Customization of spectacle frames for individuals with facial deformities by altering conventional spectacle frames – Phase I

Purpose: Manufacturing a spectacle frame for a facially deformed individual is challenging because of facial asymmetry. One of the solutions is the customization of spectacle frames. Customization of spectacle frames for facially deformed individuals requires a better understanding of the facial anthropometry of deformed faces. This study aimed to analyze the facial anthropometry of deformed faces to understand the range of variability. The results of this study will be used to find customization methods in the future. Methods: We measured and analyzed the 12 facial parameters of individuals with facial deformities using the ImageJ software. Results: The data collected were normally distributed. Paired sample test revealed a statistically significant difference between innercanthus distances (right innercanthus distance [RICD] and left innercanthus distance [LICD]). Correlation analysis showed a positive difference between horizontal and vertical pupillary distance?innercanthus distance (PD?ICD) (0.68, 0.75, and 0.81) and pupillary distance?helix distance (PD?HD) (0.57, 0.68, and 0.59) relations. PD?ICD correlations are stronger compared to the PD?HD relation. Conclusion: Altering the frame center distance and the temple heights are the most important for asymmetric faces. Large population?based data are required to make concrete decisions to design a spectacle frame for asymmetric faces.

Modeling the risk of age-related macular degeneration and its predictive comparisons in a population in South India.

Background: Objective of current study was to develop and cross-validate the prediction models for Age-related Macular Degeneration (AMD) by using Logistic Regression (LR) and Artificial Neural Networks (ANN). Methods: A population based cross-sectional epidemiologic study. The data (n=3723) were analyzed on participants aged ≥40 years in Andhra Pradesh, South India. Sub-population data from this sample was drawn by using random under sampling and random over sampling techniques to derive a risk score from the LR model. The models were compared for their predictive abilities by an Area under the Receiver Operating Characteristic Curve (AUROC). Results: The LR risk score was built with a score ranging from 0 to 60 for a sub-population dataset (n=213). A cut-off score of ≥30 had a sensitivity of 79% and a specificity of 69%. The predictive performance of ANN and LR was statistically equivalent (76% vs. 78%; P = 0.624). Both the models were stable and consistently obtained the same predictive accuracies in a 30-fold split-sample cross validation. Conclusions: The sensitivity analysis of the ANN model indicated the relative importance of prioritizing modifiable risk factors for AMD in order to base preventive interventions to reduce the impact of the modifiable factors on AMD.

Visual outcomes of bilateral congenital and developmental cataracts in young children in south India and causes of poor outcome.

Context: Bilateral pediatric cataracts are important cause of visual impairment in children. Aim: To study the outcome of bilateral pediatric cataract surgery in young children. Setting and Design: Retrospective case series in a tertiary center. Materials and Methods: Records of pediatric cataracts operated between January 2001 and December 2003, with a minimum follow-up of 3 months, were reviewed retrospectively. Statistical Methods: Independent sample t-test, Fisher's exact test, and logistic regression using SPSS (Statistical Package for Social Science, Chicago, USA) version 12. Results: 215/257 (83.7%) patients had a minimum follow-up of 3 months. The mean age of presentation to the hospital was 53 months (range: 0-168 months). Congenital cataract was present in 107 patients (58.2%) and developmental cataract in 77 patients (41.8%). The mean age at surgery was 55.2 months (range: 1-168 months). Out of 430 eyes, 269 (62.6%) had an intraocular lens implanted. The mean duration of follow-up was 13.1 months (range: 3-38 months). Pre-operatively, 102 patients (47.3%) had visual acuity <6/60, in the better eye, compared to 37 patients (17.2%) post-operatively (P < 0.001). Eighty-five patients (39.5%) had visual acuity >6/18. The most common early post-operative complication was fibrinous uveitis in 57 eyes (13.3%) and the most common delayed post-operative complication was posterior capsular opacification in 118 eyes (27.4%). The most important prognostic factor for poor outcome was congenital cataract (odds ratio [OR]: 26.3; 95% confidence interval [CI], 4.4-158.5) and total cataract (OR: 4.8; 95% CI, 1.3-17). Conclusion: Nearly half of the eyes had visual acuity>6/18. The outcome was poorer in congenital cataracts, especially those operated after >1 year of age.

Changing trends in the prevalence of blindness and visual impairment in a rural district of India: Systematic observations over a decade.

Context: Globally, limited data are available on changing trends of blindness from a single region. Aims: To report the changing trends in the prevalence of blindness, visual impairment (VI), and visual outcomes of cataract surgery in a rural district of Andhra Pradesh, India, over period of one decade. Settings and Design: Rural setting; cross-sectional study. Materials and Methods: Using a validated Rapid Assessment of Cataract Surgical Services (RACSS) method, population-based, cross-sectional survey was done in a rural district in the state of Andhra Pradesh, India. Two-stage sampling procedure was used to select participants ≥50 years of age. Further, a comparative analysis was done with participants ≥50 years from the previously concluded Andhra Pradesh Eye Disease Study (APEDS) study, who belonged to the same district. Statistical Analysis: Done using 11th version of Stata. Results: Using RACSS, 2160/2300 (93.9%) participants were examined as compared with the APEDS dataset (n=521). Age and sex adjusted prevalence of blindness in RACSS and APEDS was 8% (95% CI, 6.9–9.1%) and 11% (95% CI, 8.3–13.7%), while that of VI was 13.6% (95% CI, 12.2–15.1%) and 40.3% (95% CI, 36.1–44.5%), respectively. Cataract was the major cause of blindness in both the studies. There was a significant reduction in blindness following cataract surgery as observed through RACSS (17.3%; 95% CI, 13.5–21.8%) compared with APEDS (34%; 95% CI, 20.9–49.3%). Conclusion: There was a significant reduction in prevalence of blindness and VI in this rural district of India over a decade.

Barriers to accessing eye care services among visually impaired populations in rural Andhra Pradesh, South India.

PURPOSE: To understand the reasons why people in rural south India with visual impairment arising from various ocular diseases do not seek eye care. MATERIALS AND METHODS: A total of 5,573 persons above the age of 15 were interviewed and examined in the South Indian state of Andhra Pradesh covering the districts of Adilabad, West Godavari and Mahaboobnagar. A pre-tested structured questionnaire on barriers to eye care was administered by trained field investigators. RESULTS: Of the eligible subjects, 1234 (22.1%, N=5573)) presented with distant visual acuity < 20/60 or equivalent visual field loss in the better eye. Of these, 898 (72.7%, N=1234) subjects had not sought treatment despite noticing a decrease in vision citing personal, economic and social reasons. The analysis also showed that the odds of seeking treatment was significantly higher for literates [odds ratio (OR) 1.91, 95% confidence interval (CI) 1.38 to 2.65], for those who would be defined as blind by visual acuity category (OR 1.35, 95% CI 0.96 to 1.90) and for those with cataract and other causes of visual impairment (OR 1.50, 95% CI 1.11 to 2.03). Barriers to seeking treatment among those who had not sought treatment despite noticing a decrease in vision over the past five years were personal in 52% of the respondents, economic in 37% and social in 21%. CONCLUSION: Routine planning for eye care services in rural areas of India must address the barriers to eye care perceived by communities to increase the utilization of services.

Awareness of glaucoma in the rural population of Southern India.

PURPOSE: To explore the awareness of glaucoma amongst the rural population of Andhra Pradesh, India. MATERIALS AND METHODS: A total of 7775 subjects of all ages, representative of the rural population of Andhra Pradesh, participated in the Andhra Pradesh Eye Disease Study. The responses of subjects older than 15 years (n=5573) who completed a structured questionnaire regarding awareness (heard of glaucoma) and knowledge (understanding of disease) of glaucoma formed the basis of this study. RESULTS: Awareness of glaucoma (n=18; 0.32%) was very poor in this rural population, and females were significantly less aware (p=0.007). Awareness of glaucoma was also significantly less among illiterate persons (p<0.0001), and socially backward population (p<0.0001). Majority of the respondents who were aware of glaucoma (n=10; 55.6%) did not know if visual loss due to glaucoma was permanent or reversible. The major source of awareness of glaucoma in this population was TV/magazines and other media followed by information from a relative or acquaintance suffering from the disease. CONCLUSION: Awareness of glaucoma is very poor in the rural areas of southern India. The data suggest the need for community-based health education programmes to increase the level of awareness and knowledge about glaucoma.

Awareness of eye donation in the rural population of India.

PURPOSE: To determine the "awareness of eye donation" and "willingness to pledge eyes for donation" in the rural population of Andhra Pradesh, southern India. METHODS: A total of 7,775 subjects of all ages, representative of the rural population of Andhra Pradesh, participated in the Andhra Pradesh Eye Disease Study (APEDS). Subjects older than 15 years were interviewed regarding awareness of eye donation and willingness to pledge eyes for donation. RESULTS: Age-gender adjusted prevalence of awareness of eye donation in this population was 30.7% (95% CI: 29.5-31.9) but only 0.1% (age-gender adjusted prevalence) (95% CI: 0.05-0.25) had pledged eyes. On multivariate analysis the awareness of eye donation was significantly less in those subjects > or = 70 years old (OR 0.7; 95% CI: 0.6-0.8), illiterates (OR 0.2; 95% CI: 0.1-0.2), females (OR 0.8; 95% CI: 0.7-0.9), lower socioeconomic status group (OR 0.4; 95% CI: 0.4-0.5) and Christians (OR 0.2; 95% CI: 0.1-0.6). Media comprised the major source of information about eye donation. Of those aware of eye donation, 32.9% were willing to pledge eyes, and 50.6% needed more information to decide whether or not to pledge their eyes. CONCLUSIONS: There needs to be more transfer of knowledge if more eyes are to be pledged. One-third of those aware of eye donation have not pledged their eyes, and an additional 50.6% needed more information to decide. This means only about one-fifth of those aware of eye donations have pledged their eyes.