Purpose To assess the literature on the effects of topical intraocular pressure (IOP)-lowering medications on the ocular surface. Ocular surface assessment in these patients is seldom a priority for most clinicians since the ultimate goal of management is to preserve vision. Methods A literature search of articles (English only) on the subject matter was conducted and their findings summarized. Results This review assesses the prevalence of dry eye symptoms in glaucoma patients on topical IOP-lowering medications. We extensively reviewed the effects of the preservatives and active ingredients in these medications on the ocular surface. In particular, the effects of benzalkonium chloride (BAK), a widely used preservative, on meibomian glands are explored. Also mentioned in this review is the association between duration of therapy and severity of dry eye symptoms. The role of the pH of medications in the development of ocular surface disease is also reviewed. Finally, we probed the occurrences of ocular allergic reactions with the use of topical IOP-lowering medications. Conclusions The preservatives and active agents in most topical glaucoma medications are implicated in the prevalence of ocular surface discomfort. Whilst clinicians involved in glaucoma care are encouraged to assess the ocular surface routinely, further studies are needed to demonstrate the contributions of other physiochemical properties of these medications to the development of ocular surface disease in these patients.

Aim. The aim of this study was to assess the prevalence of computer vision syndrome (CVS) and its associated ergonomic factors among university administrative staff in Ghana. Methods. A cross-sectional survey was conducted among 200 administrative staff of the University of Cape Coast. The procedure included a self-administered questionnaire, comprehensive ocular health examination, and assessment of computer workstation and lighting conditions. The prevalence of CVS among the subjects and the association between CVS and ergonomic practices were determined. Results. The mean age of the study sample was 31.0 ± 4.7 years, and the majority were males (56.0%). The prevalence of CVS was among 103 (51.5%)participants. Over a third of the respondents used computers for 6 or more hours daily. Significant association was found between CVS and poor ergonomic practices (χ = 15.175, p=0.001). Conclusion. In addition to poor ergonomic office setup, university administrative staff spend several hours behind computer screens leading to the development of CVS. Increased awareness of CVS and adherence to recommended ergonomic practices are necessary to reduce the prevalence of CVS and ultimately enhance work satisfaction and productivity.

BackgroundHuman resources for eye health are inequitably distributed in most developing countries including Ghana. In spite of this, most eye care workers are concentrated in urban areas to the disadvantage of rural dwellers who need the services of these workers the most. The aim of the study was to investigate factors that will influence Ghanaian Optometry students’ decision to work in rural areas after completion of their training.MethodA cross-sectional survey was conducted among Ghanaian optometry undergraduate students. All undergraduate optometry students (first to sixth year) who agreed to take part in the research completed a 37 item questionnaire that explored; demographic characteristics, views about practice choice and possible attractions and incentives to practice in the rural area.ResultsA total of 333 (87.4%) participants out of 381 Ghanaian optometry students who were registered for the 2015/2016 academic year completed the questionnaire. Rural origin students had the greatest desire to practice in the rural setting when employed by the Government (78.9%) or by NGO (80.3%). Financial incentives (76.6%), scholarship for further studies (76.0%), better living conditions (71.2%) and career ladder jump for rural health workers (71.2%) were the main incentives that influenced the intention of graduate optometrists to practice in the rural areas.ConclusionRural origin students are more inclined to work in rural areas than urban origin students, a finding which is informative for optometry training schools when managing their admission policies. Financial incentives among other factors will encourage more students to engage in rural optometric practice irrespective of their place of origin.

Objective Emerging evidence suggests that the COVID-19 pandemic is disrupting health behaviors such as medication adherence. The objective of this study was to determine whether adherence to ocular hypotensive medication was affected by the pandemic and to identify factors associated with this change. Design In this cohort study, we used a controlled interrupted time series design in which the interruption was the declaration of the COVID-19 pandemic in the United States on March 13, 2020. The 300-day monitoring period, which evenly bracketed this declaration, started on October 16, 2019, and ended on August 10, 2020. Participants Patients with primary open-angle glaucoma enrolled in an ongoing longitudinal NIH-funded study initiated prior to the onset of the pandemic were selected if they were prescribed ocular hypotensive medication and had adherence data spanning the 300-day period. Methods We applied segmented regression analysis using a “slope change following a lag” impact model to obtain the adherence slopes in the periods preceding and following the segmentation. We compared the two slopes using the Davies test. Main outcome and measure The main outcome measure was daily adherence to ocular hypotensive medication—defined as the number of doses taken divided by the number of doses prescribed, expressed in percent. Adherence was measured objectively using Medication Event Monitoring System (MEMS) caps. We assessed the associations between change in adherence and demographic, clinical, and psychosocial factors. Results The sample included 79 patients (mean age, 71 years [SD, 8 years]). Segmented regression identified a breakpoint at day 28 following the declaration of the pandemic. The slope in the post-breakpoint period (-0.04%/day) was significantly different from zero ( P < 0.001) and from the slope in the period preceding the breakpoint (0.006%/day) ( P < 0.001). A significant positive association was observed between the Connor-Davidson Resilience score and the change in slope between the pre- and post-breakpoint periods ( P = 0.002). Conclusions and Relevance Adherence to ocular hypotensive medication worsened during the COVID-19 pandemic and appears to be related to patient resilience. This collateral consequence of the pandemic may translate into vision loss that may manifest beyond its containment.

Abstract:Purpose: To determine the near vision spectacle coverage and barriers to obtaining near vision correction among adults aged 35 years and older in the Cape Coast Metropolis of Ghana. Methods: A population-based cross-sectional study design was adopted and 500 out of 576 participants aged 35 years and older were examined from 12 randomly selected clusters in Cape Coast, Ghana. All participants underwent a comprehensive eye examination which included: distance and near visual acuities measurements and external and internal ocular health assessments. Distance and near refractions were performed using subjective refraction technique. Information on participants' demographics, near vision correction status, near visual needs and barriers to acquiring near vision correction were obtained through a questionnaire administered as part of the study. Results: The mean age of participants was 52.3±10.3 years of whom 280 (56%) were females and 220 (44%) were males. The near vision spectacle coverage was 25%, 33% "met need" for near vision correction in the presbyopic population, and 64% unmet need in the entire study population. After controlling for other variables, age (5 th and 6 th decades) and educational level were associated with "met need" for near vision correction (OR=2.7 (1.55-4.68), p =0.00, and OR=2.36 (1.18-4.72), p=0.02 respectively). Among those who needed but did not have near vision correction, 64 (26%) did not feel the need for correction, 55 (22%) stated that they were unaware of available interventions, and 53 (21%) found the cost of near vision correction prohibitive. Conclusion: There was a low near vision spectacle coverage in this population which suggests the need for strategies on health education and promotion to address the lack of awareness of spectacle need and cost of services.

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The dynamic structure–function (DSF) model was previously shown to have better prediction accuracy than ordinary least square linear regression (OLSLR) for short series of visits. The current study assessed the external validity of the DSF model by testing its performance in an independent dataset (Ocular Hypertension Treatment Study–Confocal Scanning Laser Ophthalmoscopy [OHTS–CSLO] ancillary study; N = 178 eyes), and also on different test parameters in a sample selected from the Diagnostic Innovations in Glaucoma Study or the African Descent and Glaucoma Evaluation Study (DIGS/ADAGES). Each model was used to predict structure–function paired data at visits 4–7. The resulting prediction errors for both models were compared using the Wilcoxon signed-rank test. In the independent dataset, the DSF model predicted rim area and mean sensitivity paired measurements more accurately than OLSLR by 1.8–5.5% (p ≤ 0.004) from visits 4–6. Using the DIGS/ADAGES dataset, the DSF model predicted retinal nerve fiber layer thickness and mean deviation paired measurements more accurately than OLSLR by 1.2–2.5% (p ≤ 0. 007). These results demonstrate the external validity of the DSF model and provide a strong basis to develop it into a useful clinical tool.