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   2017| April - June  | Volume 4 | Issue 2  
    Online since September 21, 2017

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The effect of amblyopia on contrast sensitivity, color vision, and stereoacuity
Islam Altrifi Musa Suliman, Madiha Sid Ahmed Ali
April - June 2017, 4(2):54-57
Aim: This study aims to evaluate the contrast sensitivity, color vision, and stereoacuity in amblyopic eyes. Materials and Methods: A prospective, cross-sectional, hospital-based study includes 64 amblyopic patients (79 eyes), with age between 10 and 30 years, which represents the study sample. Thirty-six normal individuals of same age group were taken as a control group. The history of the patients was taken; vision, objective, and subjective refraction were performed. Pinhole was used to determine the amblyopia. Color vision, contrast sensitivity, and stereoacuity tests were done for both groups. Results: Anisometropic amblyopia represents 51.5% of cases. Significant decrease in contrast sensitivity was detected compared with the control group (P = 0.000). Color vision defect was found in 39.2% of amblyopic patients; 27.8% were tritanopes. Amblyopia affected stereoscopic vision in 48.5% of patients with mean 43.44 ± 95.17. Conclusion: Early detection of causes of amblyopia may prevent the bad Consequences.
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Normal ranges of interorbital anthropometric values in healthy sudanese children
Mai Osman Babiker, Mahgoub Saleem
April - June 2017, 4(2):43-48
Background: The knowledge of the normal ranges of interorbital anthropometric values among schoolchildren aged 6–15 years is very important because normal values of facial measurements, inner canthal distance (ICD), outer canthal distance (OCD), canthal index, and circumferential interorbital index are useful parameters in the evaluation and treatment of congenital or posttraumatic deformities of the cephalic and facial regions such as telecanthus, ocular hypotelorism, and craniosynostosis. Objective: To assess the normal ranges of interorbital anthropometric values in schoolchildren and to measure the interorbital distances and to define the effects of age and gender in Al-Shifa area, Khartoum State. Materials and Methods: Systematic interorbital anthropometric measurements were done in 980 schoolchildren aged 5–16 years. Measurements of far Interpupillary Distance (FIPD), Near Interpupillary Distance (NIPD), Outer Canthal Distance (OCD) and Inner Canthal Distance (ICD) were taken in all study population. Comparisons were made between their gender and age using the Chi-square test. Results: In total, 980 individuals were studied. Out of these, 675 (68.9%) individuals were boys and 305 (31.1%) were girls. The mean age of the study group was 9.47 ± 2.71 years; there was a statistically significant difference in all measurements (P < 0.05) according to the age of the children. There was a statistically significant difference in FIPD and NIPD measurements (P < 0.05) between the males and the females. Conclusion: Significant interorbital measurement differences were found between Sudanese children according to gender and age. The present study suggests that age and gender should be considered in Sudanese children in any orbital surgery. To individualize the treatment planning and diagnosis, it is important for the surgeons to have a knowledge of these local Sudanese interorbital norms.
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Knowledge, attitudes, and practices on diabetic retinopathy among medical residents and general practitioners in Khartoum, Sudan
Fatima Elnagieb, Mahgoub Saleem
April - June 2017, 4(2):66-73
Background: Diabetic retinopathy (DR) is one of the major complications of diabetes mellitus (DM) and is the leading cause of blindness among working people. It constitutes 5% of the global causes of blindness. Knowledge, attitudes, and practices (KAPs) on DR among medical residents (MRs) and general practitioners (GPs) should be well assessed to insure a very good level of DR care. These groups are the most important primary health provider of the diabetic care network. Objectives: The aim is to assess the KAPs on DR among MRs and GPs in Sudan. Materials and Methods: Two hundred and twenty-five doctors, as the study population, were chosen from Khartoum state nonconsultant nonprivate working doctors, who are working in 22 general hospitals distributed across Khartoum state, between August and September 2016. All the selected study Personale were working in these hospitals, and they were exposed to diabetic patient's care which is available within the facilities of these hospitals. Specialist, consultants, and private doctors were excluded from the study. Data were collected through a well-designed self-administered questionnaire. The questionnaire was mainly included closed-ended questions with a few open-ended ones. It contains questions on demographic data, knowledge and awareness levels, practices toward screening DR, and questions on attitudes toward DR. At the end of the survey, the entire data were coded and entered into a Microsoft Excel spreadsheet in a personal computer. The responses were analyzed using Statistical Program for Social Sciences (SPSS) version 20 (Manufactured by IBM SPSS Inc., PASW Statistics for Windows, Version 20.0; 2009. Chicago: SPSS Inc., IL, USA). Results: Two hundred and twenty-five doctors; (GPs and MRs); were included in the current study. One hundred and thirty-seven (61%) of the responded participants were female and 88 (39%) were male. The mean age of the study group was 27.7 ± 8.0 years (range: 20–36 years). Two hundred and twenty-five questionnaires were distributed to all members, only 180 (93.75%) members completed the questionnaires. Fifty-eight (32%) has MBBS and 123 (68%) has MBBS + part one in medicine. Their years of medical practice was ranged from <1 year to >2 years. One hundred and sixty-one (92.5%) and 155 (89.0%) mentioned eye and kidney, respectively, as the organs affected by DM. One hundred and fifty-eight (90.8%) mentioned retina as the part of the eye that can be affected. One hundred and eighteen (68.0%) mentioned poor glucose control as the factor that influences the presence or severity of DR. Fifty-nine (34.0%) mentioned duration of DM. Fifty-six (32.4%) high blood pressure high and 13 (7.5%) lipid level is important for DR degree. One hundred and sixty-four (95.0%) respondents, mentioned retina as the part of the eye that should be examined first for changes for DR. Ninety-one percent noted that DM can cause eye complications; new vessel formations. Hemorrhages, retinal detachment… etc. Seventy-five percent have the attitude to examine the diabetics when only the vision is affected. Fifty-one percent strongly agreed to do eye examination in diabetic pregnant and to do fundoscopy for any diabetic patient. Thirty-seven percent strongly agree to check eyes when lipid is high. Most of the respondents, i.e., 99 (59%) strongly disagree that ophthalmology training in medical school was enough to detect patients with DR. Seventy-two (42%) do visual acuity for their diabetic patients and 50 (30%) examine the fundus (retina). One hundred and twenty-six (75%) disagree that eye examination is only required in diabetic patients when vision is affected. Conclusion: Participants generally had a poor knowledge on DR although they had good knowledge about relationship between DR and others end organs which can be affected by microvascular complication of diabetes mellitus and good practice in referral of diabetic patients 136(81%). Undergraduate ophthalmology training in medical school is not adequate.
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The impact of delay in diabetic patient's referral for diabetic retinopathy screening on the level of retinopathy detected in adult Sudanese diabetic Sudanese patients
Mahgoub Saleem
April - June 2017, 4(2):49-53
Background: Diabetic retinopathy (DR) is the most common complications of diabetes mellitus (DM) which needs early detection. Delay in referral of patients with significant DR by physicians to the concerned ophthalmologist may compromise visual outcome since early treatment is associated with a 50% reduction in the risk of visual loss. Objective: The aim of this study is to assess the relationship between delays in diabetic patient's referral for DR screening after diagnosis of DM and the level of the DR detected at Sudan. Materials and Methods: A 2-year prospective cross-sectional study was conducted on 240 patients with type I and II, newly referred patients in the period from January 2013 to February 2015. The estimated time lapse between this first DR screening and the onset of DM was recorded as “delay period” in diabetic patient's referral for DR screening, which was compared with the level of DR and the level of visual loss at the time of the first visits. Results: In a 2-year study (2013–2015), 240 were newly referred diabetic patients, 225 type 2 DM (93.75%), and 15 (6.25%) type I DM. DM duration was 17.6 years (2–40 years); 202 with poor control. Eighty-nine were hypertensive with a mean duration of 3.7 years. About 83.3% were referred by general ophthalmologists, 10.4% by physicians, 4.2% by optometrists, and 2.1% by their own will. Nearly 85% referred for their visual disturbances and 15% for self-referral. Two hundred and eleven patients (87.09%) had one form of DR; while only 29 patients did not apparent DR. Low-risk DR recorded in 174 (72.5%), high risk in 66 (27.5), and diabetic macular edema (DME) in 94 (39.2%). The average delay was 14.8 years; 15.5 years for men and 14.04 years for women. The average percentage of visual loss in the low-risk group was 16.7% (visual score of 83.3%). While the visual loss in the high risk was 69.3% (visual score of 30.7%). DME reported 36.6% visual loss and 63.4% visual score. The mean visual loss in all diabetic study population was 40.9% with the total visual score of 59% which equivalent to 6/40 at the moderate low vision range of the World Health Organization. Conclusion: There was a strong correlation between the levels of DR detected and the percentage of visual loss. The “no apparent DR group” recorded the minimal detection of visual loss.
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Source of knowledge regarding diabetic retinopathy among sudanese adult diabetic patients at Makkah Eye Complex-Khartoum, Sudan, 2014
Shihab Hamadnalla, Mustafa Elnimeiri, Mahgoub Saleem
April - June 2017, 4(2):58-61
Background: Diabetes mellitus (DM) is a chronic illness with prevalence of 171 million worldwide; as a result, most of body organs and particularly the eye sensitive tissues are affected. Recently, diabetes was termed as one of the main causes of blindness. There are about 126 million people worldwide affected by diabetic retinopathy (DR) with 37 million patients suffering vision-threatening DR. However, most of the people are unaware of ocular complication due to long-term DM. Research Methodology: This was a cross-sectional hospital-based study included 309 participants' ages 15 years and above who attended Makkah Eye Complex. A standardized pretested and precoded questionnaire was used for collecting the required data. The study was ethically approved from the Institutional Review Board of Al-Neelain University and Khartoum State Ministry of Health, with the permission of Makkah Research Center. Results: Regarding awareness about which part of the eye affected by DR, 46.6% of the participants stated the retina while 40.1% (124) mentioned that they did not know. Regarding awareness about the treatment of DR, 39.91% of the participants mentioned medication, 25.82% of them mentioned surgery, while 23.47% said by laser. The source of knowledge among participants was found to be as follows: 36.2% from media, 18.1% from friends and relatives, while 17.8% from physicians, general practitioners, and ophthalmologists. Conclusion: The number of DM patients who received advice (at the point of disease detection) from doctors or medical personnel to see an ophthalmologist was a minority although it is a very valuable advice since delayed detection of retinopathy leads to serious outcomes and complicates the management. Awareness program and counseling for diabetic patients toward the fact that DR is a manageable disorder if intervention took place in time.
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Basic assessment of corneal collagen cross-linking in Sudanese sample
Albadry Khlifa Siddig Abdellah, Atif Babiker Mohamed Ali
April - June 2017, 4(2):62-65
Background: Collagen Corneal Cross-Linking (CXL) is a surgical technique that combines ultraviolet light and riboflavin eye drops as a one of the modern therapies for keratoconus. Objectives: This retrospective study aimed to assess the visual outcome, corneal curvature, corneal thickness, and refractive status after CXL. Methods: The records of 25 patients did CXL during May 2012 to May 2014 at Makkah Eye Hospital were reviewed. The recorded data included uncorrected and best-corrected visual acuity (Nidek Chart Projector CP 670 Japan), central corneal thickness and average K-readings (ATLAS 9000, Corneal Topography System, Germany), and refraction (Nidek Auto Refractometer, AR310A Japan); all these measurements were taken at baseline before CXL and after 1 year post-CXL. Results: The age range of this group was 12–26 years of whom 60% females and 40% males. A little improvement of vision was achieved from a presenting mean 6/30 to CXL mean 6/20 at P = 0.024. No significant difference was observed in corneal central thickness preoperative mean 447.72 ± 27.52 μm) and postoperative (mean 448.83 ± 22.35 μm). K-readings showed only limited changes in the form of astigmatism and not in the degree of astigmatic error (mean 2.80 ± 1.327 D) preoperative and (mean 3.08 ± 1.717 D) postoperative. A moderate spherical refractive error (noncorneal) was persisting (mean 2.79 ± 2.09 D preoperative and 2.66 ± 2.10 D postoperative). Conclusions: CXL assumes controlling of corneal ectasia and regarded as one of effective procedures in improving the vision, particularly when combined with optical correction.
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