A Thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy / Pterygium, a wing-shaped fibrovascular growth of the conjunctiva onto the cornea, can impair vision and be cosmetically unacceptable. Its frequency varies in Africa and postsurgical recurrence in blacks may be high. Determinants of pterygium occurrence and recurrence in rural Africans are not known. This study aimed to establish the determinants of pterygium occurrence and recurrence in rural blacks. The case controlled study comprised 230 patients and 157 controls. Interviews and eye examination were conducted; however, data from 150 patients and 150 controls were analyzed as pre-calculated. Families of 51 cases and 50 controls were studied. Surgery was done on 200 eligible patients. Those who experienced post-surgical recurrence were subclassified as cases and those who did not, controls. Immunohistochemistry was done on 59 pterygium sections and 7 controls. Family history of pterygium was present in 46 cases (30.6%) of 150, and 15 controls (10%) of 150; Odds ratio (OR) =3.93; p <0.01. Traditional eye medication was used by 79 cases (52.6%) of 150, and 60 controls (40%) of 150; OR =2.03; p <0.01. The tear film was unstable in 10 cases (6.6%) of 150, and 26 controls (17.3%) of 150; OR =0.30; p <0.01. Groups of 3-5 individuals per household were pterygium-affected in 36 pterygium families (70.5%) of 51 vs. 1 control (2%) of 50. After surgery, only 190 patients completed followup for a minimum duration of 6 months, and 52 (27.4%) experienced post-surgical recurrence. Of the 52 cases, 21 (40%) had grade 2 pterygia v. 8 post-surgical controls having grade 2 pterygia (6%) of 138; OR =9.1; p <0.01. The limbal basal epithelium expressed p53 in 11 pterygia (18.6%) of 59 v. 5 controls (71.4%) of 7; p <0.01. It expressed matrixmetalloproteinase-1 (MMP1) in 14 pterygia (23.7%) of 59 v. 5 controls (71.4%) of 7; p =0.02. MMP2 and MMP3 were detected in 16 cases (27.1%) of 59 v. 5 controls (71.4%) of 7; p =0.03. Pterygium occurred in families and was associated with traditional eye medication. Pterygium occurrence was not associated with unstable tear film, p53, and MMPs. Postsurgical recurrence was connected to grade 2 pterygia.

MPH / Department of Public Health / See the attached abstract below

This is a study on the prevalence of refractive errors and patients requiring refractive services at 15 eye clinics in the Amathole, Chris Hani, Joe Gqabi and OR Tambo District Municipalities of the Eastern Cape. This is an area characterised by extreme poverty where the cost of an eye examination and prescription spectacles remains financially unobtainable for most. Optometry services are provided mainly by private optometrists who service the small proportion of the population that can afford them. Adults and children remain house bound or are labelled as dull and unproductive simply because they don’t have access to an eye examination and a pair of spectacles. Purpose The purpose of the study is to identify patients with refractive errors and those requiring refractive services at the 15 eye clinics in the Eastern Cape. Another purpose is to describe the refractive services that are available to patients attending health facilities, where the eye clinics are conducted. Lastly, the purpose is to explore the possibility of nurses providing refractive services independently or under the supervision of optometrists to supplement the lack to refracting and dispensing services. Study Method A quantitative and qualitative non-experimental descriptive design was used. Research involved the analysis of Vision Care’s eye clinic records collected from 15 eye clinics from January 2010-June 2010. Semi-structured interviews were conducted with 30 nurses working at the 15 health facilities where the eye clinics were conducted using purposive sampling. The quantitative data was analysed using excel spreadsheets and graphs and qualitative data was analysed using coding and categorizing methods. Conclusion According to Vision Care’s data of the patients assessed, 19.2 percent had a refractive error and 54 percent of the patients required refractive services. It is estimated that 71.41 percent of the patients had a refractive error according to the optometrist. Although there were some organisations active in the eradication of cataracts, there was little healthcare available in the form of refraction services. xiv Patients needed to travel an average of 63.8kms to access refraction services against the backdrop of poor roads, poverty and unemployment. 28 out of 30 nurses either ‘strongly agreed’ or ‘agreed’ that nurses could be trained to perform refractions and dispense spectacles. 29 out of 30 nurses thought that this would have a positive impact on eye care. Further research is necessary to assess the feasibility of implementing a nurse operated refractive program and whether it should be within their scope of practice to refract and dispense spectacles.

D. Litt et Phil. (Literature and Philosophy) / Eye health promotion is an important aspect of VISION 2020 campaign that aims to eliminate unwarranted cases of avoidable blindness worldwide by the year 2020. Most developing countries, including South Africa, have a serious burden of eye diseases and unwarranted causes of visual impairment and blindness. The purpose of this research therefore was to highlight the lack of an integrated eye health promotion policy in the South African primary health care system which can play a major role in the elimination of this burden of disease and also to make proposals for eye health promotion policy development in South Africa. A combination of quantitative and qualitative research methods was used in this study. Questionnaires and interviews were conducted with all national and provincial health managers of portfolios relevant to eye care. Also, various health policy documents were requested from the National and Provincial Department of Health to ascertain claims of any existing guidelines on eye care. The policy documents and guidelines obtained had no specific reference to eye health promotion. Only 11 (23%) of the managers of provincial health directorates reported that they have integrated vision screening in their health promotion programmes as part of eye health promotion strategies. Eye care managers in the provinces reported that school visits accounted for 75% of eye health promotion programmes target areas. Also, apart from the Northern Cape Province which has no eye care manager and consequently no eye health promotion programmes, the Western Cape Province also does not have eye health promotion programmes and relies mostly on private sector for eye care services. The lack of an integrated eye health promotion policy and most probably the lack of a dedicated directorate that deals with eye health promotion issues may be a contributing factor to the overwhelming lack of integrated eye health promotion activities in South Africa. It is therefore recommended that an integrated eye health promotion model be developed and be part of the South African primary health care system. / Health Studies