Level of utilization and provider-related barriers to the use of hydroxyurea in the treatment of sickle cell disease patients in Jos,North-Central Nigeria

BackgroundHydroxyurea is underutilized by sickle cell health-care providers in Nigeria despite available evidence of its effectiveness in reducing the manifestations and complications of sickle cell disease (SCD).ObjectivesTo assess the level of utilization and provider-related barriers to the use of hydroxyurea in SCD therapy in Jos, Nigeria.MethodsA cross-sectional study conducted among 132 medical doctors providing care for SCD patients. Data on sociodemographics, utilization and barriers to hydroxyurea use were obtained. The barriers were fed cumulatively into the logistic regression model as predictors of utilization.ResultsOf the 132 care providers, 88 (67%) had been in medical practice for ≥6years. The level of utilization of hydroxyurea was 24.2%. The significant barriers that predicted the non-utilization of hydroxyurea included lack of expertise (OR=5.1; 95% CI=2.65–9.05), lack of clinical guidelines (OR=3.84; 95% CI=2.37–14.33), fear of side-effects (OR=0.50; 95% CI=0.22–0.68) and doubt about its effectiveness (OR=0.30; 95% CI=0.20–0.90).ConclusionThe level of utilization of hydroxyurea in the treatment of SCD among the care providers is sub-optimal with the lack of expertise in its use identified as the most prominent barrier. There is an urgent need for the training of sickle cell care-providers and the development of clinical guidelines on hydroxyurea use.     

The effect of transient glare on shape discrimination threshold in myopic adults

Background

The aim was to evaluate the effect of transient glare on shape discrimination threshold (SDT) in myopic adults.

Methods

A total of 162 myopic subjects were enrolled. Of these, 121 had low to mid myopia (?1.00 D to ?6.00 D) and 41 had high myopia (?6.13 D to ?10.25 D). All subjects had corrected visual acuity of 6/6 or better, and only data for the right eye were included in the study. SDTs were measured with circular D4 (fourth derivative of Gaussian) radial frequency patterns with a radial frequency of four, peak spatial frequency of three cpds, and mean radius of 1.5 degrees. SDTs were measured under two conditions, with and without the presence of transient glare while the stimulus was displayed (duration = 500 ms).

Results

Without transient glare, SDTs were not different between the low‐mid (23.84 ± 6.02 arcsec) and high myopia groups (25.17 ± 5.98 arcsec, p = 0.16, Mann–Whitney test). With transient glare, SDTs in all subjects became significantly higher (p < 0.001, Wilcoxon signed‐rank test). SDTs in the high myopia group (55.53 ± 18.59 arcsec) became significantly higher than those in the low to mid myopia group (47.55 ± 15.06 arcsec, p = 0.014, Mann–Whitney test). The increments were significantly higher in the high myopia group (28.94 arcsec versus 20.88 arcsec, p = 0.031, Mann–Whitney test). Multiple regression showed that SDTs with glare were significantly associated with SDTs without glare (p < 0.001) and the presence of high myopia (p = 0.015).

Conclusions

Transient glare significantly increased SDTs in all myopic subjects, with the increment in subjects with high myopia being significantly larger than those in subjects with low to mid myopia.

     

The minimum test battery to screen for binocular vision anomalies: report 3 of the BAND study

Purpose

This study aims to report the minimum test battery needed to screen non‐strabismic binocular vision anomalies (NSBVAs) in a community set‐up. When large numbers are to be screened we aim to identify the most useful test battery when there is no opportunity for a more comprehensive and time‐consuming clinical examination.

Methods

The prevalence estimates and normative data for binocular vision parameters were estimated from the Binocular Vision Anomalies and Normative Data (BAND) study, following which cut‐off estimates and receiver operating characteristic curves to identify the minimum test battery have been plotted. In the receiver operating characteristic phase of the study, children between nine and 17 years of age were screened in two schools in the rural arm using the minimum test battery, and the prevalence estimates with the minimum test battery were found.

Results

Receiver operating characteristic analyses revealed that near point of convergence with penlight and red filter (> 7.5 cm), monocular accommodative facility (< 10 cycles per minute), and the difference between near and distance phoria (> 1.25 prism dioptres) were significant factors with cut‐off values for best sensitivity and specificity. This minimum test battery was applied to a cohort of 305 children. The mean (standard deviation) age of the subjects was 12.7 (two) years with 121 males and 184 females. Using the minimum battery of tests obtained through the receiver operating characteristic analyses, the prevalence of NSBVAs was found to be 26 per cent. Near point of convergence with penlight and red filter > 10 cm was found to have the highest sensitivity (80 per cent) and specificity (73 per cent) for the diagnosis of convergence insufficiency. For the diagnosis of accommodative infacility, monocular accommodative facility with a cut‐off of less than seven cycles per minute was the best predictor for screening (92 per cent sensitivity and 90 per cent specificity).

Conclusion

The minimum test battery of near point of convergence with penlight and red filter, difference between distance and near phoria, and monocular accommodative facility yield good sensitivity and specificity for diagnosis of NSBVAs in a community set‐up.

     

Bilateral,simultaneous, uveitis‐associated pupillary membranes

A 48‐year‐old Caucasian man with an established diagnosis of pathological ankylosing spondylitis with cervical spinal fusion and a lengthy history of acute, recurrent, anterior uveitis presented with decreased vision in both eyes. Biomicroscopic examination revealed bilateral inflammatory pupillary membranes associated with anterior uveitis to be the source of the visual compromise. Aggressive topical anti‐inflammatory and mydriatic therapy did not break the pupillary membranes and the patient ultimately underwent surgical resection of the membranes in both eyes. Vision returned to normal in one eye and was only slightly reduced in the fellow eye after a prolonged post‐operative period involving multiple ophthalmic surgical procedures. This is the first reported case of bilateral, simultaneous uveitis‐associated pupillary membranes.     

Efficacy of azithromycin 1% ophthalmic solution for treatment of ocular surface disease from posterior blepharitis

Background: Posterior blepharitis is an eyelid disease primarily of the meibomian glands. Bacteria and chronic inflammation are contributing factors for meibomian gland disease, which leads to ocular surface and tear film alterations and chronic patient symptoms. Azithromycin 1.0% ophthalmic solution is a broad spectrum topical antibiotic with anti‐inflammatory properties. The present study evaluates the efficacy of azithromycin 1.0% ophthalmic solution in the treatment of the clinical signs and symptoms, including vision‐related function, associated with meibomian gland dysfunction. Methods: In an open label study, 33 patients with meibomian gland dysfunction were treated with azithromycin 1.0% ophthalmic solution twice a day for two days, then every evening for a total of 30 days. Tear break‐up time, corneal staining, conjunctival staining, Schirmer scores with anaesthetic, meibomian gland score and patient's symptom scores were evaluated at baseline and after 30 days of treatment. The Ocular Surface Disease Index (OSDI) was administered at baseline, after two weeks of treatment and after 30 days of treatment. Results: Twenty‐six of 33 patients completed the study. Tear break‐up time and Schirmer score increased by 52.7 per cent (p < 0.0001) and 24 per cent (p < 0.05), respectively. There was a reduction in corneal and conjunctival staining by 83.2 and 67.9 per cent, respectively (p < 0.0001). Lid margin scores were reduced by 33.9 per cent (p < 0.0001). The patient's symptom score improved from 2.73 at baseline to 2.21 after 30 days of treatment (p < 0.01). The mean OSDI at baseline was 34.44. After two weeks and 30 days of treatment, the ODSI was 14.51 and 13.15 respectively (p < 0.0001). Conclusion: These results demonstrate clinically and statistically significant improvement in the signs and symptoms associated with posterior blepharitis. Based on these results, azithromycin 1% ophthalmic solution offers a viable option for the treatment of posterior blepharitis.     

The Developmental Eye Movement (DEM) test and Cantonese‐speaking children in Hong Kong SAR,China

Background: There is no published norm for the Developmental Eye Movement (DEM) Test for Cantonese‐speaking Chinese children. This study aimed to determine the normative values of this test for Cantonese‐speaking Chinese children in Hong Kong SAR and to compare the results with the published norms of English‐speaking and Spanish‐speaking children. Method: Cantonese‐speaking students aged from 6 to 11 years were tested by the DEM test in Cantonese and a digital recorder was used to record the process. The DEM scores for the 305 students were determined by listening again to the audio records after the test and computed by using the formula from the DEM manual, except that the ‘vertical scores’ were adjusted by taking the vertical errors into consideration. The results were compared with other norms that have been published. Results: Our subjects made more vertical errors than in other normative studies and adjusted vertical scores were proposed. In both adjusted vertical and horizontal scores, the Cantonese‐speaking children completed the tests much faster than the norms for English‐ and Spanish‐speaking children, the differences of the means being significant (p < 0.0001) in all age groups. Conclusion: The DEM norms may be affected by differences in languages, cultures and education systems among different ethnicities. The norms of the DEM test are proposed for Cantonese‐speaking children in Hong Kong SAR, China.     

Multiple evanescent white dot syndrome: a review and case report

Background: Multiple evanescent white dot syndrome (MEWDS) is a rare chorioretinal syndrome that usually presents with a unilateral, multifocal retinitis affecting mostly young women. The typical presentation includes multiple white spots extending from the posterior pole out to the mid‐peripheral retina, possible vitritis and a granular appearance to the fovea. Symptoms can include a prodromal flu‐like episode, photopsia, scotoma and decreased vision. Ophthalmoscopy is the most common method of diagnosing MEWDS but fluorescein angiography, electrodiagnostic testing, visual fields and optical coherence tomography can help confirm the diagnosis. MEWDS is usually a self‐limiting condition with complete visual recovery, although subsequent retinal sequellae may be possible. Case Report: A healthy 21‐year‐old myopic female presented with unilateral, sudden onset of photopsia, blurred vision and a ‘grey area’ in the temporal visual field. Initial examination found a vitritis, maculopathy and the presence of white dots in all four quadrants of the mid‐peripheral retina. A retinal ophthalmologist confirmed the diagnosis of MEWDS. Although the patient was less than compliant with the retinal specialist's recommendations, a subsequent examination found complete resolution of signs and symptoms. Conclusions: In the primary optometric setting, the uncommon syndrome known as MEWDS must be considered when the common symptoms of photopsia and blurred vision, combined with the atypical clinical presentation of white spots in the fundus appear in an otherwise healthy patient.