ABSTRACT
Purpose: To explore the possibility of vitamin A deficiency (VAD) detection through School Sight Program (SSP) in a tribal district of Odisha, India. Methods: In a cross-sectional observational study, we tracked school children with ocular signs/symptoms of VAD to their villages. The ophthalmologist examined their under-5 siblings and other under-5 children in the village. Information pertaining to family belief and practices of food, water, sanitation, and the socioeconomic status of the family were collected. Results: The ocular features of VAD were detected in 207 of 4801 (4.3%) examined children. This included 70 children (mean age 11 ± 2.6 years) detected in the school, 22 siblings (mean age 3.2 ± 1.2 years) of these children detected at their home, and 115 children (mean age 3 ± 1.5 years) detected in their habitat. The average family size was 5.8 ± 2.02 and the birth order of the child with VAD was 2.3 ± 1.25. Most parents were farmer, living in asbestos-roofed house, depended on public underground water, and practiced open-air defecation. The distribution of VAD in 207 children was conjunctival xerosis (X1A = 207; 100% of VAD and 4.3% of all children), Bitot's spot (X1B = 169; 81.6% of VAD and 3.5% of all children), corneal scar (XS = 3; 1.4% of VAD and 0.06% of all children), and night blindness (XN = 35; 16.9% of VAD and 0.72% of all children). Conclusion: An opportunistic screening for detection of VAD through a SSP could be cost-effective and complement the existing strategy.
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Purpose: To study the causes of severe vision impairment (SVI) and blindness among children in Andhra Pradesh (AP) and Telangana State (TS) in South India. Methods: A total of 299 children from 10 schools for the blind were examined between January and December 2017. The schools were chosen from 3 districts of AP (Guntur, Krishna and West Godavari) and 2 districts of TS (Adilabad and Mahabubnagar). The World Health Organization Prevention of Blindness' eye examination protocol for children with blindness or visual impairment (VI) was followed. Results: Based on presenting visual acuity (PVA), 248 children (82.9%) were blind, 16 children (5.3%) had SVI, 18 (6%) had moderate VI, and 17 (5.7%) were normal. The most common anatomical cause of blindness or SVI was whole globe anomaly (32%), followed by an abnormality in the retina and vitreous (26.6%). While whole globe anomalies were high both in AP (33.8%) and TS (21.6%), lens-related pathologies were higher in TS (29.7%) and retina-related abnormalities were higher in AP (29.3%). The most common cause was related to heredity (40.5%). Etiology was unknown in 33.5% of cases. Overall, 37.1% of the causes were avoidable. In AP, 33.4% were avoidable whereas in TS nearly 60% were avoidable. Conclusion: Whole globe anomaly constitutes a major cause of SVI and blindness, especially in AP. Lens-related pathologies were higher in TS. Nearly 40% of the causes were avoidable. Hence, robust screening methods and strategies must be established for timely intervention to reduce the burden on VI in children.
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Purpose: To compare the prevalence and causes of blindness and visual impairment in tribal school students in the rural day-care and in a residential urban school. Methods: This was a cross-sectional comparative study. The 4-Stage screening in the native habitat of the tribal students performed in the school and hospital involved the trained school teachers, optometrists, comprehensive ophthalmologist, and pediatric ophthalmologist. The 2-Stage screening in the urban school involved only the optometrists and pediatric ophthalmologist. In both instances, vision (presenting and best corrected) was recorded and refraction performed. In addition, fundus photo was taken in all students in the urban school using a non-mydriatic fundus camera. Results: The comparison of blindness, visual impairment, and ocular anomalies were between tribal children (153,107 children; mean age 9.3 ± 2.7 years) examined in the native school and tribal children (10,038 children; mean age 8.8 + 1.64 years) in an urban residential school. Mild and moderate visual impairment was higher in the urban settings (P < 0.05), but severe visual impairment and blindness were similar in both settings. Refractive error, amblyopia, and posterior segment anomaly were detected more often in an urban settings (P < 0.05). Vitamin A deficiency (Bitot's spot) was detected only in children studying in the native schools (P < 0.05). Conclusion: The location, urban or rural, did not influence the visual impairment profile of tribal children. The food habit and environment seem to impact nutritional status.
ABSTRACT
India has done well in eye care delivery by recognizing visual impairment and blindness as a major medical challenge. Major contributions have come from ophthalmologists (mass cataract surgery in the early 1900s; major participation of non-government organizations), policy makers (National Program for Control of Blindness and Visual Impairment 1976; systematic development under the World Bank assisted India Cataract Project, 1995–2002), and the industry (manufacturing of affordable surgical instruments and medicines). Although the country could boast of higher cataract surgical coverage and near-total elimination of trachoma, there is increasing prevalence of diabetic retinopathy and undetected glaucoma. India is in the crossroad of adherence to old successful models of service delivery and adoption of new innovative methods of teaching and training, manpower development and skill-based training, relevant medical research and product development. In the absence of these new approaches, the initial gains in eye care could not be furthered in India. A new approach, that will combine the best of the “old” tradition of empathy and the “new” technology of analytics, is required to imagine the future of eye care in India.
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Purpose: To compare the photorefraction system (Welch Allyn Spot™) performance with subjective refraction in school sight program in one Odisha (India) tribal district. Methods: In a cross-sectional study school students, aged 5–15 years, referred after the preliminary screening by trained school teachers received photoscreening and subjective correction. The photoscreener was compared to subjective refraction in the range of +2D to ?7.5D. Statistical analysis included Friedman nonparametric test, Wilcoxon signed-rank test, linear regression, and Bland–Altman plotting. Results: The photoscreener was used in 5990 children. This analysis included 443 children (187 males, 256 females, and the mean age was 12.43 ± 2.5 years) who received both photorefraction and subjective correction, and vision improved to 6/6 in either eye. The median spherical equivalent (SE) with spot photorefraction was 0.00 D (minimum ?5.0D; maximum +1.6 D), and with subjective correction was 0.00D (minimum ?6.00 D; maximum +1.5 D). The difference in the SE between the two methods was statistically significant (P < 0.001) using Friedman nonparametric test; it was not significant for J 45 and J 180 (P = 0.39 and P = 0.17, respectively). There was a good correlation in linear regression analysis (R2 = 0.84) and Bland–Altman showed a good agreement between photorefraction and subjective correction in the tested range. Conclusion: Photorefraction may be recommended for autorefraction in school screening with reasonable accuracy if verified with a satisfactory subjective correction. The added advantages include its speed, need of less expensive eye care personnel, ability to refract both eyes together, and examination possibility in the native surrounding.
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Purpose: To report endoscope-assisted fascia lata harvest (EAFH) as a minimally-invasive technique for correction of severe blepharoptosis. Methods: This was a retrospective case series between January 2013 and April 2017. Medical records of all consecutive patients who underwent frontalis suspension by EAFH in the study period were reviewed and outcome was analyzed. Results: Fourteen patients (10 males) were included in the study. Mean age of the group was 18.14 + 17.03 years (range 4-65 years) and 11 patients had simple congenital blepharoptosis. Blepharophimosis syndrome was seen in 3 patients. Eleven patients had bilateral blepharoptosis. The mean preoperative and postoperative MRD1 was –1.60 ± 0.87 mm and +2.12 ± 1.37 mm respectively. Mean lengths of the incision and fascial harvest were 2.25 ± 0.43 cm and 13.0 ± 2.35 cm (range 10-17 cm) respectively. The median follow-up of patients was 4.57 + 4.03 months (range 1-15 months). Complications included a wound dehiscence in two patients and these were resutured. The donor sites healed well in all patients leaving a small thigh scar and none needed scar revision. Conclusion: EAFH is a promising minimally-invasive technique performed with a small incision and achieved adequate length of fascial harvest.