Evaluation of Mobile Electronic Devices in Detecting Optic Disc and Visual Field Parameters in Patients with Glaucoma at a Tertiary Hospital in Northeastern Tanzania

Background: Glaucoma is a serious public health problem since it causes visual impairment impacting social, mental and physical health of an individual. Diagnosis and management of glaucoma continue to be a challenge due to few qualified personnel and high cost of the equipment. The use of portable Eye Examination Kit such as Smartphone and tablets can be used in glaucoma screening for taking high-resolution fundus photos for optic disc and visual field parameters, respectively. This study was conducted to evaluate the applicability of mobile electronic device to detect optic disc and visual field parameters for glaucoma in a resource limited setting. Objective: To evaluate the applicability of mobile electronic devices to detect optic disc and visual field parameters for glaucoma. Methodology: Across-sectional study was conducted at KCMC Eye department from October 2018 to June 2019. Study included 140 participants attending eye clinic of which 67 had glaucoma and 73 without glaucoma. Clinical and socio-demographic data were collected using a structured questionnaire and analysed using Stata 15. Glaucoma examination was made on the right eye and photo comparison made between those with and without glaucoma. PEEK Smartphone fundus photo examination was compared with the gold standard machine (Slit Lamp Biomicroscopy), Amsler grid chart installed on a tablet (Microsoft surface, internal storage 256 GB, 2013) and contrast sensitivity compared with Humphrey field analyser (i series, model 740117434, Carl Zeiss Meditec). Results: The kappa (k) agreement between Slit lump biomicroscopy fundus view image and PEEK Smartphone concerning the optic disc measurement was 0.92 with sensitivity and specificity of 90.32% (95% CI: 80.12 - 96.37) and 93.59% (95% CI: 85.67 - 97.89) with a p < 0.001 respectively. An agreement between Amsler grid and Humphrey Field Analyser was 0.67 with sensitivity of 33.33% (95% CI: 20.76 - 47.92) and specificity of 86.52% (95% CI: 77.63 - 92.83) with a p < 0.005. An agreement for contrast sensitivity and Humphrey Field Analyser was 0.51 with sensitivity of 48.91% (95% CI: 38.3 - 59.56) and specificity of 54.17% (95% CI: 39.17 - 68.63) and p value of 0.729. Conclusion: PEEK Smartphone fundus image specificity was almost in perfect agreement compared with Amsler grid and Contrast sensitivity. The PEEK Smartphone fundus view optic disc parameter for vertical cup to disc ratio has a potential to enhance detection of glaucoma and thus improve its management in resource-limited settings.

Visual Outcome and Predictors of Poor Visual Outcome among Uveitis Patients Attended at KCMC Eye Department, Moshi—Northern Tanzania

Background: Uveitis, an inflammatory disease of the middle layer of the human eye is a potentially blinding disease, carrying social, economic and individual consequence. Though not being a leading blinding disease, it causes visual impairment and blindness with its complications like cataract and glaucoma. Few studies have addressed the visual outcome after diagnoses and follow-up of patients with uveitis;and at our setting, few is known about the visual outcome, factors predicting poor outcome. Methodology and Materials: This was a hospital-based cohort study conducted at the Kilimanjaro Christian Medical Center (KCMC), Eye Department. Files of patients attended from January 2010 to December 2017 were assessed. Measures of Central Tendency and their corresponding dispersion were used to summarize continuous variables and proportions for categorical variables. One sample paired t-test was used to assess differences in mean Best Corrected Visual Acuity (BCVA) and Wilcoxon Signed Rank test for differences in median BCVA between the first visit and at one year respectively. Association between predictors and poor outcome was analyzed by using Chi square test. Multivariate regression was used to control for potential confounders and a p value less than 0.05 was considered as statistical significant. Results: A total of 291 patients were assessed, majority of them being female (54.6%), with median age being 53 years. The proportion of visual impairment reduced from the initial 57.7% at presentation to 28.2% at one year. The mean BCVA improved from the initial 0.96 log MAR to 0.70 log MAR at one year. The main factors associated with poor presenting vision were: Cataract (p value Conclusions: at one year of follow-up of patients with uveitis, the proportion of visual impairment reduces significantly, with improvement also being observed on mean visual acuity. The most common predictors of poor visual outcome were Cataract, Glaucoma CME, abnormal IOP and Maculopathy.

Prevalence and Associated Factors of Dry Eye among Glaucoma Patients at KCMC Eye Department

Propose: Dry eye is a common disease among glaucoma patient undergoing on topical medication for lowering intraocular pressure. In this study we determine the prevalence and risk factors of dry eye among glaucoma patients. Methodology: We conducted a prospective cross-sectional study at Kilimanjaro Christian Medical Center (KCMC), Ophthalmology Department, over a period of 8 months, from October 2018 to June of 2019. Purposive sampling technique was used, and patients with POAG aged 18 years and above were consecutively selected. Socio-demographic and clinical data were collected. The main outcome variable was dry eye. The data were summarized using SPSS version 23 and analyzed using the STATA software version 13. Results: A total of 325 patients were enrolled into the study;56.6% were male and 43.4% were female. The mean age was 66.1 years (SD11.7). We found that the prevalence of dry eye using OSDI questionnaire was 79.7%;among them evaporative dry eye was found in 36.9% and aqueous deficiency in 43.4%;87.1% had abnormal TBUT;abnormal ocular surface staining was found in 64.3%;Schirmer test was abnormal in 43.4% and 36.9% had meibomian gland dysfunction. The severity of dry eyes among those using OSDI questionnaire is: mild 22.1%, moderate 16.0% and severe 61.9%. Factors such as use of two or more medication (AOR = 2.55, 95% CI: 1.89 - 3.36), 2 - 5 years of medication (AOR = 1.52, 95% CI: 1.35 - 1.88) were associated with dry eye in patients with glaucoma at KCMC. Conclusion: Dry eye is highly prevalent in glaucoma patients in our setting, and showed also the high prevalence of signs and symptoms. The use of timolol combined with other medication in our study was shown to be a strong predictor of having dry eye. To be exposed to two or more medication is strongly predictors of having dry eye.