Study of Visual Evoked Potentials in Schoolchildren: A Promising Aid to Pediatric Ophthalmology.

Background Visual evoked potential (VEP) is a noninvasive investigation conducted to identify abnormalities in the visual system. It is especially suitable for young children who are unable to express visual symptoms or participate in conventional vision tests. This study was undertaken to examine the VEP among schoolchildren to assess the functionality of their optic pathway. Methodology This short-term observational study was performed in the Clinical Neurophysiology Unit of the Physiology Department of a rural medical college. The study population consisted of 60 schoolchildren aged 7-12. Both eyes were examined for transient pattern reversal VEP recordings using a Recorders & Medicare Systems Electromyography-Evoked Potential recorder (RMS EMG-EP MARK-II Pvt. Ltd., Chandigarh, India). Results VEPs were analyzed for latency and amplitude of the main components, namely P100, N70, and N155. The results showed markedly extended P100 latency in 33.33%, i.e., eight out of 24 eyes of standard (std.) III children. Similar latency prolongation was obtained in 36.36% (eight out of 22) eyes of std. IV, 30% (six of 20 eyes) of std. V, 13.63% (three of 22 eyes) of std. VI, and 50% (eight of 16 eyes) in std. VII and VIII children. A markedly reduced P100 amplitude was observed in two of 20 eyes (10%) of std. V, two of 16 eyes (12.5%) in std. VII and VIII children, amounting to a P100 amplitude abnormality in 5% eyes in toto. The interocular differences in all VEP parameters among the subjects were statistically insignificant. Conclusion In schoolchildren in whom normal latencies and amplitudes were obtained, the presence of reproducible VEPs indicated the normal functional status of their visual pathway. On the other hand, in those children where altered VEP findings were found, it hinted toward complementary information that they may have underlying ocular disorders that were yet to be diagnosed. Hence, this study provides insight into the assessment of visual system function, which is primarily difficult in young children.

Assessment of prevalence and need for screening of diabetic retinopathy using non-mydriatic fundus camera in rural and tribal diabetic populations in Maharashtra.

PURPOSE: To assess the prevalence of DR and the need for screening and management of DR with medical management of diabetes in rural and tribal population in Maharashtra. METHODS: The known diabetics of rural area and tribal area were screened at corresponding primary health centers, subcenters, and village level with the help of local healthcare workers using a portable non-mydriatic fundus camera. The prevalence of blindness among known diabetics in rural area was 1.29%, and 0.84% in tribal area. RESULTS: In the rural area, the prevalence of diabetic retinopathy (DR) was 5.67% ( n = 776), out of those 18.18% had sight threatening diabetic retinopathy (STDR). The prevalence of DR was 7.73% ( n = 711) in tribal areas, out of those, 30.90% had STDR. CONCLUSIONS: The significant risk factors were identified to be the duration of diabetes and poor glycemic control. Implementation of targeted interventions for screening and management are required to reduce the risk of blindness among known diabetics in rural and tribal areas.

Effect of health education and screening location on compliance with diabetic retinopathy screening in a rural population in Maharashtra.

Purpose: To compare the acceptance of diabetic retinopathy (DR) screening by the proximity of care and health education in rural Maharashtra. Methods: Study was done in the public health facilities in four blocks (in two blocks at community health center (CHC) level and in other two blocks at primary health center (PHC) level with the provision of transport from villages to PHCs) over 3 months. Health education was not imparted in one block in each segment. Health education consisted of imparting knowledge on diabetes mellitus (DM) and DR by trained village-level workers. The screening was done using non-mydriatic fundus camera and teleophthalmology supported remote grading of DR. Results: In the study period, 1,472 people with known diabetes were screened in four blocks and 86.6% (n = 1275) gradable images were obtained from them. 9.9% (n = 126) were detected having DR and 1.9% (n = 24) having sight-threatening DR (STDR). More people accepted screening closer to their residence at the PHC than CHC (24.4% vs 11.4%; P < 0.001). Health education improved the screening uptake significantly (14.4% vs 18.7%; P < 0.01) irrespective of the place of screening-at CHC, 9.5% without health education vs 13.1% with health education; at PHC, 20.1% without health education versus 31.6% with health education. Conclusion: Conducting DR screening closer to the place of living at PHCs with the provision of transport and health education was more effective for an increase in the uptake of DR screening by people with known diabetes in rural Maharashtra.

Establishing peer support groups for diabetic retinopathy in India: Lessons learned and way ahead.

Purpose: Complications of diabetes mellitus (DM) are a public health problem globally. DM management entails medication and self-management. Peer support groups (PSGs) can improve self-management and promote healthy behavior. The objectives of this study were to design, establish, and evaluate two PSG models for people who had been screened for diabetic retinopathy to assess self-reported lifestyle changes, satisfaction with meetings and barriers to attendance. Methods: Peer groups were established using a pre-tested facilitator's guide in 11 locations in 3 states. Group members were oriented on diabetes management and lifestyle changes to improve control. Attendees' experiences were ascertained through semi-structured interviews and self-report. Data were analyzed using MS Excel 2017. Results: Eleven PSGs were established in 3 states, in 10 community health centers and one eye hospital. 53 sessions were held and 195 people attended on 740 occasions. Lifestyle changes most frequently reported between first and second visits were taking medication regularly and dietary modification. Attendance declined in the eye hospital group. 83% of CHCs members were satisfied or very satisfied compared with 37% of eye hospital (EH) members. The barriers included distance and lack of family support. Conclusion: PSGs held in CHCs were more sustainable than those in an eye hospital, and group members were more satisfied and more likely to report positive lifestyle changes. Findings were self-reported and hence a major limitation for the study. Further studies should focus on obtaining objective measures of control of diabetes and risk factors for diabetic retinopathy from members attending peer support groups in CHCs.

Diabetic retinopathy screening at primary and community health centers in Maharashtra.

In order to integrate and improve eye care in noncommunicable disease (NCD) clinics, screening for diabetic retinopathy (DR) in people with diabetes mellitus (DM) was introduced in primary and secondary-level government health facilities. Initially, the project was carried out at the fixed health facilities at one district hospital (DH), two sub-district hospitals (SDH) and two community health centers (CHCs). This was combined with training of existing health care personnel, information-education-communication (IEC) campaign among patients and service providers along with the provision of essential equipment required for screening. In the revised strategy, NCD nurses were also trained for screening. Of 12,788 DM patients registered in NCD clinics, 63.8% (n = 8159) were screened for DR by trained paramedical ophthalmic assistants and the four trained NCD nurses using non-mydriatic fundus camera and teleophthalmology supported remote grading of retinopathy. DR was detected in 9.45% (n = 771) patients and sight-threatening DR (STDR) was detected in 2.35% (n = 192) in one or both eyes. Of 8,159 people screened, 55% (n = 4481) and 45% (n = 3678) were screened at CHC and mobile screening at primary health centers (PHC), respectively. DR screening in a fixed facility at CHC combined with the mobile screening at PHC level and fixed-day screening strategy provides effective coverage.