A Call to the Ministry of Health, Schools and Institutions

10 November 2026
To: The Minister for Health and the Ghana Health Service; the Ghana Education Service and the heads of our schools; and Ghana's universities, teaching hospitals, eye centers and professional bodies.

I am writing to ask you to act on a problem I believe is being overlooked. Young women aged 12 to 35 in Ghana and across West Africa may be losing their sight to treatable conditions that are recognized too late. No study has yet measured how often this happens, which conditions are responsible, or how long diagnosis takes. I am calling on each of you to help find out, and to protect young women while we do.

Why this call

In Accra and other Ghanaian cities, I have repeatedly met young women describing the same complaints. Their vision goes dark for seconds and returns. One or both eyes hurt and sight blurs over days. Or vision fails suddenly, with no pain at all. Most recently, I witnessed a young woman of about 23 lose her sight completely while crossing a busy road in central Accra.

I do not present these encounters as proof. They are what I have seen, not a count of who is affected. But they match conditions that medicine already knows to affect young women, and the West African evidence on those conditions is thin, scattered and mostly hospital-based. That is why I am asking for the question to be studied properly, rather than settled by anyone's impressions, including mine.

What is already known

The symptoms described do not point to one disease. They match several distinct conditions, each with a different cause, treatment and level of risk. Each can cause permanent blindness if it is missed.

Symptom pattern	Likely conditions	Who is most affected	West African evidence
Vision goes dark for seconds, often with headache, little or no eye pain	Idiopathic intracranial hypertension (raised pressure around the brain pressing on the optic nerves)	Young women, especially those carrying extra weight; some contraceptives and acne antibiotics can trigger it	Korle Bu case series: 6 patients, all female, aged 8–40 (median 22.5), all but one obese (Tagoe et al., 2019)
Painful loss of vision over days, worse when the eye moves	Optic neuritis, including neuromyelitis optica spectrum disorder (NMOSD)	Strongly female; NMOSD is relatively more common in people of African descent	Diagnosis is often badly delayed: an Ivorian case was confirmed only at the fourth attack, about 19 months after onset (Bulletin SPE, 2026)
Sudden painless loss in one eye, like a curtain or floaters	Sickle cell retinopathy and bleeding inside the eye	People with HbSC disease, which is common in Ghana and often mild enough to go undiagnosed	Korle Bu: sight-threatening retinopathy in 25.3% of HbSC patients against 3.5% of HbSS (Osafo-Kwaako et al., 2010)
Slow, painless loss, often noticed late	Glaucoma; steroid-induced cataract and glaucoma	Glaucoma rises with age; steroid damage follows long use of steroid-containing skin products	Tema: glaucoma in 6.8% of adults over 40, and only 3.3% of them knew (Budenz et al., 2013); Abidjan: 8 cataract cases, 6 in women, after 5–10 years of steroid soaps (Fanny et al., 2014)
Sudden loss of sight in both eyes	Pre-eclampsia and related brain swelling, blood clots in the brain's veins, migraine with aura, functional vision loss	Pregnant and recently delivered women; contraceptive users; functional loss is more common in young women	No systematic West African data identified

None of these studies measures how common these conditions are among young women in the general population. Most are small hospital series or studies of older adults.

Why young women may be at particular risk

The working hypothesis is not a single mystery illness. It is that several separate, preventable conditions converge on the same group, because each has a risk factor that is rising or concentrated among young West African women, and all are worsened by late diagnosis.

Rising obesity. The 2022 Ghana Demographic and Health Survey found 50.2% of women overweight or obese and 22% obese (Graphic Online, 2024). Obesity is the strongest known risk factor for idiopathic intracranial hypertension, and the Korle Bu authors linked rising cases to it.
Skin-lightening products. A 2023 WHO Africa fact sheet reported that 39% of Ghanaians use skin-lightening products, with the highest use among people aged 30 and under (Graphic Online, 2023). Many contain corticosteroids, which can cause cataract and raise eye pressure with long use.
Undiagnosed sickle cell disease. HbSC disease carries the highest risk of sight-threatening retinopathy, yet it is often mild enough elsewhere in the body that people do not know they have it.
Hormonal contraceptives and pregnancy. Some contraceptives are linked to raised pressure around the brain and to blood clots in the brain's veins. Pre-eclampsia can cause sudden blindness in pregnancy and soon after delivery.
Autoimmune optic nerve disease. NMOSD affects far more women than men and appears relatively more common in people of African descent.
Late diagnosis. Each condition needs specialist tests, such as brain imaging, measuring pressure in the spinal fluid, or blood antibody tests. These are expensive and concentrated in a few teaching hospitals, so the window for treatment may close before a diagnosis is made.

Each link above is plausible and partly supported. None has been measured in a representative sample of young West African women.

What we do not know

How common it is. There is no estimate of how many young women in Ghana or West Africa experience sudden or episodic vision loss each year.
Which conditions are responsible. No study has recorded the full range of final diagnoses among young women who present with these symptoms.
How long diagnosis takes. The delay from first symptom to correct diagnosis, and where in the health system it occurs, has not been measured.
What it costs in sight. How many affected women recover their vision, and how many are left with permanent loss, is unknown.
Which risk factors matter most here. The weight of obesity, steroid-containing skin products, contraceptives, sickle cell genotype and pregnancy has not been compared in a West African population.
What women and health workers know. Whether young women recognise these symptoms as urgent, and whether first-line health workers refer them quickly, has not been studied.

Research priorities

The studies below are ordered from quickest and cheapest to most ambitious. Each answers one of the gaps above.

Priority	Study	What it answers	Who could lead it
1	Scoping review of published and grey literature on sudden or episodic vision loss in women aged 12–35 in West Africa	What is already known, and where the evidence stops	University departments of ophthalmology, optometry or public health
2	Multi-centre review of five years of records at major eye centres, such as Korle Bu, Komfo Anokye and Cape Coast	Final diagnoses, time to diagnosis, visual outcomes, and recorded risk factors	Eye centre clinicians with a research partner
3	Prospective registry of every young woman presenting with acute vision loss at participating centres	Accurate diagnosis and outcome data, collected consistently over time	Ghana Ophthalmological Society with teaching hospitals
4	Case-control study comparing affected women with unaffected women of the same age	Which risk factors (weight, skin products, contraceptives, genotype, pregnancy) are linked to which condition	Epidemiologists with the registry team
5	Survey of young women and first-line health workers	Whether symptoms are recognised as urgent, and where referral breaks down	Public health and nursing researchers
6	Health system study of access to imaging, spinal fluid testing and antibody tests	Whether cost and distance explain late diagnosis	Health economists with the Ghana Health Service

The second study could begin quickly, because the records already exist.

What I am asking of the Ministry of Health and the Ghana Health Service

Commission and fund the research priorities above, beginning with a five-year review of records at the major eye centers.
Issue clinical guidance that sudden or episodic vision loss in a young woman is an urgent referral, to be seen by an eye specialist the same day.
Review whether the tests needed for diagnosis, such as brain imaging, spinal fluid pressure measurement and antibody tests, are affordable and reachable under the National Health Insurance Scheme.
Work with the Food and Drugs Authority to strengthen enforcement against unregistered skin-lightening products containing corticosteroids.
Add the warning signs of vision loss to adolescent health, family planning and antenatal services, where young women already meet health workers.
Encourage young people to know their sickle cell genotype, and offer eye checks to those with HbSC disease.

What I am asking of schools

I address this to the Ghana Education Service, its School Health Education Program, and the heads of junior high, senior high and tertiary institutions.

Include basic vision checks in school health screening.
Teach students and staff that sudden loss of vision, or vision that keeps going dark with headaches, is a medical emergency. It must not be dismissed as exam stress, tiredness or a spiritual matter.
Ensure that any student who loses vision suddenly is taken for care the same day.
Include in health education the risks of skin-lightening products, the value of a healthy weight, and the importance of knowing one's sickle cell genotype.
Support affected students with fair arrangements for examinations and continued learning.

What I am asking of universities, hospitals and professional bodies

I address this to university departments of ophthalmology, optometry, neurology, public health and nursing; to the teaching hospitals and eye centers; to the Ghana Ophthalmological Society and the Ghana Medical Association; and to the West African Health Organization and research funders.

Take up the research priorities above as a shared agenda, led by Ghanaian institutions.
Establish a regional registry of young women presenting with acute vision loss.
Train first-line health workers to recognize these conditions and refer quickly.
Publish the findings openly, so that policy can follow the evidence.

Safeguards the research must respect

Girls aged 12 to 17 need parental consent as well as their own agreement to take part.
Questions about contraceptives, skin-lightening products and weight must be asked without blame. The aim is to find causes, not to shame women for choices often made under social pressure.
Functional vision loss is real and distressing. It must be studied and treated with the same seriousness as any other diagnosis.
Every study needs approval from a recognized ethics committee.

A message to the public

Until the research is done, one message can save sight now. Sudden loss of vision, in one eye or both, with or without pain, is an emergency. So is vision that keeps going dark for seconds alongside headaches. The person should be seen at an eye clinic or hospital emergency department the same day, not days later. In Accra, the Korle Bu Eye Centre handles such cases.

Many of the conditions described here can be treated if they are caught early. The harm comes from waiting.

My appeal

I am not a clinician, and I cannot carry out this research myself. What I can do is ask those who can. The young women I have described deserve to know why their sight is failing, and those who might lose it next deserve a health system that recognizes the warning signs in time.

I ask the Ministry of Health, our schools and our institutions to treat this as a priority, to begin with the records that already exist, and to let the evidence guide what follows. I would welcome any response, and I am ready to support this work in any way I can.

Respectfully,
Eric Paddy Boso

Sources

Tagoe, N. N., Beyuo, V. M., & Amissah-Arthur, K. N. (2019). Case series of six patients diagnosed and managed for idiopathic intracranial hypertension at a tertiary institution eye centre. Ghana Medical Journal, 53(1), 79–87.
Osafo-Kwaako, A., et al. (2010). Ocular manifestations of sickle cell disease at the Korle-bu Hospital, Accra, Ghana.
Budenz, D. L., et al. (2013). Prevalence of glaucoma in an urban West African population: The Tema Eye Survey. JAMA Ophthalmology, 131(5).
Fanny, A., et al. (2014). Cataractes liées à l'application prolongée de dermocorticoïdes : étude de 8 cas à Abidjan. Journal Français d'Ophtalmologie, 37(5), 388–392.
Défi diagnostique et thérapeutique de la neuromyélite optique en Côte d'Ivoire (2026). Bulletin de la Société de Pathologie Exotique.
Graphic Online (2024). Half of Ghanaian women overweight, reporting the 2022 Ghana Demographic and Health Survey.
Graphic Online (2023). More than a third of Ghanaians bleaching their skin: WHO report, reporting the WHO Africa Region fact sheet of November 2023.

CC:
The Office of the President
Parliament of Ghana-Health
Ministry of Health
Ghana Health Service
Food and Drugs Authority
Ghana Education Service
Ophthalmological Society of Ghana
Ghana College of Physicians and Surgeons, Faculty of Ophthalmology

KNUST, Department of Optometry and Visual Science

University of Ghana Medical School
Korle Bu Teaching Hospital

Komfo Anokye Teaching Hospital

[email protected]

+233242171735