Retrospective study of the pattern of eye disorders among patients in Delta State University Teaching Hospital, Oghara

INTRODUCTION

Ocular diseases are important public health issues and constitute one of the commonest problems presented to the general practice clinic (10–21%) and could have significant socioeconomic consequences ;^[1] as well as educational challenges, but also reduce the quality of life and increase the risk of death.^[2] The incidence of various eye diseases in a community or area varies with the social and environmental factors. According to the Global Burden of Diseases,^[3] previous studies have reported that worldwide pre disposable factors causing injuries and other health risk factors occurs among 41.9 million people due to legal blindness, 253.08 million people with moderate vision impairment, and 33.78 million people with severe vision impairment. Data from the World Health Organization showed that at least 2.2 billion people were affected by blindness and vision impairment around the world, of whom 1 billion had preventable vision impairment or impairment that had yet to be addressed.^[2]

The pattern of occurrence of ocular diseases globally is dependent on factors such as age, gender, region, and climatic conditions.^[4] The majority of these ocular conditions which can lead to blindness are either potentially preventable or curable.^[5] Disease pattern is in a state of constant flux, over some time. The pattern of eye diseases differs in developing and developed countries and often in communities.^[6] A study of the pattern of ocular diseases is very important because while some eye conditions are just causes of ocular morbidity others may lead to blindness.^[5] Uncorrected refractive error, cataracts, age-related macular degeneration, glaucoma, conjunctivitis, corneal ulcers, uveitis, pterygium, and diabetic retinopathy are the leading causes of vision impairment globally.^[7]

Eye diseases linked to blindness have remained a genuine issue that has a colossal and wide effect on the general public, with financial misfortune as it is usually accompanied by challenges in physical capacity, passionate misery, low socialization mental, and social wellbeing. The negative impact extends from the immediate family to society at large. Studies of ocular diseases are important in understanding the causes of ocular morbidity that could lead to visual loss.^[1] Considering the complicated epidemiology of visual impairment and the wide variety of factors involved, region-specific intervention strategies are required for every community. Hence, this study evaluated the pattern of eye disorders among patients seen in Delta State University Teaching Hospital, Oghara, Delta State.

MATERIAL AND METHODS

RESULTS

The results on the pattern of eye disorders at Delta State University Teaching Hospital, Oghara are presented in [Figures 1-4 and Table 1]. A total of 2,003 patients were registered and examined in the hospital within the one (1) year period.

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Figure 1:

Sex distribution of the patients seen.

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Figure 2:

Age and sex distribution of the patients seen.

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Figure 3:

Distribution of patients by marital status.

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Figure 4:

Distribution of patients by occupation.

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The sex of patients that were diagnosed with eye disease at the Delta state Teaching Hospital Oghara within study duration was found to be 52% (1033) male and 48% (970) female [Figure 1]. This implies that majority of patient that presented at the hospital for year 2003 and were diagnosed of eye disease were male patients. This also shows that female has less access to eye care.

[Figure 2] above represents the age and sex distribution of cases that were reported to Delta State University Teaching Hospital, Oghara for diagnosis of eye diseases. Data obtained revealed that 67 (3.35%) cases reviewed for patients were between the ages of 1 month–10 years, 38 (1.9%) were male patients whereas, 29 (1.4%) cases were attributed to female patients. Patients between the ages of 11–19 years had a total of 137 (6.8%) of which males accounted for 58 (2.9%) and 79 (3.9%) were attributed to female cases. The prevalence of eye diseases among patients between the ages of 20–29 years revealed that a total of 150 (7.5%) cases were reviewed, out of which only 83 (4.1%) were male cases, while 67 (3.3%) were female cases. Similarly, a total of 212 (10.6%) cases were reviewed for patients between the ages 30–39 years, 93 (4.6%) were male patients whereas, 119 (5.9%) cases were attributed to female patients.

Additionally, Figure 2 showed that 275 (13.7%) of the cases reviewed were between ages of 40-49 years out of which 147 (7.3%) were male and 128 (6.4%) were female cases. The prevalence of eye diseases in this study for patients between the ages of 50-59 years were 294 (14.7%), out of which 105 (5.2%) were male cases and the other 189 (9.4%) were female cases. More so, 326 (16.3%) of cases reviewed were between the ages of 70-79 years, out of which 211 (10.5%) were male and 115 (6.4%) were female cases. The final category reviewed were between the ages of 80 years and above; it had a total of 145 (7.3%) cases reviewed, out of which 77 (3.8%) were male and the remaining 68 (3.4%) were female. Summarily, based on only sex distribution [Figure 1], a total of 2003 cases were reviewed out of which 1033 (52%) were male patients and the remaining 970 (48%) were female patients.

[Figure 3] represents the marital status of patients. A total of 390 (19.5%) cases reviewed were still single patients, whereas, 1399 (69.9%) cases were married, 191 (9.5%) were widows or widowers, and the remaining 21 (1%) were divorced. This implies that the majority of the cases diagnosed with eye disease in the study area were married.

Occupational distribution of patient [Figure 4] showed that 24% (480) of subjects were civil servants,19.2% (385) were traders, 18.1% (362) were farmers while the least distribution percentage were students 17.4% (349). However, patients with other occupational statuses accounted for 133 (6.6%) of the cases. This implies that more civil servants were diagnosed with eye disease in the study setting.

The pattern of various eye diseases in Delta State University Teaching Hospital, Oghara is shown in [Table 1]. Results of the study showed that eye diseases related to crystalline lenses were the most prevalent eye disorder accounting for 620 (31%) out of the total sampled cases. In this group, Unilateral Cataract was the most prevalent (455, 22.7%), followed by Bilateral cataract (142, 7.1%), and the least were Subluxated cataract (23, 1.2%). Patients with a diagnosis of Conjunctiva eye diseases were the second most detected eye diseases in the study area, with a total of 320 (16%). In this category, allergic conjunctivitis was the most prevalent (204, 10.1%), followed by bacteria conjunctivitis (98, 4.9%), and the least was Pterygium (18, 1%).

Results of the study showed that refractive errors were the third most detected group that result in visual impairment revealed with a total of 292 (14.6%). In this group, the most prevalent was myopia (143, 7.2%), this was immediately followed by patients diagnosed with hypermetropia (93, 4.7%), and the least was astigmatism (56, 2.8%). The prevalence of eye disease related to the Retina was the fourth most prevalent as recorded in this study with a total of 273 (13.6%) cases. Prevalence noted in this group were; diabetic retinopathy (128, 6.4%), age-related macular degeneration (48, 2.4%), macular edema (36, 1.8%), retinal detachment (28, 1.4%), central retinal vein occlusion (22, 1%), and ocular hypertension (11, 0.6%) had the lowest number of cases.

Cases of glaucoma eye diseases were the fifth most detected with a total of 229 (10.5%). In this category, primary open-angle (126, 6.3%) was the highest followed by advanced glaucoma (48, 2.4%), bilateral glaucoma (25, 1.3%), and primary angle closure (20, 1%) which is the least. Eye diseases of the Cornea were the sixth most detected with a total of 132 (6.6%). In this group, corneal ulcer (79, 4%) was the highest, followed by keratitis (30, 1.5%) and corneal opacity (23, 1.2%) was the least. More so, the prevalence of optic nerve and visual pathway diseases was the seventh most prevalent with a total of 86(4.3%) out of the recorded cases. In this group Optic atrophy (49, 2.5%) was the highest, followed by optic neuritis (26, 1.3%) and hemianopia (11, 0.6%) were the least recorded cases. Patients with Eyelids disorder had the lowest prevalence with a total of 59 (3%). In this group, chalazion accounted for 44 (2.2%) as the highest case, this was followed by blepharitis, (9, 0.5%), while Lipoma (6, 0.3%) was the least observed.

DISCUSSION

The results gathered revealed that 1033 (52%) of the cases reviewed were males, whereas, while 970 (48%) were females. This implies that the majority of the cases of eye disease prevalent in the study area were males. This study is similar to the general belief that more males are seen in the clinics than females.^[8] The finding from this study is similar to that of Bhoi,^[1] where out of 2348 patients included in the study, the majority 1364 (58.1%) were male and 984 (41.9%) were females. The finding in our study was contrary to the study of Achigbu et al.,^[9] where most of the study group found were female. Ademe and Edmealem^[10] in their study ascertained that 197 (51.3%) of them were females and 186 (48.4%) were males. The study conducted on ocular morbidity in rural Ethiopia indicated that, a total of 214 patients were examined, where males comprised 50.5%.^[11] This might be due to differences in sample size and gender patterns of countries.

Our study revealed that majority of the cases reviewed on eye diseases were prevalent among the older male patients between the ages of 60-69 years. The study from Muhammad and Dantani in Sokoto State Nigeria is comparable to our study in terms of the study subjects (all ages). In the study of Baranwal et al.,^[12] the majority of age distribution was 51– 65 years (17.91%) in their study subject.

Worldwide, the pattern of ocular diseases varies from one location to another. However, cataracts, glaucoma, conjunctivitis, corneal ulcers, uveitis, refractive errors, and pterygium are considered common ocular disorders.^[8] Cataracts, refractive errors/low vision, trachoma, onchocerciasis, and Vitamin A deficiency/other causes of childhood blindness were determined to be responsible for 75% of all blindness worldwide. In this present study the pattern of various eye diseases in patients seen at Delta State University Teaching Hospital, Oghara showed that ocular diseases related to the crystalline lens were the most prevalent eye disease. In this group, unilateral cataract was the most prevalent followed by bilateral cataract and the least were subluxated cataract. This finding is similar to a previous study by Monsudi et al.^[13] Moreover, Bhoi^[1] reported that Cataract was the third most common ocular morbidity.

Patients with a diagnosis of conjunctiva eye disorders were the second most detected eye diseases in the study area. In this category, allergic conjunctivitis was the most prevalent followed by bacteria conjunctivitis and the least was Pterygium Similarly, a study by Hassan et al., in South-West Nigeria noted that vernal conjunctivitis (21.1%) was the commonest disorder seen. On the contrary, Agyemang-Mireku^[6] in Ghana found the commonest eye disorder to be conjunctivitis (39.70%). Similarly, a retrospective study in India showed that conjunctivitis was the commonest ocular disorder at 21.94%; others were cataract - at 9.2%, refractive error -at 15.2%, dacryocystitis - at 6.51%, and blepharitis - 3.2%.

Results of the study showed that refractive errors were the third most detected group of eye diseases seen. It was reported in the study of Baranwal et al.^[12] that refractive error was the commonest ocular morbidity in their study followed by cataracts with follow-ups of cataract surgeries and allergic conjunctivitis which is contrary to this study. This study is in line with the study of Lakho and Ali,^[5] who reported that Refractive error is the third most common ocular disease. This is in agreement with previous reports.^[14] Balarabe et al.,^[15] reported that refractive errors have a serious effect as it impacts the quality of life and consequently affect socioeconomic and educational life. In this group, the most prevalent was myopia, which was immediately followed by patients diagnosed with astigmatism and the least was hypermetropia which is contrary to observations by other authors Baranwal et al.^[12] who reported that presbyopia was the most common refractive disorder in their study.

The prevalence of eye disease related to the Retina was the fourth most prevalent as recorded in this study. This is incomparable to what was found in the study of Adeoti et al.,^[16] and Eze et al.^[17] who reported that retina disease accounted for 111 (4.6%) and (3.9%) of cases in their respective studies. The prevalence noted in this group was diabetic retinopathy, age-related macular degeneration, macular edema, retinal detachment, and central retinal vein occlusion (22, 1%). This study is similar to the study of Nigeria and Malaysia and diabetic retinopathy accounted for 9.7% and 9.6% of retinal diseases, respectively.^[5] Cases of Glaucoma eye diseases were the fifth most detected. This is similar to the report in tropical Africa where it came third after cataracts and aphakia.^[16] However, it is not similar to the study of Glaucoma which came third contrary to previous reports where it has been reported as the second most common cause of visual impairment and blindness after cataracts.^[8]

Eye diseases of the Cornea were the sixth most detected. In the study of Das et al.,^[18] the second most common presentation was cornea and anterior segment disorders in Liberia which is different from this study. Similarly, in the study conducted by Bhoi^[1] while in the study of Sharifi and Samadi,^[19] on the pattern and prevalence of cornea disorders %). In our study, optic nerve and visual pathway diseases were the seventh most prevalent cases with optic atrophy being the highest, followed by optic neuritis and retinitis pigmentosa being the least recorded cases. Patients with Eyelid disorders had the lowest prevalence with chalazion being the highest case followed by blepharitis, while lipoma was the least observed.

CONCLUSION

From the study, eye conditions such as Cataracts, Conjunctiva, Refractive errors, Retina diseases, Glaucoma, Cornea disorder, Optic nerve, and visual pathway diseases, and Eyelid disorder such as chalazion, blepharitis, and Lipoma were identified. A cataract is the most common eye disease in this study population as the majority of them were male. It was observed that 395 (19.7%) of the cases reviewed were between the ages of 60–69 years. More attention should be paid to the management of these disorders through subspecialty development to reduce the burden of visual impairment and blindness in our environment and should be encouraged.