Refractive errors, visual impairment, and the use of low-vision devices in albinism in Malawi

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 253; no. 4; pp. 655 - 661
• Main Authors: Schulze Schwering, M., Kumar, N., Bohrmann, D., Msukwa, G., Kalua, K., Kayange, P., Spitzer, M. S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2015; Springer Nature B.V
• Subjects: Adolescent; Adult; Albinism, Oculocutaneous - complications; Child; Child, Preschool; Female; Humans; Malawi; Male; Medicine; Medicine & Public Health; Nystagmus, Pathologic - diagnosis; Ophthalmology; Pediatrics; Refraction, Ocular - physiology; Refractive Errors - etiology; Refractive Errors - physiopathology; Refractive Errors - therapy; Retinoscopy; Retrospective Studies; Sensory Aids - utilization; Vision, Low - etiology; Vision, Low - physiopathology; Vision, Low - therapy; Visual Acuity - physiology; Visually Impaired Persons - rehabilitation; Young Adult; Malawi; Visual acuity; Low vision; Albinism; Sub-Saharan Africa; Refractive error
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-015-2943-0

Background
This study focuses on the refractive implications of albinism in Malawi, which is mostly associated with the burden of visual impairment. The main goal was to describe the refractive errors and to analyze whether patients with albinism in Malawi, Sub-Saharan Africa, benefit from refraction.
Methods
Age, sex, refractive data, uncorrected and best-corrected visual acuity (UCVA, BCVA), colour vision, contrast sensitivity, and the prescription of sunglasses and low vision devices were collected for a group of 120 albino individuals with oculocutaneous albinism (OCA). Refractive errors were evaluated objectively and subjectively by retinoscopy, and followed by cycloplegic refraction to reconfirm the results. Best-corrected visual acuity (BCVA) was also assessed binocularly.
Results
One hundred and twenty albino subjects were examined, ranging in age from 4 to 25 years (median 12 years), 71 (59 %) boys and 49 (41 %) girls. All exhibited horizontal pendular nystagmus. Mean visual acuity improved from 0.98 (0.33) logMAR to 0.77 (0.15) logMAR after refraction (
p
 < 0.001). The best improvement of VA was achieved in patients with mild to moderate myopia. Patients with albinism who were hyperopic more than +1.5 D hardly improved from refraction. With the rule (WTR) astigmatism was more present (37.5 %) than against the rule (ATR) astigmatism (3.8 %). Patients with astigmatism less than 1.5 D improved in 15/32 of cases (47 %) by 2 lines or more. Patients with astigmatism equal to or more than 1.5 D in any axis improved in 26/54 of cases (48 %) by 2 lines or more.
Conclusions
Refraction improves visual acuity of children with oculocutaneous albinism in a Sub-Saharan African population in Malawi. The mean improvement was 2 logMAR units.