Corneal morbidity and associated factors among adults with reduced vision presenting to the eye clinic at Mulago National Referral Hospital

Abstract

Introduction: Corneal morbidity is an important cause of visual loss and contributes to about 5.1% of the global blindness burden. Population surveys done in sub-Saharan Africa and among developing countries have shown corneal morbidity to be the second leading cause of blindness yet many of its causes are avoidable. The eye clinic at Mulago National Referral Hospital manages several patients presenting with corneal morbidity however there is no data that describes the burden and magnitude of corneal morbidity. Objectives: The main objective of this study was to determine the prevalence and factors associated with corneal morbidity among adults with reduced vision presenting to eye clinic at Mulago National Referral Hospital. Methods: This was a descriptive cross-sectional study conducted among 427 adults with reduced vision attending the eye clinic at Mulago hospital from October 2018 to February 2019. Individuals found to have best corrected visual acuity of ≤ 6/18 by use of the Snellen chart were consecutively enrolled in the study and the data was collected using an interviewer-administered semistructured questionnaire. Data was then analyzed using STATA 15.0. The prevalence was presented as a proportion while the factors associated with corneal morbidity were presented as odds ratios with their 95% confidence intervals with significance set at a P value of less than or equal to 0.05. Results: The study found that 186 respondents had corneal morbidity giving a prevalence of 43.6% (95% CI:38.91-48.32). The mean age was 52.65 (SD=19.71) ranging from 18 to 96 years. The male to female ratio was 1:1 as 217(50.8%) were male and 210(49.2%) were female. The most frequent corneal morbidity was corneal opacity (n=54, 29.0%). The factors significantly associated with corneal morbidity were: age greater than 50 years (OR= 0.549, 95% CI:0.315-0.959, P value =0.035), having eyelid abnormalities (OR=4.031,95% CI:1.643-9.889, P value=0.002), history of previous ocular surgery (OR =2.255, 95% CI=1.425-3.571, P value=0.001), self-medication with ophthalmic drops/ointments (OR=1.674, 95% CI:1.035-2.708 P value=0.036) and diabetes (OR=0.359, 95% C1:0.179-0.721 P value=0.004). Conclusions: A large proportion of patients presenting with reduced vision at Mulago hospital eye clinic (43.6%) had corneal morbidity. Corneal opacities constituted the highest proportion of corneal morbidity. Having a previous history of ocular surgery, self-medication with ophthalmic drops/ointments, eyelid abnormalities, Diabetes and primary or tertiary education were found to be associated with corneal morbidity.