National consensus statement regarding pediatric eye examination, refraction, and amblyopia management

Childhood blindness causes significant social and economic burden. Even though pediatric eye care has gained priority under Vision 2020, it continues to come under the purview of tertiary care centers due to lack of knowhow and facilities at primary and secondary level. Currently, India does not have standard guidelines on pediatric eye examination, refraction, and amblyopia management and therefore these are being managed inadequately or inappropriately. In view of this, an expert group of pediatric ophthalmologists from across the country met under the aegis of All India Ophthalmological Society, and deliberated to reach a consensus on the correct method of pediatric eye examination, treating refractive error in children and managing amblyopia. The purpose of the consensus statement was to enable all ophthalmologists to have a broad set of guidelines, which can form the basic framework for managing common pediatric eye conditions, in most ophthalmic setups. The consensus statement is divided into three broad categories: Pediatric eye examination, pediatric refraction, and amblyopia management. The pediatric eye exam subsection discusses the recommended clinical history, which should be taken and the essential components of an ophthalmic examination including pediatric vision assessment. Additionally, it discusses the role of special tests and investigations such as imaging and electrophysiology. The section on pediatric refraction emphasizes the correct use of cycloplegia and prescribing glasses in the Indian context. The final section on amblyopia management presents the various options of treating amblyopia and provides standard guidelines for the use of occlusion therapy and its weaning over time.

Microscopia confocal en córneas de cien ojos sanos / Confocal microscopy results of one hundred healthy eye corneas

Objetivo: Analizar las estructuras celulares por microscopia confocal, Confoscan 4, en córneas sanas en nuestro medio. Métodos: Se realizó un estudio prospectivo longitudinal a 100 ojos sanos de médicos que trabajan en nuestra institución, y pacientes que asistieron al servicio de córnea. Esta investigación fue desde mayo de 2007 a mayo 2008, en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", La Habana. En los médicos se examinaron ambos ojos y en los pacientes el ojo no afectado. Se recopilaron un total de 50 casos sin afección corneal. Resultados: De los 100 ojos estudiados, 64 tenían paquimetrías por encima del valor medio. Estuvieron presentes los tres tipos de células epiteliales en casi la totalidad de los pacientes; así como los queratocitos en las diferentes profundidades del estroma corneal. La mayoría de los ojos tenían un conteo celular endotelial por encima de 2 500, cifra comprendida dentro de los valores normales. Se encontraron fibras nerviosas en cada una de sus capas. Conclusiones: La microscopia confocal se presenta como una nueva herramienta que permite observar en vivo la histología corneal y complementar las observaciones de la biomicroscopia convencional. Esto constituye un reto para el mejor entendimiento de la histopatología corneal. De esta manera podemos actuar de forma profiláctica y terapéutica, en el seguimiento y evolución de patologías corneales.

Objective: This paper is aimed at analyzing the corneal cellular structures through Confoscan S4-aided confocal microscopy in apparently healthy corneas. Methods: A prospective longitudinal study of 100 healthy eyes from practicing doctors, and from patients who had attended the corneal service at “Ramón Pando Ferrer” Cuban Institute of Ophthalmology in Havana since May 2007 was conducted. Both eyes of participating doctors were examined whereas the non-affected eye was examined in the patients. A total of 50 cases with no corneal disease notified from May 2007 to May 2008 were considered. Results: The 100 studied eyes came from apparently healthy patients, and the pachymetry values of 64 of them were above the average. Since they were healthy corneas, the 3 types of epithelial cells as well as the keratocytes were present in almost all the patients and at different depths of the corneal stroma, respectively. Most of the studied eyes had endothelial cell counts above 2 500, a figure within the normal range, and there were nerve fibers in each of their layers. Conclusion: Confocal microscope is a new tool that allows in vivo observation of corneal histology and thus supplements conventional biomicroscopy observations. It contributes to better understanding of corneal pathology, with a view to prophylactically and therapeutically acting upon corneal pathologies during their follow-up and evolution.

Preschool Vision Screening for 3 to 6-Year Old Children in Korea

PURPOSE: To inform the necessity of mass screening, we performed a mass screening for the detection of ocular disorders of preschool children. METHODS: Ocular examination was performed on 60, 827 children in Korea (3-6 years of age) during the period from March to October, 2000. The total of 3, 254 children were shown to have either visual acuity of less than 0.5 or anisometropia of over 2 lines. Detailed eye examination was conducted on those 3, 254 children. RESULTS: The numbers of first mass screening were 60, 826. Diagnosis consisted of refractive errors in 2, 216, amblyopia in 664, and strabismus in 235. Among the types of refractive errors, myopic astigmatism was the most common type (34.0%). Astigmatism was combined with all other types in 1, 659 children. Refractive error was the most common cause of amblyopia (88.0%) CONCLUSIONS: To prevent and treat amblyopia or strabismus, early detection and adequate care at preschool age seemed to be very effective. Participation rate for this mass-screening of eye disease during preschool age will be more increased by efforts of constiutional support and parental cooperation.

Preschool Vision Screening for 3 to 6-Year Old Children in Seoul

PURPOSE: To prevent permanent visual disturbance, we performed a mass screening for the detection of ocular disorders of preschool children. METHODS: Ocular examination was performed on 33,955 children in Seou(3~6 years of age)l, during the period from January to December, 2000. 435 children were shown to have either visual acuity of less than 0.5 or anisometropia of over 2 lines. Detailed Eye examination. was conducted on those 435 children. RESULTS: Diagnoses consisted of refractive errors in 325(74.7%), amblyopia in 91(20.9%), strabismus 21(4.8%) and anterior segment abnormalities in 34(7.8%). Among th types of refractive errors, hyperopic astigmatism 98(30.4%) was the most common type. Astigmatism was combined with all other types in 257(79.9%) children. In cases of strabismus, exotropia was 12(57.1%) and esotropia was 4(19.0%). Refractive error was the most common cause of amblyopia(88(96.7%)). CONCLUSIONS: To prevent and treat amblyopia or strabismus, easily detection and adequate care at preschool age seemed to be very effective. Participation rate for this mass-screening of eye disease during preschool age will be more increased by efforts of constitutional support and parental coperation.