Browsing by Author "Onyango, J."

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    Diabetic retinopathy screening program in Southwestern Uganda
    (The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2020) Arunga, S.; Tran, T.; Tusingwire, P.; Kwaga, T.; Kanji, R.; Kageni, R.; Hortense, L. N.; Ruvuma, S.; Twinamasiko, A.; Kakuhikire, B.; Kataate, B.; Kilberg, K.; Gibbs, G.; Kakinda, M.; Harrie, R.; Onyango, J.
    Between 2019 and 2045, the prevalence of Diabetes Mellitus (DM) will double; associated with this, the burden of Diabetic Retinopathy (DR) is also expected to increase, especially in low-resourced settings. To prevent avoidable visual impairment and blindness, early detection through screening and early treatment are necessary. To enable access to these services, we developed the Lions Diabetic Retinopathy Project for southwestern Uganda to serve the region including 17 Districts with eight million inhabitants. Methods: A three-pronged strategy for mass screenings levering the existing general health system and opportunistic screening of higher-risk population. Capacity building involved training a vitreoretinal surgeon and allied eye care providers, installing critical infrastructure at the referral eye hospital, and acquiring equipment for primary health centres. Results: In 1.5 years, 60 DR screening camps were implemented; this led to screening of 9,991 high risk individuals for DM and 5,730 DM patients for DR. We referred 1,218 individuals with DR for further management at the referral eye hospital, but only 220 (18%) attended referral. The main barrier for not attending referral was long travel distance and the associated direct and indirect costs. Human resources trained included 34 ophthalmic nurses, five midlevel providers, and one vitreoretinal surgeon. Major equipment acquired included a vitrectomy system, an outreach vehicle, and non-mydriatic fundus cameras. Conclusions: DR screening can be implemented in a resource-limited setting by integrating with the general primary healthcare system. However, geographic barriers stymie delivery of therapeutic services and we need to establish models to bring these services closer to areas with poorer access.
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    Factors associated with poor presenting vision among patients with microbial keratitis In Uganda
    (The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2020) Arunga, S.; Atto, G.; Ayebazibwe, B.; Onyango, J.; Macleod, D.; Hu, V. H.; Burton, M. J.
    To determine factors associated with poor presenting vision among patients with microbial keratitis in Uganda. Design: Retrospective audit study. Methods: This was a study of patients presenting with microbial keratitis at the two main eye units in Southern Uganda in the year 2015. Information on time to presentation, treatment history, use of traditional eye medicine, trauma and presenting final visual acuity was collected. Factors associated with a poor presenting vision in a regression model were analysed. Results: There were 273 cases during the year 2015. The median presentation time was 7 days from onset (IQR 2-21, total range 0-366 days). Trauma was reported in 59/88 (67%) patients and 69/162 (43%) reported using traditional eye medicine. Visual acuity was reported in only 216/273 cases at presention. Visual acuity at presentation of less than 6/60 (severe visual impairment) was strongly associated with the use of traditional eye medicine (OR 5.13, 95%CI 2.17–12.1, p=0.001) and distance from the eye hospital (OR 1.02, 95% CI 1.01-1.03, p=0.002). Conclusion: This audit highlighted the role of use of traditional eye medicine and long distance from the eye hospital in contributing to poor presentation among patients with microbial keratitis in Uganda.
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    Mooren’s ulcer in Uganda: A prospective observational case series
    (The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2020) Kavuma, D.; Arunga, S.; Onyango, J.; Leck, A.; Hoffman, J. J.; Hu, V. H.; Burton, M.
    Mooren’s ulcer is a progressive, chronic, and painful peripheral ulceration of the cornea, commonly seen in adult men. In our set up, it has been observed to be aggressive and difficult to treat, often resulting in poor visual outcomes. There is limited published evidence on its management. Objective: Our aim was to describe the presentation, treatment and outcomes of patients presenting with Mooren’s ulcer in Mbarara, Uganda over a defined time period. Methods: A prospective case series conducted over 3 months from August 2017 to November 2017, with scheduled reviews up to 3 months. Participants’ history, presentation, management and clinical course were captured. Laboratory investigations for underlying systemic diseases were performed, in addition to corneal microbiology testing. Results: A total of eight patients (6 males and 2 females) were enrolled. The median age was 26 years (IQR 22- 27.5, full range 16-32). A history of trauma was present in 3 (38%) of cases. The earliest presenting time was one month after start of symptoms. At presentation, 2 (25%) patients had normal vision, 3 (38%) had moderate vision impairment (VI), 1 (12%) had severe VI, and 2 (25%) were blind. There was no systemic disease diagnosed on investigation, but corneal microbiology revealed 3 (38%) ulcers had fungal co-infections. At 3 months, 4 (50%) patients had normal vision, 1 (12%) had moderate VI, and 3 (38%) were blind. No patients required evisceration or enucleation. Conclusion: Most patients were below 30 years and presented late to the hospital, with advanced ulcers, leading to outcomes ranging from good to poor. Mooren’s ulcer is difficult to treat and further studies to assess risk factors would be beneficial in providing evidence for better management of this condition, particularly in resource limited settings.
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    Outcomes of trabeculectomy among glaucoma patients in Uganda: A 4-year hospital based audit
    (The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2018) Mbumba, F. B.; Hirnschall, N.; Arunga, S.; Kwaga, T.; Onyango, J.; Rigal, K.
    To determine the outcomes of trabeculectomy surgery and predictors of post-operative Intra Ocular Pressure (IOP) among glaucoma patients attending Ruharo Eye Centre. Materials and Methods: In a clinical audit conducted from January to June 2016, we reviewed records of all patients who had undergone trabeculectomy at Ruharo Eye Centre (REC), at least in one eye prior to recruitment. We made phone calls to patients inviting them for a clinical examination. For the patients who turned up, we recorded their Best Corrected Visual Acuity (BCVA), Visual Fields (VFs), Intra Ocular Pressure (IOP), Cup-Disc Ratio (CDR), and any post-operative complications. We also asked patients about their general satisfaction with both the operation and vision. We did a before and after comparison analysis on several outcome measures using STATA v14. These included: visual acuity, intra ocular pressure, cup disc ratio and visual field. We defined treatment success as a post-operative IOP reduction of 40% from baseline and analyzed for its predictors in a multivariate regression model. Results: Sixty-two eyes of 38 patients were included in this study. Median age was 66 years (range 24 to 91 years). Median observation time was 2.8 years (range 0.2-4.6 years). Overall treatment success rate was 95%. Mean IOP pre-and post-operatively was 32 mmHg (95% CI 29.3-34.7) and 12.9 mmHg (11.7-14.2) respectively, P=0.001; there was no significant worsening of visual acuity and visual field loss. Mean visual acuity Log MAR pre and post-operatively was 0.58 (95% CI 0.48-0.68) and 0.65 (95% CI 0.52-0.78), P=0.21. Mean visual field defect was 23.4 (95% CI 21.4-25.5) and 22.9 (95% CI 20-9-25.0), P=0.44. Conclusion: Trabeculectomy in our setting seemed to have a good success rate and provided good IOP control, preservation of vision and visual fields.
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    Prevalence and causes of blindness and severe visual impairment (BL/SVI) among children in Ntungamo district, Southwestern Uganda: A key informant cross-sectional population survey
    (The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2016) Arunga, S.; Onyango, J.; Ruvuma, S.; Twinamasiko, A.
    To estimate the prevalence and causes of blindness and severe visual impairment among children in Ntungamo district South-western, Uganda.Methods: This was a cross sectional community survey using the key informant method; approximately 200 village health team members were carefully selected and trained to screen for severe visual impairment using a torch, 6 meter string and a 6/60 E chart. They did house to house screening for severe visual impairment and blindness among children below 16 years in the whole district. Identified children were referred to a rendezvous point within the community to be examined further by the ophthalmologist. Data was collected using the standardized WHO childhood blindness data collection form. Proportions and causes of severe visual impairment and blindness were determined. Clinical and social characteristics were described.Results: A total of 59 children were identified, 15 with severe visual impairment and 44 with blindness. Mean age was 6.5 years (95% CI 5.3-7.4) and 59% of the children were male. The prevalence of blindness and severe visual impairment was 0.02% (95% CI 0.01-0.03). Causes were analysed by anatomical site, aetiology and specific diagnosis. Majority of the anatomical causes were due to cornea (18%) and lens (17%) abnormalities. With respect to specific diagnosis, 30% was cataract and cataract surgery complications and corneal scar. Overall, 72% of the blindness and severe visual impairment was due to avoidable causes.Conclusion: Prevalence of severe visual impairment and blindness was relatively low in this population. Lens and corneal abnormalities were the leading cause of blindness. Most of the cases of visual impairment and blindness were avoidable.
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    Strengthening eye health research output in the region
    (The Journal of Ophthalmology of Eastern, Central and Southern Africa, 2020) Arunga, S.; Nyenze, E. M.; Wambiya, V.; Onyango, J.
    In this issue of the journal, we are pleased to announce an exciting three-year partnership with ‘Eye’ Journal team of the Royal College of Ophthalmologists (RCOphth). This partnership is part of the VISION 2020 COECSA-RCOphth LINK partnership that has been in existence for the last 10 years and has led to development and strengthening of the COECSA fellowship exam and examiner training, curriculum development, ‘train the trainers’ and online CPD. The purpose of this new partnership is to leverage on the COECSA-RCOphth relationship to raise the standard and profile of JOECSA as a strong scientific ophthalmic journal sharing research results across the region by providing mentorship to the journal editorial board, reviewers, and administrators. This mentorship will be offered by the London School of Hygiene & Tropical Medicine and the ‘Eye’ Journal team of the Royal College of Ophthalmologists. This process is co funded by British Council for Prevention of Blindness (BCPB) and the RCOphth.