Browsing by Author "Amissah-Arthur, K.N."
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Item Association between albuminuria and retinal microvascular dysfunction in type 2 diabetes with and without hypertension(Diabetes Epidemiology and Management, 2023) Antwi-Boasiako, C.; Obeng, K.A.; Amissah-Arthur, K.N.; et al.Background: Studies assessing the concordance of albuminuria and retinal microvascular dysfunction (RMD) in type 2 diabetes (T2D) have yielded inconsistent results. Similar to ethnicity, hypertension may be a potential explanatory variable. We compared the association between albuminuria and RMD in West Africans with T2D with and without hypertension. Materials and methods: This was a cross-sectional study among 177 systematically sampled Ghanaians with T2D aged ≥ 35 years. Albuminuria was based on urinary albumin-creatinine ratio≥30 mg/g. Retinal images were analyzed and graded according to the Early Treatment Diabetic Retinopathy Study criteria. Logistic regression was used to examine the associations of albuminuria and RMD with adjustments for age, sex, socioeconomic status, diabetes duration, HbA1c, smoking, systolic blood pressure (BP), BMI, and total cholesterol. Results: RMD was more prevalent in individuals with albuminuria than in those without albuminuria (41.7% vs. 24.0%, p = 0.026). In the fully adjusted model, albuminuria remained significantly associated with RMD (odds ratio 2.41[95% CI:1.00−5.80], p = 0.049); the association between albuminuria and RMD was more pronounced in individuals with hypertension (3.10 [1.01−9.50], 0.048) than without hypertension (1.70[0.33 −8.77],0.523). In analyses stratified by BP control, albuminuria was significantly associated with RMD in individuals with suboptimal BP (2.76[1.07−7.14], 0.037) but not in individuals with optimal BP (0.24[0.00 −17.04],0.512) Conclusion: Our study shows positive associations between albuminuria and RMD among West Africans with T2D, with the strength of association, accentuated in individuals with hypertension/suboptimal BP. Future studies could further characterize the role of hypertension in the associations between albuminuria and RMD.Item Case series of six patients diagnosed and managed for idiopathic intracranial hypertension at a tertiary institution eye centre(Ghana medical journal, 2019-03-01) Amissah-Arthur, K.N.; Tagoe, N.N.; Beyuo, V.M.Background: Idiopathic Intracranial Hypertension (IIH) occurs secondary to raised intracranial pressure (ICP) of unknown etiology and is diagnosed when all other causes of raised ICP have been excluded. It can leave devastating sequelae such as permanent visual loss, hence the need for timely diagnosis and treatment. Anecdotally, one or two cases of idiopathic intracranial hypertension (IIH) previously presented at the Eye Centre, KBTH yearly. However, six cases were seen within a 6-month period, prompting the need to study the clinical features of IIH in this population. Objective: We aim to evaluate the clinical features of patients presenting with IIH at KBTH. Methodology: This is a retrospective case series with contemporaneous collection of data of six patients who presented to the Eye Centre (KBTH) between October 2016 and March 2017 with clinical features suggestive of IIH. The patients were evaluated and diagnosed based on clinical judgement as well as using the modified Dandy criteria. Results: All six patients were female and all except one were obese. The age range was 8 to 40 years with median 22.5 years. Symptoms in the 8-year-old were preceded by oral doxycycline for acne treatment. One patient had a history of using oral contraceptive pills prescribed for irregular menses. Clinical features of blurred vision, headache, and papilloedema were relieved with oral acetazolamide. Conclusion: The upsurge of IIH may be due to the increased incidence of obesity in Ghana. Timely diagnosis and treatment is needed to avoid irreversible blindnessItem Characterization of West African Crystalline Macular Dystrophy in the Ghanaian Population(Elsevier, 2022) Sampalli, A.; Silvestri, V.; Cushley, L.N.; Akafo, S.; Amoaku, W.M.; Amissah-Arthur, K.N.; Lartey, S.; Hageman, C.N.; Hubbard, W.C.; Pappas, C.M.; Zouache, M.A.; Stevenson, M.; Hageman, G.S.; Silvestri, G.; Ghana AMD Study GroupObjective West African crystalline maculopathy (WACM) is characterized by the presence of macular hyperrefractile crystal-like deposits. Although the underlying pathophysiology has not been elucidated, a few biologic drivers have been proposed. We analyzed a large WACM case series to gain a more robust understanding of its features and etiology. Design Prospective, cross-sectional cohort study. Subjects Participants with WACM were selected from the large cohort recruited in the Ghana Age-Related Macular Degeneration Study. Methods Demographic and detailed medical histories, full ophthalmic examinations, digital color fundus photographs, and OCT images were obtained. All cases with WACM were evaluated by 3 retina experts. Crystal numbers, location, and distribution were determined. Associations between WACM and White age-related macular degeneration (AMD) risk variants were assessed using Firth’s bias-reduced logistic regression, including age and sex as covariates. Main Outcome Measures Phenotypic features of, and genetic associations with, WACM. Results West African crystalline maculopathy was identified in 106 eyes of 53 participants: 22 were bilateral and 24 were unilateral. Grading for AMD was not possible in 1 eye in 7 participants with WACM; therefore, laterality was not assessed in these subjects. Thirty-eight participants were women and were 14 men; sex was unrecorded for 1 participant. The mean age was 68.4 years (range, 45–101 years). Typical WACM crystals were demonstrated on OCT, which were more easily identified at high contrast and predominantly located at the inner limiting membrane. In eyes with copathology, crystals localized deeper in the inner retina, with wider retinal distribution over copathology lesions. There was no association with age or sex. A significant association was observed between the complement factor H (CFH) 402H risk variant and WACM. Conclusions This study confirms the localization of crystals adjacent to the inner limiting membrane and distribution over lesions in eyes with copathology. The evaluation of OCT images under high contrast allows improved identification. West African crystalline maculopathy may be associated with the CFH-CFHR5 AMD risk locus identified among Whites; however, it is also possible that the combination of crystals and the CFH 402H allele increases the risk for developing late AMD. Further analyses using larger sample sizes are warranted to identify causalities between genotype and WACM phenotype.Item The past, present and future management of sickle cell retinopathy within an African context(Eye (Basingstoke), 2018-07) Amissah-Arthur, K.N.; Mensah, E.Sickle cell retinopathy is a potentially blinding condition that affects young people in the working age group. This review looks at the past, present and future management of sickle cell retinopathy within an African context. After Sickle cell disease was first reported in 1910, some reports from Africa were pivotal in describing the retinal changes associated with the disease. It soon became obvious that there was a varied clinical picture and clinical course. Several landmark studies were carried out in Jamaica to help elucidate the complexities of the disease and outline appropriate clinical management. In most of the developed world, the clinical management of sickle cell disease has improved with concurrent improvement in outcomes. Currently resource constraints in most Sub-Saharan African countries where there is a high burden of disease means that the management of sickle cell retinopathy is fraught with numerous challenges. Future large scale trials in Africa shall hopefully help to better elucidate the mechanisms behind proliferative sickle retinopathy and help in the development of new and improved therapeutic pathways. The use of technology can help immensely in the screening of patients with sickle cell to detect early proliferative changes and if necessary treat accordingly.Item Prevalence, Causes, and Factors Associated with Visual ImpairmentandBlindnessamongRegistered Pensioners inGhana(Journal of Ophthalmology, 2019-10-07) Nuertey, B.D.; Amissah-Arthur, K.N.; Addai, J.; Adongo, V.; Nuertey, A.D.; Kabutey, C.; Mensah, I.A.; Biritwum, R.B.Purpose. To determine the prevalence, causes, and factors associated with presenting visual impairment and blindness among pensioners. Design. A nationwide cross-sectional study. *is study was part of the analysis on data obtained in the pensioners’ medical survey conducted among members of the National Pensioners Association in Ghana. Method. (i) Setting: it was a multicenter study involving thirteen centers throughout Ghana with a center in each regional capital. (ii) Study population: the study involved 4813 pensioners. (iii) Observation procedures: data were captured through the use of questionnaires, physical examinations including eye examinations, and urine and blood sample analysis. (iv) Main outcome measure: presenting visual impairment and blindness (as defined by the WHO ICD-10 classification). Results. *e overall prevalence of blindness among pensioners in Ghana was 3.8% (95% CI � 3.2–4.4), while the prevalence of moderate and severe visual impairment was 21.7% (95% CI � 20.5–23.0). *e prevalence of blindness was lowest in the 60–65-year-old age group (2.1% (95% CI � 1.3–2.8)) and highest in the above 80-year-old age group (12.2% (95% CI � 6.6–17.8)). Cataract was the leading cause of blindness (62.4%) and moderate and severe visual impairment (55.7%). Factors significantly associated with blindness and visual impairment include educational status, vegetarianism, arthritis, and having proteins in urine. Conclusion. *ere is a high prevalence of visual impairment and blindness among the pensioners in Ghana. Sadly, the greatest cause was cataract, which is correctable. Increase in formal education status will be important in the prevention of blindness and visual impairment.Item Safety of intravitreal ziv-aflibercept in choroido-retinal vascular diseases: A randomised double-blind intervention study(Plos One, 2019-10-24) Braimah, I.Z.; Kenu, E.; Amissah-Arthur, K.N.; Akafo, S.; Kwarteng, K.O.; Amoaku, W.M.Aim To evaluate the safety of 1.25mg and 2mg intravitreal ziv-aflibercept (IVZ) in Ghanaian eyes with choroido-retinal vascular diseases. Design Prospective, randomised, double blind, interventional study. Methods Twenty patients with centre involving macular oedema in diabetic retinopathy, retinal vein occlusion, and neovascular age-related macular degeneration were assigned to 2 groups receiving 3 doses of 1.25mg/0.05ml (group 1) and 2mg/0.08ml IVZ (Group 2) at 4 weekly intervals. Safety data was collected after 30 minutes, 1 and 7 days, and 4, 8 and 12 weeks after injection. Changes in continuous variables were compared using paired t-test and categorical variables were compared using chi-square test of proportions. Repeated-Measures ANOVA with nesting test was used to compare variations in continuous variables by IVZ dose over time. Primary outcome measures were ocular and systemic adverse events at 4 weeks. Results Eleven females and nine males, with mean age of 63.2± 7.3 years were included. Ocular adverse events included subconjunctival haemorrhage in 1 eye, intraocular pressure (IOP) >21mmHg at 30 minutes in 6 eyes and mild pain in 3 eyes at 1-day. There was no significant difference in IOP rise between the 2 groups at 30 minutes (p = 0.21). No other ocular or systemic adverse events were observed. There was significant improvement in the best corrected visual acuity (LogMAR) from 0.95±0.6 to 0.6±0.4 (p<0.01) and 0.47±0.3 (p<0.01),reduction in central subfield foveal thickness from 405.9±140 um at baseline to 255.6±75 um (p<0.01) and 238±88 um (p<0.01) at 4 and 12 weeks respectively, although no difference was observed between the 2 groups (p = 0.34). Conclusion IVZ at 1.25mg and 2mg had similar safety profiles, and did not have any major unexpected adverse events. Further studies with larger cohorts are required to confirm efficacy.Item Utilization of eye health services and diabetic retinopathy: a cross-sectional study among persons living with diabetes visiting a tertiary eye care facility in Ghana(BMC Health Services Research, 2021) Akrofi, B.; Tetteh, J.; Amissah-Arthur, K.N.; Buxton, E.N.A; Yawson, A.Background: There have been a major advance made in screening, early diagnosis, and prompt treatment of Diabetic Retinopathy among Person living with diabetes (PLWD). However, screening services remain a challenge in Low-Middle-Income-Countries where access to eye care professionals is inadequate. This study assesses the utilization of Eye Health Service prevalence (UEHS) among PLWD and associated factors and further quantifies its association with Non-Proliferative Diabetic Retinopathy (NPDR). Methods: A cross-sectional study design with a random sample of 360 PLWD was conducted at Korle-Bu Teaching Hospital, a National Referral Centre in Ghana from May to July 2019. UEHS and DR were the study outcomes. We adopted Poisson and Probit regression analysis to assess factors associated with UEHS over the past year. We employed pairwise and phi correlation (fourfold correlational analysis) to assess the relationship between UEHS and DR (ordinal and binary respectively). Ordered Logistic and Poisson regression were applied to assess the association between the UEHS and DR. Stata 16.1 was used to perform the analyses and a p-value ≤ 0.05 was deemed significant. Results: The prevalence of UEHS over the past year and DR was 21.7 %(95 %CI = 17.7–26.2) and 65.0 %(95 %CI = 59.9–69.8 respectively. The prevalence of severe NPDR with Clinically Significant Macular Edema (CSME) was 23.9 %(19.8–28.6). Type of diabetes, increasing age, educational level, mode of payment for healthcare services, marital status, years since diagnosis, and current blood glucose significantly influenced UEHS. There was a negative relationship between DR and UEHS (Pairwise and φ correlation were − 20 and − 15 respectively; p < 0.001). Non- UEHS among PLWD doubles the likelihood of experiencing severe NPDR with CSME compared with UEHS among PLWD [aOR(95 %CI) = 2.05(1.03–4.08)]. Meanwhile, the prevalence of DR among patients per non-UEHS was insignificantly higher [12 %; aPR(95 %CI) = 0.89–1.41)] compared with patients who utilized eye care health service. Conclusions: Most of the PLWD did not utilize the eye health service even once in a year and that was highly influenced by type of diabetes and increasing age. Type 2 diabetes patients and middle age decreased the likelihood of UEHS. There was a negative relationship between DR and UEHS among PLWD and this doubled the likelihood of experiencing severe NPDR with CSME. Structured health education and screening interventions are key to improving UEHS.