Retinal diseases in Ibadan

Sir,

Retinal disease was thought to be uncommon in the developing countries, hence was not given enough attention by the blindness prevention programmes.¹ Secondly, the equipments needed for treatment were expensive and difficult to maintain, hence the high cost of treatment where the equipment are available. These explained the paucity of trained personnel sub-specializing in vitreoretinal surgery in the developing countries such as Nigeria. Retinal disease was found to be a significant cause of blindness and visual impairment in Nigeria.^{2, 3}

A review of cases seen in the eye clinic of the University College Hospital, Ibadan during a 5-year period (November 1998–October 2003) was carried out. Case files of 395 patients with vitreoretinal diagnoses were enrolled into the study. Male : female ratio was 1.3 : 1. Peak age of presentation was 60 years and above. The common diseases noted were macular diseases 141 (35.6%), comprising age-related macular degeneration (AMD), macular scar, and holes. The elderly, aged 60 years and above carried the burden of retinal disease. This is explained by the presence of macular diseases especially AMD. It is an important cause of blindness and low vision, in Nigeria.^{2, 3, 4} Other workers found the disease to be uncommon in people of African descent.^{5, 6, 7} All the patients seen were Nigerians. The early type of AMD with drusens and pigmentary changes predominates. Because of the difficulties in making diagnosis of occult subretinal neovascularization, the prevalence is likely to be higher. Futhermore, the problems of making accurate retinal diagnoses owing to lack of trained retinal surgeons coupled with inadequate facilities made management of AMD and other retinal diseases an uphill task. Retino-choroiditis occurred especially in young adults. More than half of the patients with this condition were below 40 years. Complications noted were vitreoretinal fibrosis and cataract. Diabetic retinopathy is a significant cause of posterior segment disease in this study. As the society urbanizes, the prevalence of diabetes increases. In a developing country such as India, diabetes mellitus is a significant cause of blindness.⁸ Laser treatment combined with tight control of diabetes will prevent retinal detachment, which will need a more invasive treatment. Early detection and detailed examination by a trained vitreoretinal surgeon will improve visual prognosis after retinal detachment surgery. Surgery for retinal detachment is very effective in developing countries such as India and East Africa.⁹ A significant number of patients also presented with retintis pigmentosa, retinal vascular occlusions, sickle cell retinopathy, couching, intraocular foreign body, and pseudophakos dislocated into the vitreous (see Table 1). It is likely that the incidence of vitreoretinal disease will increase, with the increasing number of cataract surgery causing more posterior segment complications.

Table 1 Retinal diseases in Ibadan, Nigeria

The need for vitreoretinal intervention was assessed. One hundred and forty-two (35.9%) cases needed laser therapy, 82 (20.8%) cases needed vitreoretinal surgery such as scleral buckling and vitrectomy whereas 158 (40%) needed further vitreoretinal investigations like flourescein angiography and fundus photography that were not readily available. The need for laser treatment was assessed. About one-third of the patients require laser treatment, especially in patients with diabetic retinopathy, vascular occlusions, and sickle cell retinopathy. The facility is not available in the hospital, hence referral to hospitals where the facilities are available. It is likely that most of these patients would find the cost of treatment in the private hospitals unaffordable. In Nigeria, cost is a barrier to hospital presentation.¹⁰

A vitreoretinal centre manned by a trained vitreoretinal surgeon is desirable in the University College Hospital, Ibadan, a tertiary centre involved in training. The general ophthalmologist will benefit from a sponsored training in vitreoretinal surgery. He will in turn train residents and other general ophthalmologists. Vitreoretinal equipments though expensive can be made to be cost effective when high volume treatments are carried out.