Eye care seeking behavior among rural adults in South India: Tamil Nadu Rural Eye Examination (TREE) Study Report 1

Purpose: To present the eye care seeking behavior among rural adults in South India. Methods: This cross?sectional study was conducted between 2019 and 2020 covering three blocks of the Thiruvannamalai district, Tamil Nadu, India. Door?to?door survey was performed to collect demographic information, status of literacy, occupation, and details of previous eye examination. Distance visual acuity was tested for individuals available in the house using a log MAR (logarithm of minimum angle of resonance) chart. Association between demographic details, details of previous eye examination, and status of vision was analyzed using logistic regression. Results: A data of 12,913 individuals were included for the analysis, of which 6460 (50.03%) were females. Of the total individuals, 2007 (15.54%) had undergone an eye examination previously. There were 1639 (28.50%) people who had a vision less than 0.2 log MAR in at least one eye. The odds of reported ‘previous eye examination’ were more among females [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.32–1.66, P < 0.001]; individuals aged above 60 years [OR: 11.46, 95% CI: 9.44–13.91, P < 0.001], between 40 and 60 years [OR: 10.43, 95% CI: 8.85–12.30, P < 0.001], and between 18 and 40 years [OR: 2.48, 95% CI: 2.16–2.84, P < 0.001]; illiterates (OR: 1.76, 95% CI: 1.45–2.15, P < 0.001); and farmers (OR: 1.32 95% CI: 1.12–1.55, P = 0.001). Conclusion: The study presents the utilization of eye care among rural South Indian adults. Almost 84.46% of individuals had not undergone any eye examination. Robust measures to promote eye care management would help in effective utilization of eye care services among rural adults.

Visual impairment and refractive errors in school children in Andhra Pradesh, India

Purpose: Addressing childhood vision impairment (VI) is one of the main goals of the World Health Organization’s (WHO) combating blindness strategies. The primary aim of this study was to estimate the prevalence of VI, causes, and its risk factors in school children in Krishna district, Andhra Pradesh, India. Methods: Children aged 4–15 years were screened in schools using the 6/12 Snellen optotype by trained community eye health workers, and those who failed the test and those reported or found to have obvious eye conditions were referred to primary (VC), secondary (SC), or tertiary (TC) care centre appropriately, where they underwent a complete eye examination including cycloplegic refraction and fundus examination. Results: A total of 56,988 children were screened, of whom 51.18% were boys. The mean age was 9.69 ± 3.26 years (4–15 years). Overall, 2,802/56,988 (4.92%) children were referred to a VC, of which 632/56,988 (1.11%) required referral to SC/TC. PVA of <6/12 was found in 1.72% (95% confidence interval [CI]: 1.61–1.83). The prevalence of refractive error (corrected and uncorrected) was 2.38% (95% CI: 2.26–2.51) and myopia was 2.17% (95% CI: 2.05–2.29). In multivariable analysis, older children, those in urban schools, private schools, and children with a disability had an increased risk of VI and myopia. Additionally, the risk of myopia was higher among girls than boys. Of those referred and reached SC/TC, 73.64% were due to avoidable causes. Conclusion: Childhood VI prevalence was 1.72% in this region. Uncorrected refractive error (URE) was the major cause of VI in children. Older age, schools in urban locations, private schools, and the presence of disability were associated with the risk of VI among children

Tele-rehabilitation for persons with vision impairment during COVID-19: Experiences and lessons learned

Purpose: The COVID?19 pandemic imposed challenges to access rehabilitation intervention to individuals with visual impairment, thereby increasing their disability effects. This study explored the viability maintaining the continuum of care through telerehabilitation. Methods: This study is a retrospective analysis of individuals with vision impairment who underwent telerehabilitation at the center of excellence in eye care at Hyderabad, Telangana, India, between April and September 2020. The International Classification of Functioning, Disability and Health framework was followed to provide services such as counseling for mental well?being, information and resources, educational interventions, Assistive Technology programs, therapeutic interventions for children with multiple disabilities, access to digital audio books and rehabilitation helpline. A team of professionals involved in the service care. Phone and what’s app calls were used to facilitate the training. The duration and the number of training sessions were individual need?based with an average of 45 minutes per session and 175 training sessions. Results: Three hundred and fifty individuals and their families benefited. The service include early intervention (n = 129), and low vision care (n = 176) inclusive of computer training (n = 53), soft skills (n = 53), digital books (n = 55). Nearly two?thirds of the participants were male (n = 205). Conclusion: Evidence from this study suggests telerehabilitation as a successful model of care. A well?planned telerehabilitation approach can expand the scope of reaching the visually impaired from geographically isolated areas where scarcity of service providers and service centers.

Retrospective analysis of 2 298 children with ocular trauma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To characterize a large cohort of patients presenting to the Department of Ophthalmology in Hunan Children's Hospital for ocular trauma, thus to offer supports for treatment and prevention of ocular trauma in children.<p>METHODS:The retrospective study was conducted between January 2016 and December 2020, and the medical recorded of 2 298 children(2 332 eyes)diagnosed with ocular trauma in the Ophthalmology Department and Ophthalmic Emergency of Hunan Children's Hospital were reviewed. The record data included gender, age, wounded eye, time of day, injury month, cause of injury, zone of injury, types of ocular injury, complications, method of treatment and prognosis of visual acuity. <p>RESULTS: The results showed that 44.26% of ocular trauma occurred in the age of 3-6 years old in children, and 1 718 cases(1 745 eyes)in male children versus 580 cases(587 eyes)in female children, with a male to female ratio of 2.96:1.00. The high incidence months were February and November for pediatric ocular injury. Collisions and falls were the main causes, accounting for 40.95%, following with blunt object injury and sharp object injury, accounting for 40.82%. Eyelid and other accessory organs were the main injury sites(65.40%). After injury, 58.62% of the children were treated with debridement, primary closure or topical administration of eye drops, 38.38% were treated with debridement and suturing, and 3.00% were treated with complex intraocular surgery. Most children patients were difficult to cooperate with the vision examination. Among the children who completed the vision examination, 60.60% showed visual impaired due to eye trauma. And after treatment, their vision improved to varying degrees. The severe impairment of visual acuity was mainly caused by corneal contusion, traumatic cataract, vitreous hemorrhage, bulbar foreign body and rupture of eyeball.<p>CONCLUSION: Pediatric ocular injuries are usually accidental, with an increasing incidence in recent years. The majority of children with ocular trauma are male and preschool children, with generally mild injuries and relatively good visual prognosis. Prevention and education on children's ocular traumas should be emphasized, and timely treatments after injury can effectively reduce the visual damage.

Causes of vision impairment and blindness among children in schools for the blind in South Indian States of Andhra Pradesh and Telangana

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.

Factores asociados a caídas en adultos mayores chilenos: evidencia de la Encuesta Nacional de Salud 2009-2010 / Factors associated with falls in older adults in chile: analysis of the National Health Survey 2009-2010

Background: A decrease in functional capacity due to ageing is one of the main risk factors for falls in older people. Aim: To investigate factors associated with falls in Chilean older adults. Material and Methods: We analyzed the self-reports of falls of 1,334 people aged ≥ 60 years who answered the National Health Survey 2009-2010. Falls during the last 12 months were recorded. Lifestyle, socio-demographic and health status were analyzed. A Poisson regression with robust variance estimates was performed to identify factors associated with falls. Results: Falls during the preceding year were reported by 37% of respondents (95% confidence intervals (CI): 32-42]. Fall frequency was higher in women (Prevalence ratio (PR):1.30 [95% CI:1.11; 1.53], p < 0.01) and those aged ≥ 75 years (PR:1.29 [95% CI:1.04; 1.61], p = 0.02). Hearing impairment (PR: 1.31 [95% CI: 1.07; 1.61], p < 0.01), impaired vision (PR:1.46 [95% CI:1.20; 1.77], p < 0.01), low self-reported wellbeing (PR: 1.41 [95% CI: 1.03; 1.94], p = 0.03) and disability (PR: 1.54 [95% CI:1.32; 1.79], p < 0.01) were associated with falls. However, multimorbidity (having ≥ 3 diseases) was negatively associated with falls (PR: 0.79 [95% CI: 0.63; 0.99], p = 0.04). Conclusions: Among older people, female sex, being aged > 75 years and having disability, hearing or vision impairment are risk factors for falls.

Incidence and risk factors of near vision impairment in patients with asthenopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the incidence and risk factors of near vision impairment(NVI)in patients with asthenopia.<p>METHODS: Totally 51 patients(102 eyes)with visual fatigue in our hospital from May 2017 to May 2018 were enrolled. According to whether the near vision of daily life is damaged, it is divided into daily near vision impairment group(24 cases)and no near vision impairment group(27 cases). General information of all patients were collected, and routine eye examination, subjective optometry and binocular eye movement parameter detection were detected.<p>RESULTS: In the survey, 27 patients(53%)with near vision impairment in naked eye and 24 patients(47%)with impaired near vision in daily life, and all patients had a significant improvement in visual acuity after correct optometry, and there was no one who has best corrected near visual acuity impairment. The age of patients with daily near vision impairment was significantly higher than that of patients without near vision impairment. The proportion of patients aged ≥45 years was significantly higher than that without near vision impairment(<i>P</i><0.01). NRA/PRA, vergence \〖BO(40cm)\〗, and amplitude of vergence(40cm)were significantly different between the two groups(<i>P</i><0.05).<p>CONCLUSION: Nearly half of patients with asthenopia would suffer NVI. The increase of age and imbalance between NRA and PRA as the predominant risk factors for its development.

Effectiveness Of Vision Screening Program Conducted By Preschool Teachers

@#Vision impairment when undetected early can affect the social and mental development of a child. Early detection of visual impairment can provide better prognosis and can be conducted through vision screening at pre-school. Vision screening performed using pre-school teachers would allow cost and time savings while providing greater access to perform this screening. The objective of this study was to determine the effectiveness of vision screening conducted by pre-school teachers. A total of sixty pre-school teachers from KEMAS Tabika’s and Taska’s in the Klang Valley were randomly selected and divided into two groups i.e. a Study Group and a Control Group. The Study Group was given participative and handson vision screening training whereas the Control Group was only given brief verbal instructions on conducting the screening. Each of these pre-school teachers was asked to conduct vision screening on 15 pre-school children aged 4 to 6 years old. Trained optometrists then repeated the vision screening on the same children. The results showed that there was a higher validity in the vision screening findings from the Study Group (sensitivity = 79%, specificity = 95%) compared to the Control Group (sensitivity = 26%, specificity = 95%). The level of agreement concurrence between the pre-school teachers in the Study Group and the optometrist was high for all tests (AC1 ≥ 0.89). In conclusion, the vision screening program conducted by pre-school teachers was effective but needed proper training for the screeners. This program is seen to be able to empower pre-school teachers using vison screening techniques to allow them to identify pre-school children with vision impairment who would then require further examination and management by an eye-care professional. This program would be able to reduce the prevalence of vision impairment among pre-school children in Malaysia in the long term.

Vision impairment following macular edema secondary to diabetes combined with branch retinal vein occlusion and its potential risk factors / 眼科新进展

Objective To compare visual impairment following secondary macular edema between diabetic and non-diabetic patients with branch retinal vein occlusion (BRVO) and assess the potential risk factors.Methods All 92 eyes in 87 patients with BRVO and secondary macular edema were recruited from Shaanxi provincial people's hospital and their clinical data were retrospectively analyzed.The patients were divided into 2 groups based on their blood glucose level:diabetic group including 38 patients (40 eyes) with diabetes mellitus and non-diabetic group including 49 patients (52 eyes) without diabetes.Baseline demographic assessments of vascular risk factors were evaluated at the beginning,including gender,age,medical history,BMI,blood pressure,serum lipid,HbAlc and ischemic heart disease.Visual acuity,axial length,intraocular pressure and central macular thickness (CMT) were observed when patients were admitted and at 1 month,3 months and 6 months during follow-up in the both groups,and logistic regression analysis was used to determine the related risk factors for visual impairment.Results There was no significant difference in the best corrected visual acuity between the two groups before treatment (P ＜ 0.05).The visual acuity of the nondiabetic group improved significantly during 1-month follow-up when compared with the diabetic group (t =2.22,P ＜ 0.05).However,no difference in visual acuity was found between the two groups during 3-month and 6-month follow-up.With " long-distance visual acuity ＞ 0.5 logMAR" as the dependent variable and various risk factors as the independent variable,univariate logistic regression analysis showed that diabetes mellitus (P =0.000),hyperlipidemia (P =0.000) BMI and axial length (P =0.000) were significantly associated with visual impairment following BRVO.According to the logistic regression analysis,hyperglycaemia (OR =8.222,P =0.014),hyperlipidemia (OR =25.247,P =0.002) and overweight (OR =1.388,P =0.014) were associated with the increased risk for final vision impairment,and axial length (OR =O.213,P =0.000) was proved to be a protective factor,which could alleviated the vision impairment.Conclusion Severe vision impairment following BRVO occurs more often in diabetic patients than non-diabetic patients,and controlling weight,glucose and lipid level may be an effective method for preventing vision impairment.

2014 updated recommendations for preschool vision screening: Guidelines for Filipino children entering the Philippine public school system

@#In 2004, the University of the Philippines Manila published the Philippine Guidelines on Periodic Health Examination (PHEX): Effective Screening for Diseases among Apparently Healthy Filipinos. 1 The document was envisioned to “contribute… to the quality and efficiency of health care and health maintenance for all Filipinos… It was an appeal for rational medical decision-making, and an important step toward “equitable distribution of health and health resources.” The guidelines were prepared by designated task forces, with vision disorders, specifically vision impairment, and glaucoma identified as areas of interest. PHEX recommendations were drafted using standardized principles and a common protocol, with each statement undergoing four phases of development: (1) preparation of the evidence- based draft; (2) en banc meeting that gave panelists a chance to assess and revise the draft, where issues of feasibility, resource limitations, value judgment, and experts’ opinions were taken into account. A consensus was declared when at least 75% agreed on a recommendation; (3) for unresolved issues, modified Delphi technique was employed by correspondence until a consensus was reached or a maximum of three circulations were accomplished. If still unresolved, the issue was labeled as such and included in the final draft; (4) lastly, a public forum was conducted before the final draft was written. In this manner, the recommendations for Screening for Visual Impairment were written by the Task Force for Vision Disorders.

" Um sonho cortado pela metade... ": estudo de caso sobre o impacto da prematuridade e da deficiência visual do bebê na parentalidade / " A dream cut in half... ": A case study of the impact of prematurity and the vision impairment of the babyon parenthood / " Un sueño cortado al medio... ": Estudio de caso sobre el impacto de la prematuridad y de la discapacidadvisual del bebé en la parentalidad

Quando a prematuridade culmina com um diagnóstico de retinopatia da prematuridade com perda da visão, os pais sofrem um duplo impacto. O presente estudo teve por objetivo investigar as reações emocionais dos pais nesse contexto e seu impacto na parentalidade. Para tanto, pais de uma menina de 13 meses foram entrevistados conjuntamente. Os dados foram examinados, utilizando-se a análise de conteúdo. Os resultados mostraram um choque dos pais com a aparência do bebê prematuro, o medo da morte do bebê, dificuldades para a compreensão do diagnóstico, negação, culpa, sentimentos hostis em relação à equipe médica e diminuição da autoeficácia do casal como pais. Por outro lado, identificou-se uma busca de reorganização do casal e alegrias frente à parentalidade...

Prematurity in conjuction with diagnosis of premature retinopathy aimed to with loss of vision cause, in parents a double impact. This study aimed to investigate the emotional parents reactions in this context and its impact on parenthood. Parents of a 13 months old baby girl were interviewed together. The data was examined by means of content analysis. The results revealed that parents were in shock with the appearance of the premature baby, faced fear of the baby's death, difficulty to understand the diagnosis, denial, guilt, hostile sentiments toward the medical team and diminished self-efficacy as parents. On the other hand, a couple's reorganization and happiness in the face of parentality, were also identified...

Cuando la prematuridad culmina con un diagnóstico de la retinopatía, con pérdida de la visión, los padres sufren un doble impacto. El presente estudio tuvo como objetivo investigar las reacciones emocionales de los padres en este contexto y su impacto en la parentalidad. Para ello, se entrevistó conjuntamente a los padres de una niña de 13 meses. Los datos fueron analizados mediante análisis de contenido. Los resultados mostraron un choque de los padres con la aparencia de un bebé prematuro, miedo de la muerte del bebé, dificultades para comprender el diagnóstico, negación, culpa, sentimientos de hostilidad hacia el equipo médico y la disminucíon de la auto-eficacia de la pareja como padres. Por otra parte, fue identificada una búsqueda de reorganización de la pareja y de alegrías por la parentalidad...

Comparison of Accessibility among Vision-impaired Patients Visiting Mobile and Stationary Hospitals in Rural Bangladesh.

The aim of this study is to compare accessibility of vision-impaired (VI) patients to other eyecare centres before attending the mobile and stationary hospitals. Under a cross-sectional study design, VI patients were consecutively enrolled if they visited one of the three Impact Foundation Hospitals—one mobile and two stationary hospitals. The cost and service output of all hospitals were also reviewed; 27.7% of patients at the mobile and 36.8% at the two stationary hospitals had sought eyecare at other health facilities in the past. Mobile hospital patients lived closer to the hospital but spent more time in travelling, bore less direct cost, needed less extra support, and had a higher level of satisfaction on the service. They also identified more barriers to access eyecare in the past. The mobile hospital had a higher percentage of patients with accessibility problems and should continue to help the remote population in overcoming these problems.

Isolation & characterization of Bartonella sp. from optic neuritis patients.

Background & objectives: Optic neuritis (ON) is characterized by sudden and rapid impairment of vision. Bartonella henselae is a known aetiological agent of cat scratch disease (CSD), which is a common cause of neuroretinitis, the least common type of optic neuritis. The present study was carried out to determine the microbiological aetiology of optic neuritis in patients attending a tertiary care eye hospital in north India, which was later confirmed with molecular characterization. Methods: Of the 50 patients suffering from optic neuritis reported to the Ophthalmology OPD of a tertiary care eye hospital in New Delhi, India, 29 were included in the study. Blood culture from these patients were processed for aerobic and anerobic cultures to rule out infective aetiology. Subsequently, PCR was done on archive, glycerol-stocked cultures. Results: Gram-negative pleomorphic coccobacilli grew in four of 29 patients tested. Characterization of these revealed Bartonella like organism as tested by the API 20E, API Staph, API Strept and RapID ANA systems. Electron microscopy revealed presence of polar flagella and bleb like projection all over the bacterial surface. PCR performed on preserved culture confirmed these as Bartonella sp. Interpretation & conclusions: Infections with Bartonella like organisms have not been demonstrated from India in cases of optic neuritis or in any of the other clinical syndromes in the past. The present study shows the isolation and characterization of Bartonella like organisms from optic neuritis patients. From clinical point of view it will be important to look for these organisms as aetiological agents in ON cases in order to treat with appropriate antibiotics.

Usefulness of Color Vision Test for Early Detection of Neurological Damages by Neurotoxic Substances / 예방의학회지

This paper reviews the published literature that is concerned with color vision impairment from industrial and environmental exposure to neurotoxic substances, and we evaluated whether testing for color vision impairment could be an affordable procedure for assessing these neurotoxic effects. In general, most cases of congenital color vision impairment are red-green, and blue-yellow impairment is extremely rare. However, most of the acquired color vision impairment that is related to age, alcohol or environmental factors is blue-yellow impairment. Therefore, many studies have been performed to identify this relationship between exposure to neurotoxic substances, such as organic solvents and heavy metals, and the prevalence of blueyellow color vision impairment. The test for color vision impairment is known to be very sensitive to the early signs of nervous system dysfunction and this can be useful for making the early diagnosis of neurotoxic effects from exposure to very low concentrations of toxic substances.