Distinct gene expression profiles underlie morphological and etiological differences in pediatric cataracts

Purpose: Pediatric cataract is a major cause of preventable childhood blindness worldwide. Although genetic mutations or infections have been described in patients, the mechanistic basis of human cataract development remains poorly understood. Therefore, gene expression of structural, developmental, profibrotic, and transcription factors in phenotypically and etiologically distinct forms of pediatric cataracts were evaluated. Methods: This cross?sectional study included 89 pediatric cataract subjects subtyped into 1) prenatal infectious (cytomegalovirus, rubella, and combined cytomegalovirus with rubella infection), 2) prenatal non?infectious, 3) posterior capsular anomalies, 4) postnatal, 5) traumatic, and 6) secondary, and compared to clear, non?cataractous material of eyes with the subluxated lenses. Expression of lens structure?related genes (Aqp-0, HspA4/Hsp70, CrygC), transcription factors (Tdrd7, FoxE3, Maf, Pitx 3) and profibrotic genes (Tgf?, Bmp7, ?SmA, vimentin) in surgically extracted cataract lens material were studied and correlated clinically. Results: In cataract material, the lens?related gene expression profiles were uniquely associated with phenotype/etiology of different cataracts. Postnatal cataracts showed a significantly altered FoxE3 expression. Low levels of Tdrd7 expression correlated with posterior subcapsular opacity, whereas CrygC correlated significantly with anterior capsular ruptures. The expression of Aqp0 and Maf was elevated

Nexus of ocular motility and dry eye

Purpose: To evaluate the effectiveness of vision therapy (VT) in patients with chronic presumed refractory dry eye disease (DED) and concurrent nonstrabismic binocular vision anomalies (NSBVAs). To propose an algorithmic approach to manage patients with refractory DED. Methods: Thirty?two patients with chronic (>1 year) presumed refractory DED and NSBVA were prospectively evaluated. The baseline dry eye evaluation and comprehensive orthoptic evaluation were done. VT was administered by a trained orthoptist for 2 weeks. The binocular vision (BV) parameters and percentage subjective improvement were assessed after the VT. Results: On evaluation, 12 patients (37.5%) had both DED and NSBVA, and 20 patients (62.5%) had only NSBVA. Twenty?nine patients (90.62%) showed significant improvement in BV parameters following VT. Binocular near point of accommodation (median, range) improved from 17 (8–40) to 12 (5–26) mm (P value < 0.0001), and near point of convergence (median, range) improved from 6 (3–33) to 6 (5– 14) (P value 0.004) with VT. Thirty?one patients (96.87%) reported symptomatic improvement after VT, and 62.5% of these showed more than 50% improvement in symptoms. Conclusion: The present study confirms the beneficial role of VT in the treatment of patients with DED with concurrent NSBVA. It is essential to diagnose and treat NSBVA in patients with DED to ensure complete relief of symptoms and patient satisfaction. As there is a significant overlap between symptoms of dry eye disease and that of NSBVA, a complete orthoptic evaluation is recommended in all patients presenting with refractory dry eye disease related symptoms

Socioeconomic factors in childhood cataracts – A descriptive study from a tertiary eye care center in India

Purpose: While there are a few studies that show the prevalence of blindness and ocular morbidity in children, studies on socioeconomic factors in childhood cataracts are scarce. We aimed to study the socioeconomic status, education and occupation of the parents, consanguinity, and gender inequality among children presenting with cataracts. Methods: This was a hospital?based, prospective, descriptive study of 68 children with cataracts (aged 0–18 years). In addition to the data on clinical parameters and surgical management, we also collected data on age, gender, age at which the chief complaint was noticed, consanguinity of parents, socioeconomic class, and occupation and education of parents. All statistical analyses were performed using MedCalc statistical software (MedCalc Software 2019, Ostend, Belgium). Results: Sixty?eight children with pediatric cataract, out of which 36 were bilateral, were studied. Thirty children (44%) were in the age group of 1–5 years. Out of the 36 bilateral cataracts, 25 (69.44%) were males and 11 (30.56%) were females. Thirty (44.1%) had a delayed presentation. Also, 31% belonged to middle class and 28% belonged to lower middle class. Moreover, 65% of the mothers had an undergraduate education. Conclusion: There is a gender?based inequality and late presentation of childhood cataracts. To improve early detection, red reflex screening should be mandatorily done. Further studies are required to identify barriers to access of eye care specific to girls, in order to plan interventions to improve uptake of treatment. The lower socioeconomic status of the patients should be taken into account in the management of this disease.