Part of the book: Cataract Surgery
Background: Primary open angle glaucoma is one of the leading causes of avoidable blindness in Sub-Saharan Africa
Part of the book: Advances in Eye Surgery
Background: Sub-Saharan Africa disproportionately accounts for high number of avoidably blind largely caused by cataracts.
Part of the book: Difficulties in Cataract Surgery
There is a close relationship between the visual pathway and other neuro endocrine structures. Tumours and other compressive lesions could often present with visual impairment and/or finite visual field changes. Careful clinical assessment could aid in accurate diagnosis and treatment. Pituitary gland lies in the fossa located in the sphenoid bone. Growth hormone, adreno cortico tropic hormone, and prolactin secreting adenomas could present with respective endocrine features. Optic chiasmal compression by pituitary adenoma is an indicator of suprasellar extension. Meningioma and vestigial remnant craniopharyngioma arise in the parasellar region and can compress on different parts of the optic chiasma often giving rise to classical radiological appearances and visual field changes. This includes atheroma and aneurysm of the internal carotid artery impinging on the temporal chiasma exerting direct pressure and counterpressure on the contralateral side. Others are aneurysms of the precommunicating section of the anterior cerebral artery and those of the posterior communicating artery. Compressive lesions of the visual pathway require a multi-disciplinary approach involving neurosurgeon, endocrinologist as well as the ophthalmologist.
Part of the book: Optic Nerve
Optical coherence tomography (OCT) is a non contact, non invasive and reproducible imaging technique that produces thin slices of tissue section images. OCT identifies retinal nerve fiber damage before detection of visual field changes making it a handy and effective tool in early detection and monitoring in glaucoma. Retinal fiber layer thickness measurements provide vital knowledge of extent of neural damage. This enables the clinician to counsel the patient and take the best decision towards achieving glaucoma control. Early and quantifiable macular thickness measurements are obtained, allowing for detection of clinically significant diabetic macular edema. OCT allows monitoring of the impact of laser or other interventions. Changes in age-related macular degeneration are relatively easily determined and impact of treatment interventions monitored. In conclusion, OCT is a vital emerging tool in the evaluation and management glaucoma and macular diseases in all parts of the World, including low income countries of sub-Saharan Africa.
Part of the book: Frontiers in Ophthalmology and Ocular Imaging
Pediatric strabismus is not uncommon. Poor knowledge and religious and cultural practices result in inattention to the child’s need and stigmatization. Horizontal strabismus consisting of esotropia and exotropia constitutes the common types presenting. Childhood ocular deviations are associated with uncorrected refractive errors, diseases causing obstruction of the visual axis such as cataract, and intra ocular tumors commonly retinoblastoma. In parts of the developing world, there is poor documentation and recollection of medical events at family and community levels. Squint in a child is not a painful dramatic condition that can prompt quick action from the parents or caregiver. There is generalized inequity in access to health care. Pediatric ophthalmic services are at best in developmental stage, and purpose design service centers are quite few. Neglect of the causes and timely treatment of amblyopia can retard child’s development resulting in dependency and aggravation of poverty circle. A comprehensive approach to management of childhood eye diseases including strabismus is desirable in the low income developing countries. Provision of health insurance as a citizen’s right will reduce most of the health challenges.
Part of the book: Frontiers in Ophthalmology and Ocular Imaging