Epidemic Optic Neuropathy Is Evident in the Somalian Population

Background: Optic neuropathy epidemics have proven to be a serious public health problem around the world. Recently, documented outbreaks have occurred in Cuba and Tanzania, with almost identical clinical presentation. Investigations of both epidemics have implicated nutritional deficiencies as part of a multifactorial etiology, and thus, it is proposed that there may be many undetected epidemics in other food-deprived nations. Somalia, a country subject to prolonged droughts and civil war, may be at particular risk of nutritional deficits. We conducted a case series in Mogadishu, the Somalian capital, with the aim of identifying and characterizing any cases of epidemic optic neuropathy. Methods: Cases were recruited at the Al-Noor Eye Hospital, Mogadishu, between 2002 and 2004. Individuals were screened by trained ophthalmic nurses, and a full ophthalmic examination was undertaken by an experienced ophthalmologist. Patients also completed a lifestyle questionnaire to identify any common risk factors. Results: One hundred five acute cases of optic neuropathy were identified. Progression from hyperemia to pallor of the optic discs and greatest visual loss occurred over the first month. Our findings are similar to those reported in the Tanzanian epidemic, including involvement of young patients (mean age: 24 +/- 5.3 years) and evidence of peripheral neuropathy. Conclusion: Epidemic levels of optic neuropathy are evident in Somalia. The extent of visual loss in the first month emphasizes the need to initiate treatment early in the course of the disease. Training and establishing health surveillance systems in community clinics may form a central component to this strategy.