Acta Scientific Ophthalmology (ISSN: 2582-3191) Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria. --Implications for Eye Care Planning and Budgeting

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Acta Scientific Ophthalmology (ISSN: 2582-3191)
Volume 3 Issue 3 March 2020
Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria.
--Implications for Eye Care Planning and Budgeting
Ireju Onyinye Chukwuka* and Elizabeth Akon Awoyesuku
Department of Ophthalmology, College of Health Sciences, University of Port Harcourt,
Nigeria
*Corresponding Author: Ireju Onyinye Chukwuka, Department of Ophthalmology,
College of Health Sciences, University of Port Harcourt, Nigeria.
Research Article
Received: February 16, 2020
Published: February 27, 2020
© All rights are reserved by Ireju Onyinye
Chukwuka and Elizabeth Akon Awoyesuku.
Abstract
Keywords: Ocular Disorders; Semi-Urban; Eye Care; Planning and Budgeting
Introduction
Aim: This preliminary (pilot) study was to elucidate the demographic characteristics and pattern of Ophthalmic Disorders at a Com-
munity Eye Outreach in a Semi-Urban Area of Rivers State, Nigeria and its implications for eye care planning and budgeting.
Methodology: A descriptive cross-sectional study was done. Participants at a one-day free eye camp at Rumuapu community had a
comprehensive ophthalmic examination involving visual acuity, ocular examination of the anterior and posterior segment, tonom-
etry and refraction. The data generated was subsequently analyzed using SPSS version 20.
Results: 104 subjects were seen with a mean age of 38.3 ± 16.6 years. 71.2% of the participants were female while 28.8% were male.
30.8% were in the 41 - 50years age group, 80% of the participants had normal distant vision but 77.9% were presbyopic. The most
common cause of ocular morbidity was refractive error closely followed by allergic conjunctivitis.
Conclusion: The commonest Ophthalmic disorder in our study was refractive error which occurred with a mean age of 36.2 years,
followed by allergic conjunctivitis. More females than males attended the free eye screening activities and the prevalence of visual
impairment was 22%.
        -
veloping economies as they present an avenue for economically
disadvantaged individuals to have access to ophthalmic care. They

other causes of preventable blindness [1].
The Nigerian National Blindness and Visual impairment Survey
puts the overall prevalence of blindness in Nigeria at 4.2% and
3.4% in South –South Nigeria [2].
Knowledge of ocular diseases prevalent in different regions has
implications for preventive ophthalmology as scarce resources can
be better channeled to prevalent disease with improvement in oph-
thalmic health. The aim of this study is to elucidate the ophthalmic
disorders prevalent in a semi-urban community as well as demon-
strate its association with the age of the participants. Rumuapu is
a semi urban community in Obio Akpor local government area in
Rivers State and has no health care or eye care facility domiciled
in it. Residents have to travel over one hour to the nearest eye care
facility in the State. This pilot study aims to elucidate the pattern
of ocular disorders prevalent in this community, as well as its as-
sociation with age to enable appropriate healthcare planning and
budgeting of available resources. To the best of our knowledge no
data exists from this community.
Citation: Ireju Onyinye Chukwuka and Elizabeth Akon Awoyesuku. “Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria.
--Implications for Eye Care Planning and Budgeting”. 3.3 (2020): 01-05.

Methodology
A descriptive cross-sectional study was employed. Participants
were seen at a one-day free eye camp conducted at Rumuapu com-
munity in Obio/Akpor local government area, Rivers State on 18th
November, 2017. All participants gave a verbal and written /signed
informed consent to partake in the study while parents gave signed
informed consent for underage children. The study was carried out
in accordance with the tenets of Helsinki declaration and every
participant was free to withdraw from the research at any time.
Minor ocular disorders were treated on site while those requiring
more investigations were referred to the nearby tertiary care facil-
ity. Ethical approval was obtained from the ethical review board of
our institution. All participants had a comprehensive ophthalmic
examination. This included visual acuity using a Snellen chart for
distant acuity and the near vision using the near chart. The ante-
rior segment was visualized using a pen torch while the posterior
segment was seen using the Welch Allyn direct Ophthalmoscope.
Participants who were unable to read the 6/6 on the Snellen chart
were given a pin hole and visual acuity repeated. Those with im-
provement in visual acuity had their refraction done using Welch
Allyn retinoscopes. Tonometry was also done on all participants
using a non-contact Keeler tonometer. There were no inclusion and
exclusion criteria as we wanted the data to be truely representive
of the ocular health status of the residents of Rumuapu community.
Data on age, sex, visual acuity and ophthalmic disorders of the
participants were entered into Microsoft Excel and exported to
IBM Statistical Package for Social Sciences (SPSS) version 20 for
descriptive and inferential statistical analyses. Descriptive statis-
tics included frequencies and percentages for categorical variables
while means and standard deviation were employed for numerical
variables. The differences in mean ages across type of ophthalmo-
logical disorders were compared using one-way Analysis of Vari-

Results
104 subjects were seen with a mean age of 38.3 ± 16.6 years.
71.2% of the participants were female while 28.8% were male (M:F
= 1:2.4) and 30.8% were in the 41 - 50years age group. More than
80% of the participants had visual acuity better than 6/18 in both
eyes. Refractive error was the commonest condition encountered
(77.9%) followed by allergic conjunctivitis (17.3%) and glaucoma
suspects (10.6%). Most of the participants with refractive error
had presbyopia. The mean age of those with refractive error was
36.2 years while the mean age of cataract was 70.0years. Cataract
was uncommon (2.9%).
The age group with the largest number of attendees was the 41-
50 years age group (Figure 1), followed by the 31 - 40 years and the
11 - 20 years age group. The lowest attendance (2.9%) was by the
over 70 years old age group.
Figure 1: Age distribution of participants in the study (N=104).
Sex distribution
The vast majority of attendees were female (71.2%) while the
males were only 28.8%.
Figure 2: Sex distribution of participants in the study (N=104).

About 79% of participants had a visual acuity better than 6/18
in their right and left eyes.
02
Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria. --Implications for Eye Care Planning and Budgeting
Citation: Ireju Onyinye Chukwuka and Elizabeth Akon Awoyesuku. “Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria.
--Implications for Eye Care Planning and Budgeting”. 3.3 (2020): 01-05.

Visual acuityRight Eye Frequency
(Percentage)
Left Eye Frequency
(Percentage)
Better than 6/18 83 (79.8) 82 (78.8)
6/18 – 6/36 15 (14.4) 13 (12.5)
Worse than 6/36 6 (5.8) 9 (8.7)
Total 104 (100.0) 104 (100.0)
Table 1:
participants.
Ophthalmic disorders
-
lowed by allergic conjunctivitis and glaucoma suspects while the
least common were ocular albinism, and dry eye disorder. 3.8% of
participants had no ophthalmic disorder.
Comparison of mean ages of participants based on ophthal-
mological disorders
Refractive error occurred in 77.9% of participants (Figure 3)
and Allergic conjunctivitis in 17.3%. The mean age of occurrence of
refractive error was 36.2 years while that for allergic conjunctivitis
was 20.5 years (Figure 4). Furthermore the mean age of the glau-
coma suspects was 46.6 years, pterygium - 43.3 years, macular de-
generation 40.3 years, Cataract- 70 years, and Dry eyes 63.0 years.
Figure 3:
in the study.
N.B
ANOVA statistics shows that the differences in mean ages by the
 -

Figure 3: Error bar chart showing mean ages (±1 Standard
Deviation) of the participants across the ophthalmological
disorders.
Discussion
A sizeable amount of various populations screened have oph-
     
[3]. Osuji in a three day exercise at a rural setting in Enugu state, Ni-
geria screened 650 people out of whom 466 had eye diseases and
the population consisted of 37.3% male and 62.7% females (M:F
= 1: 2). Our study population was also made up of more females
[71.2%] than males [28.8%] which is a common trend in many se-
ries [4-6]. This may be due to culture, attitude or socioeconomic
factors. This is in line with the greater health-seeking behavior of
women in many parts of Nigeria primarily because they are eco-
nomically disadvantaged compared to the men. In contrast stud-
ies in Northern Nigeria [4] and India report the reverse [7] prob-
ably due to cultural restrictions on women. There is a large body
of evidence that women are 40% more affected by blindness and
visual impairment than men [8]. The reason may be that men are
       
polygamous settings older wives tend to be neglected in favour of
the youngest one. So if their grown children are not available or are

without intervention [9]. Visual impairment in older adults pro-
   -
ment, poor psychological health, overall worse health outcomes,
and increased health care spending. Therefore, promoting the visu-
al health of the elderly, especially women is not only a public health
concern, but also an economic one. The age group with the largest
number of participants in this study was the 41 - 50 years group.
03
Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria. --Implications for Eye Care Planning and Budgeting
Citation: Ireju Onyinye Chukwuka and Elizabeth Akon Awoyesuku. “Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria.
--Implications for Eye Care Planning and Budgeting”. 3.3 (2020): 01-05.

This agrees with similar studies done at Enugu, Southeastern Ni-
geria [11], Northern Nigeria [12] and other parts of the country
[13-15] From table 1 the visual acuity was greater than 6/18 in the
right eyes of 79.8% and the left eyes of 78.8% of the participants,
so it is not surprising that the 41 - 50 years age group was the larg-
est group, since these are presbyopic people with good distance vi-
sion. In Nigeria, its around this age that many patients come out of
 
age group also has a large representation because some African pa-
tients have early-onset presbyopia which may present even before
the age of 35 years and is always of great concern to the patient.
Unfortunately according to 2019 estimates, the life expectancy in
Nigeria stands at 54.49 years and this may account for the 2.9%
attendance of people over the age of 70 years who in a country like
Japan with a life expectancy of 84.55 years would have formed a
much larger percentage. Visual impairment is known to increase
with age amongst all racial and ethnic groups [10]. There was a
 -
ticipants and various ophthalmic disorders. The mean age for re-
fractive orders was 20.5years while that for cataract was 70.0years.
The commonest ocular disorder seen was refractive error which
presented in 77.9% of participants, followed by allergic conjuncti-
vitis 17.3% A few studies done in our region have reported Cata-
ract, uncorrected refractive error [5], Glaucoma, allergic conjunc-
tivitis [13], Refractive error, cataract [16,17], cataract, refractive
error [18]. It is noteworthy that refractive error appears in most
of the studies as a common cause of ocular morbidity except in
the study by Osuji (3) where glaucoma was the commonest ocu-
lar disorder followed by cataract and pterygium. Refractive error
only made up 3% of that series probably because his population
was largely illiterate. Cataract (2.9%) did not feature a lot in our
study which is an advantage of the semi-urban setting with prox-
imity to professional eye care services while allergic conjunctivitis
(77.9%) featured prominently. Recent studies in the South-south
have shown that allergic conjuntivitis plays a major role in ocular
mobidity in our area [19,20]. This is thought to be linked to envi-
ronmental pollution mostly from hydrocarbon products.
More than 78% of the participants had normal vision, 13% had
mild visual impairment similar to the study by Achigbu [5] while
9% had moderate to severe visual impairment which makes the
prevalence of visual impairment in our study 22%. This is in keep-
ing with the global data on visual impairment which is topped by
uncorrected refractive errors. Urbanization is associated with a
decline in preventable causes of blindness such as cataract and
corneal opacity with an increase in causes such as refractive er-
ror with some hypertensive and diabetic retinopathy which did
not feature in this semi-urban setting. Health challenges seen with
urbanization relate to an increase in non- communicable diseases
like cardiovascular disease, diabetes, cancers and chronic respira-
tory disease [21,22]. This is seen in our study with a high preva-
lence of allergic eye diseases.
         
Budgeting are as follows; there is need to set up adequate, cost-
effective refraction services in each community to address the
problem of uncorrected refractive error, tackle the problem of al-
   -
ing activities in the Niger Delta by sustained advocacy by stake
holders assisted by Non-governmental organizations highlighting
the potentially catastrophic dangers of inhalation of by-products
of hydrocarbon combustion on the respiratory system of the af-
fected population, Finally, preventing blindness from glaucoma
can no longer be the sole responsibility of our Ophthalmologists
but prominent and well-known members of the society like Poli-
ticians, Actors and Sports personalities should join the team by
yielding themselves for screening and to publicize intermittent
         
the people who will not come to the hospital/ other designated
screening venues can be reached.
Conclusion
The prevalence of visual impairment in Rumuapu community
is 22% and the commonest ophthalmic disorder is refractive er-
ror, followed by allergic conjunctivitis and glaucoma suspects. The
main limitation of this study is the small sample size, so we recom-
mend that a larger scale study be carried out. To include most of
the residents of the community. However this pilot study is very
important for planning future prevention of blindness programs in
this area and other semi-urban locations nationwide.

Nil.
04
Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria. --Implications for Eye Care Planning and Budgeting
Citation: Ireju Onyinye Chukwuka and Elizabeth Akon Awoyesuku. “Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria.
--Implications for Eye Care Planning and Budgeting”. 3.3 (2020): 01-05.

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Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria. --Implications for Eye Care Planning and Budgeting
Citation: Ireju Onyinye Chukwuka and Elizabeth Akon Awoyesuku. “Pattern of Ocular Disorders in A Semi-Urban Community in Rivers State, Nigeria.
--Implications for Eye Care Planning and Budgeting”. 3.3 (2020): 01-05.