Non-glaucomatous optic neuropathy in Ibadan: Extrapolations to healthcare funding in Nigeria

Abstract

Background: Optic neuropathy is not a diagnosis in itself, as potential
aetiologies are myriad. A pilot study conducted in the Eye Clinic,
University College Hospital, Ibadan, between September 2007 and
November 2009, showed that 46.8% of new cases presenting to the
neuroophthalmology unit, had non-glaucomatous optic neuropathy
(NGON) in which, the precise aetiology of optic neuropathy was never
diagnosed.
Methods: All cases of NGON, seen in the neuro-ophthalmology unit,
between September 2007 and June 2014 were analyzed to determine
common aetiologies and identify the difficulties encountered in their
investigation or management.
Results: There were 159 cases of NGON. The age range was 6 months to
87 years (mean 39.0, SD 21.3). Male: Female ratio was 1.2: 1, and the
commonest diagnosis was optic atrophy of unknown aetiology. Challenges identified included difficulty obtaining recommended radiological and serological investigations, as well as no access to genetic studies and high loss to follow-up.
Conclusion: There are major constraints in the investigation of patients
presenting with optic nerve disease in Ibadan, despite the prevalence of
NGON as a major cause of visual disability among neuro-ophthalmic
patients in this setting. Diagnostic constraints must be addressed, to
facilitate neuroophthalmology patient care, within our limited resources.

Key words: Optic atrophy, Non-glaucomatous optic neuropathy, Neuroophthalmology, Aetiology, Healthcare funding, National health insurance