Ametropias in Kinkala: Epidemiological and Clinical Aspects

Ametropia is one of the leading causes of visual impairment. This study de-scribes epidemiological and clinical aspects of ametropia as part of a free medical care program in Kinkala, Republic of Congo. Patients and Methods: We conducted a cross-sectional study from August 25th to September 24th, 2019; patients presenting complaints suggestive of ametropia were evaluated. The ametropia was determined by the objective method under cyclopentolate eye drops according to the following protocol: 3 applications of one drop every 5 minutes, followed by auto-refractometry at least 45 minutes after the first instillation. The auto-refractometer gave us the objective refraction. An anatomical examination was performed in order to eliminate any organic pa-thology. Results: Of the 2352 patients received, only 137 patients were included in our survey. Of the 137, 14 were emmetropic. Astigmatism was the most common ametropia. Its axis reversed with age, with more than 65% of direct astigmatism before age 40. There was nearly 65% of reversed astigmatism at 60 years and over. In spherical equivalents, hyperopia accounted for more than 80% of ametropia. Conclusion: Ametropia in Kinkala is dominated by astigmatism. Spherical equivalent, hyperopia represents more than 80% of refractive error.

performance, reduce employability, productivity and generally affect the quality of life [1]. Its simple correction is reflected in the prescription of corrective lenses.
Countries in Africa are responsible for 1.1% to 7.9% of cases of visual impairment [4].
In Congo, studies have been tested on children [5] [6], but do not have data on the general population.
This study was conducted on the basis of data collected as part of a free consultation program in a region with shortage of adequate ophthalmic care.

Patient
We conducted a cross-sectional study in Kinkala, South Congo Brazzaville, as part of a free medical care program, in a mobile clinic.
Included in our study were patients over 5 years of age with no apparent organic disease. The study lasted one month, from 25 August to 24 September 2019.

Method
After registration, patients were complaining of a decrease in visual acuity or asthenopia, were placed on cyclopentolate eye drops according to the following protocol: 3 applications of one drop every 5 minutes. An auto-refractometry was performed at least 45 minutes after the first instillation, allowing us to determine the objective ametropia of patients.
Only static ametropias were taken into account in this study, presbyopia was not evaluated.
Only results greater than or equal to 0.5 dioptres (D) of spherical (hyperopia and myopia) or cylindrical (astigmatism) ametropia were considered.
The patients were then examined with a slit lamp to eliminate associated organic lesions.
Data analysis was done with epi-info software 7.
Among patients with ametropia 42 were men versus 81 women. Or a sex ratio of 52.
The prevalence of ametropia for all patients was 5.22%.
Astigmatism was the most common ametropia in all age groups.
In spherical equivalent more than 80% of patients had hyperopia between 0 and 2.5 D.

Discussion
Cycloplegia in objective refraction is one of the methods used to detect ametropia. It is a bit more expensive because of the equipment it requires. It gives reproducible ametropia values, slightly higher than those obtained in subjective refraction [7].
Performing refraction only in patients with complaints about ametropia probably missed other ametropia.
Among the 273 eyes that benefited from objective refraction, in addition to the complete anatomical examination, 28 were emmetropic, which corresponds to a prevalence of ametropia of 5.22%. This prevalence corresponds to African data [4].
The prevalence of ametropia varies from one study to another depending on the study population: children [8] or adults [9]; or the methodology used: some authors have considered ametropia from refractive values of 0.5 diopters [9] [10], and others from the value of 0.25 diopters [11].
The most frequent ametropia was astigmatism, with 70.61% of cases, followed by hyperopia with 25.71%. Myopia accounted for only 3.67% of cases (Table 1).
These results are close to those of Ebana [12] in Cameroon with 4.6% myopia and 51% hyperopia. We had a little more patients with astigmatism because of the use of the auto-refractometer which is a little more sensitive to the detection of astigmatism [7].
There was no difference in the frequencies of different types of ametropia by sex ( Table 2). The axis of astigmatism evolved with age, between 5 and 39 years. More than 65% of patients had direct astigmatism, between 40 and 59 years of age. There was almost as much direct as there was reversed astigmatism. At 60 and over, reversed astigmatism was almost 65% of cases. This inversion of the axis of astigmatism with age had already been described in the literature [14]. Shah [15] who worked on adults noted a low prevalence of direct astigmatism (14%).
Taking into account the spherical equivalent of different ametropia, 79.57% of our patients had hyperopia between 0.25 and 2.5 diopters (Table 3), which is consistent with Ebana [12] results in Cameroon, where hyperopia and astigmatism hyperopia accounted for 78.5% of patients.

Conclusion
Static ametropia in Kinkala, Congo, is dominated by astigmatism. The axis of astigmatism evolves with age, from direct astigmatism to childhood to inverse astigmatism in the elderly. Considering the spherical equivalent, hyperopia accounts for more than 80% of all ametropia encountered.