4th Annual Scientific Congress · 2016-08-18 · Arusha, Tanzania 3 COECSA Congress 2016 A Word...

4th Annual Scientific Congress

“Eye care challenges and opportunities in developing countries”

24th – 26th August 2016

Ngurdoto Mountain Lodge

Arusha, Tanzania

Hosted by the Tanzania Ophthalmology Society

We are grateful to all

the Sponsors of

COECSA Congress 2016

[DAEH group]

Arusha, Tanzania 1 COECSA Congress 2016

TABLE OF CONTENTS

COECSA Congress 2016 Committees .................................................................................................................................... 2

A Word from the Chairman................................................................................................................................................... 3

PROGRAMME AT A GLANCE ................................................................................................................................................. 5

DETAILED PROGRAMME ....................................................................................................................................................... 6

CPD Afternoon, Wednesday, 24th August 2016 ................................................................................................................ 6

Thursday Morning, 25th August 2016 ............................................................................................................................... 8

Thursday Afternoon, 25th August 2016 ........................................................................................................................... 10

Friday Morning, 26th August 2016 .................................................................................................................................. 11

Friday Afternoon, 26th August 2016 ................................................................................................................................ 14

Speakers of Invited Presentations & Committee Chairs ..................................................................................................... 16

Abstracts ............................................................................................................................................................................. 22

COECSA Congress 2016 2 Arusha, Tanzania

COECSA Congress 2016 Committees

Chair: Dr Frank Sandi

PROTOCOL AND COMMUNICATIONS COMMITTEE

Chair: Dr. Nkundwe Mwakyusa

Members: Dr. Cyprian Ntomoka, Dr. Bernadetha Shilio, Dr. Neema D Kanyaro, Dr. Ng’hungu Lufunga,

Dr. Ole Motika and Dr. Judith Mwende

SOCIAL AND LOGISTICS COMMITTEE

Chair: Dr. Mustafa Yusufali

Members: Dr. Neema D Kanyaro, Dr. Christopher Mwanansao, Dr. Baruani Sufian, Dr. Anna Sanyiwa and

Dr. Mattaka Christine

SCIENTIFIC COMMITTEE

Chair: Dr. Heiko Philippin

Members: Dr. William Makupa, Dr. Kazim Dhalla, Dr. Milka Mafwiri, Dr. Elisante Muna, Dr. Bernadetha

Shilio, Dr. Hassan G Hassan, Prof. Nicholaus Kinabo and Dr. Furahini Godfrey

FINANCE COMMITTEE

Chair: Dr. Ng’hungu Lufunga

Members: Josiah O Onyango, Hulda Nduru, Neema D Kanyaro, Dr. Dilawar Padhani and Emeritus

Chibuga

Event planning: Shades of Green


A Word from the Chairman

Dear Friends and Colleagues,

It is my pleasure to welcome you to this year’s COECSA Scientific Congress.

It is an honour to chair the 4th Annual COECSA Scientific Congress on “Eye Care Challenges

and Opportunities in Developing Countries” at Ngurdoto Mountain Lodge, Arusha, Tanzania.

I am humbled to be tasked by the Tanzania Ophthalmology Society (TOS) and COECSA to

oversee the premium ophthalmology event in the ECSA region.

This year’s Congress is unique in many ways. The number of delegates continues to increase

each year: more than 400 delegates are expected this year. We begin the Congress with a

sub-specialty afternoon comprised of eight sessions covering different subspecialties, including a special course on

neuro-ophthalmology, a discipline that still lags in our region. The subspecialty afternoon includes a phacoemulsification

introductory course and a wet lab session targeted at residents and all those who would like to sharpen their phaco skills.

For the first time the Congress includes two sessions targeted at allied health professionals. Three keynote speeches

from eminent local and international speakers will elaborate on the Congress theme.

I took it upon myself to handle all the responsibilities of chairing this Congress. I was involved in all the preparatory details

of this important event – never only partially involved, I committed myself fully to ensuring this would be a successful

and enjoyable Congress for everyone. For almost 12 months, the organising committee has been planning and preparing

for this event: booking speakers, judging abstracts and finalising the scientific, recreational and social programme for this

wonderful event.

This Congress could not have happened without the dedication of so many people. I cannot begin to describe the hard

work and effort that the TOS, COECSA and PCO committees have exerted in the preparation, promotion and organisation

of this Congress; they have proven their skills in managing this most successful and important meeting. I especially want

to thank the TOS members for their tireless support, the COECSA Secretariat for their guidance, the PCO for their

organisation skills, KCMC Hospital for offering a space for live surgery and provision of venue for congress planning

meetings, MNH/MUHAS for offering venue for planning meeting and our generous sponsors for their support of this

event.

My heartfelt thanks go to all of the keynote speakers, invited guests and presenters for their valuable and unique

contributions. I would like to thank the session chairs and co-chairs for providing each session with context, structure

and character.

Finally, I’d like to thank all of the delegates and everyone who was interested but could not attend; your involvement

makes the COECSA Congress the success it is today and into the future. Please enjoy your time in Arusha.

Sincerely,

Frank Sandi, 4th COECSA Congress Chairman


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PROGRAMME AT A GLANCE

Wednesday, 24th August - CPD and Sub-Specialty Afternoon

Time Main Hall Room 1 Room 2 Room 3 KCMC / Exhibition

1300 CPD Glaucoma

CPD Eye Movement Disorders I

CPD Paediatric Ophthalmology

CPD Management of Retinal Diseases

CPD Phaco Introductory Course

1500 Afternoon Tea

1530 CPD Cataract Surgery

CPD Eye Movement Disorders II

CPD Cornea CPD Vitreoretinal

Surgery

1730 Break

1830 Welcome Cocktail Reception & Opening of the Exhibition

Thursday, 25th August - Scientific Day I Time Main Hall Room 1 Room 2

0800 Glaucoma Training & Education Alcon Symposium Room

0930 Official Opening

1030 Morning tea, Exhibition & Poster presentations

1100 Keynote Speech I

1130 Cornea Training the Trainers Young Ophthalmologists’ Forum

1300 Lunch, Exhibition & Poster presentations

1400 Cataract

Training the Trainers Allied Health Professionals

Nursing in Eye Care 1530 Ophthalmology Gladiators

1630 Afternoon tea, Exhibition & Poster presentations

1700 COECSA AGM

1830 Break

1930 Gala Dinner and Awards Ceremony

Friday, 26th August - Scientific Day II Time Main Hall Room 1 Room 2

0800

Retina Innovations in Eye Care

Maintenance of Equipment Course The Eye and Systemic Disorders


1100 Keynote Speech II

1130 Community Ophthalmology & Management of Eye Care

Ophthalmic Oncology & Oculoplasty Allied Health Professionals

AMOO


1400 Keynote Speech III

1430

Paediatric Ophthalmology Cataract Open Subspecialists Meetings



DETAILED PROGRAMME

CPD Afternoon, Wednesday, 24th August 2016

Main Hall CPD - GLAUCOMA

Chairs: Dan Kiage, Michael Gichangi

1300 Creating awareness for glaucoma Admassu Fisseha

1320 Detecting glaucoma and further diagnostics Hassan G Hassan

1340 Target IOP and rational use of glaucoma medication Sheila Marco

1410 Aftercare of trabeculectomy – key to a successful outcome Neema Kanyaro

1430 Questions & answers AF, HGH, SM, NK

1500 Afternoon Tea

CPD - Cataract Surgery Chairs: Dilawar Padhani, Honest Maro

1530 Pearls for Small Incision Cataract Surgery William Dean

1600 IOL and nucleus drop management Manoj Khatri

1630 Phacoemulsification in white and black cataract M Nivean

1700 Questions & answers WD, MK, MN

1730 Break

1830 Welcome cocktail reception & opening of the exhibition

Room 1 CPD - Eye Movement Disorders I

Chairs: Chileshe Mboni, Gerald Msukwa

1300 The control of eye movements Mike Burdon

1330 Examination of eye movements Mike Burdon

1400 Double vision Mike Burdon

1430 Questions & Answers MB

1500 Afternoon Tea

CPD - Eye Movement Disorders II Chair: Paul Nyaluke

1530 Cranial nerve palsies Mike Burdon

1600 Supranuclear disorders Mike Burdon

1630 Nystagmus Mike Burdon

1700 Questions & answers MB

1730 Break



CPD Afternoon, Wednesday, 24th August 2016

Room 2 CPD - Paediatric Ophthalmology

Chairs: Ibrahim Matende, Grace Ssali

1300 Retinoblastoma: what are our challenges? Can we do better? Anna Sanyiwa

1330 How and when to examine a child? John Onyango?

1400 Congenital cataract – surgical tips and postoperative care Ibrahim Matende

1430 Questions & answers AS, JO, IM

1500 Afternoon Tea

CPD - Cornea Chair: Elisante Muna

1530 Herpetic eye disease Geoffrey Tabin

1600 Keratitis Simon Arunga

1630 Corneal transplantations – what’s next? Elisante Muna

1700 Questions & answers GT, SA, EM

1730 Break


Room 3 CPD - Management of Retinal Diseases

Chairs: Githeko Kibata, William Makupa

1300 Introduction Chair, presenters

1310 Interface diseases Louis Kruger

1335 Posterior complications of anterior segment surgery Bernard Wolff

1400 Endophthalmitis after intraocular procedures Silvia Bopp

1425 Practical management of diabetic macular edema Louis Kruger

1450 Questions & answers LK, BW, SB

1510 Afternoon Tea

CPD - Vitreoretinal Surgery Chairs: Githeko Kibata, Emeritus Chibuga

1530 Vitrectomy for proliferative diabetic retinopathy Silvia Bopp

1555 Basics of retinal detachment surgery Bernard Wolff

1620 Combined phaco-vitrectomy: why and how? Silvia Bopp

1645 Questions & answers BW, SB

1745 Break


KCMC / Exhibition area CPD - Phaco Introductory Course: Live Surgery & Wet Lab

Chair: Japhet Bright

1300 Departure for Live Surgery at KCMC Ramanuj Hitesh

1700 Return at Ngurdoto Mountain Lodge and start of wet lab Ramanuj Hitesh



Thursday Morning, 25th August 2016

Main Hall Glaucoma – complex problems in need for regional solutions

Chairs: Dan Kiage, Neema Kanyaro

0800 Outcomes of trabeculectomy among glaucoma patients in Uganda: a hospital based audit

Freddy Mbumba

Prevalence of blindness, diagnostic assessment and pattern of risk factors associated with glaucoma in patients attending Ruharo Eye Center

Byamungu Sakano

Factors associated with loss to follow-up among glaucoma patients who attended Kilimanjaro Christian Medical Centre

Jacquiline Mchilla

Questions & answers FM, BS, JM

0830 An approach to optic neuropathies Mike Burdon

0850 Is beta-radiation better than 5-fluorouracil as an adjunct for trabeculectomy surgery when combined with cataract surgery? A randomised controlled trial

Kazim Dhalla

Remote interpretation of optic nerve head cupping from images acquired using a new low cost retinal camera (epiCam)

Andrew Blaikie

Questions & answers KD, AB

0910 Challenges of managing advanced glaucoma Edward Deepak

Official opening of the 4th COECSA Scientific Congress 0930 Welcome announcements & Opening – President, TOS Cyprian Ntomoka

Welcome address – President, COECSA Ibrahim Matende

Official opening – Minister of Health, Tanzania Guest of Honor

1030 Morning tea, exhibition & poster presentations

Keynote speech 1100 Eye care challenges and opportunities in developing countries Kunle Hassan

Cornea – battling with infections and sequelae Chairs: John Nkurikiye, Elisante Muna

1130 Microbial keratitis in South Western Uganda: a hospital based retrospective chart review Gladys Atto

Epidemiology of Mooren’s ulcer at Ruharo Eye Centre, Southwestern Uganda; a hospital based retrospective study

Denise Kavuma

Pigmented fungal keratitis: a case report Einoti Matayan

Prevalence of keratoconus in patients with allergic conjunctivitis attending Kenyatta National Hospital

Stella Mugho

Questions & answers GA, DK, EM

1210 Update on Trachoma Matthew Burton

1230 Impact of Trichiasis Surgery on Quality of Life: a longitudinal study in Ethiopia Esmael Habtamu

Penetrating keratoplasty in Kenya: a review of indications and outcomes over a 2-year period

Abba Hydara

ReLex Smile compared to PRK and (Femto-) Lasik Harald Gaeckle

Questions & answers EH, AH, HG



Thursday Morning, 25th August 2016

Room 1

Training & Education 0800 JOT: Empowering students and educators worldwide to engage using cutting edge

technology Mahmood Dhalla

0830 ICO fellowships and examinations Clare Davey

0930 [Official opening of the 4th COECSA Scientific Congress in Main Hall]


1100 [Keynote speech in main hall]

Training the trainers (TTT)

1130 Training the trainers (TTT) Melanie Corbett


Room 2

Alcon Symposium Room 0800 Journey of MIVS in Africa : 27 G VR system Nilesh Kanjani

0815 Express mini shunts : new hope for glaucoma Ciku Mathenge

0830 Target 20/20 : Refractive IOLS Neera Kanjani

0845 Anti VEGF : cutting edge tool in medical retina Asiwome Seneadza

0900 Magic of Toric IOLS C S Geetha

0915 Questions & answers NK, CM, NK, AS, CSG

0930 [Official opening of the 4th COECSA Scientific Congress in Main Hall]



Young ophthalmologists’ forum Practical leadership tips for young ophthalmologists Chairs: Simon Arunga, Christopher Mwanansao

1130 Advocacy in eye care: the latest in the USA Sidney Gicheru

1200 Excelling in Ophthalmology as a carrier for young Ophthalmologists Jay Chhablani

1230 Practical leadership tips for young ophthalmologists Ciku Mathenge


Notes


Thursday Afternoon, 25th August 2016

Main Hall Cataract management – improving quality and quantity

Chairs: Amos Twinamasiko, Levi Kandeke

1400 IOL options in aphakia today – glued IOL, claw IOL, SFIOL Manoj Khatri

1430 Cataract pre-operative workup among COECSA countries Lindsay Hampejsková

Efficacy of Manual Small Incision Cataract Surgery in Hospital based eye camps in Eastern Province of Rwanda

Egida Seba

Questions & answers MK, LH, ES

1450 Posterior capsule rupture – the way to go M Nivean

1510 Outcome of age-related cataract surgery at Mbingo Baptist hospital eye unit, North West Region, Cameroon

Beyiah Pius

Cataract surgery in patients with very small pupils: know the risks, avoid the complications

S Briesen

Questions & answers MN, BP, SB

Ophthalmology Gladiators

1530 Sponsored symposium Ciku Mathenge

1630 Afternoon Tea

COECSA AGM

1715 COECSA AGM Ibrahim Matende

Room 1 Training the Trainers (TTT)

1400 Training the trainer (TTT) – Course (continued)

Melanie Corbett

1630 Afternoon Tea

Room 2 Allied Health Professionals Session

Nursing in eye care Chairs: Apaisaria Kiwia, Emelda Lwena

1400 The 3 NT technique Kazim Dhalla

1430 Low vision aids for visually impaired Aimbora Kimaro

1500 Care of ophthalmic micro instruments Rose Shirima

1530 Triage systems in eye care Emelda Lwena

1600 Questions & answers KD, AK, RS, EL

1630 Afternoon Tea


Friday Morning, 26th August 2016

Main Hall Retina – challenges and opportunities

Chairs: Githeko Kibata, Asiwome Seneadza

0800 The outcomes of laser treatment for diabetic retinopathy in Malawi: towards developing a systematic service

Petros Kayange

Assessment of Diabetes and Diabetic Retinopathy Services in Tanzania Mainland Bernadetha Shilio

Diabetic Retinopathy among adult diabetic patients at the Muhimbili National Hospital with no prior ophthalmic consultation for diabetic retinopathy

Aza Lyimo

Questions & answers PK, BS, AL

0830 The Diabetic Retinopathy Network – DR-NET.com Nick Astbury

Managing cluster endophthalmitis cases after Intravitreal Bevacizumab (Avastin) injection

Shaileen Parikh

The paradigm shift: management of diabetic macular edema Asiwome Seneadza

Questions & answers NA, SP, AS

0900 Management of AMD Jay Chhablani

0930 Visual outcomes for rhegmatogenous retinal detachment patients who underwent surgery and determinants for success at KCMC eye department

Majala Jafar

Persistent pseudophakic cystoid macular edema – risk factors and intravitreal treatment options

David Schell

Outcome of posterior segment injuries after ocular trauma at the vitreoretinal unit in Kikuyu Eye Hospital

Grace Nguyo

Questions & answers MJ, DS, GN

1000 Recent advances in retinal imaging Jay Chhablani

1025 Announcement of WOC 2020 in South Africa Kgao Legode


Keynote speech

1100 Partnerships and Synergies in Eye Health Carrie MacEwen

Community ophthalmology, VISION 2020 & management of Eye Care Chairs: Jefitha Karimurio, Ciku Mathenge

1130 Human Resources for Eye Health Ronnie Graham

Announcement of IAPB 10th General Assembly in Durban, South Africa Ronnie Graham

1150 Perception and willingness of MUHAS undergraduate medical students to pursue ophthalmology as a career and factors influencing their decision June-Aug 2015

Zainab Hassan

COECSA country participation in the Commonwealth Clinical Fellowship Programme Nick Astbury

To what extent has Burundi achieved VISION 2020, “The Right to Sight” global initiative, targets for eye service delivery?

Jean Niyonzima

Questions & answers RG, JN, ZH, NA

1215 Key aspects of a successful partnership in Eye health - tips from the CBM eye health advisor for East Africa region

Demissie Tadesse

1230 Madagascar financial data utilisation project Peter Kileo

Facial cleanliness and prevention of cross-border spread of infection are needed in the final push to eliminate active trachoma

Jefitha Karimurio

New WHO Guidelines for stopping mass drug administration the verifying elimination of human onchocerciasis (river blindness)

Tony Ukety

Questions & answers DT, PK, JK, TU




Room 1

Innovations in eye care Chairs: Hillary Rono, Grace Mutati

0800 Arclight vs Keeler: an Ophthalmoscope Showdown Monica Hytiris

Diabetic retinopathy screening; Quantitative clinical comparison of a low-cost, solar-powered pocket ophthalmoscope (Arclight) with a traditional device in Malawi

Andrew Blaikie

Validity of a portable eye examination kit (Peek) compared to a gold standard fundus camera in grading patients with diabetic retinopathy at KCMC eye clinic

Christopher Mwanansao

Questions & answers MH, AB, CM

0830 Anterior approach white line advancement (WLA) ptosis surgery: long term results and patient satisfaction from a large series

Ben Parkin

Visual & refractive outcome after trifocal intraocular lens implantation Shrikant Dalwadi

Central corneal regularisation followed by collagen cross-linking: a new modality in the treatment for keratoconus

Mukesh Joshi

Questions & answers BP, SD, MJ

Short Break

The eye and systemic disorders Chairs: Nkundwe Mwakyusa, Petros Kayange

0900 Awareness of HIV/AIDS ocular manifestations among people living with HIV/AIDS attending the HIV clinic at Muhimbili National Hospital

Frank Patrick

The prevalence of ocular manifestations and visual impairment among adult HIV/AIDS patients in South Western Uganda; a hospital based study

Amos Twinamasiko

Patterns of contrast sensitivity abnormalities in HIV positive children attending Harare Central Hospital’s paediatric Opportunistic Infections clinic

Tendayi Mutungamiri

Questions & answers FP, AT, TM

0930 Presentation and Outcome of Uveitis among Patients in Ruharo Eye Centre, Uganda Emmanuel Agwella

Outcomes of sympathetic ophthalmia at a tertiary care centre in Southern India Hatim Yusufali

Ophthalmic findings and visual rehabilitation in people with albinism – a project report

Shaileen Parikh

Questions & answers EA, TU, HY

1000 The pupil Mike Burdon



Opthalmic Oncology & Oculoplastics – learning from challenging cases Chairs: Stephen Gichuhi, Anna Saniywa

1130 How to create and manage a national or regional ocular pathology service Edward Deepak

1150 Delay along the care-seeking journey of patients with ocular surface squamous neoplasia in Kenya

Stephen Gichuhi

Questions & answers ED, SG, HR

1210 Gaps in essential retinoblastoma care in Africa Lindsay Hampejsková

One RB World Online: A Virtual Retinoblastoma Clinic Helen Dimaras

Outcome of globe preservation therapy in patients with bilateral retinoblastoma at the Kenyatta National Hospital, Kenya

Rebecah Namweyi

Questions & answers LH, HD, RN

1240 Pterygium Pearls Hitesh Ramanuj




Room 2 Training course in cleaning and care of ophthalmic equipment 0800 Short free course aimed at ophthalmologists and equipment support technicians. It

includes an overview of common ophthalmic equipment and how to handle its maintenance, cleaning and repair.

Terry Cooper



Allied Health Professionals Session

Assistant Medical Officers Ophthalmology Chairs: Irma Makupa, Elisante Muna

1130 Transition from ECCE to SICS – tips and tricks Hassan G Hassan

1150 Vitreous management for anterior segment surgeons Emeritus Chibuga

1210 When to refer your patient to a vitreoretinal clinic Kazim Dhalla

1230 Congenital cataract – what role to play Judith Mwende

1250 Questions & answers HGH, EC, KD, JM


Notes


Friday Afternoon, 26th August 2016

Main Hall Keynote speech

1400 Ophthalmology in Eastern Africa – a historical view on challenges and opportunities Milka Mafwiri

Paediatric ophthalmology – saving and improving lives Chairs: Bernadetha Shilio, Kahaki Kimani

1430 Impact of provision of photochromic prescription glasses and educational support on the academic performance of children with albinism in Kenya

Prabha Choksey

Ocular morbidity and blindness among children in Southern Tanzania: prevalence and causes

Milka Mafwiri

Profile of amblyopia at Sabatia Eye Hospital Maria Wanyonyi

Questions and answers PC, SP, MW

1500 Towards a global standard of care for retinoblastoma: challenges & opportunities for the COECSA region

Helen Dimaras

1520 Outcomes of Surgery for Primary Congenital Glaucoma in Kenya: a Multicentre Retrospective Case Series

Jalikatu Mustapha

The Situation Analysis of Child Eye Health in Uganda Anne Musika

Prevalence and factors associated with childhood visual impairment among children attending Mulago National Referral Hospital, Uganda

Patience Kinengyere

Prevalence of strabismus and outcomes of its management among children attending Ruharo Eye Centre, Uganda: a hospital based retrospective audit

Seraphine Ntizahuvye

Questions & answers HD, MM, AM, PK,SN

1600 A review of severe ocular trauma in children hospitalised at Sabatia S Esevwe

Incidence and risk factors of retinopathy of prematurity among low birth weight children at Kilimanjaro Christian Medical Centre

Theophile Tuyisabe

Retinopathy of prematurity: prevalence and risk factors among infants in rural Kenya Sarah Sitati

Prevalence of retinopathy of prematurity (ROP) among infants born in Nairobi hospital

Oscar Onyango

Questions & answers SE, TT, SS, OO


Notes


Friday Afternoon, 26th August 2016

Room 1 Increasing access, quality and volume of cataract surgery services in Sub

Saharan Africa – lessons from an entrepreneurial initiative Chairs: Sasipriva Karumanchi, Dan Kiage

1430 Hilton Cataract Initiative in Sub-Saharan Africa - Project design, inputs, key intervention strategies and expected outcomes

Sasipriva Karumanchi

1445 Converting need to demand for cataract services in African settings – what makes it work?

Dan Kiage

1500 Practice protocol and monitoring to enhance cataract surgical visual outcomes Fitsum Bekele

1515 Key considerations to ensure financial viability Kibata Githeko

1530 Challenges in developing high volume sustainable eye care providers and the way forward

Kunle Hassan

1545 Panel Discussion SK (moderator), DK, FB, KG, KH


Room 2 Open vitreo-retinal surgeons sub-specialists meeting

Chairs: Kazim Dhalla, Jafferji Shafiq

1430 Complex vitreo-retinal surgeries Jay Chhabblani

1500 Round table discussion on: - DR management protocols for COECSA region? - Introducing the Kenyan Vitreoretinal Society - Research collaboration with LVPEI-COECSA?

All VR subspecialists are invited to discuss, all delegates are invited to attend.


Notes


Speakers of Invited Presentations & Committee Chairs Arunga, Simon Dr. Arunga is a lecturer at the department of ophthalmology Mbarara University of Science and Technology, Uganda, and a consultant ophthalmologists at the Referral Hospital Eye Centre.

Bopp, Silvia PD Dr. med. Silvia Bopp is senior consultant at the Augenklinik Universitaetsallee MVZ, Bremen, Germany. She did her medical studies in Wuerzburg and Luebeck from 1975-1981 and made her doctorate on nephrotoxicity of aminoglycosides. During her residency at the university of Luebeck she already focussed on the vitreoretinal field (director: Prof. Horst Laqua) and continued subspecialization over the following years (1981-1993). Her basic scientific work in Luebeck was subsumed in her habilitation on „Lectin histochemical findings of normal human retina and in proliferative vitreoretinal disorders“. In 1993 she founded the first outpatient vitreoretinal clinic in Bremen, Germany, together with Klaus Lucke. In

Bremen she continued clinical scientific projects and worked on various subjects, ranging from anterior to posterior segment diseases to improve surgical techniques with respect to safety and efficacy and quality management. Her surgical experience consists of more than 20000 intraocular procedures, both in the anterior and posterior segment. Furthermore, she is member of numerous scientific societies. Her publication list comprises more than 550 papers as 1. author and about 70 scientific articles and book chapters. She esteems teaching an important task to pass knowledge and performs courses regularly at national and international meetings. Further tasks include participation in multicenter studies and advisory boards.

Burdon, Michael FRCOphth FRCP(Edin) Consultant Neuro-Ophthalmologist, University Hospital Birmingham, Birmingham, UK Michael Burdon is a consultant ophthalmologist with an interest in neuro-ophthalmology at the Queen Elizabeth Hospital, Birmingham. He underwent subspecialty training in Brisbane, St Thomas' Hospital, Moorfields Eye Hospital, and the National Hospital for Neurology and Neurosurgery. He is Chairman of the Royal College of Ophthalmologists Scientific Committee and the British Isles Neuro-Ophthalmology Club. He has an established reputation as a teacher of neuro-ophthalmology, speaking at numerous national and international meetings, and co-authoring "The Neuro-Ophthalmology Survival Guide" with Anthony Pane and Neil Miller. He has extensive experience in the diagnosis and management (including surgical correction) of adult motility disorders. His main research interests are papilloedema

and idiopathic intracranial hypertension. Since nearly 10 years he was active in establishing and maintaining an active link between KCMC eye department and University Hospital Birmingham with numerous bilateral visits and exchange of knowledge and experience.

Burton, Matthew Matthew Burton is Professor of International Eye Health at the London School of Hygiene & Tropical Medicine. He is an Ophthalmologist, whose main research focus is on trachoma and corneal infection. He qualified in medicine from Cambridge University and did his post-graduate training in Oxford and at Moorfields Eye Hospital, London. From 2001 to 2004 he worked as a clinical research fellow based at the MRC Laboratories in The Gambia. He was subsequently based at the Department of Ophthalmology, KCMC Hospital, Moshi, Tanzania, from 2008 to 2012. Matthew holds a Wellcome Trust Senior Research Fellowship in Clinical Science which supports research on the control and pathogenesis of blinding trachoma in Ethiopia and Tanzania. Matthew is Director of the Commonwealth Eye Health Consortium and an Honorary Consultant Ophthalmologist at Moorfields Eye Hospital in London.

Chhablani, Jay Jay Chhablani completed his master’s in ophthalmology from Kasturba Medical College, Mangalore. He did a clinical vitreo-retina fellowship at Sankara Nethralaya, Chennai. He was an International Council of Ophthalmology (ICO) fellow at Jules Gonin Eye Hospital, Switzerland, in 2009 and a Clinical Instructor at the Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, USA (2010 to 2012) before he joined L V Prasad Eye Institute, Hyderabad, India as faculty. His areas of interest are macular disorders and recent imaging techniques. He has published more than 150 articles in peer-reviewed journals and several non-peer reviewed articles. He is a reviewer for journals such as IOVS, Retina and Experimental Eye Research. He has received several awards including honor awards from American Society of Retina Specialists. He has received travel awards from Association for Research in

Vision and Ophthalmology (ARVO) and Asia Pacific Ophthalmology Society. He is on the editorial board for Indian Journal of Ophthalmology, PLOS One, and Clinical Ophthalmology. He is associate editor for BMC Ophthalmology. He is member of Global ONE network committee of American Academy of Ophthalmology.

Chibuga, Emeritus Emeritus Chibuga is a consultant ophthalmologist, with a subspecialty interest in vitreoretinal surgery, from CCBRT in Dar es Salaam, Tanzania. In addition to his varied medical and surgical practice, Emeritus enjoys his role in training the next generation of ophthalmologists. Prior to his current post, Emeritus worked as a consultant ophthalmologist at King Faisal Hospital in Kigali, Rwanda. After completing his undergraduate training at the University of Dar es Salaam in 1995, Emeritus went on to graduate from Kilimanjaro Christian Medical College – Tumaini University, Moshi in 2005. Emeritus obtained a Master of Public Health degree in 2013 from the University of Western Cape in South Africa.

Emeritus is the current treasurer of COECSA.


Cooper, Terry Terry Cooper is a Regional Manager for Volk Optical with responsibility for managing it's business in Europe and Japan. Volk Optical is the leading global supplier of diagnostic, laser and surgical ophthalmic lenses. Terry is also a dedicated charity worker as well as a professional documentary and portrait photographer with a special interest in documenting the impact of diabetic retinopathy, HIV/AIDS and Ebola Virus Disease on the people of Africa.

Corbett, Melanie Miss Melanie Corbett is a Consultant Ophthalmologist at the Western Eye Hospital, UK, where she provides specialist cataract, corneal and ocular surface services for the whole of West London. She also leads the Medical Contact Lens Service. Miss Corbett is responsible for the training both junior ophthalmologists and their trainers, both locally for the London Deanery and nationally for The Royal College of Ophthalmologists. She has run her popular ‘Training the Trainers’ programme also for COECSA fellows for the past three years.

Davey, Clare Clare Davey was appointed as consultant ophthalmologist at the Royal Free Hospital, London in 1987. She specialised in medical and surgical ophthalmology and set up the diabetic retinal screening service to the local population. Later she specialised in medical Retina. She took on a teaching and education role in the Hospital and became deputy director of postgraduate medicine, at the Royal Free, and increasingly involved in the London teaching programme and the Royal College of Ophthalmologists. She became the head of the Part 1 FRCOphth exam. She is the lead consultant for the Royal Free arm of the VISION 2020 Link between Mulago Hospital and the Royal Free Hospital, with Grace Ssali she maintains an active and enjoyable link.

She is now the deputy head of exams for the International Council of Ophthalmology and Head of the International Committee at the Royal College of Ophthalmologists, and so is very involved with the COECSA link.

Dean, William Will is a UK-trained ophthalmologist, with a special interest in glaucoma, cataract and surgical education. After working in Nkhoma Mission Eye Hospital, Malawi, for 4 years; he completed his specialist training in Bristol, UK; and attained a Masters degree in surgical education at Imperial College London. He will continue his passion in global blindness prevention, commencing a PhD in 2017 through the London School of Hygiene and Tropical Medicine: looking at the role of simulation-based surgical training in glaucoma and small-incision cataract training in Sub-Saharan Africa. When not working, teaching, or travelling extensively around Southern Africa; Will enjoys cycling, writing music, and spending weekends with family and friends.

Deepak P. Edward Deepak P Edward, M.D. FACS, FARVO is the Jonas S. Friedenwald Professor of Ophthalmology and a Professor of Pathology at the Wilmer Eye Institute and the Executive Medical Director at King Khaled Eye Specialist Hospital in Riyadh, Kingdom of Saudi Arabia. Dr. Edward is an active clinician who maintains a busy clinical and surgical schedule for the treatment of advanced and complex glaucoma. He has been listed in the Best Doctors in America list for many years. He has a wide range of research interests in the fields of ophthalmic education, glaucoma, ophthalmic pathology, biomarkers, cell biology and proteomics. He has over 190 publications including those in Nature Medicine and Genetics. Dr Edward has memberships in a number of professional societies including the prestigious Verhoeff-Zimmerman

Society, and the American Ophthalmological Society. He is also Editor in Chief of Middle East African Journal of Ophthalmology and is on the editorial board of several other journals and publications. Dr Edward is an innovative educator and has been awarded several teaching awards during his career including a Lifetime teaching award at the University of Illinois. He has been instrumental in initiating a web based teaching program for ophthalmology for 3 Universities in Nigeria for the Middle East Africa Council of Ophthalmology.

Dhalla, Kazim Dr. Dhalla was born in Zanzibar and has been trained at various institutions in and outside Tanzania and Africa. He is currently a senior consultant ophthalmologist and vitreoretinal surgeon at the CCBRT hospital in Dar Es Salaam

Dimaras, Helen Dr. Helen Dimaras is Director of Global Eye Health Research in the Department of Ophthalmology & Vision Sciences at The Hospital for Sick Children, and Scientist in the Child Health Evaluative Sciences program, SickKids Research Institute. She also holds positions as Assistant Professor in the Department of Ophthalmology & Vision Sciences, Faculty of Medicine, and Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto; and Honorary Lecturer in the Department of Human Pathology at the University of Nairobi. She has a PhD in Molecular & Medical Genetics, and completed post-doctoral training in clinical trials and global health Dr. Dimaras’ research spans the disciplines of global health, cancer genetics and clinical science. Her studies have

contributed to the understanding of the molecular genetic development of the childhood eye cancer, retinoblastoma. She is currently studying approaches to reduce the global retinoblastoma health equity gap that results in poor survival in much of the world.


Dr. Dimaras teaches undergraduate courses in genetics and global health in the Human Biology Program, and a module on technology & innovation for global health within the Global Health Education Initiative at the University of Toronto. Her interest in global health education has also led her to study the ethics of voluntourism and global health study abroad/service learning experiences.

Fisseha, Admassu Gondor, Ethiopia

Gicheru, Sidney Dr. Sidney Gicheru is an ophthalmologist working in Texas, USA, he has a wide array of experience with LASIK, PRK, Laser Cataract Surgery and Refractive Cataract surgery (including the TORIC and ReSTOR multifocal lens implant). He also performs Comprehensive eye exams, as well as Laser treatments for Glaucoma and Diabetes. He is a 2012 graduate of the Leadership Development Program of the American Academy of Ophthalmology. He has held leadership positions in many Ophthalmology institutions, including the Texas Ophthalmological Association (Past President). Dr. Gicheru received his undergraduate degree in Electrical Engineering and Pre-Medical studies from Southern Methodist University. He obtained his Medical degree from the University of Texas Southwestern Medical School.

Thereafter he completed his Medical Internship at the prestigious Beth Israel Hospital/Harvard Medical School program. He went on to complete his Ophthalmology Residency at the University of Texas Southwestern Medical Center. Dr. Gicheru has a love of teaching and helping the underserved. He has given lectures all over the world. For several years, our local medical school has awarded him an Outstanding Service Award for his work teaching young surgeons. He has volunteered his skills and time in Thailand, the Philippines, Kenya, South Africa, China, Japan and Haiti. On a personal note, Dr. Gicheru was born in Superior, Wisconsin. He has lived in the DFW metroplex for over 30 years. He is married with 2 children. For recreation, he enjoys long distance running, cycling, swimming, world travel and electronic gadgetry.

Hassan, G Hassan A graduate of Mmed Ophth from Tumain University, KCMC Medical College - Moshi Tanzania in year 2006. Worked as an Ophthalmologist at KCMC Eye Department (Sept 2006-June 2008). From July 2008 – Nov 2010 he was working as Head of Ophthalmology Department at Dodoma Regional Referral Hospital also at capacity of Regional Eye Care Coordinator (REC) for Dodoma region. From 2009 to 2013 he was a Chairperson of then Ophthalmological Society of Eastern Africa (OSEA) Tanzania Chapter. In Jan 2011 he joined CCBRT Hospital in Dar es Salaam and two years letter he was the Head of Ophthalmology Department up to Nov 2015. For the past 10 years he has lead different teams to great successes in setting glaucoma clinics for better

management of glaucoma patients. Dr Hassan has dedicated most of his time by continuously improving his knowledge and skills by attending several conferences and seminars both within the country and abroad. Throughout his career in ophthalmology he has been a tireless mentor to different levels of students including Mmed residents in Ophthalmology, AMO-Ophthalmology, and nurses in several Eye Departments he has been working. Currently Dr Hassan is working as a Director, practicing Ophthalmologist and Consultant Eye Surgeon at New Vision Specialist Eye Clinic in Dar es Salaam.

Kanyaro, Neema Neema is a consultant ophthalmologist and Glaucoma specialist in the department of ophthalmology at Muhimbili National hospital. She completed her residence in ophthalmology 2010 at Muhimbili University. She did her Glaucoma fellowship at LV.Prasad Eye Academy in India. She has participated in the writing of the COECSA glaucoma management guideline. She is an active member of Glaucoma communities of practice COECSA and the General Secretary of Tanzania Ophthalmology Society.

Khatri, Manoj Manjo Khatri completed his MBBS from Nagpur University with a distinction in Ophthalmology and his Diploma in Ophthalmology (DO) from Chennai University and adjudged as best Outgoing Postgraduate. Subsequently, after finishing his DNB (Diplomate Of National Board in Ophthalmology), he did his Vitreo-Retina fellowship from the prestigious L V Prasad Eye Institute, Hyderabad and later on a Clinical and Research fellowship in Vitreo-Retina and Uveitis from the esteemed Sankara Nethralaya, Chennai. During his tenure as a fellow he worked extensively on the SNDREAMS (Sankara Nethralaya Diabetic Retinopathy Epidemiological and Molecular Genetics Study) project. He has achieved a certification in Basic and Clinical Sciences in Ophthalmology from the International Council of

Ophthalmology (ICO), UK and The Royal College of Physicians and Surgeons of Glasgow (FRCS Glasg), UK. He is also a Fellow of All India Collegium of Ophthalmology in Retina and Vitreous (FAICO). He has published several papers in peer reviewed scientific journals, presented widely nationally and internationally at various scientific forums. He is also a Principal investigator and Co-investigator of various drug trials in Ophthalmology and a DNB (Diplomate Of National Board in Ophthalmology) teaching cum thesis guide.

Kimaro, Aimbora Aimbora is currently working at KCMC Eye department as low vision therapist, pediatric optometrist and orthoptist. She is also a part time tutor, supervisor and mentor of optometry students at the KCMC School of Optometry. She started working at KCMC in 2006. Aimbora Kimaro was the first female graduate in Tanzania with a Bachelor of Science in Optometry. She did her B.Sc. in Optometry at Lotus college of Optometry, Mumbai India from 2008 – 2011. Before her bachelor she did a diploma in Optometry at KCMC School of Optometry, Moshi, Tanzania and graduated in 2005. She also did a Bausch & Lomb contact lens course from Jan-June 2011 at Mumbai India. In August 2012 she went for training in orthoptics at University Hospitals Birmingham, UK, as part of the LINKS program. Aimbora is a member

of the Tanzania Optometrist Association (TOA) and among the speakers in TOA conferences.

Kruger, Louis


Kunle, Hassan Dr. Kunle Hassan is an international acclaimed, Ophthalmic Surgeon with wide experience in Vitreo-Retina Surgery, Glaucoma, Anterior Segment, Cataract and Ocular Plastic Surgery. He is the President, African Ophthalmology Council and Board Member International Council of Ophthalmology.

Lufunga, Ng’hungu Dr Ng'hungu Lufunga Kuzenza (MD MMED MUHAS)

TOS Treasurer

Head Department of Ophthalmology, Singida Regional Referral Hospital,

Regional Eye Care Coordinator

Lwena, Emelda Highly qualified and experienced Graduate Registered Nurse, with a total of nineteen years working experience in different areas as a Ophthalmic nurse, reproductive and child health nurse, eye service coordinator, Clinical Nurse, clinical instructor, nurse trainer and Nurse Manager. My professional work experience includes reproductive health, orthopedic nursing, paediatric nursing, ophthalmic nursing, nursing leadership and coordination. I have worked with private institution and NGO; have actively been involved in implementing change at the hospital setting, co-ordinate different groups of staff and conduct eye training to nurses.

MacEwen, Caroline President RCOphth and Consultant Ophthalmologist, Ninewells Hospital, Dundee Professor Caroline (Carrie) MacEwen is a Consultant Ophthalmologist at Ninewells Hospital, Dundee and Head of the Department of Ophthalmology at the University of Dundee. She trained in Glasgow, Dundee and London and her subspecialty clinical interest lies in the field of eye movement disorders and squint. Research interests include epidemiology of ocular trauma, paediatric eye disease and the clinical management of strabismus. She has published more than 140 papers and written and contributed to textbooks for both undergraduate students and qualified doctors. She has an interest in sport and exercise medicine and was made an honorary fellow of the Faculty of Sport

and Exercise Medicine in 2012. She is an Associate post-graduate Dean in the East of Scotland for flexible medical post graduate training.

Mafwiri, Milka COECSA 2016 Keynote Speaker: “Ophthalmology in East Africa: decades of challenges and opportunities” Dr Milka Madaha Mafwiri is an Ophthalmologist and Senior Lecturer in the Department of Ophthalmology at Muhimbili University of Health and Allied Sciences (MUHAS). She did a Master of Science in Community Eye Health at the London School of Hygiene & Tropical Medicine in 2010 and graduated as MMed Ophthalmology in 1990 at the Faculty of Medicine of the University of Dar-es-Salaam. She was the Associate Dean for Undergraduate Studies at the School of Medicine of MUHAS from 2011-2015. Previous to these positions she had worked as head of the eye department at MUHAS as well as CCBRT Hospital

where she was involved in Paediatric Ophthalmology. She has published 22 articles in international peer-reviewed journals in various fields of ophthalmology including a publication on risk factors for endemic optic neuropathy in Tanzania. She has done numerous consultancies in International Ophthalmology and served as an external examiner in several postgraduate training programmes.

Marco, Sheila, MBChB, MMED (Ophthal), FEACO, Glaucoma Specialist Dr Sheila Marco is a Consultant Ophthalmologist and Section Head at the Ophthalmology Unit, Aga Khan University Hospital in Nairobi. Previously she worked as senior lecturer at the department of ophthalmology of the University of Nairobi. She did a glaucoma fellowship with Professor Karim Damji at the University of Alberta, Canada. She is also a Fellow of EACO since 2009 and finished her Masters in Medicine Ophthalmology at the University of Nairobi 2006. Her areas of interest include Adult and paediatric glaucoma; glaucoma based research; teleophthalmology; development of glaucoma guidelines for Eastern and Central Africa region and cataract surgery.

Mathenge, Ciku Honorary Professor of Ophthalmology at University of Rwanda; Consultant Ophthalmologist Rwanda International Institute of Ophthalmology & Dr Agarwal's Eye Hospital, Kigali ; Regional Medical Advisor, Fred Hollows Foundation.

Mwakyusa, Nkundwe Dr. Nkundwe Mwakyusa is the National Eye Care Program Manager at the Ministry of Health, Community Development, Gender, Elderly and Children since 2009. She qualified as an Ophthalmologist in 2003 from Muhimbili University College of Health Sciences, Tanzania. Dr. Mwakyusa is a founder fellow of COECSA. In 2007, she received a Master’s of Public Health from the Royal Tropical Institute in the Netherlands. She is also an Afya Bora Global Health Leadership fellow. Dr. Mwakyusa is experienced in developing national eye care strategic plans. Nkundwe has extensive experience in Control of Neglected Tropical Diseases. She has spearheaded the designing of an eye care services management information system for Tanzania as well as two eye care projects; Strengthening Eye Care Coordination and Strengthening Child Eye Health services. These projects have contributed significantly in raising


the profile of eye care within the health care system in Tanzania. Dr. Mwakyusa’s work contributes significantly to prevention of blindness in the country.

Mwende, Judith Dr Judith Kivugo Mwende worked at Bombo Hospital in Tanga Region till 1987, where she left for further studies in Bulgaria from 1987 to 1994, where she graduated as a Medical Doctor. On returning to Tanzania she joined the Muhimbili National Hospital for an Internship, and Morogoro Regional Hospital as a General Practiotional till 2000, when she joined the Tumaini University for Masters degree in Medicine specializing in Ophthalmology. She graduated in 2004 as an Ophthalmologist , She worked at CCBRT Hospital where She joined a Fellowship in Paediatric Ophthalmology. Currently she is working at Muhimbili National Hospital as a Paediatric Ophthalmilogist. She has been an External Examiner for Assistant Medical Officer in Ophthalmology ( AMO-O) for three years. She is also a National Trainer in

Childhood Eye Health - training Health Workers ( different cadres) and Primary School Teachers. Because she is working at the National Hospital is also engaged in Training the Residents and Undergraduates. She is married to an Engineer with three children.

Nivean, M Dr. M.Nivean finished Vitreo-Retinal Fellowship- Sankara Nethralaya , Chennai, 2009-2011, M.S (Ophthalmology) He worked at Aravind Eye Hospital , Madurai , India 2005-2009. Dr. M. Nivean is a well-trained ophthalmic surgeon in both Anterior and Posterior segment surgeries. He had his Basic training in Ophthalmology (M.S,2009) in Aravind Eye Care System, Madurai, one of the most Premier Institutes for Post Graduation, under the able guidance of Dr. Prajna .N.V. He did his Super Speciality Fellowship in Vitreous and Retina (FMRF, 2011) at Shankara Nethralaya ,Chennai, one of the renowned Institutes, under the able guidance of Dr. Lingam Gopal. He was 1st to perform live

3D cataract surgery in South India. Padhani, Dilawar Dilawar Padhani works as a lecturer in ophthalmology at Muhimbili Universith of Health and Allied Sciences (MUHAS) since 2006. He organized and attended many outreach eye camps as an ophthalmologist and organizer. He is a member of COECSA and Fellow of EACO.

Philippin, Heiko Consultant Ophthalmologist, Kilimanjaro Christian Medical Centre (KCMC), Tanzania Dr Heiko Philippin graduated from the University of Freiburg, Germany, in 2000 and completed his postgraduate ophthalmology training there afterwards. Since January 2007 he worked at the Sabatia Eye Hospital, Kenya, before moving in 2009 to the KCMC Department of Ophthalmology in Moshi, Tanzania. Currently, Dr Philippin is the Head of Postgraduate Training and the glaucoma subspecialist at KCMC Department of Ophthalmology. In 2011, Dr Philippin did an international glaucoma fellowship with Professor Peter Shah at the University of Birmingham, UK. His research interests are largely related to glaucoma and diabetic retinopathy. Among other research projects, he is currently involved in a trial exploring the role of laser treatment for glaucoma in Sub-Saharan

Africa (SSA) and in the Kilimanjaro Diabetic Retinopathy Screening Programme: a pilot project identifying challenges and exploring innovative solutions for diabetic retinopathy screening in SSA.

Ramanuj, Hitesh Dr Ramanuj is the Director of Raghuvir Eye Hospital in Ahmedabad and the president of the North Gujarat IHL. He has performed more than 25,000 cataract surgeries. He was involved in clinical trials of Medical Devices and pharmaceutical products. He is the former vice president of Gujarat Ophthalmological Society and Ahmedabad Ophthalmological Society. He has a MBBS from BJ Medical College, Ahmedabad (1991) and M.S. (ophthalmology) from BJ Medical College, Ahmedabad (1995).

Sandi, Frank Frankie is a Young Ophthalmologist, Clinical Instructor and Lecturer at The University of Dodoma, Tanzania. He is one of the potential future Ophthalmology leaders in the ECSA region and has passion to make eye health matters to be taken as a priority in Tanzania and around ECSA region, where blindness is rampant with little emphasis on its control. He is currently enrolled in Leadership development Programme under the AOC/ ICO. He was selected as a chairman of the 4th COECSA congress 2016 because of his outstanding organizational capacity, team working and other leadership attributes he is possessing.

Sanyiwa, Anna Dr Anna is a lecturer and Ophthalmologist at Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania .She has over 15 years experience in general ophthalmology. From 2009 through 2015, Dr Anna was the head of department of ophthalmology at MUHAS. Her main areas of clinical interest include community ophthalmology, neuropthalmology and paediatric ophthalmology with special interests in retinoblastoma. She is a team lead of the Tanzania Retinoblastoma (TRbT) team, a working group which was established in March 2016 as part of efforts to encourage early diagnosis through awareness campaigns and it spearheads to improve the quality of care of patients with retinoblastoma. Dr Anna holds two master degrees, Master of medicine in ophthalmology, Master of public health and diploma in

Global heath. She is one of the first batch beneficiaries of Commonwealth Eye Health Consortium 3 month clinical fellowships (paediatric ophthalmology). She is an active member and one of the founder members of COECSA.


Shilio, Bernadetha She is an Ophthalmologist working at the National Eye Care Program, Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania. She obtained her Medical Doctor degree from the Muhimbili University College of Health Sciences, University of Dar Es Salaam and later, postgraduate Masters of Science in Community Ophthalmology from the International Centre for Eye Health, University College London in 1999. She graduated as MMed Ophthalmology in 2002 at Kilimanjaro Christian Medical College of Tumaini University in Kilimanjaro. She was a Lecturer at Kilimanjaro Medical College and Centre from 2000 instructing Mid level eye Cadres and other health cadres and later on MMed Ophthalmology. She did a short fellowship course in Paediatric Ophthalmology at CCBRT in 2006. Dr. Shilio was the assistant head of the Department of Ophthalmology at Kilimanjaro Christian

Medical Centre. In that capacity, in addition to her work as an ophthalmologist, she oversaw activities of the department and coordinated medical doctor degree students. Dr. Shilio has performed research in Paediatric Ophthalmology and other Ophthalmology areas and published some in peer-reviewed journals. Before joining the Ministry in 2009, she was a country Director for International Trachoma Initiative- Tanzania office. Dr Shilio is currently more engaged in programmatic researches and capacity building that will bring positive impact the lives of most Tanzanians through evidence based advocacy as well as competency based performance in Ophthalmology area. Dr. Shilio is a founding fellow of COECSA.

Shirima, Rose Rose Shirima is a registered nurse in the KCMC eye department. She did a certificate course as ophthalmic assistant at Mvumi Hospital in 2002 and holds a degree of bachelor of science in nursing which she did from 2005 to 2008 at KCM College of Tumaini University, Tanzania.

Tabin, Geoffrey Dr. Tabin is a Professor of Ophthalmology and Visual Sciences, John E. and Marva M. Warnock Presidential Endowed Chair, and Co-Director of the Division of International Ophthalmology at the University of Utah’s John A. Moran Eye Center. He specializes in cornea, cataract and refractive surgery. He graduated from Yale College and earned an M.A. in philosophy at Oxford as a Marshall Scholar, followed by an M.D. from Harvard Medical School. Dr. Tabin is committed to providing quality ophthalmic care and education to all the patients he serves. He has traveled the world extensively conducting sight restoring surgeries and training local doctors. In 2009, Dr. Tabin was named an "unsung hero" by the Dalai Lama for his dedication to eradicating unnecessary world blindness and

implementing a model for sustainable ophthalmic care in the developing world. An avid mountaineer, Dr. Tabin was the fourth person in the world to climb the "7 summits," the highest point of all seven continents.

Tadesse, Demissie Demissie Tadesse is a senior Ethiopian ophthalmologist with over 20 years of clinical experience in Ethiopia and abroad. An anterior segment surgeon, who has collaborated with the ophthalmology departments of Addis Ababa & Nairobi Universities in training residents for many years. He is an established leader in promoting eye health and blindness alleviation programs in Eastern Africa, having provided transformational leadership as a Director of Sabatia Eye Hospital in Kenya for six years. During his tenure, Sabatia became one of the major high volume and self-sustaining ophthalmic surgical centres in Kenya. He is former President of the Ophthalmological Society of Ethiopia and Chair of the National Committee for

Blindness Prevention. Dr. Demissie presently serves as Eastern Africa Regional Eye Health Consultant and adviser for Christian Blind Mission International (CBM). He currently serves on various national eye health & Trachoma control committees and forums in promoting eye health in Ethiopia and the region.

Wolff, Bernard Current Position Private practice Vitreoretinal Specialist, Johannesburg Experience >5000 Retinal surgeries Vitreoretinal Fellowship Royal Victorian Eye and Ear Hospital, Melbourne, Australia 2009-2010 Opthalmology training Medical University of South Africa, 2002-2006 under Prof Robert Stegmann Qualifications MMed (ophth), Fellowship of the College of Ophth of SA, FC Ophth(SA) 2005

Yusufali, Mustafa Currently Dr Yusufali is working at Kairuki Hospital as well as Kairuki University as a lecturer for undergraduate students. He did his MMed Ophth at MUHAS, Dar Es Salaam, Tanzania where he graduated in 2014. He is a member of the Bohora Volunteers Institution where he organized various medical related events such as medical camps, stage programmes and presentations.


Abstracts New WHO Guidelines for stopping mass drug administration the verifying elimination of human onchocerciasis (river blindness) T Ukety Objectives: As many onchocerciasis endemic countries are approaching the end of intervention or treatment phase known as phase 1 using mainly ivermectin mass drug administration (MDA), WHO has developed and published new guidelines in January 2016 to assist ministries of health and their partners to stop MDA and conduct post-treatment surveillance of 3 to 5 years period prior of confirming interruption of transmission of Onchocerca volvulus parasite. Design and Methods: The development of this new tool was based on GRADE methodology. Results: The demonstration and confirmation of interruption of transmission of is mainly based on entomological assessment of O-150 PCR testing in black flies (Simulium species) to ensure that the upper bound of 95 % confidence interval for the prevalence of infective flies is less than 0.05 % and serological evaluation of Ov-16 IgG4 antibody in children under 10 years of age to detect a prevalence of less than 0.1 % at the upper bound of the 95 % interval. The guidelines also provide step by step standard operating procedures for endemic countries to prepare for the verification of elimination of human onchocerciasis before the acknowledgement of elimination by WHO Director General. Conclusions: This new tool should be now used in replacement of the 2001 WHO guidelines for certification of elimination of human onchocerciasis.

Patterns of contrast sensitivity abnormalities in HIV positive children attending Harare Central Hospital’s paediatric Opportunistic Infections clinic T Mutungamiri Objectives: Contrast Sensitivity (CS) is a function of vision. Vision. CS is affected by disease processes that affect individual structures of the eye and the visual pathway. Human Immune Deficiency Virus (HIV), Highly Active Antiretroviral Therapy (HAART), Opportunistic Infections (OI) and the drugs used in their treatment have an effect on the eye and the visual pathway. This makes HIV positive children more likely to have poor visual function than the general paediatric population, however there is limited data available on CS in HIV positive children both in Zimbabwe and sub- Saharan Africa. Objectives were 1.to characterise the patterns and quantify prevalence of CS abnormalities in HIV positive children and 2. to establish the existence and type of association between CS and CD4+ T cell count, WHO HIV clinical stage and previous anti-Tuberculosis treatment. Design and Methods: This was a cross sectional study of patients attending the Harare Central Hospital’s paediatric Opportunistic Infections Clinic, Harare, Zimbabwe. Systematic sampling was used to recruit participants. A structured questionnaire was used to gather patient information. A complete ocular examination was done inclusive of Visual acuity (Snellen chart), Contrast sensitivity (Pelli Robson chart), Slit lamp and dilated fundus examination. Results: 1. A total of 168 participants were enrolled into the study (age range 7-12 years). BCDVA was better or equal to 6/12 in 98.8% of the participants. 2. The mean Log CS was 1.71 (range 1.2-1.95), with a standard deviation of 0.12. 3. The prevalence of poor contrast sensitivity was 12.5%. 4. An association was established between poor contrast sensitivity and decreasing CD4+ T cell count (p=0.05). 5. Participants on HAART had a lower Log CS than those not on HAART (p=0.002). 6. Participants on second line HAART therapy had a lower Log CS than those on first Line HAART therapy, (p=0.02). 7. There was no associations established between previous anti TB treatment in participants and abnormalities in contrast sensitivity (p=0.63). Conclusions: This study showed that poor contrast sensitivity is common in HIV positive children, with decreasing CD4+ T cell count being associated with poor contrast sensitivity. Contrast sensitivity abnormalities were found to occur even with good visual acuity.

Pigmented fungal keratitis: a case report E Matayan, J Wilkes, H Philippin, M Burton Objectives: Fungal keratitis accounts for around half of the culture positive microbial keratitis cases in the East African region. These are most frequently Fusarium spp or Aspergillus spp., which are non-pigmented. Here we report an unusual case of pigment filamentary fungal keratitis. Design and Methods: A case report Results: A 63 year old man presented with a three week history of a left painful red eye with loss of vision (HM). There was not history of trauma or diabetes. On examination, there was an injected conjunctiva, pigmented epithelial plaque, stromal infiltrate (3x4mm) and no hypopyon. Corneal scraping for gram stain/KOH and culture showed a pigmented filamentary fungus. HIV test was negative. The subtype of fungus was not identifiable with lactophenol cotton blue mount of the culture. A final diagnosis of “unidentifiable pigmented fungus” was made. The patient was started on topical Ciprofloxacin and Econazole, Atropine, oral Doxycycline and itraconazole. The keratitis was resolving after 3 weeks following treatment. Conclusions: Keratomycosis is most commonly caused by filamentous fungi, which can be sub-divided into pigmented (dematiaceous) and non pigmented (moniliaceous) fungi. Pigmented fungal keratitis is often a clinical diagnosis, due to its characteristic appearance which can usually be differentiated from bacterial keratitis. Curvularia species are considered the commonest cause of pigmented fungal corneal ulcer. However, it is often difficult to identify the specific subtype of pigmented fungus. It is important that patients receive aggressive treatment, as pigmented fungus have an aggressive course and require often a surgical intervention. Natamycin is usually the first line topical antifungal


especially for superficial fungal keratitis . This case report highlights a relatively common cause of keratitis which can be a spot diagnosis if the described clinical signs are known by the clinician.

Outcome of posterior segment injuries after ocular trauma at the vitreoretinal unit in Kikuyu Eye Hospital G Nguyo Objectives: Ocular trauma is a significant cause of monocular blindness worldwide. Eye injuries involving the posterior segment have been a matter of concern particularly due to the related poor visual outcome. These injuries require specialised intervention and follow up care to achieve best possible visual outcome. The study aimed to give baseline information on outcomes of posterior segment eye injuries in a standard vitreoretinal setup in Kenya. Objectives were to review the outcome of posterior segment injury after ocular trauma at the vitreoretinal unit of Kikuyu Eye Unit. Design and Methods: Study Design: Retrospective case series. Materials and Methods: a structured questionnaire was the main data collection tool from hospital records. Data was analysed using SPSS. Subject demographics, interventions done after injury as well as outcomes after interventions were analysed using appropriate statistical tests. A 95% confidence level was used. Results: One hundred and six eyes of 102 patients were reviewed. Seventy nine eyes (74.5%) were closed globe injuries with retinal detachment and vitreous haemorrhage being the most common findings, at 49(46.2%) and 47 (44.3%) eyes respectively. Ninety nine eyes (92.5%) had surgical interventions done, with PPV and silicon oil fill done in 39 eyes (39.40%) which had retinal detachment. There was a marked improvement in the visual acuity from presentation and at final review after various interventions (p<0.001) with 39 eyes (37.9%) having a final visual acuity of 6/36 or better at final follow up. Retina was attached in 72.3% of eyes after retinal detachment surgery at final follow up. Eyes which had more number of surgical interventions done had a higher chance of a worse visual outcome (p= 0.049).The median follow up time was 5 months. Conclusions: Surgical and medical intervention is potentially vision saving in eyes with ocular injuries involving posterior segment with good outcome being achieved in eyes with extensive injuries.

Persistent pseudophakic cystoid macular edema - risk factors and intravitreal treatment options D Schell Objectives: Persistent pseudophakic cystoid macular edema (PCME) following cataract surgery is a known complication even after uneventful cataract surgery. A standard treatment regime is not established yet and may be a therapeutic challenge. Who are the high risk patients and what kind of alternative treatment options are available nowadays? Design and Methods: Based on clinical case examples of patients with PCME we show risk factors and treatment options. Results: As intravitreal therapy devices are commonly available they prove to be a good alternative compared with long term application of NSAID, corticosteroid eye drops and carbonic anhydrase inhibitor. Conclusions: The identification of high risk patients to develop a PCME demands an accurate pre-operative diagnostic, documentation, prophylactic treatment and a high post-operative attention. If a PCME occurs, an active disease management is crucial to obtain an early treatment response to assure a high contentment of the patient.

Awareness of HIV/AIDS ocular manifestations among people living with HIV/AIDS attending the HIV clinic at Muhimbili National Hospital F Patrick, C Mhina, A Sanyiwa, M Mafwiri Objectives: Approximately 70% of people living with HIV/AIDs will develop HIV ocular complications at some point during the course of their illness; and blindness occurs in 10%-20% due to cytomegalovirus infection among people living with HIV/AIDs. However, awareness of ocular manifestations of HIV/AIDS among HIV infected people in Dar-es-Salaam is not known. Objective to assess awareness of HIV ocular manifestations among people living with HIV/AIDS attending the HIV clinic at Muhimbili National Hospital in Dar-es-Salaam. Design and Methods: A hospital based cross-sectional study. Two hundred HIV infected people who were attending for services at the HIV/AID clinic between October to November 2015 were conveniently sampled for the study. Patients were interviewed on: demographic characteristics, whether they know HIV can affect their eyes, known symptoms due to HIV and whether they had had an eye exam. Analysis was aided by SPSS version 20 software. Results: 82(41%) of the respondents agreed that HIV/AIDs can affect their eyes. Symptoms mentioned to be due to HIV infection were swollen eyelids (51.2%, dry eyes (32.9%) itching and burning sensation (68.3%), painful eyes (51.2%) and visual loss or blindness (68.3%).Self-experience (39(47.6%) was the main source of awareness while only 25(30.5%) reported to have had the information from the health workers. Majority (95%) agreed that regular checkup is necessary but only 36(18%) had had an eye exam. Conclusions: Awareness about HIV/AIDS ocular manifestation among people living with HIV/AIDS is inadequate and is mainly acquired through self- experience. Efforts to establish education on HIV/AIDS ocular and other complications need be instituted in HIV/AIDS clinics in order to avoid loss of eyes and blindness.

Perception and willingness of MUHAS undergraduate medical students to pursue ophthalmology as a career and factors influencing their decision June-Aug 2015 Z Hassan, A Sanyiwa Objectives: There is little understanding on how different medical specialties are perceived by students and the impact of this perception on their career choices. Wrong perceptions and attitudes of medical students towards ophthalmology can be accounted as one of the reason as to why we have few ophthalmologists in the world. The WHO estimates that 90%of the blind people live in low-income countries, with the lack of an eye health workforce being a key factor to the high prevalence of avoidable blindness, in Sub-Saharan Africa the issue has reached crisis levels(WHO, 2010), In 2015 the total number of ophthalmologists in Tanzania was 45 with an uneven distribution of ophthalmologists in the regions, with Dar es Salaam alone having more than half the total number of ophthalmologists in the country. OBJECTIVE; To determine


the perception and willingness of undergraduate medical students to pursue ophthalmology as a career and factors influencing their decision of career choice. Design and Methods: it was a descriptive cross section study, recruited 246 fourth year and fifth year medical students at MUHAS. Convenience sampling method was used. Structured English questionnaire was used as an assessment tool. Data were entered and analyzed in SPSS software v20 Results: In this study 54% of respondents found ophthalmology interesting, 85% felt that it needs special skills and high accuracy, it has easy job opportunities(51.2%) and few working hours(68.3%). Also majority did not know the requirements for joining postgraduate training(40.2%). Forty six percent were willing to pursue a career in ophthalmology and among these majority had ophthalmology as their third choice. The greatest motivating factors were desire to help people with visual problems(67.8%) and its perceived few working hours which allow more time to spent with family(60.2%). Conclusions: Most of the respondents had ophthalmology as their third choice among the career they would like to pursue in future and it was preferred mostly for its perceived controllable lifestyle (few working hours) and for its noble practices which involves helping people with visual problems. However, the perceived high skills and accuracy required in the career was an important deterrent amongst many. Almost all students would like to have career orientation program in the university.

Diabetic Retinopathy among adult diabetic patients at the Muhimbili National Hospital with no prior ophthalmic consultation for diabetic retinopathy A Lyimo, J Kisimbi, C Mhina Objectives: Diabetes is a non-communicable disease affecting people of all races with the estimate of 381 million people living with diabetes globally. Its prevalence is increasing rapidly and is expected to double by the year 2030, especially in developing world. Retinal changes seen in patients with diabetes mellitus are referred to as diabetic retinopathy, a chronic progressive sight-threatening disease of the retinal microvasculature affecting up to 80 percent of all patients who have had diabetes for 10 years or more. Diabetic retinopathy has little or no symptoms until visual loss develop, signifying regular screening. The methods for screening and treatment are available and effective. This study aimed at providing the magnitude and severity of the diabetic retinopathy among diabetic patients who had never been screened for diabetic retinopathy. Design and Methods: This was a cross-sectional descriptive hospital based study done at diabetic clinic in Muhimbili National Hospital. Diagnosis and grading of diabetic retinopathy was as per Early Treatment Diabetic Retinopathy Study System (ETDRS) guideline. Results: A total of 200 adult diabetic patients who had never been screened by an ophthalmologist for diabetic retinopathy were recruited. The prevalence of diabetic retinopathy was high accounting to 57%. Nearly half of these had advanced disease necessitating agent treatment. The prevalence of diabetic maculopathy among patients with diabetic retinopathy was 78.9%, of whom 66.7% had clinically significant macula edema. Duration of diabetes was associated with increased risk of developing diabetic retinopathy (P < 0.001) Conclusions: There was high prevalence of diabetic retinopathy among diabetic patients who had never screened. The alarming finding is nearly half of those with diabetic retinopathy had advanced disease requiring agent treatment. Therefore screening programs for diabetic retinopathy for every diabetic patient should be instituted in every diabetic clinic to prevent avoidable blindness.

Is Beta-radiation better than 5-Fluorouracil as an adjunct for trabeculectomy surgery when combined with cataract surgery? A randomized controlled trial K Dhalla, S Cousens, R Bowman, M Wood, I Murdoch Objectives: Two recent large population based surveys in Nigeria and Kenya have identified the glaucomas as the second most common cause of blindness. In an African setting surgery is generally accepted as the treatment of first choice. A problem with trabeculectomy surgery for the glaucomas is the frequent co-existence and exacerbation of cataract. Despite extensive discussion of combined cataract and trabeculectomy surgery in the literature, there are remarkably few trials and none are from the African continent. We report a randomized controlled trial to compare the use of beta radiation with 5FU in combined cataract and glaucoma surgery. Design and Methods: Consenting adults aged >40year with glaucoma, an IOP>21mmHG and cataract were enrolled and randomised to receive1000cG β radiation application or sub-conjunctival 5 Fluorouracil (5FU) at the time of combined trabeculectomy and phaco-emulsification with lens implant surgery. 385 were eligible for inclusion of whom 301 agreed to inclusion in the study (one eye per patient). 150 were randomised to the 5FU arm and 151 received β radiation. Results: To exactly 12 months there were 40 failures (cumulative survival 70% (62% to 77%)) in the 5FU arm and 34 failures (cumulative survival 74% (65% to 80%)) in the beta arm. The mean presenting acuity of 0.91 and 0.86 logMAR improved to 0.62 and 0.54 in the 5FU and beta arms respectively. Complications did not differ between the two groups. Conclusions: This study highlights several critical points in the quest for a therapeutic strategy for the glaucomas within an African context. Firstly, phacotrabeculectomy is a successful operation that improves vision as well as controlling IOP in a majority of patients. Second, there is no major difference between the use of 5FU and beta radiation as an antimetabolite. The success of trabeculectomy in lowering IOP is reduced when combined with phacoemulsification in comparison with trabeculectomy alone. This finding has to be set against the possible need for subsequent cataract surgery in the presence of a functioning trabeculectomy which represents a second trip and expense for the patient and results in 10-61% failure of the trabeculectomy at one year post-cataract surgery

Facial cleanliness and prevention of cross-border spread of infection are needed in the final push to eliminate active trachoma J Karimurio, H Rono, G Odhiambo Objectives: Active trachoma is an eye infection caused by Chlamydia trachomatisand a dirty face is the most important risk factor. Mass drug administration (MDA) plus facial cleanliness and environmental improvements (FE) are the recommended interventions. Trachoma inflammation-follicular (TF) in children 1-9 years old is the routine monitoring indicator. Aim was to assess the progress towards elimination of TF as a public health problem in NarokCounty located at the Kenya-Tanzania border


Design and Methods: Project documents were reviewed and survey methods published elsewhere. Narok County comprises of previous Narok and Transmara districts.A district-baseline trachoma surveys was conducted in Narok district in 2004 and interventions commenced in 2007. Thereafter, impact surveys were conducted in 2010 and 2014 in geographical areas (segments) with 100,000 to 200,000 people each. In Transmara district, a baseline survey was conducted in 2011 and interventions began in 2013. Results: In 2004, 1,348 children 1-9 years old were examined in Narok district. Prevalence of TF was 30.5% (95%CI:25.6%- 35.8%). In 2010, 3,998 children were examined in 5 segments.The prevalence of TF in the district was 11.0% (95%CI:8.0%-14.0%). Three segments (North Eastern, North Western and Central) had prevalence of less 5%. The prevalence in the Southern Western segment was 26.7% (95%CI:18.7%-34%) and in South Eastern segment 21.6% (95%CI:15.4%-27.8%). In 2014, 800 children were examined in South Eastern and 720 in South Western segment. Prevalence of TF in South Western was 21.0%(95%CI:12.8%-29.2%) and South Eastern 21.8%(95%CI: 14.2%-29.3%). Prevalence of a dirty face in the South Eastern segment was 43.0%(95%CI: 35.9%-50.1%) and South Western segment 31.1%(95%CI: 24.4%-37.9%). In 2011, 1,600 children were examined in two segments in Transmara district. The prevalence of TF inthe district was 10.6%(95%CI: 4.6%-16.5%), North Eastern segment 2.9%(95%CI:0%-6.5%)and South Western 18.3%(95%CI:7.9%-28.6%). The prevalence of dirty faces in Transmara West was 34.4%(95%CI:28.1%-40.6%) and in Transmara East 33.1%(95%CI:19.8%-46.4%). The South Western segment was incorporated in the Narok County trachoma control project. There were cross-border nomadic migrations between Narok County and Tanzania. Trachoma interventions in the Kenya and Tanzania were not harmonized. Conclusions: There was an impressive progress towards elimination of TF in Narok district between 2004 and 2010. Dirty faces, delayed interventions in Transmara district and cross-border migrations dampened the progress in the County. Laboratory testing is needed to verify occurrence of Chlamydia infection.

Delay along the care-seeking journey of patients with ocular surface squamous neoplasia in Kenya S Gichuhi, J Kabiru, A M'bongo, H Rono, E Ollando, J Wachira, R Munene, T Onyuma, M Sagoo, D Macleod, H Weiss, M Burton Objectives: To assess referral pathway and treatment delay for patients with ocular surface squamous neoplasia (OSSN) in Kenya. Design and Methods: Adults with conjunctival lesions presenting to four eye centres were asked about their occupations, when they noticed the growth, health facilities visited in seeking care, cost of consultation, surgery, medicines and histopathology and dates at each step. The time-to-presentation was divided into quartiles and correlates analysed using ordinal logistic regression. Results: We evaluated 158 first-time presenters with OSSN. Most were women (102 [65%]), living with HIV (78/110 tested [71%]), with low to medium income (127 [80%]). Most of the HIV patients (49/78 [63%]) were in antiretroviral care programs. About half (88/158, [56%]) presented directly to the study centres while the rest were referred. Indirect presenters sought care earlier than direct presenters (median 2.0 months vs 5.5 months) and travelled a shorter distance to the first health facility (median 20km vs 30km) but had surgery later (median 12.5 months vs 5.5 months). Visits beyond the first health facility for indirect presenters markedly increased delay (median 7.3, 29.0, 37.9, and 32.0 months for 1-4 facilities, respectively). Delay was associated with number of health facilities visited (adjusted ordered OR=9.12; 95%CI 2.83-29.4, p<0.001) and being female (adjusted ordered OR=2.42; 95%CI 1.32-4.44, p=0.004). Conclusions: Referral delays definitive treatment for OSSN. Women were more likely to experience delay. Despite regular contact with the health system for those with known HIV infection, delays occurred. Early detection and referral of OSSN in the HIV service might reduce delays.

Validity of a portable eye examination kit (Peek) compared to a goldstandard fundus camera in grading patients with diabetic retinopathy at KCMC eye clinic C Mwanansao Objectives: Diabetic retinopathy (DR) is damage to blood vessels of the retina stemming from diabetes. It is the most common microvascular complication of diabetes mellitus (DM) and a leading cause of visual loss among individuals of working age. Diabetic retinopathy is often diagnosed in advanced stages in patients who are living in remote or rural areas because of lack of screening opportunities and specialist eye services. The study determined the validity of Portable Eye Examination Kit (PEEK) as a screening tool for diabetic retinopathy compared to the gold standard fundus camera at KCMC eye clinic. Design and Methods: This is a Crossectional clinic-based comparative study. Results: The overall exact agreement of PEEK and Topcon between the two examiners in grading DR was 80% and 83% for examiner one and two respectively. The simple kappa score for examiner one was 0.73 (SE: 0.04) and 0.77 (SE: 0.04) for examiner two. The sensitivity was greater than 80% for grading of all stages of DR except PPDR where it was 55.8%. The specificities were all greater than 90% except for BDR. Based on diabetic macular edema, kappa score is 0.83 (SE: 0.05) for examiner one and 0.90 (SE: 0.05) for examiner two. The agreement is 89% and 94% for examiner one and two respectively. CONCLUSION Conclusions: With these findings of the study, PEEK has demonstrated a good capability for detecting DR changes. It has the potential to be a useful tool for screening of diabetic maculopathy and diabetic retinopathy.

Anterior approach white line advancement (WLA) ptosis surgery: long term results and patient satisfaction from a large series B Parkin, A Penwarden, R Nicholson, K Roque Objectives: This novel technique was developed by the author in 2009, presented at BOPSS 2014 and 549 procedures have been carried out to date. The white line (underside of levator aponeurosis at mullers muscle insertion) is advanced without breaching the orbital septum via a skin crease approach allowing simultaneous blepharoplasty. In order to establish the long-term effectiveness, reliability and acceptability of this surgery, 70 consecutive patients were invited to a research clinic for review. Design and Methods: Surgical success was defined as a post-operative MRD of >= 2 mm and <5 mm, inter-eyelid height asymmetry of <=1 mm with a satisfactory eyelid contour. Patient reported outcome measures included both a patient satisfaction and Glasgow Benefit Index questionnaire. Three independent observers recorded the postoperative skin crease height, levator function and took 3 repeated MRD measurements. MRD data were included from clinical digital photographs taken by an ophthalmic photographer by standardised technique.


Results: Analysis was carried out on 90 eyelids of 52 patients able to attend the clinic. Mean time from surgery was 2.5 years (1.6 - 4 years). Surgical success rate was 85.4% (increasing to 89.6% when 2 completely satisfied patients within 0.1mm of surgical success parameters are included). 94% of patients were satisfied or completely satisfied with surgery. No relationship was found between the final lid height and time from surgery indicating stability of results over time. Conclusions: In a large series with long term followup, anterior approach WLA technique is highly effective, stable and acceptable to patients. The advantages of posterior approach surgery are retained while preserving conjunctival integrity and allowing simultaneous blepharoplasty.

Outcomes of trabeculectomy among glaucoma patients in Uganda: a hospital based audit F Mbumba, S Arunga, J Onyango, H Nino Objectives: To determine the outcomes of trabeculectomy surgery among glaucoma patients attending Ruharo Eye Centre. Design and Methods: Records of all patients who had undergone trabeculectomy surgery in at least one eye at Ruharo Eye Centre (REC) were reviewed and phone calls were made to the patients inviting them for a clinical examination. For the patients who turned up, their vision, visual fields, intraocular pressure (IOP), disc cup disc ratio (CDR) and any post- operative complications were recorded. Patients were also asked about their general satisfaction with their vision. The main outcome measure was post-operative IOP. Results: In total, 62 eyes of 38 patients were included in this study. Median age was 65 years, range 24 to 91 and female to male distribution was 13: 23. Median observation time was 3 years, range 1 year – 4.5 years. Indication for trabeculectomy was primary open angle glaucoma in 51 eyes. Mean intraocular pressure pre- and post-operatively was 32.0 (SD: 10.6, range: 12 to 66) and 12.9 (SD: 4.7, range: 6 to 30), respectively (p<0.001). Mean visual acuity pre- and post-operatively was 0.36 (SD: 0.27, range: 0.02 to 1.2) and 0.33 (SD: 0.24, range: 0 to 1.18), respectively (p=0.244) In terms of satisfaction, 27 out of 38 patients were “happy” with their vision. Only 5 out of 62 eyes had failed trabeculectomy. Conclusions: Outcomes among patients in our setting were good. Trabeculectomy showed good control of IOP and preservation of vision.

Presentation and Outcome of Uveitis among Patients in Ruharo Eye Centre, Uganda E Agwella, S Arunga, J Onyango Objectives: To describe the presentation and outcome of uveitis among patients in Ruharo Eye Centre, Uganda from January to December, 2015. Design and Methods: This was a facility based retrospective study, which involved review of records of patients who presented with uveitis at Ruharo Eye Centre from January to December, 2015. Data were collected on demographic characteristics, clinical presentation and vision before and after the treatment. The data was analysed using stata 11.1 where the aetiology of uveitis, associated diseases, visual and clinical outcome was presented in tables and graph. Results: A total of 162 and 181 eyes were studied. Male to female ratio was 1.79:1 and the median age was 36 years. 44.44% of the uveitis were post-traumatic, 4% AIDS related, 3% associated with herpes zoster ophthalmicus, 2% post cataract surgery, tuberculosis 1%, traditional eye medicine use 1% and in the remaining 44.44% causes were not identified. Anterior uveitis accounted for 27 (16.67%), posterior uveitis (4.94%) unclassified uveitis, 122 (75.30%), and the rest were other forms. For patients who were reviewed, median visual acuity at presentation was 6/24 and during follow up visit was 6/18. The main complications were posterior synechiae 38, secondary glaucoma 13 and cataract 8. Conclusions: The majority of uveitis was post-traumatic. Median age of presentation was 36 years and visual acuity improved by one line.

Prevalence of blindness, diagnostic assessment and pattern of risk factors associated with glaucoma in patients attending Ruharo Eye Center, Southwestern Uganda: a hospital based retrospective audit B Sakano, S Ruvuma Objectives: To assess the proportions of risk factors associated with open-angle glaucoma, the diagnostic procedures and the prevalence of blindness among patients with open-angle glaucoma attending Ruharo Eye Center from January 2015 to December 2015. Design and Methods: In a hospital based retrospective clinical audit, records of all adult patients with open angle glaucoma who attended Ruharo Eye Center from January 2015 to December 2015 were reviewed. Information was collected on demographic characteristics, risk factors associated with open-angle glaucoma ,diagnostic assessment and best corrected visual acuity. The data was analyzed using Epi info 3.1.1, proportions of known risks factors associated with open-angle glaucoma was presented as histogram and proportions of patients assessed with gonioscopy and visual field test were presented as frequency tables. Results: 216 patients charts were collected. However, 93 were analyzed for diagnostic assessment, best corrected visual acuity and known risk factors for open-angle glaucoma and the rest excluded because of missing data. The mean age at presentation was 60 with a standard deviation of 16, and the male to female ratio was 1.62. The known risk factors of interest were positive family history of glaucoma, positive history of diabetes, hypertension or hypotension, alcohol consumption, smoking, intra ocular pressure>21mmHg and myopia. For most of the patients the risk factors were not indicated. However, the majority of patients 42(45.2%) had bilateral increased intra ocular pressure, 69 patients(74.2%) were assessed for myopia, of these,16 (17.2%) were confirmed myopic. The prevalence of blindness was found to be 57% and of these, 20(21.5%) were bilaterally blind according to WHO. 42(45.5%) of patients had their visual field test done and only11(11.8%) were assessed for gonioscopy. Conclusions: The majority of glaucoma patients presented with blindness. Only a few of them were assessed for gonioscopy and visual field test. Increased intraocular pressure and myopia were the known risk factors predominantly found.

One RB World Online: A Virtual Retinoblastoma Clinic H Dimaras, K Hougham, C Moses, L He, C Baik, M Lee, A Mallipatna Objectives: Retinoblastoma (childhood eye cancer) is curable, but patient outcomes remain poor in many low-and-middle-income countries. Optimal resources and expertise for retinoblastoma management have been outlined in published clinical guidelines, serving to direct health policy and practice at national, regional and institutional levels. However, the capacity of retinoblastoma treatment centers to implement such guidelines varies worldwide.


We performed a situational analysis to document resources and expertise available at retinoblastoma treatment centers, and to map their global distribution with retinoblastoma incidence. The overall goal is to use this data to inform systems of patient referral and capacity development, ultimately enhancing patient care and outcomes. Design and Methods: Clinicians at global retinoblastoma treatment centers were contacted by email, and asked to complete an e-survey documenting local expertise and resources available for the care of children with retinoblastoma. An online platform was developed to disseminate this information in an interactive and data-rich format (www.1rbw.org). Results: The website serves as a virtual clinic that connects patient families to caregivers. It documents features of 166 centers in 56 countries. Knowledge of where and how retinoblastoma is managed worldwide provides an efficient and rapid path for parents to access urgent care. The website indicates the closest expert center and contacts. Paths of referral and multicenter co-management aim to keep the children close to home while optimizing access to advanced therapies when needed. Estimated incidence vs location and capabilities of treatment centers reveals opportunities to increase capacity, collaboration and coverage in key regions. Conclusions: The One Retinoblastoma World Virtual Clinic connects stakeholders and strengthens capacity to care for the global retinoblastoma population. This first-of its-kind collaboration promotes global standards of care, setting the stage for multicenter clinical trials and other research, thereby accelerating the translation of results from lab to clinic.

Microbial keratitis in south western Uganda: a hospital based retrospective chart review G Atto, S Arunga, J Onyango, M Burton Objectives: To describe the presentation, management and outcomes of Microbial Keratitis in Uganda. Design and Methods: A retrospective chart audit of all patients with Microbial Keratitis who attended Ruharo Eye Centre from January 2015 to December 2015. Information was collected on: demographics, history of trauma and use of traditional eye medicine, examination findings, treatment and outcome. Data was entered in Microsoft access database and tabulation analysis was done with STATA 12. Results: Of the 609 charts reviewed, 483 were analyzed. The median age was 32 years (16-50); male to female ratio was 1.5:1; and, Microbial keratitis was unilateral in 96.48% of the cases. The commonest symptom was pain, 261 (54.04%), followed by reduced vision, 135 (27.95%). 153 (31.68%) of the patients presented after 14 days of onset. Most of the patients, 220(45.55%) had been on some form of prior therapy and most notable was use of traditional eye medicine, 109 (48.44%). Only 63 (13.04 %/) of the patients were recorded as having had a history of trauma and 38 (7.87%) recorded as no trauma, the rest had missing data. Initial treatment consisted mainly of; chloramphenicol eye ointment, 357 (73.9%), Atropine eye drop, 262(54.24%) and Ciprofloxacin eye drop, 210(43.48). By last review visit, visual acuity had improved in 100 (20.7%), remained the same in 276 (55.28%) and reduced in 116 (24.02%) patients. Conclusions: This audit provided insight on the main problems of microbial keratitis in our setting such as delayed presentation, use of traditional eye medicine and poor outcomes.

COECSA country participation in the Commonwealth Clinical Fellowship Programme N Astbury Objectives: The clinical fellowship programme, sponsored by the Queen Elizabeth Diamond Jubilee Trust and administered by the Commonwealth Eye Health Consortium (CEHC) at the London School of Hygiene and Tropical Medicine aims to provide specialty training in paediatrics, glaucoma, medical retina, oculoplastics, cornea, vitreo-retina, uveitis and low vision for ophthalmologists in Commonwealth countries where there is a demonstrable need. Over 100 fellows will be competitively enrolled over 5 years and return to their countries to increase capacity in these specialist areas. Six of the COECSA member countries are in the Commonwealth and hence eligible for the scheme. This paper seeks to explore the needs, chosen specialties and experiences of COECSA members who have participated to date and to compare the demography and distribution of all the Commonwealth applications and awards. Design and Methods: Applicants must meet certain criteria and be supported (position, facilities, equipment) on their return. The majority of training takes place in India. Fellows are asked to report regularly, including post-fellowship, to record the impact of their new skills and learning. We ask about plans for the future including intended new services and teaching and training. Results: To date (in the first three rounds) we have awarded 136 fellowships (81 long and 55 short). COECSA countries account for 15% and West Africa 50% of the awards made. The first two years saw a greater uptake from COECSA countries as opportunities were taken as part of the VISION 2020 LINKS Programme. COECSA members have undertaken or are currently undertaking six long-term fellowships at Aravind or LVPEI (3 cornea, 2 vitreo-retinal and 1 paediatric). Conclusions: The paper will review the learning objectives and outcomes of the CEHC COECSA fellowships undertaken to date, examine some of the challenges faced and assess the impact and opportunities of the programme for COECSA

The Diabetic Retinopathy Network – DR-NET.Comm D Mabey, N Astbury Objectives: It is estimated that there are 415m adults with diabetes in the World and approximately 10% will have sight threatening diabetic retinopathy – 41.5m people. In sub-Saharan Africa, this figure is 1.4m. There is an overwhelming need to have in place services to screen, refer and treat patients who otherwise will lose their sight. At present, in sub-Saharan Africa, less than 2.5% of people with diabetes are being identified and treated. The goals of the DR Network are to raise awareness of diabetic retinopathy, increase skilled human resource, provide equipment and encourage National frameworks and protocols to be put in place. The priorities are for all countries that are part of the wider DR-NET.Comm to develop their DR services, share learning with each other and especially to gain high level commitment from each country Ministry of Health. Design and Methods: This challenge is being addressed by the Diabetic Retinopathy Commonwealth Network (DR-NET.Comm), a 5-year initiative run by the VISION 2020 LINKS Programme and launched in 2014. The DR-NET.Comm is part of the Commonwealth Eye Health Consortium at the London School of Hygiene and Tropical Medicine and funded by the Queen Elizabeth Diamond Jubilee Trust. Results: The initial DR-NET.Comm workshop in 2014 involved 70 participants from 10 Commonwealth countries who carried out situational analyses and formulated 2-year screening and treatment plans. Progress in Tanzania will be presented as an illustration. Each LINK institution resolved to treat one more patient a week, to save a cumulative 37,500 years of blindness.


Conclusions: There are 5 COECSA countries in the DR-NET.Comm LINKS Programme (Kenya, Malawi, Tanzania, Uganda and Zambia) who are actively working to improve the lives of patients with sight threatening DR. Through shared learning, skills transfer and a health systems approach, the DR-NET.Comm aims to build on existing LINKS to expand the programme

Impact of provision of photochromic prescription glasses and educational support on the academic performance of children with albinism in Kenya P Choksey, U Choksey, A Coutinho Objectives: Children with Albinism silently suffered the anguish and pain of being born different for generations in Africa. The world stigmatized them and the society discriminated against them. All these years the focus was on the skin a ‘White’ child born in a ‘black’ family overlooking the fact that involvement of the eyes is the Primary Challenge and disability in persons with Albinism. In the past a high percentage of Children with Albinism were forced to attend the schools for the visually impaired without addressing their low vision needs and challenges. Large proportions were taught in Braille. Objective of this study was to evaluate the Academic Performance of Children with Albinism after correcting the underlying refractive error. Design and Methods: This is a study of 80 Children with Albinism 7 in preprimary 45 in primary 28 in secondary schools. All children were offered Ophthalmic Services free of cost and were also provided with Prescription Photochromatic glasses after correcting the underlying refractive error for free. Since they all belonged to very poor socioeconomic background they all received financial educational support to study in Print in regular schools. Results: All the Children (100%) had uncorrected refractive errors though not a single child (0%) came in the bracket of legal blindness. Academic performance was judged as Excellent : over 75% seen in 37 Children (46%) Good : over 50% seen in 39 Children (49%) Average : less than 50% seen in 4 Children (5% Conclusions: Given the educational support and Prescription glasses all Children with Albinism can study in Print and in regular schools and are capable of achieving high Academic excellence.

Managing cluster endophthalmitis cases after Intravitreal Bevacizumab (Avastin) injection. S Parikh Objectives: To describe clinical presentation and management of cluster endophthalmitis after intravitreal Avastin Injection. Design and Methods: The study shows retrospective analysis of 16 patients who underwent intravitreal Avastin injection from the single vial on the same day. All the patients developed intraocular inflammation on the next day of the injection. All the patients underwent anterior chamber and vitreous tap followed by intravitreal antibiotic and steroid. All the patients underwent surgery (Vitrectomy) along with intravitreal antibiotic and steroid. All the patients were followed up for 6 month after the surgery. Results: Culture report for aqueous and vitreous tap was negative in all the eyes. All the patients were recovered from intraocular inflammation after the surgery. None of the patients developed severe complications due to endophthalmitis. 3 eyes developed cataract after surgery.13 eyes from 16 had recovered pre Avastin vision within 1 month of the surgery. 8 eyes out of 13 improved vision within 3 months of surgery. Conclusions: Off label use of intravitreal Avastin can give rise to cluster endophthalmitis. Early intervention and surgery is the key factor for successful visual outcome.

Incidence and risk factors of retinopathy of prematurity among low birth weight children at Kilimanjaro Christian Medical Centre T Theophile Objectives: Retinopathy of prematurity has been associated with childhood blindness. There is limited information about the epidemiology of retinopathy of prematurity in Tanzania. The aim of this study was to determine the incidence and the risk factors of retinopathy of prematurity. Design and Methods: prospective cohort study was conducted. Purposive sampling was used to get 173 children with low birth weight admitted in pediatric who were first examined by a pediatrician, measuring the weight, estimation of the age by finnstrom score and maturity was dedicated then a base line fundus examination was performed. The screening started 4 weeks postnatal and follow up to the time the retina is fully vascularized or the signs of retinopathy of prematurity were regressed. Chi-square was used to assess the association and p-value of < 0.05 was considered statically significant. Results: From October 2015 to April 2016 173 children were enrolled, unfortunately 64 children died before the screening and 109 underwent full screening. The incidence of ROP was 2.75% in low birth weight group; 9.09% in very low birth weight group. Very low birth weight (p value = 0.026), small for gestational age (p value = 0.002), were statically associated with the occurrence of retinopathy of prematurity. While gestational age (p value = 0.230), oxygen therapy (p value = 0.082), sepsis (p value = 1.00) were not statistically associated. Conclusions: our study confirmed the existence of retinopathy of prematurity among children born with very low birth weight in Tanzania. Those findings emphasize the role of preventing preterm birth and screening protocol for retinopathy of prematurity in our setting.

The Situation Analysis of Child Eye Health in Uganda A Musika, J Mwaka, I Matende, K Naidoo, J Jyoti, J Karimurio Objectives: To undertake a baseline survey (situation analysis) of child eye health in Uganda mainly on the service delivery systems, policies, co-ordination, partnerships, human resources for child eye health, infra-structure and school health services in 2012 Design and Methods: This cross-sectional descriptive retrospective study employed both quantitative and qualitative methods in 14 facilities (11 government and 3 private not for profit). Desk based and key Informant evaluations were carried out using self-administered questionnaires which were collected during on spot verification.


Results: The extent and coverage of the child eye health services depended on the facility’s support and ophthalmologist’s availability. The referral system was not functional. Supply of essential eye drops and consumables was irregular and inadequate.The available HMIS tool was not relevant for eye health and children above 5 years. There was no national child eye health coordinator, no policy for eye health or child eye health and no school eye health programs The school health policy was still in draft form. The national budget for eye care services was inadequate under the disability package. Initiatives and organisations running child eye health programmes had reduced. Child eye health workers were far below the Vision 2020 required numbers. Only one facility had a nearly complete paediatric team. Most non-functional equipment required minor repairs. The training programmes trained a few cadres with low output. Conclusions: Training for the eye care workers should be increased especially for members of the paediatric eye care team. Motivation of eye care workers, urgent equipment repair, National HMIS tools revision and deployment of ophthalmologists should be done. A national eye health policy should be put in place. Ophthalmic services should be moved from disability section urgently.

Prevalence and factors associated with childhood visual impairment among children attending Mulago National Referral Hospital, Uganda P Kinengyere, G Wabulembo, A Musika Objectives: To determine the prevalence and factors associated with childhood visual impairment Design and Methods: A hospital based descriptive cross-sectional study was done between February 2015 and March 2015 on consecutively recruited eye patients aged below 18 years. Data collected included the bio-data of the patients, prenatal, natal and postnatal history, ocular and systemic examinations. Results: A total of 318 patients was seen, 170 females and 148 males ranging from 5months to 17 years with a mean age of 6.67years. The prevalence of visual impairment was found to be 42.14% (134 patients). 15.41% had moderate visual impairment, 14.15% had severe visual impairment and 12.58% were blind. Trauma, cataracts, squints, infections and refractive errors were the commonest ocular conditions associated with visual impairment. Trauma and age were significantly associated with visual impairment. Conclusions: The prevalence of childhood visual impairment is very high. For every ten children seen at Mulago hospital four are likely to have visual impairment. Risk of visual impairment increased with having history of trauma and with the advancing age of the child. Sensitization of the community, teachers and parents on the presentation and factors associated with childhood visual impairment is essential for prevention and early treatment.

Ophthalmic findings and visual rehabilitation in persons with albinism – a project report S Parikh, S Soni, S Dalwadi, K Solanki, A Patel Objectives: To describe the results of ophthalmic findings and visual rehabilitation in persons with albinism in association with National Council for persons with disability. (NCPWD) Design and Methods: A retrospective data of ophthalmic findings in 869 persons with Albinism has been analyzed. All persons from different parts of Kenya have been brought to Eye & U ophthalmics by NCPWD. All the persons have undergone complete ocular examination including visual acuity, refraction, tonometry, slit lamp examination, fundus examination, pachymetry, perimetry, retinal nerve fiber thickness analysis and orthoptic check up. All the persons were given corrected visual glasses and if needed low visual aids have been provided. Results: The age of all persons varied from 6 months to 77 years with 80.6% persons were less than 30 years of age. 57% of the persons had albinism in hereditary. 20% of the persons had higher education. 33.7 5 of the persons were unemployed. 96% of the persons had oculo cutaneous presentation. Visual field defect was present in the 50.5 % of the person. Hypopigmentation was observed in 95% of the persons. 15.3 had squint. Most of the persons had visual acuity of 6/36 with improvement of 1 line after correcting glasses. All the persons above 5 years of the age showed improvement after low vision aids. Conclusions: Complete ocular examination is very important in screening of persons with albinism. Visual rehabilitation is an important integrated part of albinism program.

Prevalence of strabismus and outcomes of its management among children attending Ruharo Eye Centre, South Western Uganda: a hospital based retrospective audit S Ntizahuvye, J Onyango Objectives: To determine prevalence of strabismus and outcomes of its management among children attending Ruharo Eye Center, South western, Uganda from January 2014 to December 2015. Design and Methods: In this retrospective descriptive study, medical records of all strabismus patients aged below 16 years seen during the study period were reviewed. Information was collected on demographic characteristics, refractive errors, the type of strabismus, the type of management and their outcomes. The data was analyzed using Stata 12, the prevalence of pediatric strabismus was calculated as a percentage of all children with pediatric strabismus out of all children consultations at REC within the study period. Proportions and pie-chart were used to describe the types of pediatric strabismus. The outcomes of pediatric strabismus management by treatment method used, were presented as frequency tables. Successful outcome was alignment post treatment. Results: 125 cases of childhood strabismus were identified during the study period giving a prevalence of 1.4%. Type of strabismus included esotropia which formed the bulk of our cases with (80%) and exotropia with 20%. Post-operative alignment was achieved in 25 cases (73. 53 %) and under correction occurring in 17.65 %. Conclusions: The prevalence of strabismus at Ruharo Eye Center was comparable to those published in the literature. The most common type of pediatric strabismus in this study was esotropia. The surgical success rate was generally good.

Outcome of globe preservation therapy in patients with bilateral retinoblastoma at the Kenyatta National Hospital, Kenya R Namweyi, L Njambi, K Kimani Objectives: The past 60 years have seen an evolution in treatment of retinoblastoma from primary enucleation to attempts to salvage the globe and preserve vision in addition to saving life. The developed countries have reported good success rates. Globe preservation was


introduced in KNH as early as the 1980s but started being practiced routinely in 2008. This study set out to determine the outcome of globe preservation in Kenya, KNH, from January 2008 to December 2014. Design and Methods: A descriptive retrospective case series. Using the ICD 69.2 records of a total of 35 patients diagnosed with bilateral retinoblastoma who underwent globe salvage at KNH between January 2008 to December 2014 were retrieved for the study. Data on demographics, presenting complaints, relevant examination findings, globe preservation modalities employed and globe salvage outcomes was collected. Analysis was done using STATA version 13. Results: The mean age at presentation was 16.8 months (SD = 12.2, range 2 - 36 months), median 13 months (IQR 6-24). Mean duration between onset of symptoms to presentation at KNH was 7.2 months (SD = 7.3), median duration of 6 months (IQR 3-10). Out of the 35 salvage eyes 12 (34.3%) were Group A eyes, 11 (31.4%) Group B, 5 (14.3%) Group C and 7 (20.0%) Group D. Twenty patients (57.1%) patients received systemic chemotherapy for intraocular chemoreduction of the tumours in the salvage eye. Only 2(5.7%) patients received sub-tenon carboplatin. The main modes of focal consolidative therapy was laser photocoagulation and thermotherapy and cryotherapy. No patient had EBRT of plaque radiotherapy as it was not available. Seven (20.0%) patients had relapse with a median survival time for tumour to relapse of 6.8 months. Nine patines (25.7%) developed new tumours with a median time to development of new tumours of 6.5 months. Fourteen (40.0%) eyes were salvaged with preservation of vision. Of these 12 (85.7%) were Group A and B eyes. Mean duration to salvage was 7.27 months (SD = 4.62). Six eyes (18.18%) were enucleated with a mean duration to enucleation of 15.7 months (SD = 15.51).Nine (25.7%) got lost to follow up and 3 patients (8.6%) developed metastatic disease and globe salvage was abandoned. Conclusions: The main treatment modalities employed at the KNH were laser photocoagulation and cryotherapy complemented with systemic chemotherapy where intraocular chemoreduction was required. Forty percent of eyes were salvaged using the resources available. However our rate was low compared to the developed countries. Tumour relapse occurred in 20% of patients with subretinal seeding being a risk factor. Twenty five percent of patients developed new tumours which was similar to other international studies. Efforts should be made towards seeking treatment early, improve patient adherence to follow up and introduction of EBRT, plaque radiotherapy and more advanced treatment for patients with Group C and D eyes. A prospective study is also recommended.

Retinopathy of prematurity: prevalence and risk factors among infangs in rural Kenya S Sitati Objectives: Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that is seen in premature infants born before 31 weeks of gestation or weighing less than 1500grams at birth. Data is scanty on prevalence rates in Africa. This study was done to determine the prevalence and risk factors for ROP in a hospital serving a largely rural population in Kenya. Design and Methods: A prospective study carried out at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu between March 2015 and April 2016 in the neonatal unit and outpatient eye clinic. All infants less than 32 weeks gestation and/or weighing less than 1500 grams, plus those with an unstable clinical course had a dilated fundoscopic examination. Exam findings were recorded in a questionnaire. Results: 131 babies were included in the study, with a male to female ratio of 1:0.95 (64/67). Mean gestational age was 30.64 ± 3.6 weeks and mean birth weight was 1478 ± 414.08 grams. Of these, 91 (69.5%) had been on oxygen, with a mean of 4.6 ±5.9 days on oxygen. 4 babies had ROP, a prevalence of 2.29%. 3 (75%) had stage 1 ROP and 1 (25%) had stage 2 ROP, all of which regressed. There was no vision-threatening ROP found. Peri-natal risks identified in this group included respiratory distress syndrome, intra-ventricular hemorrhage and seizures. Conclusions: The ROP prevalence found was much lower than that reported in other studies, with all cases of ROP regressing. This presents a challenge in advocating for an ROP screening program in this setting. A larger study is required to determine the country wide prevalence.

Visual & refractive outcome after trifocal intraocular lens implantation S Dalwadi, K Solanki, A Patel, S Soni Objectives: To evaluate the visual outcomes of patients who have undergone cataract surgery with trifocal intraocular lens. Design and Methods: The study shows prospective analysis of 20 eyes of 10 patients who underwent trifocal IOLs. All the surgeries are carried out at Eye & U ophthalmics, Nairobi by 3 different surgeons. All the patients were examined for refraction, keratometry, intraocular pressure, corneal topography, Optical coherence tomogram and fundus examination. IOL power calculation was done by IOL master. All the eyes were implanted with zeiss or acriva trifocal lens after removal of cataract through a clear corneal incision by phacoemulsification method under topical anesthesia. Surgery in second eye was done in all the patients within 1 month of the fist eye. All patients were followed up for 3 months after the surgery. Results: All the patients had visual recovery of to 6/6 and N6 after bilateral trifocal IOL implantation. Some of the patients who had delayed surgery in the second eye, had some difficulty in near vision, but eventually were doing well when second eye was operated. All the patients are leading spectacle free life. One patient had a complaint of night glare. Conclusions: The trifocal intraocular lens provides good near, intermediate and far visual acuity and patients can expect a spectacle free life after implantation.

Central corneal regularization followed by collagen cross-linking: a new modality in the treatment for keratoconus M Joshi Objectives: Results using tomography Central corneal regularization (CCR) followed by Collagen cross-linking to treat Keratoconous at our centre was assessed in 162 eyes. Design and Methods: Patient selection: Confirmed keratoconus with irregularly irregular astigmatism and atopic disease. Pre-operative assessment: uncorrected and best corrected visual acuity, slit examination, tomography and topography, central corneal thickness, intra-ocular pressure and posterior segment examination. Tompgraphy guided corneal regularization was performed using a 1000Hz Excimer laser (IVIS platform) followed by collagen cross-linking using 18mv/cm3 using riboflavin HPMC for five minutes. Bandage contact lenses applied (1 week), moxifloxacin eye drops (1week) and FML and systane eye drops (6 weeks). After 3 months, tomography was repeated and pre-op and post-op evaluation compared.


Results: 152/162 eyes showed improvement to now allow refraction improving best corrected visual acuity. 8 eyes: Refraction not possible but Keratoconus was stabilized and hybrid contact lenses were applied. 1 eye: Progression of Keratoconus, Laser-assisted DLKP performed Conclusions: Tomography guided CCR with Excimer laser followed by Cross-Linking is a useful modality in the majority of Keratoconus patients. It improves best corrected visual acuity and stabilizes Keratoconus and can avoid the need for Keratoplasty

Outcomes of sympathetic ophthalmia at a tertiary care centre in Southern India H Yusufali, S Devi, D Worah, J Biswas Objectives: Sympathetic ophthalmia is uncommon in recent times and prompt management of the sympathizing eye is of utmost importance to retain the only seeing eye in majority. Management protocol of these cases is variable and depends on many factors which are poorly understood because of rarity of this entity in recent times. We retrospectively analysed clinical profile and outcomes of 24 cases with clinical diagnosis of sympathetic ophthalmia and assessed their long term outcomes. Design and Methods: A total of 24 cases were retrieved from records over the last 20 years and analysed for various parameters Results: Total of 24 patients were tabulated with mean age of 34.92yrs (+/-17.29yrs) and time gap ranging from 3 days to 47 years between initial trauma and appearance of symptoms in sympathizing eye, with median gap of 2 months. Mean duration of follow-up was 163.23 months. The mean visual acuity improved from 20/500 to 20/80 Snellen’s, and the change was statistically significant (p<0.002). Good association was seen between choice of treatment and number of lines of improvement (p<0.03) and independent of presence or absence of exudative retinal detachment. Conclusions: There are favourable visual outcomes irrespective of eye segment involvement and initial visual acuity. High suspicion of sympathetic ophthalmia and prompt initiation of immunosuppressives yielded favourable visual outcomes.

The prevalence of ocular manifestations and visual impairment among adult HIV/AIDS patients in South Western Uganda; a hospital based study M Tambula, S Ruvuma, A Twinamasiko Objectives: To determine the clinical ocular manifestations and the prevalence of visual impairment among adult HIV/AIDS patients attending Mbarara Regional Referral Hospital Immune Suppression syndrome (MRRH/ISS) clinic. Design and Methods: This was a cross-sectional study. Systematic random sampling was used to get participants who were ≥18 years. Participants’ demographic data and medical history were recorded. Distance visual acuity and refraction were determined for each participant. The lids, anterior and posterior segments of the eyes were examined for any lesions. Visual impairment was defined as presenting visual acuity that is worse than 6/18, in the better eye.Data were collected using standard optometric instruments and a questionnaire. Univariate analysis was done using Stata 12.0 to generate proportions in form of frequencies and the data were summarized in one-way tables. Results: A total of 290 participants were interviewed and examined, average CD4 count was 480 cells/µL. All participants were taking co-trimoxazole prophylaxis, and 93.5% were on Highly Active Antiretroviral Therapy (HAART). The prevalence of HIV-related ocular manifestations was 2.1%.These included:molluscum contagiosum (33.3%), toxoplasma scars (33.3%),Kaposi’s sarcoma (16.7%) and squamous cell carcinoma (16.7%).The prevalence of visual impairment was 1.4%. Conclusions: The prevalence of HIV-related ocular conditions and visual impairment were low.

Can the developing world help the developed? M Hytiris, E Fioratou, S Gillan, S Law Objectives: This study compared skill acquisition of the Arclight, designed for use in developing countries, with the traditional Keeler ophthalmoscope, in inexperienced medical students. Design and Methods: Forty first and second year Dundee University students took part in a cross-over trial comparing the Arclight with the Keeler ophthalmoscope. They were taught using a video tutorial and assessed using simulated OSCEs. Group A learned the Keeler ophthalmoscope first, followed by the Arclight. Group B were taught in the reverse order. Students had no prior experience with ophthalmoscopy or either ophthalmoscope. Four model heads were set up with pre-made fundus slides, with six random letters allocated at the key areas examined using ophthalmoscopy. Each mannequin head was fitted with a different sized font. A questionnaire was distributed to ascertain students’ preferences and opinions on each ophthalmoscope. Results: Overall, 92.5% of students performed better with the Arclight, irrespective of cross-over trial period. In the first period, the Keeler’s mean result was 23.70 (out of 48 letters) with a SD of 9.20. The Arclight’s was 40.47, with a SD of 6.88. The difference in means was 16.77, 95% C.I between 11.63 and 21.93. A two-sample T test showed p <8.7x10-7. In the second period, the mean result using the Arclight was 44.26, with a SD of 2.77. The mean result of the Keeler was 36.24 with a SD of 6.81. The difference in means was 8.02, 95% C.I. between 4.52 and 11.52. A two-sample T test showed p<0.000179. When asked, 82.5% favoured using the Arclight, preferring it for future practice. The Arclight was felt to give a clearer view of the retina, was simpler to learn, easier to use, with less complex functions and more manoeuvrablility. Conclusions: The Arclight was found to be preferred and better performed. It is a successful method of training healthcare professionals, and a suitable, economical solution.

Penetrating keratoplasty in Kenya: a review of indications and outcomes over a 2-year period A Hydara, D Ilako, S Marco, D Kiage Objectives: To document the indications for and outcomes of penetrating keratoplasty-only surgeries in Kenya over a 2-year period Design and Methods: Medical records of patients who underwent penetrating keratoplasty were reviewed and analysed; lamellar grafts and combined surgeries were excluded. A case must complete follow-up of 3-months and the maximum follow-up end-point was 2-years from date of surgery.


A retrospective case series review of 174 eligible penetrating keratoplasties performed in 6 different facilities in Kenya from January 2001 to December 2011 was undertaken. Univariate and multivariate analyses were done. Corneal graft survival probabilities were determined. Primary outcome was the proportion of grafts that remained clear. Secondary outcome measures were final visual acuity, complications, and predictors of poor outcome. Results: Keratoconus was the commonest indication at 48.8% followed by bullous keratopathy at 18.4%. Pre-operatively, 66.7% of the eyes had visual acuities <3/60. Corneal epithelial defect (43.5%) was the commonest complication followed by corneal oedema (25.2%); persistent corneal oedema was the commonest late complication. At 24 months, 82.2% of the grafts remained clear while 17.8% (n=31) were not; 8.2% of keratoconus grafts failed while 26.9% from other indications failed (relative risk= 3.27, [95% CI 1.48 - 7.19], p=0.0012). Postoperatively, 71.8% of all grafts had final uncorrected vision of 6/60 or better, while 16.6% of grafts remained blind; 31 (17.8%) grafts failed, of which 25.8% was due to primary failure and 74.2% was due to secondary failure. At 24 months, 90% of keratoconus grafts survived while 68% for other indications survived, p=0.0068. Poor predictors of graft outcome were pre-operative bullous keratopathy (p=0.0019), postoperative glaucoma (p=0.0023), infection (p<0.0001), and persistent corneal oedema (p<0.0001). Conclusions: Keratoconus remains the leading indication for corneal grafts in Kenya. Overall graft survival has improved, especially for dystrophies and keratoconus. Poor predictors were corneal ulcers, herpes simplex keratitis, corneal graft glaucoma, and corneal graft oedema. These findings suggest most corneal grafts in this region could attain longer survivals and better visual outcomes.

Gaps in essential retinoblastoma care in Africa L Hampejsková, C Bascaran, M Zondervan Objectives: Retinoblastoma is one of the most common childhood cancers with about 25% of the global burden in Sub-Saharan Africa, due to high population and birth rates. Survival from retinoblastoma in Africa is low, at less than 20-50% chance of survival primarily due to a delay in diagnosis and abandonment of treatment. Early detection by leukocoria and early treatment and increase this number to 90% survival. This study aims to evaluate the current gaps in providing essential retinoblastoma care in 11 VISION2020 Paediatric LINKS across 8 African countries. Design and Methods: Descriptive cross-sectional study conducted in Ethiopia, Malawi, Ghana, Nigeria, Uganda, Tanzania, Zambia and Zimbabwe on comprehensive retinoblastoma care. 45 participants, ophthalmologists identified through LINKS, oncologists and pathologists using snowballing. Participants completed Internet-based questionnaire, ophthalmologists also participated in telephone interviews and fieldwork was conducted in Tanzania and Zimbabwe. A tool was developed on essential retinoblastoma care to determine gaps across VISION 2020 LINKS. Results: The overall gap across the 11 VISION2020 LINKS is 38%, Zimbabwe with an 18% gap and Ethiopia with 51%. A 45% gap was found in providing an essential programme with equitable financing and adequate access to services, 55% gap providing primary care services to diagnosis and refer, 25% gap providing ophthalmology services with expertise specific to retinoblastoma, 26% gap providing oncology and radiology services and 42% gap providing specialized investigation and timely histopathology reporting. Conclusions: Oncologists are the main caregivers for children with retinoblastoma in sub-Saharan Africa due to extraocular tumour extension. While ophthalmologists in developed countries provide the main care. Huge effort need to be made in early detection of retinoblastoma by families and healthcare workers with direct referral pathways, including adoption of national guidelines, formation of a national retinoblastoma working group, and access to specialised equipment, supplies, and secure patient medical funding.

Cataract pre-operative workup among COECSA countries L Hampejsková, C Bascaran, N Astbury, J Onyango, G Mwangi Objectives: Among COECSA countries, 2.3 million people are estimated blind from cataracts each year. Cataract surgery is a cost-effective treatment, however there is evidence that the quality of cataract surgery in sub–Saharan Africa (SSA) is often poor with good outcomes ranging from 23% to 70%. Some of the postulated reasons for a bad cataract surgical outcome are incorrect patient selection, surgical complications and lack of spectacle correction. A survey was conducted to assess current pre-operative cataract practices that will inform future content for continuing professional development. Design and Methods: An online questionnaire was emailed to 396 College of Ophthalmologists for Eastern, Central and Southern Africa (COECSA) members. Basic demographic information was captured on country, city/town and institute. Questions assessed their access to and usage of keratometry, A-Scan Biometry, B-Scan Ultrasound, intraocular lenses (IOLs) and monitoring outcomes for cataract pre-operative surgical assessment. Results: Response rate 32.3% from Burundi (3), Ethiopia (23), Kenya (33), Malawi (7), Rwanda (11), South Sudan (3), Tanzania (19), Uganda (7), and Zambia (19), The Gambia (1), Somalia (1) and unknown (1). 66.4% have access to a working Keratometer, 68.7% to A-Scan Biometry (5 non-responses), 54.7% to B-Scan (5 non-responses), 85.9% patients receive an IOL (10 non-responses), 25.8% indicated that all patients receive a standard lens (7 non-responses), 44.5% only have access to Aurolab IOLs (11 non-responses), 72.6% indicate they monitor their cataract outcomes (8 non-responses). Conclusions: The questionnaire was used to gain insight into some of the challenges that may be faced with access to equipment and resources to help inform the development of a continuing professional development short course to help improve surgical cataract outcomes in the sub-Saharan African region through the COECSA online education platform.

Factors associated with loss to follow up among glaucoma patients who attended Kilimanjaro Christian Medical Centre J Mchilla, H Philippin Objectives: Glaucoma is a chronic irreversible medical condition. It accounts for about 8% of all causes of blindness. Good adherence to treatment and regular follow up visits play a major role in preventing progressive loss of vision. Studies have shown that more than half of patients who initiated treatment are lost to follow within one year of treatment. Missed appointments have serious consequences not only from a clinical perspective but also economically. Main objective was to determine factors associated with loss to follow up among glaucoma patients who attended KCMC.


Design and Methods: Retrospective cross-sectional study using qualitative and quantitative methods. Phone interviews were conducted with a random sample of patients who lost follow up. Chi square test and logistic regression analysis were used to assess causes of loss to follow-up. Results: 96 participants (45 female, 51 male) were included in the study and 15 phone interviews were conducted. Mean age was 62 years (SD 15, range 21-91). 70 patients travelled for less than 5 hours to the hospital, 26 had longer journeys. 71 patients were peasants, 25 professionals. 54 patients had a visual acuity ≥ 6/18, 42 < 6/18. A significant association between loss to follow and visual acuity was identified. The qualitative analysis revealed financial barriers, lack of family support, lack of knowledge of the disease, presence of other diseases, emotional barriers as repeating themes in relation to loss to follow up. Conclusions: The high rate of dropouts among glaucoma patients was associated with poor vision, a lack of knowledge and economical constraints. There is a need for strategies to improve knowledge on glaucoma among patients

Efficacy of Manual Small Incision Cataract Surgery in Hospital based eye camps in Eastern Province of Rwanda E Seba Objectives: Cataract is the main leading cause of treatable blindness in Rwanda. A national population survey 2015 indicated that the main cause of avoidable blindness in Rwanda was cataract by 56%. Aims: Our study was to assess the post-operative visual outcome after manual small incision cataract surgery (MSICS) in district hospital surgical outreach patients during the study period from December 2015 to April 2016 Design and Methods: Cataract surgeries were carried out in patients (both with and with no known systemic diseases). After registering all operated patients. All senile cataracts were included and complicated cataracts were excluded from the study. Patients underwent manual SICS with posterior chamber intraocular lens implantation. Post-operatively patients received antibiotic-steroid eye drops for 6 weeks. Patients were followed-up at regular intervals. Refraction was done at the end of 2 months. Results: A total of 100 patients were included in this study. At the end of 2 months, best corrected visual acuity (BCVA) was 6/12 on Snellen's chart and even better (6/9-6/6) in 82% cases with post-astigmatism of 2.0 diopter (D) + 1 D. Results showed good vision after MSICS at low cost in district hospital surgical outreach. Conclusions: Our study assessed the efficacy of hospital based surgical outreach in terms of visual. Our study results in terms of visual recovery showed 82% of patients had BCVA more than 6/12 on Snellen's chart. Average astigmatism was 2.0 D with no intraoperative complications justifying efficacy of district hospital base cataract surgeries.

Epidemiology of mooren’s ulcer at Ruharo Eye Centre, Southwestern Uganda; a hospital based retrospective study D Kavuma, S Arunga Objectives: To describe the clinical presentation, management, and treatment outcomes of Mooren’s Ulcer in Uganda. Design and Methods: Records of all patients who had been diagnosed with Mooren’s Ulcer at Ruharo Eye Centre from January 2013 to December 2015 were reviewed. 52 patient charts were reviewed and data collected on demographic characteristics, history and presenting complaints, eye affected, clinical presentation, modes of medical and surgical treatment, and post treatment visual acuity. Stata 12 was used to analyze the data and results were tabulated. Results: The median and mean ages were 24.5 years and 29.1 years respectively. The ratio of males to females was 7.7:1. In terms of presentation, 32 (82.1%) patients presented with pain, 13 (33.3%) with redness, and 10 (25.7%) with tearing. 47 (90.4%) patients had unilateral disease and 5 (9.6%) had bilateral disease. 4 (80%) of those with bilateral disease were aged 30 years and above while 1 (20%) was below 30 years. In terms of treatment, 29 (55.8%) of the patients received only medical treatment and 23 (44.2%) received various forms of surgical management.. In terms of outcome, 3 (5.8%) of the patients were marked as healed on their last review date, 7 (13.5%) perforated after admission, 1 (1.92%) was eviscerated, and 41 (78.8%) still had active ulceration on their last review date. By vision, 11 (21.2%) of the patients had an improvement in visual acuity on date of last review, 20 (38.5%) had no change in visual acuity, and 21 (40.4%) had a decline in visual acuity. Conclusions: This primary study provided background information on epidemiology of Mooren’s ulcer in Uganda; younger males seemed to be the most affected group; severe disease was seen in older patients.

Cataract surgery in patients with very small pupils: know the risks, avoid the complications S Briesen Objectives: The growing use of alpha-1 receptor antagonists in the treatment of benign prostatic hyperplasia (BPH) has created a new problem in ophthalmic surgery, the so-called intraoperative floppy iris syndrome (IFIS). This consists of a billowing iris, insufficient pupillary dilation with progressive intraoperative miosis, and protrusion of iris tissue through the tunnel and side port incision that are made for access to the anterior chamber during surgery. IFIS presents particular difficulties in cataract surgery which is carried out through the pupil with manipulations in the immediate vicinity of the iris. The complications range from poor visibility of the operative field to iris damage with the surgical instruments and to rupture of the posterior capsule, with loss of lens material into the vitreous body. Design and Methods: Selective literature review. Results: Alpha-blockers have a direct effect on the alpha-receptors of the iris but also induce ultrastructural changes in the iridial stroma, leading to IFIS. The most important factor in avoiding complications of IFIS seems to be the ophthalmic surgeon's knowledge that the patient is taking an alpha-1 receptor antagonist. Conclusions: A thorough medical history and an optimized information flow among all physicians treating the patient-the urologist, the family physician, and the ophthalmic surgeon-are essential for safe cataract surgery.

Profile of amblyopia at Sabatia Eye Hospital


M Wanyonyi, L Njambi, M Kariuki, S Sitati Objectives: This study aims to determine the proportion of children who have amblyopia among those presenting at the Sabatia Eye Hospital in 2014, as well as the profile of amblyopia in these children. Amblyopia is a visual development disorder whose onset is in childhood. It becomes resistant to treatment after the critical period of 7 – 8 years when the visual system is estimated to have matured. Therefore early diagnosis is vital to the prevention of visual impairment caused by amblyopia. Design and Methods: Study Design: Quantitative, hospital-based, retrospective case series study. Study Population: All children aged below 16 years who fit the case definitions of amblyopia and were seen at Sabatia Eye Hospital between 1st January and 31st December 2014. Data Collection and Management: The 2014 outpatient records to recruit the study population as per the flow chart and study case definitions. Data was analyzed using SPSS 20.0. Frequencies and percentages were used to analyze categorical variables while continuous variables were analyzed using mean, median, mode, and range. P-value <0.05 was considered statistically significant. The analyzed data was presented in the forms of tables and graphs. Results: A total of 268 patients (451 eyes) were recruited in the study from the 4,269 files assessed, giving a proportion of 6.3%. Most patients [183 (68.28%)] had bilateral amblyopia while 85 (31.72%) had unilateral amblyopia. Refractive amblyopia (56.54%) was the most common type. It had a late diagnosis with two thirds of children presenting after the age of 8 years, and was predominantly due to ametropia which is bilateral by definition. Moderate amblyopia (58.47%) was more common than deep amblyopia (41.53%) and was predominantly due to refractive errors. Conclusions: Pre-school vision screening programmes are recommended for early diagnosis and timely treatment of refractive errors since they do not have obviously visible signs.

Madagascar financial data utilization project P Kileo Objectives: To facilitate use of cost and revenue data in eye program decision making in order to improve financial self-sustainability from service fees Design and Methods: One year observational study of the impact of modifying costs and revenues on hospital net profit. Detailed cost and revenue estimates were developed by activity (consultation, refraction, cataract operation) and location (hospital or outreach) for 3 regional programs (Vakinankaratra, Sava, Atsinanana) as well as at Ambohibao, a tertiary level hospital in Antananarivo, for 5 years 2010-14. The financial data were gathered annually from all programs by one local hospital manager using a standardized Excel data collection template. For 2014, all 4 Madagascar programs agreed to reduce 3 cost items and to increase 3 revenue items they primarily tried to decrease the cost of outreach and consumables and to increase the proportion of patients accepting cataract surgery, purchasing glasses and paying for cataract surgery. Results: 2014 compared to 2013, two sites increased net profit from sale of eye glasses by about 20%, one hospital decreased profits due to costs of renovations of the optical shop, and the one government hospital was not allowed to sell glasses. One site increased net profit from consultations by about 25%, two decreased by about 20% due to a decrease in patient volume, while the government hospital stayed about the same. Two hospitals increased net profit from cataract surgery by 30 to 40%, while 2 hospitals decreased by 30% due to increased costs of outreach activities. Conclusions: Cost revenue analysis by activity provides critical data to hospital managers and medical directors on key aspects of hospital performance, including acceptance rates cost drivers. Use of cost - revenue data by activity can lead to improved hospital self sustainability from service fees

To what extent has Burundi achieved VISION 2020, “The Right to Sight” global initiative, targets for eye service delivery? J Niyonzima, M Nyenze, J Karimurio, L Kandeke Objectives: To assess the extent to which VISION 2020 eye care service delivery targets had been met in Burundi by 2015 Design and Methods: This was a descriptive cross-sectional study targeting District, Regional, and National Hospitals in Burundi. A questionnaire was used to collect data on number and distribution of different cadres of eye personnel. The recommendations of Vision 2020 were used to benchmark human resources as meeting, exceeding or not meeting targets. A separate questionnaire was used to capture the number of cataract surgeries conducted in the country. Results: In 2015, Burundi had 15 ophthalmologists (37.5% of the target), 33 Ophthalmic Clinical Officers (66.0% of the target) and 2 Optometrists (5.1% of the target). The mean deficit for all cadres was 72.8%. Eighty-percent of the ophthalmologists in were based in Bujumbura. Four out of the 7 regions had no ophthalmologist. Sixty-eight percent of eye care facilities belonged to the private sector. Seventy-five percent of the facilities were in urban areas. The cataract surgical rate for the entire country (138 surgeries per million populations per year). Conclusions: Burundi had not met the targets for human resources by 2015. Cataract surgical was very low Most of eye care personnel and services were concentrated in the capital Bujumbura.

Impact of Trichiasis Surgery on Quality of Life: a longitudinal study in Ethiopia E Habtamu, T Wondie, S Aweke, Z Tadesse, M Zerihun, K Callahan, P Emerson, R Bailey, D Mabey, S Rajak, H Kuper, S Polack, H Weiss, M Burton Objectives: Trachomatous trichiasis significantly reduces Quality of Life (QoL). We measured the impact of trichiasis surgery on vision related quality of life (VRQoL) and health related quality of life (HRQoL) in a longitudinal study. Design and Methods: We recruited 1000 adult participants with trichiasis (cases) and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years), sex and location. VRQoL and HRQoL were measured using the WHO/PBD-VF20 and WHOQOL-BREF questionnaires respectively, at enrolment and 12 months after enrolment. All trichiasis cases received free standard trichiasis surgery immediately after enrolment. The difference-in-difference in QoL score by baseline trichiasis status was analysed using random effects linear regression, adjusted for age, sex and socioeconomic status.


Results: At 12-months follow-up, data was collected from 980 (98%) and 198 (98%) trichiasis cases and comparison participants respectively. At this follow-up, VRQoL and HRQoL scores of trichiasis cases improved substantially in all domains by 19.1 to 42.0 points (p<0.0001) and 4.7 to 17.2 points (p<0.0001), respectively. In contrast, among the comparison participants, there was no evidence of improvement in VRQoL and HRQoL domain scores during follow-up. The improvement in QoL in cases was independent of the presence of visual acuity improvement at 12 months. However, larger improvements were observed among trichiasis cases with visual improvement compared to those with vision deterioration or no change, in the VRQoL overall eyesight (p<0.0001), physical (p=0.006) and general functioning (p=0.03) subscales. In multivariable analysis, longer trichiasis duration (p<0.02) and central corneal opacity at baseline (p<0.005) predicted larger improvements in all VRQoL subscales. Conclusions: Trichiasis surgery substantially improves both VRQoL and HRQoL, even when there is no visual acuity change. Unprecedented effort is needed to scale-up trichiasis surgical programmes to prevent the risk of sight loss as well as to improve overall wellbeing and health perception of affected individuals.

The outcomes of laser treatment for diabetic retinopathy in Malawi: towards developing a systematic service C Kiire, P Burgess, P Kayange, G Msukwa, K Kalua, T Allain, S Harding Objectives: The effectiveness of laser treatment for diabetic retinopathy (DR) in Africa is often assumed from Afro-Caribbean populations in resource-rich countries without taking into account confounders that could be particularly relevant in sub-Saharan Africa. Our objective was to assess the effectiveness of laser treatment in Malawian diabetic patients and compare it to laser outcomes from the developed world. Design and Methods: Prospective, interventional cohort study. Laser outcomes were assessed at 12 months and compared with those from a retrospective, hospital-based study in the UK. Results: Forty-eight laser-treated diabetic patients (mean age: 54.5 years; mean diabetes duration: 9.7 years; mean HbA1c: 8.5%) were followed up for 12 months. Thirty-three of the 48 had macular laser resulting in a mean change in visual acuity (VA) of -3.7 letters. The proportion of patients stable (+/-4 letters) or improved at 12 months was 70%. In comparison, 100 patients who underwent macular laser treatment in the UK study (mean age: 59 years; mean diabetes duration: 13.5 years; mean HbA1c: 8.5%) had a mean change in VA of -0.5 letters at 12 months. The proportion of patients stable or improved was 73%. Conclusions: The preliminary results at 12 months following macular laser treatment in Malawi appear to be comparable to published data from UK hospital setting. More Malawian patients are being treated and the cohort remains under active follow up. We plan to assess whether the effectiveness of laser treatment is maintained at 24 months.

ReLex Smile compared to PRK and (Femto-) Lasik H Gaeckle, C Richter, L Schretzenmayer, H Guembel Objectives: ReLex Smile is a method to safely correct myopic astigmatism. This method offers superior stability compared to Femtolasik. Main objective was to evaluate the outcome, stability and patient comfort after refractive surgery by ReLEx Smile, Femtolasik and PRK in patients with thin corneas (<500microns). Design and Methods: In this prospective study, one hundred and fifty myopic patients who had thin corneas below 500 microns were included. Type of surgery was patients choice. Range of Myopia was -3 – 8 dpt. (median -4,5 dpt) and Astigmatism -2 to -5 dpt (median -1,75dpt). Only patients with a minimum remaining stroma of 280 microns were included in the study. We reviewed the 6 months postoperative refraction and corneal thickness. All patients filled out a questionnaire about their level of comfort during and after surgery. Results: The median Visual acuity 6 months postoperatively was 6/6 in all groups. Femtolasik showed minimal regression of myopia and astigmatism (median -0,25 sphere and -0,25 astigmatism) 6 months after surgery (p<0,005) . ReLex Smile and PRK patients showed no statistical significant difference in regression (p = 0,2). Mean corneal stromal loss per diopter sphere/astigmatism, 6 months after surgery was 13 microns in the PRK group, 16 microns in the Femtolasik group and 15 microns in the ReLex Smile group. Peri-operative Patient comfort (Day 0-3) was not statistically different in the Femtolasik and ReLeX smile groups but was significantly higher in both groups compared to the PRK group (p<0,001). Dry eye symptoms were not present in the ReLex Smile and PRK group compared to 38% in the femtolasik group. Conclusions: Relex Smile in thin corneas has all the advantages of a PRK without PRK’s disadvantages. Femtolasik seem to cause more dry eye syndrome and the refractive stability was not as good compared to PRK and ReLex Smile.

Visual outcomes for rhegmatogenous retina detachment patients who underwent surgery and determinants for success at KCMC, eye department M Jafar Objectives: The aim of this study was to determine Visual outcomes for rhegmatogenous retina detachment patients who underwent surgery and determinants for success at KCMC eye department. Design and Methods: This was a retrospective cross sectional hospital based study at Kilimanjaro Christian Medical Centre (KCMC) eye department, Northern Tanzania. A Data Collection Form was used to collect data from 201 patients. Results: Of the 201 patients Pre-operatively some 22 patients had visual acuity of 6/60 or better in the affected eye, representing some 11% of the patients. This proportion increased to 28.4% on final visit after retina detachment surgery in the affected eye. Age cut-off point at 50 years, The younger group had a greater chance for having final post-operative visual acuity of 6/60 or better at 36% than those aged above 50 years has who stood at 22%. With this regard retina detachment surgery, made patients four times more likely to have 6/60 or greater vision compared to their state before intervention . There were more men patients some 23.4% of them were found to have a final visual acuity of equal to or greater than 6/60, this proportion stood at 40.7% for women. The presence of other ocular diseases was present in 43% of the eyes operated, with 27.5% of the achieving final visual acuity of 6/60 or better, a much larger proportion was found in the 112 eyes that had no co-existing ocular malady at the moment of diagnosis of rhegmatogenous retina detachment at 29.2%.


Conclusions: The type of retina detachment surgery, co-existing eye disease and history of previous eye surgery did not impact on the visual outcome as did the location of the retina break, number of breaks and type of retina break. Younger age and being of the female gender was associated with better outcome. Finally, undergoing retina detachment surgery for rhegmatogenousretina detachment increased the likelihood of having visual acuity of 6/60 or greater at least four times compared with the moment of diagnosis We recommend Public awareness campaign on the importance of early presentation in case of sudden loss of vision. Studies to investigate the cause of gender bias.Myopic patients to have regular eye examination for detection of impending rhegmatogenousretina detachment.

Ocular morbidity and blindness among children in Southern Tanzania: prevalence and causes M Mafwiri, S Mosenene, C Moshiro, B Mshangila, B Fakih Objectives: To determine the prevalence of blindness and pattern of ocular morbidity among children in Mbarali district, Southern Tanzania. Design and Methods: A community based cross-sectional study was conducted between March-June 2016 among children bellow 16 years. One village health worker from each of the 113 villages in the district were trained for half-day to identify and refer children with poor-vision, white pupillary-reflex, squint and any other ocular abnormality. Children were identified for 2 weeks and were referred at nearby pre-determined examination centers where assessment of visual acuity, anterior and posterior segments and ocular motility was performed by 2 ophthalmologists and 2 optometrists. Blindness was classified according to World-Health-Organization. Data were analyzed using SPSS version 20 software. Results: A total 268 children were identified and examined. Fifty one (0.03% (95% Cl 0.2-0.4) children were blind. Ninety one out of 150,258(0.6/1000) children had uniocular blindness. Cataract was the leading cause of blindness followed by corneal scarring. Strabismus, cataract, refractive error and nasolacrimal duct obstruction were the main diagnoses. Trained village health workers correctly identified blind children. 116 children were referred for tertiary treatment. Conclusions: The prevalence of blindness in the district was found to be lower than that estimated by World-Health-Organization WHO. Cataract and corneal scarring were the leading causes of blindness. Strabismus, cataract, refractive error and nasolacrimal duct obstruction were the main diagnoses. Further studies on how to ensure all identified children present for examination are recommended.

Prevalence of retinopathy of prematurity (ROP) among infants born in Nairobi hospital O Onyango Objectives: To determine the prevalence and severity of ROP in preterms with birth weight <1500 grams and/or gestational age < 32 weeks. Also to record any adverse risk factors associated with treatment requiring ROP. Design and Methods: Design: Hospital based cross sectional retrospective study. Study period: Retrospective study extending over a 5 year period from June 2010 to June 2015. Inclusion criteria: Preterms born with <1500grams and/or <32 weeks gestation. First eye examination done 4-6 weeks post delivery. Sample size 102 Exclusion criteria: Neonates with critical illness on ventilator support. Sampling method: Medical records were used to determine the list of patients meeting the inclusion criteria by consecutive sampling. Methodology: Preterm babies all underwent ophthalmological examination (anterior segment and dilated indirect ophthalmoscopy). Laser treatment given in all cases classified as threshold stage 3 or prethreshold type 1. Results: Gender male 53 female 47. Mean age 30.2 weeks. Mean birth weight 1328g. Mean maternal age 33.3 years. Prevalence of ROP 40.9 %( 31-50 95% CI). At first examination stage 1 disease RE 28(68.3%) LE 26(63.4%), stage 2 RE 12(29.3%) LE 13(31.7%), stage 3 RE 1(2.4%) LE 2(4.9%). Zone 1 disease RE 2(4.9%) LE 0, zone 2 RE 14 (34.1%) LE 15(36.6%), zone 3 RE 25 (61%) LE 26(63.5%). Plus disease RE 13(31.7%) LE 10(24.3%). Laser treatment carried out in 9 babies. 15(36.6%) of babies with ROP had undergone blood transfusion. Blood culture positive sepsis noted in 3(7.3%) babies. Conclusions: Zone 1 disease was present in only 2 eyes. Current treatment modalities advise use of anti vascular endothelial growth factors in posterior cases. With better neonatal care in the developing world, eye examination needs more vigilance to this potentially blinding condition.

Outcome of age related cataract surgery at mbingo baptist hospital, eye unit, North West Region, Cameroon P Kamsang, M Mukuria, L Njambi, O Marvice Objectives: The overall objective was to assess the outcome of age related cataract surgery at Mbingo Baptist Hospital, Eye Unit, North West Region, Cameroon from the 1st January 2014 to 31st December 2014. Design and Methods: This was a retrospective hospital based case series conducted at Mbingo Baptist Hospital, Eye Unit, North West Region, Cameroon. Data was abstracted from files of patients 40 years old and above, who had undergone cataract surgery for age related cataract. The data was captured using a data collection tool and analyzed using STATA Version 20.0. Descriptive and univariate analysis was carried out. Results: Of the 230 files analyzed 82.2 % of eyes were blind and 3.5 % had severe visual impairment preoperatively. The uncorrected visual acuity was 6/18 or better in 2.3% eyes on day one and improved to 10.2 % eyes at 4-6 weeks. The uncorrected visual acuity was less than 6/60 in 30.3 % of eyes on day one and reduced to 20.4% eyes at 4-6weeks.Only 6% of the eyes had refraction done. All the eyes had biometry done. Intraoperative complication rate was 13% with vitreous loss accounting for 4.3%. At 4-6 weeks post-operatively the major cause of poor outcome was ocular comorbidity and found to be statistically significant (p-value 0.040). Conclusions: Uncorrected visual acuity at 4-6 weeks was below the WHO bench mark and ocular comorbidity was a major cause of poor outcome. This study emphasis the importance of provision of a wide variety of IOL powers and making refraction mandatory for all patients; as well as improving patient follow up.

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4th Annual Scientific Congress · 2016-08-18 · Arusha, Tanzania 3 COECSA Congress 2016 A Word...

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