| dc.description.abstract | OBJECTIVEST:he study was aimed at describing the characteristics of patients presenting at
low vision clinic of the Kikuyu Eye Unit, with emphasis on the underlying causes of low vision,
of which it would identify preventable and potentially treatable causes, to document any
associateddisability, and to assess the type of LVA's prescribed to these patients.
STUDYDESIGN: Retrospective case series
STUDYSETIING: P.C.E.A Kikuyu Hospital, Eye Unit, Low Vision Clinic, Kiambu District, 20km
from Nairobi.
SUBJECTS:Any new patient assessed in the Low Vision Clinic from 1st January 2007 to si"
December 2007, and found to have low vision as per the low vision case definition.
MATERIALSAND METHODS: Copies of low vision assessment sheets of patients were
scrutinized and records of eligible patients were retrieved from the hospital registry and
analyzed. The data was collected on a structured questionnaire and entered into Microsoft
access,then exported to Microsoft Excel and analyzed using the Statistical Package for Social
Scientists (SPSS).
RESULTS: Two hundred and ninety nine files were reviewed, of which 190 patients were
found to be eligible for this study. A hundred and twenty two (64.2%) were adults and 68
(35.8%) were children and the M:F ratio was found to be approximately 2:1 in both adults and
children. 45.6% of adults were classified as low vision category IV patients, while 41.2% were
category "I. Only 1 adult was classified in category I. Children mainly belonged to category "I
(66.4%). The majority of patients had a 10gMAR BCVA of 0.5 to 1.0(69.7% adults and 57.4%
children) with a range of 0.5 to 2.0. HVF was done for 11 patients (5.8%) and field defects
within 10° of or involving the point of fixation were found in 7 of them (63.6%). Many of the
patients hailed from Nairobi, Central and Rift Valley provinces and the main points of referral
were in Nairobi in the files where it was recorded. Of the 122 adults, 64 had retinal disorders,
mainly diabetic retinopathy, maculopathy, Stargardt's disease and retinitis Pigmentosa. The
other common causes of low vision in adults were optic nerve disorders including glaucoma
1
andoptic atrophy, and corneal scarring and opacification. In children, the main cause was
optic atrophy, followed by maculopathy, amblyopia and keratoconus. Fifty six percent of low
visionin children is preventable or potentially treatable. Of the causes of low vision found in
adults,16 were potentially treatable and 64 were preventable accounting for 80 of 122 adults
(65.6%) in whom low vision could have been avoided. Associated disabilities were found in
only 6 of the patients who presented at the Low Vision Clinic in 2007. LVA's were provided to
72.6% of patients, and it was found that near optical aids were more likely to be given to
adults. For distance optical aids, the commonest given to adults was the 4x telescope while
for children it was the 2x or the 4x telescope. In near optical aids, both adults and children
were most likely to be provided with a +4 DSspectacle magnifier. The non-optical aids most
commonly provided to adults were training in functional print reading and orientation and
mobility training. Children were provided with CBM boxes, colour filter lenses and visual
stimulation techniques. VA for near was found to improve significantly in adults with the use
of LVA's and a significant number of children <16 yrs were introduced into the integrated
programme/given school placements/vocational training. Eight patients refused LVA's at
prescription.
CONCLUSIONS: Considering that the low vision project was geared towards children at
inception, there were surprisingly more adults presenting at the low vision clinic than
children. Centres in Nairobi referred a number of patients for low vision assessment and
management, and patients at the clinic were usually from Nairobi, Central or Rift Valley
province. Most of the patients were likely to be classified in category III/IV of low vision with a
10gMAR BCVA of 0.5-1.0, which bodes well for the project since this signifies that these
patients can be assisted with appropriate aids. Visual field testing was done in fewer patients
than necessary. Considering the underlying causes of low vision, diabetic retinopathy was the
commonest cause in adults, and optic atrophy in children. More than half of the cases of low
vision could have been avoided with appropriate prevention, or early diagnosis and
appropriate, timely treatment. Associated disability was found in fewer patients than
expected. Adults were more likely to benefit from near optical aids, training in reading
functional print and O&M training, while children were more likely to be given distance
2 | en |
| dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
