Ophthalmoscopy- a useful but neglected skill by the non-ophthalmologist doctors

The purpose of this study was to assess the views of hospital doctors on ophthalmoscopy and their ability to examine the ocular fundi and diagnose abnormalities. A questionnaire based cross-sectional study. Khyber Teaching Hospital Peshawar, Pakistan, where study lasted from June 2007 to September 2007. An indigenous questionnaire was designed and distributed among non-ophthalmologists doctors of different specialties of the hospital. The subjects were asked to rank the frequency of using ophthalmoscope and difficulties facing in using it. A list of common ophthalmoscopic findings was also given in questionnaire and doctors were asked about their recognition using ophthalmoscope. A total of 71 non-ophthalmologist doctors were included in the study. Twenty four [33.8%] belonged to medical and allied specialties, 39 [54.9%] to surgical and allied specialties, six [8.5%] to paediatrics and two [2.8%] to emergency department. Only 28 [39.4%] had ophthalmoscope at their work place, 9 [32%] of which were non functional. Only 14 [19.7%] use ophthalmoscope daily, 26 [36.7%] occasionally and 31 [43.7%] do not use it at all. Only 20 [50%] of the 40 doctors who perform ophthalmoscopy, dilate pupil and the rest do not. Regarding competency of using ophthalmoscope only 22 [31.2%] doctors were confident in ophthalmoscopy, 17 [24%] had difficulty in focusing fundus, 22 [31.2%] had difficulty in recognizing findings and 10 [14.7%] did not know its use. Almost all [96%] mentioned the need of a training course to improve their skill of ophthalmoscopy

Short term results of primary acrysof hydrophobic acrylic foldable intraocular lens implantation in children at primary children medical center university of Utah USA

To study short term results of primary acrysof hydrophobic acrylic foldable intraocular lens implantation in children. A descriptive hospital based study. Pediatric Eye Unit, Primary Children Medical Center, University of Utah USA, where study was conducted from 1 st July 2004 to 31 st December 2007. Thirty five children aged 2 years to 13 years with congenital cataract who underwent phaco aspiration with posterior capsulotomy and anterior vitrectomy with acrysof hydrophobic acrylic foldable intraocular lens implantation in year 2004 to 2007 were included in the study. Outcome measures were visual acuity, clarity of the visual axis, postoperative inflammation and intra ocular pressure measurement. Out of 35 children 4 had bilateral cataract and 31 had unilateral cataract. There was family history of congenital cataracts in 3 children. Preoperatively 25 eyes [64.1%] had visual acuity of < 20/80, 12 eyes [30.8%] had 20/80 and 2 eyes [5.1%] had 20/60. Two weeks postoperatively 28 eyes [71.7%] had visual acuity of 20/20, 8 eyes [20.7%] of 20/40 and 3 eyes [7.6%] 20/60. One year after surgery 9 eyes [23.07%] had visual acuity of 20/20, 12 eyes [30.76%] 20/40, 6 eyes [15.39%] 20/60, 3 eyes [7.70%] 20/80 and 9 eyes [23.08%] had visual acuity of <20/80. Two weeks postoperatively 31 eyes [79.50%] were emmetrope and 8 eyes [20.50%] had astigmatism. One year after surgery 33 eyes [84.6%] were myope and 6 eyes [15.4%] had astigmatism. At the end of first year postoperatively children age 2-5 years showed mean change of refraction of 2.5 diopters, 6-9 years showed 2 diopters and 10-13 years showed 1 diopter change after one year. Postoperative inflammatory membranes occurred in 9 eyes [23.07%]. Five eyes [12.8%] responded to topical steroids while 4 eyes [10.2%] required pars plana membranectomy. Visual axis/ posterior capsular opacification occurred in 10 eyes [25.64%]. Secondary posterior capsulotomy was performed in 9 eyes [23.07%] while Neodynium Yag Laser capsulotomy was performed in one eye [2.56%]. Intraocular pressure recorded during postoperative period was normal in all the ages. The primary acrysof hydrophobic acrylic foldable intraocular lens implantation in children with posterior capsulotomy and anterior vitrectomy is a safe technique resulting in good visual acuity and normal intraocular pressure measurement postoperatively. Visual axis/posterior capsular opacification, postoperative inflammatory membranes and myopic shift are recognized complications of hydrophobic acrylic intraocular lens implantation

Refractive errors in children attending out-patient department of ophthalmology, Khyber teaching hospital, Peshawar

The objectives of the study were to estimate the occurrence of refractive errors in children age up to 15 years, attending outpatient department of Ophthalmology Khyber Teaching Hospital Peshawar, identify their types and provide them with glasses. A repetitive hospital based study. Place and duration of study: Eye Department, Khyber Teaching Hospital, Peshawar, where study was conducted from 1st October 2006 to 31st March 2007. All children age upto 15 years with refractive errors coming to Outpatient Eye Department Khyber Teaching Hospital from 1st October 2006 to 31st March 2007 were included in this repetitive study. Detailed ocular examination was performed on each patient. It consisted of visual acuity testing, pupillary reaction, ocular motility examination, anterior segment examination and direct ophthalmoscopy. The refractive error was noted with type and the patients who needed glasses were provided free glasses. Out of 2340 children 300 [12.8%] had refractive error. Mean age of children was 6 years. Forty five [15%] children were below 3 years, 180 [60%] were between 3-10 years and 75 [25%] were between 11-15 years. One hundred thirty five [45%] were male and 165 [55%] were female. Myopia occurred in 85 [28.33%] Hypermetropia occurred in 75 [25%] and astigmatism in 140 [46.67%] children. Myopic astigmatism occurred in 19 [6.3%], hypermetropic astigmatism in 38 [12.7%] and mixed astigmatism in 83 [27.7%] children. Free glasses were provided to all the children. Anisometropia occurred in 19 [6.3%] patients. Bilateral amblyopia occurred in 10 [3.3%] patients. Unilateral amblyopia occurred in 10 [3.3%]. This study showed that the uncorrected refractive error was a major problem among children. Females were almost equally affected as males. Astigmatism was the most common problem. Treatment for refractive errors is perhaps the simplest and most effective form of eye care

Frequency of vitamin A defficiency in children of age 6 months to 72 months at the out patient ophthalmology department of agency headquarter hospital Landikotal, Khyber agency

To determine the frequency of Vitamin A deficiency [VAD] and associated clinical features in children of age group 6 months to 72 months in order to plan comprehensive eye care program. It was a non-interventional, cross- sectional study based on 2373 children aged between 6 months to 72 months, attending the Eye OPD from 1 st April 2005 to 1 st April 2006. Xerophthalmia was diagnosed on the basis of ocular signs and symptoms set by WHO. Dietary intake of Vitamin A was assessed and correlation of vitamin A deficiency with various risk factors was evaluated. Out of 2373 children, 94 [4%] children were suffering from VAD. Out of 94 children, 37 [39.4%] had Bitot spots, 27 [28.7%] had signs of corneal Xerosis/ Ulceration/ Keratomalacia while 24/94 [25.5%] had a history of night blindness. Thirty one [33%] children belonged to age group 61-72 months. Diarrhoea was the most frequent illness in 33[35%]. Most of the children [80/94; 85%] belonged to poor socio economic class. Vitamin A deficiency is not uncommon in children attending eye OPD. Most of them had already developed corneal involvement. Majority are under the age of 3 years; belonging to poor families, with poor dietary intake of vitamin A and with history of preceding illnesses like diarrhea etc. Community based studies are needed to assess the real burden of VAD and to plan for the major preventive strategies