Childhood Blindness: Beyond VISION 2020 and the COVID-19 Pandemic.

The World report on vision in 2019 found it difficult to evaluate VISION 2020's impact on childhood blindness and VI since data on prevalence and causes were scarce. Considering the high chance of the global initiative missing its desired goal in children, we recommend that a sustainable version of it be launched soon. Central to this new initiative shall be better data collection on prevalence and causes of childhood blindness and VI, eye care provision and an updated and uniform system of reporting. Complete and updated data can better reflect the burden and monitor the impact of interventions. However, data collection will continue to be difficult due to the COVID-19 pandemic so the initial phase shall be tailored to the current situation.

Does offering only the spherical contact lens trial to the low astigmats mislead the practitioners?

AIM: To compare the visual acuity (VA), comfort, and patient preference in a soft toric contact lens (TCL) versus soft spherical contact lens (SCL) in low astigmatic subjects during the contact lens (CL) trial. METHODS: This subject-masked, block randomized, 2×2 crossover study recruited 40 neophyte subjects (80 eyes) aged 18 to 33y with astigmatism in the range of 0.75-1.25 D with or without spherical power from -6.00 D to +6.00 D. The participants were scheduled for two days CL trial and were fitted with the best-fit SCL and TCL. After 4h of wear, they were assessed objectively for high contrast VA and subjective vision, comfort, and preference. RESULTS: The responses of 36 subjects (response rate 90%) with a mean age of 23.02±2.97y (range 18 to 33y) were analyzed. One-line improvement of monocular VA in the logMAR chart was reported to TCL as compared to SCL (-0.044±0.06 vs 0.04±0.03 logMAR, P=0.01) but the binocular vision remained similar (-0.12±0.07 vs -0.14±0.04 logMAR, P=0.38). Subjects felt a noticeable difference in clarity when shifted to TCL as compared to the SCL. The satisfaction with vision (vision quality) was significantly better with TCL (P=0.03). The fatigue with TCL was graded less at 2.5±0.6, compared to SCL at 4.6±1.3 (P=0.04). Thirty-three participants (91.6%) preferred to use contact lens of which 26 participants (79%) preferred TCL. CONCLUSION: The findings suggest that VA and comfort are better with TCL as compared to SCL which is only observed if the patient was offered both offering SCL with spherical equivalent power alone as the first option can mislead the practitioner; TCL trial should be the first choice of the lens in low-to-moderate astigmatism.

The Pediatric Eye Health Challenge Beyond 2020.

Evidence suggests that improved eye health offers the potential to progress toward achieving United Nations Sustainable Development Goals (SDGs). With Vision 2020: Right to Sight Initiative coming to an end and the emergence of the coronavirus pandemic, it is necessary to revisit the priority of pediatric eye health. Considering the profound impact of childhood blindness and visual impairment, it is important to draw the attention of public health leaders, policymakers, organizations, and governments to create innovative and effective strategies to combat the emerging eye health challenges of children and their families.

Review on current concepts of myopia and its control strategies.

Myopia poses a significant burden on the healthcare system, economy and quality of life. It is an emerging global public health challenge and requires interventions to delay or stop onset and progression. With changing times and evidence, the concepts of myopia are changing along with the treatment and control strategies. Behavioural modifications including increased outdoors time and reduced near work, optical and pharmaceutical management options are reviewed. This paper presents a current overview on the concepts of myopia, and is expected to summarize updates on myopia control methods.

Corneal collagen cross-linking with and without simultaneous intrastromal corneal ring segment implantation: One-year pilot study.

AIM: The aim of this study was to assess and compare the visual, refractive, and topographic outcomes of keratoconic eyes treated with corneal collagen cross-linking combined with and without same day intrastromal corneal ring segment over the first 12 months. METHODS: This prospective randomized study analyzed 38 eyes of 30 consecutive keratoconus patients aged 26.21 ± 6.97 (range = 15-41) years. A total of 20 eyes were treated with collagen cross-linking alone, and 18 eyes underwent collagen cross-linking combined with simultaneous femtosecond laser-assisted intrastromal corneal ring segment. Visual acuity, manifest refraction, and corneal topography (using a rotating Scheimpflug topographer) were assessed and compared between the two groups at baseline, 6, and 12 months. RESULTS: On an average follow-up duration of 12.2 ± 0.50 (range = 11-13) months, both collagen cross-linking alone and collagen cross-linking with simultaneous intrastromal corneal ring segment implantation were effective. However, collagen cross-linking plus intrastromal corneal ring segment resulted in an additional improvement of uncorrected distance visual acuity of 0.16 (95% confidence interval = 0.01 to 0.32) logarithm of the minimum angle of resolution units (p = 0.035), cylindrical power by 1.16 D (95% confidence interval = 0.25 to 2.06, p = 0.014), and spherical equivalent by 1.40 D (95% confidence interval = -2.71 to -0.08, p = 0.038) at 1 year. During the study period, no serious intraoperative or postoperative complications were noted in either group. CONCLUSION: One-year follow-up results suggest that collagen cross-linking with simultaneously combined intrastromal corneal ring segment implantation could yield an additive visual and refractive outcome. The combined procedure is safe and merits consideration for the treatment of progressive keratoconus to achieve better visual rehabilitation.

Mobile health intervention for promotion of eye health literacy.

PURPOSE: Improving eye health awareness in the underserved population is a universal eye health priority. The ubiquity of cell phones and internet usage provides new and innovative opportunities for health promotion. This study evaluated the effect of mobile health intervention (text message link) to promote eye health literacy (EHL) of priority ocular morbidities. METHODS: This study was an intervention evaluation and employed a two-armed pre-test post-test approach. Baseline assessment on EHL was performed on 424 university students. Participants were categorised into intervention and control groups, using the 1:1 allocation ratio. The intervention and control group received a text message alone and text message with a link, respectively. EHL was assessed via a self-administered questionnaire. The primary outcome measures were changes in EHL scores between baseline and one month post-intervention. Descriptive analysis was performed to assess the cost-effectiveness of the intervention. RESULTS: With low attrition and a response rate of 95.6%, 409 responses were eligible for analysis. The mean age of the participants (49.4% males and 50.6% of females) was 19.9±1.68 years. Baseline EHL scores were low, and there was no correlation with a demographic profile (all p<0.05, CI 95%). The demographic characteristics were similar between the two groups (for all, P <0.05, CI 95%) at baseline. The EHL scores improved in both groups between the pre-and post-test assessment; however, improvements were statistically significant only in the control group. The one-month post-intervention EHL scores were also higher in the intervention group compared to the control (p≤0.001, CI 95% for all). The total cost incurred for the intervention used was 11.5 USD. CONCLUSION: Text message link demonstrated effectiveness for improving the EHL scores; the low baseline EHL scores substantially improved with intervention. The text message link intervention is a cost-effective method and could be considered in advocating for eye health in developing countries, particularly during global emergencies.

Visual impairment and refractive error in school children in Bhutan: The findings from the Bhutan School Sight Survey (BSSS 2019).

PURPOSE: To estimate the nationwide prevalence of visual impairment and associated refractive error in school children in Bhutan. METHODS: The sample of this prospective cross-sectional national survey comprised of randomly selected classes in levels IV-IX (age 10 to 15 years) from schools throughout Bhutan. The examination included measurement of visual acuity (VA), evaluation of ocular motility, refraction under cycloplegia, examination of the external eye, media and fundus. The principal cause of impairment was determined for eyes with uncorrected VA ≤6/12. The main outcome measures were distance VA and cycloplegic refractive error. RESULTS: With a sampling frame of 1967 class-based clusters from 190 schools, 160 classes in 103 schools were randomly selected; 4985 (98.5%) of 5060 enumerated children were examined. The prevalence of uncorrected, presenting, and best-corrected visual impairment (VA≤6/12) in the better eye was 14.5%, 12.8%, and 0.34%, respectively. Refractive error was the principal cause (94.2%) of impaired vision and 88% of children who could achieve VA ≥6/9 with best correction were without necessary spectacles. The prevalence of myopia (≤ -0.5 D) was 6.64% and was associated with female gender (P = 0.004), urban schooling (P = 0.002), and greater parental education (P<0.001). The prevalence of hyperopia (≥ +2.0 D) was 2.17% and was significantly associated with lower class-level (P = 0.033), and female gender (P = 0.025). The overall prevalence of astigmatism (≥ 0.75 D) was 9.75%. CONCLUSIONS: Reduced vision because of uncorrected refractive error is a public health problem among school-age children in Bhutan. Effective school eye health strategies are needed to eliminate this easily treatable cause of visual impairment.

Changing trends of blindness, visual impairment and cataract surgery in Bhutan: 2009-2018.

PURPOSE: To obtain new rapid assessment of avoidable blindness (RAAB) data on the prevalence, causes and trends of blindness, visual impairment and cataract surgery; and compare the new 2018 data with the older RAAB 2009 data. METHODOLOGY: The second nationwide RAAB used android based mRAAB technique and technology for data collection. Using the compact segment sampling probability proportionate to size, 5,050 participants from 101 clusters of 50 people aged 50 years and older were enrolled through house-to-house visits. Eligible participants received ophthalmic examination and interview by the ophthalmologist-led emuneration team as per the RAAB protocol. RESULTS: The age-sex adjusted magnitude of bilateral blindness in Bhutan was 1.0% (95% Confidence Interval, CI 0.5-1.4) with relatively higher prevalence in rural population (Odds Ratio, OR 1.5, p = 0.13) and women (OR 1.6, p = 0.06). Untreated cataract accounted for the most of blindness (53.8%), severe vision impairment (57.1%), and moderate visual impairment (65.3%); uncorrected refractive error was the main cause of early visual impairment (46.7%). Cataract Surgical Coverage was 86.1% with relatively better coverage in men (76.7% men; 73.1% female) and urban population (79.2% urban; 70.2% rural). Good cataract surgical outcome was achieved in 67.3% and leading cause of poor outcome was ocular comorbidity (43.6%). Accessibility was a significant barrier to the uptake of cataract surgical services. CONCLUSION: There is a 33% reduction in blindness from 1.5% to 1.0%, since the first RAAB survey in 2009. In order to further reduce blindness and visual impairment, Bhutan should continue to implement long-term strategic action plan for eye health focused on strengthening primary eye care and comprehensive eye care service.