Summary Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.

Background and Objectives:Pneumoperitoneum during laparoscopy can produce changes in intraocular pressure (IOP) that may be influenced by several factors. In this study, we investigated changes in IOP during laparoscopy with different positioning.Methods:We recruited adult patients without eye disease scheduled to undergo laparoscopic operation requiring a reverse Trendelenburg tilt (rTr; group A; n = 20) or Trendelenburg tilt (Tr; Group B; n = 20). IOP was measured at 7 time points (T1–T7). All procedures were performed with standardized anaesthetic protocol. Mean arterial pressure (MAP), heart rate (HR), peak and plateau airway pressure, and end-tidal carbon dioxide (ETCO2) measurements were taken at each time point.Results:Both groups were similar in age, sex, mean body mass index (BMI), duration of surgery, and preoperative IOP. A decrease in IOP was observed in both groups after induction of anaesthesia (T2), whereas induction of pneumoperitoneum produced a mild increase in IOP (T3) in both groups. The Trendelenburg tilt produced IOP elevations in 80% of patients compared to 45% after the reverse Trendelenburg tilt (P = .012). A significant IOP increase of 5 mm Hg or more was recorded in 3 (15%) patients in the Trendelenburg tilt group and in none in the reverse Trendelenburg group. At T7, IOP had returned to preoperative levels in all but 3 (15%) in the Trendelenburg and 1 (5%) in the reverse Trendelenburg group. Reversible changes were observed in the MAP, HR, ETCO2, and airway pressures in both groups.Conclusions:IOP changes induced by laparoscopy are realigned after evacuation of pneumoperitoneum. A Trendelenburg tilt however produced significant changes that may require careful patient monitoring during laparoscopic procedures.

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Purpose: To assess morphological optic disc dimensions using spectral-domain optical coherence tomography (OCT) in a Nigerian population. Materials and method: Good quality SD-OCT scans of the optic disc of 147 eyes of 88 participants were selected, enrolled, and retrospectively reviewed. All subjects had optic nerve head and retinal nerve fibre layer OCT imaging, as well as analysis, done using the Topcon 3D OCT-1 Maestro®. The age, sex, and some OCT-generated optic disc dimensions namely disc area (DA), vertical disc diameter (VDD), horizontal disc diameter (HDD) were retrieved from the database and analyzed. Results: The mean age of the study subjects was 52.6±20.9 years with a range of 8–90 years; male to female ratio was 1:1.3. The right eye and left eye accounted for 75 and 72 of the 147 scans respectively. The mean DA, VDD, and HDD were 2.54 ± 0.48 mm2, 1926.5 ± 189.6 μm and 1673.9 ± 173.9 μm, respectively. Males had significantly larger DA than females (2.56 ± 0.53 mm2 vs 2.51 ± 0.44 mm2, p = 0.043). The mean DA and VDD of eyes of subjects aged 21–40 years were significantly higher compared to subjects aged 60 years and more ( p = 0.008 and 0.001, respectively). Conclusion: The mean optic disc area and diameters are larger than those reported in similar studies involving blacks and other races. The mean disc area reduces with increasing age.

Background. Automobile spray painters in Nigeria are exposed to organic solvents due to the hazardous nature of their work. Inadequate use of personal protective equipment (PPE) may intensify exposure to high levels of chemical hazards with resultant health problems. Objectives. The present study assessed PPE use and work practices and compared work-related health problems of spray painters and controls in Ile-Ife, Nigeria. Methods. A cross-sectional study was conducted among 120 spray painters and 120 controls (electronic technicians). Data on socio-demographics, work practices, knowledge about organic solvent-related hazards and self-reported health symptoms were obtained using a semi-structured questionnaire. Clinical examinations were performed for all respondents and the composition of organic solvents in paints and paint products were derived from material safety data sheets. Results. All respondents were male, and the mean age was 32.7±13.8 years for painters and 33.9±15.5 years for controls. Few (7.5%) painters perceived their use of PPE to be adequate. All spray painters worked in enclosed workshops and N-butyl acetate was the most commonly used organic solvent. Spray painters reported excessive tear production, recurrent cough, and short-term memory loss more frequently than controls (P<0.05). In addition, 89% of painters noticed paint-stained sputum immediately after spray painting. The prevalence ratio of respiratory symptoms was higher in spray painters than controls (prevalence ratio=21.0, CI=2.9–153.6). On clinical examination, more spray painters had corneal opacity and dry skin when compared with controls (P<0.05). Conclusions. Spray painters in the study area worked amidst chemical hazards and had poor use of PPE. Exposure to organic solvents may be responsible for the higher prevalence of self-reported health problems among spray painters. Interventions to enforce the use of PPE and improve the knowledge of organic solvent-related hazards among spray painters are essential. Participant Consent. Obtained Ethics Approval. Ethical approval to conduct the study was obtained from the Health Research and Ethics Committee of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife Nigeria (HREC No: IPHOAU/12/463). Competing Interests. The authors declare no competing financial interests.