Acta Ophthalmologica 2013
Sikorski BL, Bukowska D, Kaluzny JJ,
Szkulmowski M, Kowalczyk A & Wojt-
kowski M (2011): Drusen with accompany-
ing fluid underneath the sensory retina.
Ophthalmology 118: 82–92.
Szkulmowski M, Wojtkowski M, Sikorski BL
et al. (2007): Analysis of posterior retinal
layers in SOCT images of the normal retina
and retinal pathologies. J Biomed Opt 12:
041207.
Correspondence:
Bartek L. Sikorski
Department of Ophthalmology
Nicolaus Copernicus University
9 M. Sklodowskiej-Curie St.
Bydgoszcz 85-094
Poland
Tel: + 48 52 585 4520
Fax: + 48 52 585 4033
Email: sikorski@doctors.org.uk
Prevalence of visual
problems in a rural
population of Kenya
Isabel Signes-Soler,1,2 David P. Piñero3,4
and Jaime Javaloy5,6
1
NGO Vision Without Borders (Visio
Sense Fronteres, VSF), Alicante, Spain
2
Optics Department, University of
Valencia, Burjassot, Valencia, Spain
3
Foundation for the Visual Quality
(Fundación para la Calidad Visual,
FUNCAVIS), Alicante, Spain
4
Department of Optics, Pharmacology,
and Anatomy, University of Alicante,
Alicante, Spain
5 Retinal diseases
Vissum Corporation, Alicante, Spain
6
Universidad Miguel Hernandez,
Medicina Elche, Alicante, Spain
doi: 10.1111/j.1755-3768.2012.02507.x
Dear editor,
T he poverty that is present in low-
income countries has drastic
consequences for blindness, visual
impairment and general eye care ser-
vices. Despite containing 10% of the
world’s population, Africa accounts
for 19% of the global blindness with
an incidence of more than 1% (Nai-
doo 2007). Kenya is an African coun-
try of low development, with a human
development index of 0.47. In this
country, we have recently conducted a Table 1. Summary of the refractive outcomes
massive campaign of refractive error obtained in the current study.
assessment in the context of interna-
Refractive
tional cooperation that has allowed us parameter Mean (SD) Range
to study the prevalence of refractive
errors and blindness associated with J0 (D) )0.10 (0.30) )1.50 to +0.95
this factor in large sample of popula- J45 (D) )0.01 (0.07) )0.43 to +0.32
B (D) 1.12 (0.73) 0.00–4.00
tion. A total of 326 people attending
M (D) )0.32 (1.26) )2.50 to +4.00
for eye examination in April 2011 in
the area of Voi and Buguta in South SD = standard deviation; J0 and
Kenya were examined. Mean age was J45 = power vector components of manifest
43.0 (SD: 19.3) years, with 53.1% cylinder; M = spherical equivalent; B =
women. LogMAR uncorrected visual overall blurring strength of the manifest
spherocylindrical error; D = dioptres.
acuity (UCVA) at distance was found
to range from )0.08 to 1.30, with a
mean value of 0.17 (SD: 0.25). oma (2 patients, 0.6%), ocular trauma
Refraction was obtained in a total (6 patients, 1.9%), exotropia (1 patient,
0.3%), glaucoma (3 patients, 0.9%)
of 100 eyes because of the significant
limitation in UCVA (‡0.3 Log- and conjunctivitis (4 patients, 1.2%).
MAR). Table 1 summarizes the Pseudophakia was present in a total of
mean refractive outcomes obtained. 18 patients (5.5%).
The percentage of refracted eyes with The prevalence of blindness (1.3%)
myopia, defined as an SE of and visual impairment (6.3%) found
)0.50 D or more negative, was 58%. (Table 2) was similar than that
The percentage of refracted eyes with reported in Kibera slums of Nairobi
hyperopia defined as an SE of (0.6% and 6.2%) (Ndegwa et al.
+0.5 D or greater was 30%, while 2006) as well as than that reported in
the percentage of hyperopia defined the Nakuru district (2% and 5.8%,
as an SE of +2.00 D or greater was respectively) (Mathenge et al. 2007).
4% (Fig. 1). Therefore, our results are consistent
The main pathological conditions with the previous scientific evidence.
that were detected were as follows: cat- The incidence of refractive error as a
aract (14 patients, 4.3%), corneal leuk- cause of visual impairment was higher
Table 2. Number and causes of blind and visual impaired eyes.
Prevalence of blindness Prevalence of visual impairment
(LogMAR UCVA < 1.3) (0.5 < LogMAR UCVA < 1.0)
Causes of blindness or 1% (six of 587 eyes) 6.3% (37 of 587 eyes)
visual impairment % (n ⁄ N) % (n ⁄ N) (65 missing data)
Bad results after 50% (3 ⁄ 6)
cataract surgery
50% (3 ⁄ 6)
Refractive errors 21.6% (8 ⁄ 37)
Cataracts 8.1% (3 ⁄ 37)
UCVA = uncorrected visual acuity; n = number of cases; N = total number of eyes.
25%
20%
15%
% eyes
10%
5%
0%
+6 to +4.1 +4 to +2.1 +2 to +1.1 +1 to +0.51 +0.50 to 0 –0.1 to –0.50 –0.51 to –1 –1.1 to –2 –2.1 to –4 –4.1 to –6
Spherical equivalent (D)
Fig. 1. Distribution of the spherical equivalent in the 100 eyes in which spherocylindrical refrac-
tion was obtained.
e165
Acta Ophthalmologica 2013
than that caused by cataract, but per-
centages were smaller (21.6% and
8.1%, respectively) than those
reported in the previous mentioned
studies. This suggests a greater cover-
age of vision services in the area anal-
ysed compared to other regions
evaluated previously. One factor
accounting for this may be the
increasing number of campaigns for
the prevention of blindness carried
out in rural Kenya in the recent years.
In this campaign, prescription was
provided in a total of 181 patients
(55.5%), sunglasses in 29 patients
(8.9%) and artificial tears in 12
patients (3.7%). From the total of
prescription glasses provided, 137
were for the correction of presbyopia
(75.69%). It should be considered that
presbyopia is the most common spec-
tacle requirement in low-income
regions, and the unmet need for pres-
byopic spectacles in these regions is
very high (Sherwin et al. 2008).
In conclusion, the main cause of
visual impairment is the presence of
refractive error followed by cataract.
Both causes are avoidable with a cor-
rect clinical management. This sug-
gests that there is still a need of
implementation of the eye care ser-
vice in this region in spite of existing
lower rates of visual impairment in
comparison with other African
countries.
Acknowledgements
We thank the MATH-Kenya (Embra-
cing the World) for their support in the
campaign.
References
Mathenge W, Kuper H, Limburg H, Polack
S, Onyango O, Nyaga G & Foster A
(2007): Rapid assessment of avoidable
blindness in Nakuru district, Kenya. Oph-
thalmology 114: 599–605.
Naidoo K (2007): Poverty and blindness in
Africa. Clin Exp Optom 90: 415–421.
Ndegwa LK, Karimurio J, Okelo RO &
Adala HS (2006): Prevalence of visual
impairment and blindness in a Nairobi
urban population. East Afr Med J 83:
69–72.
Sherwin JC, Keeffe JE, Kuper H, Islam FM,
Muller A & Mathenge W (2008): Func-
tional presbyopia in a rural Kenyan popu-
lation: the unmet presbyopic need. Clin
Experiment Ophthalmol 36: 245–251.
e166
Correspondence:
Isabel Signes-Soler, PhD
NGO Vision Without Borders
Calle Corbeta no 6
Calpe 03710
Alicante
Spain
Tel ⁄ fax: 0034 965832080
Email: isabel@onvivim.com
Prevalence of retinal
macroaneurysms. The
Central India Eye and
Medical Study
Vinay Nangia,1,* Jost B. Jonas,2,*
Anshu Khare,1 Ajit Sinha1 and
Sarang Lambat1
1 consent, according to the Declaration
Suraj Eye Institute, Nagpur, Maha-
rashtra, India
2 age of 30+ years. Out of 5885 sub-
Department of Ophthalmology, Fac-
ulty of Clinical Medicine Mannheim,
University of Heidelberg, Mannheim,
Germany
doi: 10.1111/j.1755-3768.2012.02465.x
*These authors contributed equally to
this work.
Proprietary interest: none.
Supported by an unrestricted grant
from Om Drishti Trust Nagpur;
Heidelberg Engineering Co. Heidelberg,
Germany; Rotary Sight Saver
Netherlands; Orbis India; and Carl Zeiss
Meditec Co., Jena, Germany.
Editor,
A retinal arterial macroaneurysm
is an acquired retinal vascular
abnormality, typically a solitary,
round or fusiform aneurysm arising in
one of the four major retinal arteries
at the posterior pole of the eye (Cle-
ary et al. 1975; Panton et al. 1990;
Jonas & Schmidbauer 2010). Visual
loss caused by exudation or bleeding
from the aneurysm may be improved
by intravitreal injection of an anti-vas-
cular endothelial growth factor (Jonas
& Schmidbauer 2010). According to
the hospital-based investigations, most
patients in whom this pathologic con-
dition develops are in their sixth or
seventh decade of life and have a his-
tory of systemic hypertension, oph-
thalmoscopic evidence of retinal
arteriolar sclerosis or both. With the
exception for the Chinese population
(Xu et al. 2007), no information has
been available about the prevalence of
retinal macroaneurysms in other eth-
nic groups, nor have the findings from
the Beijing Eye Study on the Chinese
population been confirmed in another
population-based investigation. There-
fore, the purpose of our study was to
assess the prevalence of retinal macro-
aneurysms in the Indian population.
The Central India Eye and Medical
Study is a population-based cross-sec-
tional study performed in rural Cen-
tral India (Nangia et al. 2010). The
Medical Ethics Committee of the
Medical Faculty Mannheim of the
Ruprecht-Karls-University Heidelberg
and the Ethics Committee of the Suraj
Eye Institute ⁄ Nagpur approved the
study; all participants gave informed
of Helsinki. Inclusion criterion was an
jects, 4711 (80.1%) people with a
mean age of 49.5 ± 13.4 years (range:
30–100 years) participated. A ques-
tionnaire was administered on the
parameters of socioeconomic back-
ground, life style and related parame-
ters. The ophthalmic evaluation
included refraction, biometry and
photography of the lens, optic disc
and macula. Participants were
included on the availability of assess-
able fundus photographs. Statistical
analysis was performed using the spss
software (version 19.0. IBM-SPSS,
Chicago, IL). To test the significance
of differences between study group
and control group, we applied the chi-
square test to compare frequencies,
the student’s t-test for unpaired sam-
ples for the comparison of normative
parameters and the Mann–Whitney
test for unpaired samples for non-
parametric parameters.
Out of the 4711 subjects included in
the study, assessable fundus photo-
graphs were available for 8944 (94.9%)
eyes of 4543 (96.4%) participants.
Mean age was 48.8 ± 13.0 years and
mean refractive error was )0.10 ± 1.72
dioptres (range: )19.4 dioptres to
+7.75 dioptres). Retinal macroaneu-
rysms were detected in 3 eyes (2 right
eyes) of 3 subjects (2 women) with an
age of 43, 60 and 81 years. The preva-
lence rate per eye was 0.03 ± 0.02%
(mean ± standard error) (95% confi-
dence interval (CI): 0.0, 0.07), and the
prevalence rate per subject was