Primary eyecare in paediatrics population (PREPP) - II study: Study of satisfaction of services and barrier for not reporting to the base hospital on referral among pediatric patients treated in six major vision centers of a tertiary eye care facility in Southern India.

PURPOSE: This study was conducted in continuation of Primary Eyecare in Paediatrics Population (PREPP-I) and was aimed to assess parents' satisfaction with pediatric-eye-care services across six vision centers (VCs) of a tertiary eye hospital in Southern India. The barriers among the parents for not attending the base hospital (BH) when referred from these VCs were also evaluated. METHODS: A standard-validated-satisfaction questionnaire (VSQ) was used to assess patient satisfaction. Responses were assessed on a 5-point Likert scale: 0 (very dissatisfied) to 4 (very satisfied) against each response. Responses were expressed as percentages with 0 (very dissatisfied) and 100% (very satisfied). Patients were referred with a form mentioning reasons for referral (urgent/non-urgent). All referrals were evaluated by the principal investigator. In case of failure to report, parents were enquired about the barrier based on the validated barrier questionnaire (VBQ) over a telephonic conversation. RESULTS: All 250 patients of the PREPP-1 study were included in the satisfaction study. Different domains were evaluated using VSQ (accessibility of VC, waiting hours, financial aspects, spectacle dispensing service, and teleophthalmology). The overall satisfaction was 75%. The most common reason for dissatisfaction was the lack of meeting the ophthalmologist in person, followed by waiting time. 58 patients wanted to visit BH to consult a pediatric ophthalmologist in person (23%). For the barrier study, 14 out of 47 referrals did not report and were evaluated using VBQ (knowledge, physical, time, and financial barriers). The majority had a financial barrier (43%), followed by knowledge (28.6%) and time barrier (14%). CONCLUSION: PREPP-II demonstrated that 3/4 th of pediatric patients are happy to be treated at VC with teleophthalmology services. However, a significant percentage want to consult a specialist at BH. One-fourth of total referrals did not report to BH due to financial constraints and a lack of awareness of the child's condition.

A tale of orbital cellulitis and retinopathy of prematurity in an infant: First case report.

PURPOSE: Orbital cellulitis is an infectious pathology affecting fat and muscles behind the orbital septum. Retinopathy of prematurity (ROP) is an abnormal retinal blood vessel proliferation affective preterm low birth weight infants. Here we report the first case report of a 4-month-old infant who presented to our outpatient setting with orbital cellulitis and bilateral ROP sequelae. CASE REPORT: A 4-month-old female infant was brought by her mother to the OPD with sudden onset redness, discharge, and swelling in the right eye accompanied by fever for 1 day. The child was born preterm at 8 months gestational age with a birth weight of 1.3 kg. Ocular examination revealed orbital cellulitis. Bruckner's reflex revealed an altered red glow. Ultrasound B scan confirmed bilateral localized highly reflective peripheral anterior looping membranes suggestive of retinal detachment as sequelae of ROP. The child was treated with topical eyedrops 0.5% Moxifloxacin 2 hourly and was referred to a tertiary hospital for higher management in the form of intravenous injections of Cefixime 50 mg/kg in two divided cases with Vancomycin 60 mg/kg/day in two divided doses for 5 days in a critical care unit (CCU). CONCLUSION AND IMPORTANCE: Orbital cellulitis is an emergency ocular condition that should be promptly treated with a multidisciplinary approach. There is a high probability of missing the posterior segment pathology in such cases. Meticulous history taking, detailed ocular examination along with Bruckner's reflex help in immediately clinching the correct diagnosis in such cases and safeguards the clinician from any medicolegal issues in the future.

Knowledge, Attitude, and Practice Patterns Related to Digital Eye Strain Among Parents of Children Attending Online Classes in the COVID-19 Era: A Cross-sectional Study.

PURPOSE: To assess the prevalence of digital eye strain among children and extrapolate the association between knowledge, attitude, and practice patterns related to device use during the coronavirus disease 2019 (COVID-19) lockdowns. METHODS: A cross-sectional, descriptive, questionnaire-based analysis was done to assess the knowledge, attitude, and practice patterns related to digital device use among parents of children attending online classes. RESULTS: A total of 305 responses were obtained. The most common reason for device use was online classes (288 children; 94.4%) and the most common mode was smartphone (263 children; 86.3%). The prevalence of digital eye strain was 64.6%. The mean knowledge score was 48.5 ± 5.1, the mean attitude score was 26.7 ± 4.9, and the mean practice score was 17.8 ± 3.5. The difference between knowledge, attitude, and practice scores among parents of children with and without glasses was not statistically significant (P = .580, .521, and .503, respectively). A direct correlation was found between the knowledge and practice scores (P = .002), but attitude scores did not show a significant correlation (P = .712). CONCLUSIONS: Digital devices have been a boon to continue education during the ongoing COVID-19 pandemic. This study reveals a large knowledge gap among parents related to safe digital device use. Further, there is a need to adopt methods that would help spread awareness to the masses about the effects of excessive screen time in children in the form of digital eye strain and myopia and the corrective measures to avoid the same. [J Pediatr Ophthalmol Strabismus. 2022;59(4):224-235.].

To assess the accuracy of Plusoptix S12-C photoscreener in detecting amblyogenic risk factors in children aged 6 months to 6 years in remote areas of South India.

PURPOSE: To assess the screening accuracy of a novel fourth generation, handheld Plusoptix S12 C photo screener in detecting amblyogenic risk factors in children aged 6 months to 6 years in remote areas of South India. METHODS: In this cross sectional study, 381 children aged 6 months to 6 years were screened by a trained fieldworker in Anganwadis and schools using the Plusoptix photoscreener. This was followed by complete ophthalmic evaluation including retinoscopy, subjective refraction, and strabismus evaluation by an optometrist and an orthoptist. All children further underwent complete ocular examination by the senior pediatric ophthalmologist for validation of the results. RESULTS: A total of 367 children were included in the study. The sensitivity and specificity of the photo screener were found to be 86.76% and 82.27%, respectively. Positive Predictive Value, Negative Predictive Value, and Receiver Operative Characteristics were 52.67%, 96.47%, and 83.11%, respectively. In subgroup younger than 3 years, sensitivity and specificity was 89.19% and 81.18%, respectively. Myopic astigmatism was the most common amblyogenic risk factor in our study group. CONCLUSION: In India, with a lack of adequate healthcare professionals and poor health-seeking behavior; photo screeners can play an important role. We recommend the use of photo screeners for screening children as young as 6 months, especially in remote low-resource settings. This will help in expanding reliable eye care services to previously underserved areas.

Barriers in utilisation of low vision assistive products.

AIM: To understand the barriers in utilisation of low vision assistive products (LVAPs) from the perspective of patients with low vision. METHODS: Patients referred to low vision clinic in a tertiary eye care hospital in India who were prescribed LVAPs but were un-willing to accept the products were interviewed using questionnaires. Data pertaining to the age, diagnosis, gender, occupation, preferred LVAPs, patient's perception of vision loss and the primary reason for non-acceptance of LVAPs were analysed. RESULTS: A total of 235 among the 413 patients who noticed improvement in visual performance with LVAPs were unwilling to utilise these products. The questionnaire revealed that 53% of the patients who felt they were not candidates for LVAPs were experiencing severe visual impairment (p < 0.02). Non-acceptance was highest (68.6%) in patients < 15 years of age. The most common causes of non-acceptance were social stigma in patients < 40 years (41.3%; p < 0.0001), fear of loss of employment in patients 41-60 years (26.6%; p < 0.01) and low necessity in patients > 60 years (25%; p < 0.001). Denial of the magnitude of their illness was more common in patients above 60 years (16.5%). Non-acceptance rate was lowest for macular disorders (39.6%) and highest for retinitis pigmentosa (81%). Among devices, hand and stand magnifiers had the lowest non-acceptance rate (41%). Telescopes and electronic devices had the highest rate of non-acceptance (92% and 89%, respectively). CONCLUSION: Reasons for poor utilisation of LVAPs are multifactorial extending beyond affordability or accessibility. Knowledge of these barriers can help in creating content for awareness campaigns among patients, healthcare professionals and general society. Further research is necessary on the psychological and psycho social contributors to this process.

Bilateral simultaneous disc edema and cataract associated with albright hereditary osteodystrophy.

A 16-year-old female presented with poor vision in both eyes. On clinical examination, she had bilateral cataracts and optic disc edema bilaterally on ultrasound examination. Extensive intracranial calcification was evident on computerized tomography. Physical examination revealed short stature, rounded chubby face, dental abnormalities, brachydactyly, and obesity. Laboratory evidence of hypocalcemia, hyperphosphatemia, elevated parathyroid hormone level (indicative of pseudohypoparathyroidism) along with the constellation of phenotypical characteristics lead to a diagnosis of Albright's hereditary osteodystrophy. This case is being presented to increase awareness regarding presence of coexisting and previously undiagnosed hypocalcemic syndromes in pediatric cataracts. The role of an ophthalmologist may be pivotal in diagnosing such an entity as documented in the present case.