optometrists. District co-ordinators also pointed out that a devolved health system places more managerial and financial autonomy at the level of the hospital management which can cause delays in career progression and procurement of equipment. Discussion The demographic profile of the currently serving public sector optometrists poses many human resource challenges and opportunities. While universities have selected students to better redress past inequities in higher education, there still appears to be a lack of representation of white and coloured optometrists in the public sector. Marketing of the profession of optometry needs to be done by innovative methods over and above mainstream media, to be more attractive to rural candidates. From the Department of Health’s perspective, the provision of study bursaries is the prime method to increase optometrists in health districts. At the same time, however, it creates a multi-generational mix of health professionals (Millennials and Generation X’s, in this sample) with each requiring their own unique retention interventions and methods of workforce motivation. Review of salaries and advocacy for comparable salaries requires attention if the Department of Health wishes to retain optometrists with financial incentives. More engaging and responsive human resource management systems are needed at the hospital level to better articulate career progression for professionals. Processes for the efficient procurement of equipment are imperative to not only retain optometrists, but also to provide quality service delivery. From a District Co-ordinator’s perspective, despite decision making powers existing at the institute level, there needs to be regular, transparent communication and discussion of plans for better synergy between hospital management, optometrist and district office. Conclusion Universities appear to recruit a representative proportion of optometrists, but more attention needs to be paid to rural origin and prior exposure of candidates. Departments of Health use a study bursary incentive to recruit health workers, but much consideration needs to be given to financial (salaries comparable to other allied health professionals, rural allowance) and non-financial incentives (career pathway development, recognition by management, equipment and infrastructure) to retain optometrists. Emphasis needs to be placed on human resource management at hospital level, with clear and well-articulated programme planning and budgeting shared with all.
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    Contribution of refractive errors to vision impairment in the Ashanti Region, Ghana.
    (2014) Afari, Clement.; Naidoo, Kovin Shunmugam.; Amedo, Angela O.
    Purpose: To determine the prevalence and causes of vision impairment with particular emphasis on uncorrected refractive error (URE) in Ashanti region, Ghana. A baseline vision impairment study in the Ashanti region is necessary to effectively plan for refractive services and blindness prevention strategies. Methods: A cross-sectional multistage cluster sampling was conducted in 24 communities in Ashanti region, Ghana. A total of 1420 participants aged 18 years and above were enumerated using a modified Rapid Assessment of Vision impairment (RAVI) protocol. This was limited to unaided visual acuity (VA) using a Snellen chart at a distance of 6 meters, near binocular visual acuity and direct ophthalmoscopy for all participants after obtaining an informed consent. The VA was repeated using a pinhole for participants with VA ≤ 6/12. A non-cycloplegic refraction was done for those whose pinhole VA improved. Near vision refraction was also assessed for each participant whose near vision was less than N8. Simple proportions were used to compute the prevalence of vision impairment and refractive error in the studied population. The results were analyzed using STATA 11. Results: One thousand three hundred (1300) of those enumerated (1420), participated in the study, a response rate of 91.5%. The mean age of the participants was 46.29 (CI 95% 45.29-47.29). The minimum age was 18 years and the maximum 99 years. Prevalence of vision impairment was 16.15% (n= 210, 95% CI, 14.15 – 18.16). Refractive error was the leading cause of vision impairment with 47.14% (n = 99, 95% CI of 40.33 - 53.9) Conclusion: Refractive error was the main cause of visual loss in Ashanti region, Ghana.
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    Cosmetic contact lens awareness, procurement and usage amongst students at a university in Cape Town South Africa : a descriptive study.
    Hendricks, Angelique Laetitia.; Moodley, Vanessa Raquel.
    No abstract available.
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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.
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    An investigation of saccadic eye movement abnormalities in children with HIV/AIDS on highly active antiretroviral therapy.
    (2013) Naicker, Nashua.; Moodley, Vanessa Raquel.
    Introduction: The Human Immuno-deficiency Virus (HIV) and the consequent Acquired Immuno-Deficiency Syndrome (AIDS) have cost the lives of millions of people globally over the past 30 years since the first cases of illness appeared. Due to the overlap in areas in the brain that are damaged by the HIV with those that control saccadic eye movements, screening of eye movement functions in children with HIV/AIDS could thus be a valuable early indicator of a declining neurological and immunological state. Therefore, movement testing through non-invasive means may give the optometrist valuable insight into the developing central nervous system (CNS) in HIV-infected children. Aim: To determine if abnormal saccadic eye movements in children with HIV/AIDS on HAART could be a predictor of the status of their immune system. Methodology: The study population comprised of 128 conveniently selected subjects aged 5 to 14years diagnosed with HIV/AIDS on HAART. This prospective study, used a descriptive design. The two significant biological parameters such as CD4 count and viral load (VL) data of patients were accessed and subjects performed the DEM test, which is a visual-verbal reading speed test, used to detect oculomotor function as well as automaticity skills. The subjects were then classified according to the different „behaviour types‟ as is specified in the DEM test based on their test performances. Statistical Analysis Software (SAS) version 9.2 was used to analyse the data. Results: Nine year olds were the most prevalent comprising of 23% of the sample. Subjects were categorised into three categories of their VL and CD4 count parameters from minimal to severe immunosuppression. Seventy eight percent (78%) of subjects had minimal immunosuppression with CD4 counts ≥500cells/mm3 with a median value of 778.5 cells/mm3. Sixty five percent (65%) of the subjects had undetectable VL (<40 copies/mm3) with the median value of <40 copies/mm3 in the sample. With the DEM test, 93% had vertical and 92% had horizontal times that were outside of the standardised DEM norm. The classification of subjects into behaviour types revealed that 53% were type 3 – automaticity problems, 22% type 4 – oculomotor problems and automaticity problems, 8% type 1 – normal performance and 3% were type 2 – oculomotor dysfunction. Fourteen percent were in the unspecified behaviour type category. The relationship between the VL with behaviour types (p=0.2) and the CD4 count against the behaviour types (p=0.17) were neither statistically nor clinically significant, hence no relationship could be established. Discussion: Since the cognitive functioning in children with HIV/AIDS was moderately affected, the DEM test could be a valuable tool, if not to only detect eye movement problems but to assess the automaticity skills, which shows the impact on their neurodevelopment. It therefore does prove to be worthwhile for optometrists and other health professionals to use the DEM test as part of a battery of neurodevelopmental tests to assess different neurocognitive functions, specifically in children with HIV/AIDS. Recommendation: DEM norms for a South African paediatric population should be established as the characteristics of this population differ from the population of English-speaking American children on which this test was standardised. Conclusion: Immunologic and virologic statuses in children with HIV/AIDS on HAART cannot be predicted from abnormal saccadic eye movements. Performances across all age groups were significantly below the standard DEM norms. Saccadic eye movement abnormalities were the least prevalent and automaticity deficiencies were the most prevalent across the sample with no associations to the CD4 count and viral load.
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    Schirmer tear test 2 and tear break-up time values in a South African young black adult population.
    (2012) Khan, Naimah Ebrahim.; Oduntan, Olalekan Alabi.
    Aim: The aim of this study was to establish normal values for Schirmer tear test (version 2) and tear break up time (TBUT) in a South African young adult Black population. Method: Following ethical approval by the biomedical research and ethics committee, KwaZulu-Natal, participants were recruited from the city of Durban in South Africa via personal invitations, poster advertisements and University of KwaZulu-Natal optometry clinic clients. McMonnies questionnaire for dry eye diagnosis was administered and those who failed were excluded from the main study. Two hundred (100 males and 100 females) participants who met the inclusion criteria were included in the study. Following a slit lamp examination of the eye, the Schirmer test was administered and the following day, the TBUT was measured. A re-test version of the two procedures were conducted one week after, at about the same time of the day for each subject. Results: The participants were aged 18-30 years, mean = 20.77 ± 2.29 years. The mean Schirmer test values for all participants (N = 200; 400 eyes) was 15.96 ± 6.86mm. The values for the males and females (200 eyes each) were 16.34 ± 6.93mm and 15.58 ± 6.81mm respectively. The mean TBUT (400 eyes) was 7.18 ± 1.89 secs. The mean values for the males and females (200 eyes each) were 6.90 ± 1.88 secs and 7.32 ± 1.67 secs respectively. A strong positive correlation (r = 0.895) and (r = 0.914) respectively was found between the right and left eyes in the two tests. Conclusion: Generally, the mean values found in this study for the Schirmer test are similar to those that have been reported in the literature. However, values for TBUT differ from the values that have been previously reported, being higher in some instances and lower in others. These findings have implications for dry eye diagnosis and also contact lens practice in South Africa.
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    Design, reliability and validity of a paediatric rate of reading (PRR) chart.
    (2012) Nirghin, Urvashni.; Oduntan, Olalekan Alabi.
    Background: Reading rate is a measure of fluency, reflecting the level of reading performance especially in children, which is not typically measured during routine eye examinations. Optometric clinical tests such as Snellen visual acuity are often poor predictors of everyday reading performance, as they test the smallest print a person is able to read rather than fluency. Conventional reading rate tests for educational purposes presents with many limitations; they concentrate on linguistic skills, increase in complexity as the reading progresses, limited by the readers vocabulary but more importantly, they do not take the level of the child's vision into consideration. There is currently no reading rate chart that is designed with optometric notations specifically for children with normal vision and low vision. It is therefore necessary to design a reading rate chart that takes the above limitations into consideration. Aim: This study aimed to design a chart that can be used to measure reading rates in normal sighted and low vision primary school children. Methods: The aim of the study was achieved in four parts; the design, reliability, validity of a reading rate chart and finally the testing of the chart on low vision participants. In the design of the chart, ten frequently used words in grade one English reading books were randomly selected from five primary schools in KwaZulu-Natal province, South Africa. The reliability and validity of the chart were established on normal sighted children, aged nine to twelve years from two primary schools in the Durban area chosen by convenience sampling method, with sample size of 100 for reliability and 100 for validity. Reliability was established with test and retest reading rates using the new chart while validity was established by determining the reading rates using new the chart and the Wilkins reading rate chart. Data were analyzed using the Paired t-test, Pearson correlation, and Bland and Altman method. Finally, the testing of the new chart without and with low vision device, on fourteen low vision children, aged eight to nineteen years, attending a school for the visually impaired in KwaZulu-Natal. Data was analyzed using Paired t-test and Pearson correlation. Results: The words were arranged in random order, ten words per row and ten rows per paragraph. The chart consisted of six paragraphs (versions A, B, C, D, E and F) with six acuity levels and four optometric notations. Each version was printed on a separate sheet, in Arial and Times New Romans fonts and printed in black ink on approximately white cardboards. In reliability, the mean test and retest reading rates were 77.65 ± 25.30 and 78.23 ± 24.70 (p = 0.29, R² = 0.95). In Bland and Altman method, the mean difference was −0.58 with confidence limits at +10.07 and -11.23. In validity, reading rate for Wilkins chart and the new chart were 75.82 ± 23.64 and 74.92 ± 23.58 (p = 0.01, R² = 0.99) respectively. In Bland-Altman method, the mean difference was +0.90, upper limit at +6.33 and lower limit at –4.53. The mean reading rate, of the low vision children, without and with the low vision device were 59.32 ± 24.08 words per minute (wpm) and 67.04 ± 25.63 words per minute (wpm) respectively (p = 0.09 and r = 0.82). Conclusions: This chart can be used for reading rate assessment for both normally sighted and low vision children and is statistically reliable and valid.