Prevalence of refractive error and spectacle coverage in schoolchildren in two urban areas of Chile

[ABSTRACT]. Objective. To assess the impact of efforts to reduce visual impairment by detecting and treating refractive errors (REs) among schoolchildren in two urban areas of Chile. Methods. In 2013, in the communities of Concepción and La Florida, we conducted a multicenter, multistage-sampling, cross-sectional study employing methods used by the Refractive Error Study in Children (RESC) survey. Best-corrected visual acuity was assessed using pinhole, with and without glasses. The coverage for correcting visual impairment due to refractive error was estimated. Results. We examined 5 412 schoolchildren, in the communities of Concepción (n = 3 049) and La Florida (n = 2 363). Uncorrected visual acuity (VA) of > 0.63 in at least one eye was found in 4 721 children (87.23%; 95% confidence interval (CI): 86.58%–88.30%). Of the remaining children, 1 017 of them (18.79%; 95% CI: 17.78%–19.80%) had a VA of < 0.5 in at least one eye. Of the 691 children with uncorrected visual impairment with both eyes open (12.77%; 95% CI: 11.9%–13.64%), 476 of them (8.76%; 95% CI: 8.03%–9.49%) achieved normal vision using best possible correction, and with 271 of the 476 (56.93%) having a normal presenting VA in the better eye. Conclusions. We found an increased coverage of services for RE-associated visual impairment and an increased percentage of children wearing glasses as compared to values reported for La Florida in an article published in 2000. The National Board of School Aid and Scholarships (JUNAEB) in Chile is achieving better results in its schoolchildren eye care program.

[RESUMEN]. Objetivo. Evaluar la repercusión de las medidas para reducir la deficiencia visual mediante la detección y el tratamiento de los errores refractivos en escolares de dos zonas urbanas de Chile. Métodos. En el 2013, en las comunas de Concepción y La Florida, realizamos un estudio transversal multicéntrico, con muestreo en varias etapas, con los métodos del estudio de error refractivo en niños conocido como RESC por su sigla en inglés. La agudeza visual mejor corregida se evaluó con un agujero estenopeico, con y sin lentes. Se calculó la cobertura de la corrección de las deficiencias visuales secundarias a errores de refracción. Resultados. Examinamos a 5 412 escolares en las comunidades de Concepción (n = 3 049) y La Florida (n = 2 363). Se encontró una agudeza visual sin corrección >0,63 cuando menos en un ojo en 4 721 niños (87,23%; intervalo de confianza de 95% [IC]: 86,58%–88,30%). De los niños restantes, 1 017 (18,79%; IC de 95%: 17,78%–19,80%) tenían una agudeza visual <0,5 cuando menos en un ojo. De los 691 niños con deficiencia visual sin corrección con ambos ojos abiertos (12,77%; IC de 95%: 11,9%–13,64%), 476 niños lograron la visión normal con la mejor corrección posible (8,76%; IC de 95%: 8,03%–9,49%); 271 de estos 476 (56,93%) tenían agudeza visual normal en el ojo mejor al inicio. Conclusiones. Encontramos una mayor cobertura de los servicios para la deficiencia visual secundaria a errores refractivos y un mayor porcentaje de niños que usaban lentes en comparación con los valores notificados para La Florida en un artículo publicado en el 2000. La Junta Nacional de Auxilio Escolar y Becas (JUNAEB) de Chile está logrando mejores resultados en su programa de atención oftalmológica para los escolares.

[RESUMO]. Objetivo. Avaliar o impacto dos esforços para reduzir a baixa visão ao detectar e tratar erros de refração em escolares em duas áreas urbanas do Chile. Métodos. Foi realizado um estudo transversal multicêntrico com amostragem em múltiplos estágios, com a aplicação da metodologia do Estudo de erros de refração em crianças (RESC), nas comunidades de Concepción e La Florida em 2013. A melhor acuidade visual corrigida foi avaliada com fenda estenopeica, com e sem óculos. Foi estimada a cobertura para corrigir a visão por erros de refração. Resultados. Foram examinados 5.412 escolares nas comunidades de Concepción (n = 3.049) e La Florida (n = 2.363). Acuidade visual (AV) não corrigida >0,63 em pelo menos um olho foi observada em 4.721 crianças (87,23%; intervalo de confiança de 95% [IC]: 86,58%–88,30%). Do restante, 1.017 crianças (18,79%; IC de 95%: 17,78%–19,80%) apresentaram AV <0,5 em pelo menos um olho. Das 691 crianças com baixa visão não corrigida medida com ambos os olhos abertos (12,77%; IC de 95%: 11,9%–13,64%), 476 (8,76%; IC de 95%: 8,03%–9,49%) atingiram visão normal com a melhor correção visual possível e, destas, 271 (56,93%) tiveram AV normal no melhor olho. Conclusões. Foi observado um aumento da cobertura dos serviços para baixa visão associada a erros de refração e um aumento na porcentagem de crianças usando óculos quando comparado aos dados informados na comunidade La Florida em artigo publicado em 2000. A comissão nacional chilena de auxílio escolar e bolsas de estudos (JUNAEB) está conseguindo obter resultados melhores com o programa de atenção à saúde ocular de escolares.

Prevalence of refractive error and spectacle coverage in schoolchildren in two urban areas of Chile.

OBJECTIVE: To assess the impact of efforts to reduce visual impairment by detecting and treating refractive errors (REs) among schoolchildren in two urban areas of Chile. METHODS: In 2013, in the communities of Concepción and La Florida, we conducted a multicenter, multistage-sampling, cross-sectional study employing methods used by the Refractive Error Study in Children (RESC) survey. Best-corrected visual acuity was assessed using pinhole, with and without glasses. The coverage for correcting visual impairment due to refractive error was estimated. RESULTS: We examined 5 412 schoolchildren, in the communities of Concepción (n = 3 049) and La Florida (n = 2 363). Uncorrected visual acuity (VA) of > 0.63 in at least one eye was found in 4 721 children (87.23%; 95% confidence interval (CI): 86.58%-88.30%). Of the remaining children, 1 017 of them (18.79%; 95% CI: 17.78%-19.80%) had a VA of < 0.5 in at least one eye. Of the 691 children with uncorrected visual impairment with both eyes open (12.77%; 95% CI: 11.9%-13.64%), 476 of them (8.76%; 95% CI: 8.03%-9.49%) achieved normal vision using best possible correction, and with 271 of the 476 (56.93%) having a normal presenting VA in the better eye. CONCLUSIONS: We found an increased coverage of services for RE-associated visual impairment and an increased percentage of children wearing glasses as compared to values reported for La Florida in an article published in 2000. The National Board of School Aid and Scholarships (JUNAEB) in Chile is achieving better results in its schoolchildren eye care program.

Prevalence of refractive error and spectacle coverage in schoolchildren in two urban areas of Chile / Prevalencia de los errores refractivos y cobertura del uso de lentes en escolares de dos zonas urbanas de Chile / Prevalência de erros de refração e cobertura de óculos em escolares em duas áreas urbanas do Chile

ABSTRACT Objective. To assess the impact of efforts to reduce visual impairment by detecting and treating refractive errors (REs) among schoolchildren in two urban areas of Chile. Methods. In 2013, in the communities of Concepción and La Florida, we conducted a multicenter, multistage-sampling, cross-sectional study employing methods used by the Refractive Error Study in Children (RESC) survey. Best-corrected visual acuity was assessed using pinhole, with and without glasses. The coverage for correcting visual impairment due to refractive error was estimated. Results. We examined 5 412 schoolchildren, in the communities of Concepción (n = 3 049) and La Florida (n = 2 363). Uncorrected visual acuity (VA) of > 0.63 in at least one eye was found in 4 721 children (87.23%; 95% confidence interval (CI): 86.58%-88.30%). Of the remaining children, 1 017 of them (18.79%; 95% CI: 17.78%-19.80%) had a VA of < 0.5 in at least one eye. Of the 691 children with uncorrected visual impairment with both eyes open (12.77%; 95% CI: 11.9%-13.64%), 476 of them (8.76%; 95% CI: 8.03%-9.49%) achieved normal vision using best possible correction, and with 271 of the 476 (56.93%) having a normal presenting VA in the better eye. Conclusions. We found an increased coverage of services for RE-associated visual impairment and an increased percentage of children wearing glasses as compared to values reported for La Florida in an article published in 2000. The National Board of School Aid and Scholarships (JUNAEB) in Chile is achieving better results in its schoolchildren eye care program.

RESUMEN Objetivo. Evaluar la repercusión de las medidas para reducir la deficiencia visual mediante la detección y el tratamiento de los errores refractivos en escolares de dos zonas urbanas de Chile. Métodos. En el 2013, en las comunas de Concepción y La Florida, realizamos un estudio transversal multicéntrico, con muestreo en varias etapas, con los métodos del estudio de error refractivo en niños conocido como RESC por su sigla en inglés. La agudeza visual mejor corregida se evaluó con un agujero estenopeico, con y sin lentes. Se calculó la cobertura de la corrección de las deficiencias visuales secundarias a errores de refracción. Resultados. Examinamos a 5 412 escolares en las comunidades de Concepción (n = 3 049) y La Florida (n = 2 363). Se encontró una agudeza visual sin corrección >0,63 cuando menos en un ojo en 4 721 niños (87,23%; intervalo de confianza de 95% [IC]: 86,58%-88,30%). De los niños restantes, 1 017 (18,79%; IC de 95%: 17,78%-19,80%) tenían una agudeza visual <0,5 cuando menos en un ojo. De los 691 niños con deficiencia visual sin corrección con ambos ojos abiertos (12,77%; IC de 95%: 11,9%-13,64%), 476 niños lograron la visión normal con la mejor corrección posible (8,76%; IC de 95%: 8,03%-9,49%); 271 de estos 476 (56,93%) tenían agudeza visual normal en el ojo mejor al inicio. Conclusiones. Encontramos una mayor cobertura de los servicios para la deficiencia visual secundaria a errores refractivos y un mayor porcentaje de niños que usaban lentes en comparación con los valores notificados para La Florida en un artículo publicado en el 2000. La Junta Nacional de Auxilio Escolar y Becas (JUNAEB) de Chile está logrando mejores resultados en su programa de atención oftalmológica para los escolares.

RESUMO Objetivo. Avaliar o impacto dos esforços para reduzir a baixa visão ao detectar e tratar erros de refração em escolares em duas áreas urbanas do Chile. Métodos. Foi realizado um estudo transversal multicêntrico com amostragem em múltiplos estágios, com a aplicação da metodologia do Estudo de erros de refração em crianças (RESC), nas comunidades de Concepción e La Florida em 2013. A melhor acuidade visual corrigida foi avaliada com fenda estenopeica, com e sem óculos. Foi estimada a cobertura para corrigir a visão por erros de refração. Resultados. Foram examinados 5.412 escolares nas comunidades de Concepción (n = 3.049) e La Florida (n = 2.363). Acuidade visual (AV) não corrigida >0,63 em pelo menos um olho foi observada em 4.721 crianças (87,23%; intervalo de confiança de 95% [IC]: 86,58%-88,30%). Do restante, 1.017 crianças (18,79%; IC de 95%: 17,78%-19,80%) apresentaram AV <0,5 em pelo menos um olho. Das 691 crianças com baixa visão não corrigida medida com ambos os olhos abertos (12,77%; IC de 95%: 11,9%-13,64%), 476 (8,76%; IC de 95%: 8,03%-9,49%) atingiram visão normal com a melhor correção visual possível e, destas, 271 (56,93%) tiveram AV normal no melhor olho. Conclusões. Foi observado um aumento da cobertura dos serviços para baixa visão associada a erros de refração e um aumento na porcentagem de crianças usando óculos quando comparado aos dados informados na comunidade La Florida em artigo publicado em 2000. A comissão nacional chilena de auxílio escolar e bolsas de estudos (JUNAEB) está conseguindo obter resultados melhores com o programa de atenção à saúde ocular de escolares.

Amniotic membrane transplantation for restrictive strabismus.

PURPOSE: To report the use of amniotic membrane transplant in patients with restrictive strabismus. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Patients with restrictive strabismus treated with amniotic membrane transplantation. METHODS: Chart review of 7 consecutive patients (8 eyes) who developed restrictive strabismus after periocular surgery and were treated with surgical removal of restrictive adhesions and placement of an amniotic membrane transplant. MAIN OUTCOME MEASURES: Intraoperative findings to explain the mechanism of restrictive strabismus, and clinical postoperative results, including ocular alignment, ductions and versions, symptom relief, and resolution of diplopia. RESULTS: Restrictive strabismus occurred after surgery for pterygium, retinal detachment, orbital floor fracture, dermoid cyst, and dermatochalasis. Restrictive strabismus was due to a combination of conjunctival contracture, fat adherence, or rectus muscle contracture. All patients developed postoperative scarring, with failed additional standard surgery to remove the adhesions, including 1 patient treated with mitomycin C for recurrent scarring after pterygium. Reoperation using amniotic membrane transplantation was associated with improvement of ocular motility in 6 of the 7 patients; 1 patient had recurrence of scarring with persistent diplopia. The remaining 6 of 7 patients had no significant recurrence of scarring, and motility remained stable during the follow-up period of 5 to 13 months. CONCLUSIONS: Amniotic membrane transplantation seems to help prevent recurrence of adhesions in patients with restrictive strabismus caused by conjunctival scarring, fat adherence syndrome, or rectus muscle contracture. Use of an amniotic membrane transplant should be considered as a treatment option for these difficult cases of restrictive strabismus. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Manejo del estrabismo en el alto miope / Management of strabismus in high myopia

Se analiza un grupo de 12 personas con estrabismo asociado a alta miopía, en términos de su presentación clínica, cirugía realizada y sus resultados. En 7 de éstos pacientes se realizó un tipo de unión entre los músculos rectos superior y lateral (técnica de Yokohama), pero se consideraron diferentes enfoques quirúrgicos sobre el recto medio. Se obtuvieron buenos resultados en la mayoría de los casos, observándose solamente 2 casos que requirieron reoperación.

A group of 12 patients with strabismus associated to high myopia is analyzed in terms of clinical presentation, surgery performed and its results. In 7 of these patients a type of muscular union between superior and lateral rectus (Yokoyama's technique) was done, but different approaches to the medial rectus were considered. Good results were obtained in most cases with only 2 patients requiring reoperations.

[Markers of thrombophilia in patients with retinal vein thrombosis]. / Determinación de factores trombofílicos en pacientes con trombosis venosas retinianas.

BACKGROUND: Thrombophilia is an alteration of hemostasis that increases the risk to venous or arterial thrombosis. This condition may be the underlying cause of retinal vein thrombosis. AIM: To study the presence of thrombophilia in patients with retinal vein thrombosis. PATIENTS AND METHODS: Prospective study of 55 patients aged 22 to 86 years, with retinal vein thrombosis (central or branch). Antithrombin III, coagulant protein C, functional protein S, resistance to activated C protein, homocysteine, prothrombin G20210A gene, lupus anticoagulant and anticardiolipin antibodies were measured in all. RESULTS: Seventeen patients had thrombophilic markers (antiphospholipid syndrome in seven, hyperhomocysteinemia in six and resistance to protein C in three). Of these 17 patients, 53% had high blood pressure, 35% an abnormal serum lipid profile and 23% a personal history of thrombosis. The thrombosis was central in 12 (ischemic in four) and of a branch in five (ischemic in two). CONCLUSIONS: Thrombophilic markers must be assessed in patients with retinal vein thrombosis.