March 2011 D.

Kumah et al Presbyopia in public high school teachers

PRESBYOPIA AMONG PUBLIC SENIOR HIGH SCHOOL TEACHERS IN

THE KUMASI METROPOLIS
D. B. KUMAH1, S. Y. LARTEY2 and K. AMOAH-DUAH1
1
Kwame Nkrumah University of Science and Technology, Private Mail Bag, Kumasi, Ghana 2Kwame
Nkrumah University of Science and Technology, Department of Eye, Ear, Nose and Throat, Kumasi, Ghana
2
Eye Clinic, Komfo Anokye Teaching Hospital, P O Box 1934 , Kumasi, Ghana

Corresponding Author: Dr. Seth Y. Lartey Email: sylartey@[Link], [Link]@[Link]

Conflict of Interest: None Declared

SUMMARY INTRODUCTION
Background: Presbyopia if uncorrected causes Presbyopia is an age-related loss of accommodation
inability to see and do near work. It is unavoidable as that results in an inability to focus at near distances. 1,2
one ages. High school teachers whose work depends It is the most common physiological change occurring
much on near work need proper and adequate in the adult eye and is thought to cause universal near
correction of their presbyopia to increase effectiveness vision impairment with advancing age.3,4
and efficiency.
Objectives: The aim was to determine the uptake of It is generally first reported clinically between 40 and
correction and prescription for presbyopia of 45 years of age, with its peak onset between ages 42
presbyopic teachers of public Senior High School and 44 years, and generally occurs in females earlier
(S.H.S.). Design: Descriptive cross-sectional study. before 40 years.5 It progresses gradually over a number
Methods: The study was conducted in 12 public S.H.S. of years. From approximately age 52 years on, the
in the Kumasi, with a total sample size of 298. prevalence of presbyopia is considered to be essentially
Questionnaire was administered to teachers. Their 100%; however, its prevalence across all ages in the
visual acuity, refraction and ophthalmoscopy were population is 31%.6
done.
Results: The prevalence of presbyopia among the The main symptoms include vision at the customary
teachers was 68.1%. Out of the number examined near-working distance being blurred or can be
197(66.1%) were males and 10(33.9%) were females. sustained only with excessive effort and some eye
Amongst the presbyopes 60 did not have presbyopic discomfort and also reading material must be held
correction, representing 29.6% of the presbyopes. A farther away to be seen more clearly.6 Presbyopia
total of 52 presbyopic teachers required an add of cannot be cured, but individuals can compensate for it
+2.00DS and this was the highest diopter of correction by wearing reading (single-vision), bifocal, or
needed (25.6%). Among those with presbyopic progressive eyeglasses. A convex lens is used to make
correction 55.5% of them use single vision type of up for the lost automatic focusing power of the eye. 7
correction whiles the remaining 44.5% use bifocals.
Out of the 48% presbyopic teachers who have had their Presbyopia is not simply an inconvenience; it has
presbyopia corrected before, 6% were not wearing their significant effects on quality of life, particularly in the
correction. lives of teachers, whose work depends mostly on
Conclusion: The study has demonstrated a relatively reading and writing. In Ghana where most of the
higher prevalence of uncorrected presbyopia amongst marking of examination scripts and evaluation of
teachers in public Senior High Schools in the Kumasi students work in class are done manually, a teacher
Metropolis of 29.6%. Among those with correction 6 might not perform efficiently if he/she is unable to read
% were not using their correction. Proper and adequate and mark correctly. So corrective spectacle for
correction is needed by presbyopic teachers through presbyopia are necessary.
screening to ensure their maximum performance.
But the type of correction used depends much on the
Keywords: Presbyopia, teachers, lens correction, individual’s preference and normally the environment
prescription, senior high school. in which he finds himself. Teachers who do a lot of
close work may consider single-vision reading glasses.
Others who work between far and near distance
intermittently or have distant vision problems may
consider multifocals (bifocal or progressive).

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March 2011 Volume 45, Number 1 GHANA MEDICAL JOURNAL

Though the choice of corrective lens depends on the their presbyopia has been corrected before and how
client, a wrong choice can affect his comfort and often they wear their correction.
sometimes ocular health (in relation to contact lens),
and this can lead to the client not putting on his Data Analysis
correction although he might have had the right power The SPSS 16 software was employed in entering the
of correction. data,analyzing them and drawing the tables.
Percentages and prevalence were calculated for all the
Full correction is needed by teachers for maximum variables
performance. Yet there is no data in Kumasi to indicate
if they are getting their right correction. Results of the RESULTS
study will help inform policy makers give maximum More males were screened than females (197/298,
help on teachers’ correction. The aim was to determine 66.1%). Of the teachers, 71.1% were between the ages
the uptake of correction and prescription for presbyopia of 36-55 with 46-50 having the highest frequency
of presbyopic teachers of public Senior High School 60(20.1%). There were 203 teachers with presbyopia
(S.H.S.). and the prevalence of presbyopia was 68.1%. Amongst
the presbyopes, 29.6% (60) did not have presbyopic
The specific objectives included determining the correction.
number of presbyopic teachers (both corrected and
uncorrected) , the type of presbyopic prescription used The most common correction required was +2.00DS
and the number of presbyopic teachers with corrected representing 25.6% (52) of presbyopic teachers. Also
presbyopia who are not wearing their prescription. presbyopic teachers requiring this correction
(+2.00DS) represented the largest group who have had
METHODS previous correction before. All the presbyopic teachers
Sampling Technique who were having an add of +2.50DS had their
All public Senior High Schools in the Kumasi presbyopia corrected before.
Metropolis were listed as eligible for the study. The
teachers were divided into clusters according to their Among those who had presbyopic correction, (55.5%)
school.. Teachers were randomly selected from each used single vision type of prescription while the
cluster using simple random technique. remaining (44.5%) used bifocals. A total of 46% of the
teachers who were presbyopic had distant correction.
A sample size of 338 was calculated and 298 teachers And amongst these (the 46%), 90.5% preferred bifocal
were screened, giving us a respondent rate of to single vision prescription.
88.2%.Materials employed in the collection of the data
included Snellen distance and near acuity charts, trial Among those who do not wear distant correction,
case and accessories, trial frame and a Heine 94.6% preferred to use single vision. Table 1. A total of
ophthalmoscope. 143 (48%) of presbyobic teachers have had previous
prescriptions for correction. However of the presbyobic
Data Collection teachers who have had previous prescription for
Visual acuity was tested separately for distant and near correction, 6% were non compliant and not wearing
vision using Snellen charts. Teachers with visual acuity their spectacles.
(VA) less than 6/9 were refracted for both distance and
near with the help of a trial frame, a trial case and some Table 1 Types of near presbyopic prescription
of its accessories. Type of near prescription used
Have distant Single Bifocal Total
Teachers with VA of 6/9 or better were subjected to correction vision
near refraction. Myopes with a visual acuity of 6/12 or Yes 6(9.5%) 57(90.5%) 63(100.0%)
worse were also made to wear their correction before No 70(94.6%) 4(5.4%) 74(100.0%)
taking the near visual acuity test. For the purpose of Total 76(55.5%) 61(44.5%) 137(100.0%)
this study people who could not read N6 and
emmetropes who are 40 years and above were
DISCUSSION
considered as presbyopes.
Prevalence of presbyopia in this study was 68.1%. This
seems to be high as compared to the prevalence studies
A questionnaire was also used to determine personal
in Brazil, 55%,8 Southern India, 55%5 and in Ghanaian
information such as name, age, sex and the type of
women, 65%.9
correction used to correct their near vision, whether

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March 2011 D. Kumah et al Presbyopia in public high school teachers

A total of 30% of the presbyopic teachers had no In that study the factors responsible for non compliance
correction. Holden et al estimated 517 million people were: Perceived inability to afford spectacles (16.1%;
out of 1.04 billion presbyopes (49.7%) to be without 9/56), poor cosmetics (41.1%; 23/56) and
correction or having inadequate correction.10 This is embarrassment (37.5%; 21/56), with neither being
higher than what we found among teachers. This may gender biased. Unwillingness to wear spectacles was
be because teachers are educated and are expected to associated with illiteracy, but not with gender or rural
have been more receptive to uptake of correction for living.12
their error.
There seems to be hardly any published papers on
The 49.7% in Holden’s study was estimated and presbyopia among high school teachers in the African
therefore cannot be said to represent the actual setting and it is difficult to compare our work to others
population. They also used the general population in the region. The limitation of this study was that
whilst we restricted the population to high school some of the selected teachers could not participate due
teachers. Of these 29.6% had high presbyopia which to their work schedule. Four principals did not consent
could affect their performance. Perhaps some teachers to data collection in their school the results cannot be
may be reluctant to give class exercise and assignment extrapolated for the Ghana.
in order to avoid marking.
CONCLUSION
Amongst presbyopes who have had previous The study has demonstrated a high prevalence of
correction +2.00DS was the most common correction uncorrected presbyopia amongst teachers in public
required 52(25.6%). And this could be as a result of Senior High Schools in the Kumasi Metropolis of 30%.
increasing difficulty in performing near work from this It has also shown that among those with correction 6%
stage (+2.00DS to +2.50DS) without correction. Even were non compliant and not using their correction.
though it was expected for presbyopic teachers who Considering that proper and adequate correction is
required +0.75 to +1.00DS correction to have the needed by presbyopic teachers to ensure maximum
lowest presbyopic correction +1.50DS was the lowest performance, all S.H.S. teachers 35 years and above
prevalence of presbyopic correction. should be encouraged to go for presbyopic screening
and wear their spectacles. This will help improve
A survey of ocular morbidity in rural Uganda found performances in the teaching profession. Teachers who
patients with uncorrected presbyopia accounting for have their presbyopia corrected should seek
48% of those presenting with visual impairment.11A professional advice on the type of prescription suitable
total of 55.5% preferred single vision prescription to for them. Further studies are required to find out why
bifocal, probably to avoid the inconvenience of having some teachers who have their presbyopia corrected do
to put on their correction most of the time. not put on their prescription and to determine the
relationship between correction of presbyopia and
Among those who wear distant correction the bifocal performance of S.H.S. teachers and their students.
was the preferred choice since opting for a single
vision correction meant having to change spectacles ACKNOWLEDGMENT
during teaching. The teacher has to use his/her We thank the Ghana Education Service and the various
presbyopic correction to read and his distant correction head teachers for their support. We also want to show
to look at his/her pupils during teaching. None of them our appreciation to Oswald Kofi Domfeh who did most
wore progressive lens and this could be that of the data entry and typing without whose help this
progressive lenses are relatively expensive and paper wouldn’t have been completed.
unknown to most clients.

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