Topiramate-induced acute onset myopia: a case report.

BACKGROUND: Topiramate is a drug which emerged from its anticonvulsant properties and now over the years is used for a wider range of indications, including migraine prophylaxis. We described a very rare case of topiramate induced acute onset myopia during use for migraine. It is the first reported case of its kind from Sri Lanka with only a handful of reported cases in world literature. CASE PRESENTATION: A 35-year-old Sri Lankan female presented with long standing history of intermittent headache with recent worsening. A diagnosis of migraine was made and due to poor response to other medication was initiated on topiramate. Two weeks later patient developed visual impairment which was finally attributed to topiramate. Following discontinuation of the drug, within 3 days the symptoms started to improve with full recovery in 10 days. CONCLUSION: All clinicians should be aware of the potential ocular side effects of topiramate. Although relatively rare, prompt recognition is key to appropriate management.

A survey of severe visual impairment and blindness in children attending thirteen schools for the blind in sri lanka.

PURPOSE: To identify the causes of blindness and severe visual impairment (BL/SVI) in children attending schools for the blind in Sri Lanka, and to provide optical devices and ophthalmic treatment where indicated. METHODS: Two hundred and six children under 16 years from 13 schools for the blind in Sri Lanka were examined by a team of ophthalmologists and optometrists. Data were entered in the World Health Organization Prevention of Blindness Eye Examination Record for Childhood Blindness (WHO/PBL ERCB). RESULTS: Of the 206 children, 83.5% were blind (BL = Visual acuity [VA] <3/60), and 9.2% had severe visual impairment (SVI = VA <6/60 to 3/60 in the better eye). The major anatomical site of BL/SVI was the retina in 35.9% of cases, followed by the whole globe in 22.4% of cases. The major underlying aetiologies of BL/SVI were unknown in 43.8% of cases and hereditary in 37.5%. Avoidable causes of BL/SVI accounted for 34.9% of cases; retinopathy of prematurity made up the largest proportion of this subgroup. One third of the children required an optical device to improve their vision. CONCLUSION: Just over one third of the children in schools for the blind in Sri Lanka had potentially avoidable causes of BL/SVI. Vision could also be improved in a third of children. The data support the need to develop specialized pediatric ophthalmic services, particularly in the face of advancing neonatal life support in Sri Lanka, and the need for increased provision of optical support.

Ocular rhinosporidiosis with staphyloma formation: a case with unusual features.

A case of ocular (bulbar) rhinosporidiosis is described; its unusual features included a) the rapid development of a primary, rhinosporidial lesion with a scleral staphyloma, close to but noncontiguous with the rhinosporidial lesion, 3 weeks after exposure to a lacustrine reservoir, the putative source of the pathogen Rhinosporidium seeberi; b) ocular coherence tomography which revealed no retinal abnormalities unlike in previous cases reported from Sri Lanka; c) atypical histopathology that resulted in an initial mis-diagnosis of chronic inflammation with mucus cysts and a missed diagnosis of rhinosporidiosis; the rhinosporidial etiology was confirmed on replicate histopathological sections of the ocular mass. The pitfalls of histopathological diagnosis of rhinosporidiosis are pointed out.

Prevalence of and risk factors for primary open-angle glaucoma in central Sri Lanka: the Kandy eye study.

PURPOSE: To report the prevalence and risk factors associated with primary open-angle glaucoma (POAG) in the Kandy district of central Sri Lanka. METHODS: A cross-sectional, population-based ophthalmic survey of the inhabitants >or= 40 years of age from villages in the Kandy District, Sri Lanka was conducted. Selection was randomized using a cluster sampling process; 1721 eligible participants were identified, 1375 participated in the study and sufficient examination data to diagnose glaucoma in at least one eye was obtained in 1244 participants. A detailed ophthalmic history and examination including ocular biometry was made of each participant. Primary open-angle glaucoma was classified into three levels according to diagnostic evidence. RESULTS: The overall prevalence of POAG was 2.3% (95% CI 1.5-3.2). In the univariate analyses, increasing age (P = 0.001), intraocular pressure (IOP) (P < 0.001), myopia (P < 0.001) and axial length (P = 0.003) were significantly associated with POAG. In the multivariate analysis, age (P = 0.001), mean IOP (P < 0.001) and mean axial length (P = 0.008) were significant risk factors of POAG. CONCLUSIONS: The prevalence of POAG in the population aged >or=40 years in central Sri Lanka was 2.3%. POAG in this population was independently associated with increasing age, IOP and axial length.

Cataract in central Sri Lanka: cataract surgical coverage and self-reported barriers to cataract surgery.

PURPOSE: To determine the cataract surgical coverage and investigate the barriers to cataract surgery in the Kandy District of central Sri Lanka. METHODS: A population-based, cross-sectional ophthalmic survey of the inhabitants of rural villages in central Sri Lanka was conducted; there were 1721 eligible subjects and 1375 participated (79.9% participation rate). The recorded data included age, gender, education, district, corrected visual acuity, dilated slit-lamp examination and stereoscopic fundus examination. Lens opacity was graded using the Lens Opacities Classification System III. Participants with cataract-induced visual impairment (acuity <6/18 in the better eye) were also invited to respond to a verbal questionnaire about barriers to cataract surgery. RESULTS: Cataract surgical coverage per individual for visual acuity cut-offs of <6/18, <6/60 and <3/60 was 41.9%, 76.8% and 82.7%, respectively; and per eye was 34.0%, 60.3% and 65.2%, respectively. Cataract surgical coverage was higher for men than women, and two-thirds refused referral for surgery, for the following reasons: no desire to improve vision, fear of surgery and lack of awareness were the most frequently reported barriers. SUMMARY: Cataract surgical coverage in central Sri Lanka is higher than that in neighbouring developing regions. Surgical uptake may be improved through better community education.

Exophthalmometric values and their biometric correlates: The Kandy Eye Study.

BACKGROUND: To determine normal exophthalmometric values for a Sri Lankan population and investigate their demographic, physical, refractive and ocular biometric correlates. METHODS: The Kandy Eye study was a population-based, cross-sectional study. By randomized cluster sampling, 1721 eligible participants, who were 40 years old and over were identified; 1375 participated. Exophthalmometry was performed with Hertel's exophthalmometer. Participants' demographics including age, gender and ethnicity were recorded. Height, weight, body mass index, non-cycloplegic refraction and ocular biometry were measured with standardized methods. Summary statistical analysis was performed for exophthalmometric values and relationships with other factors were tested using Pearson product-moment correlation coefficient analysis, standard single and multiple linear regression analysis. RESULTS: A total of 1341 subjects were included in the analysis. Exophthalmometric values for the population had a mean of 15.82 mm, standard deviation of 2.73 mm and range of 10.46-21.28 mm. Exophthalmometric values for men were significantly higher than women. There were no significant differences between the racial groups' exophthalmometric values (Sinhalese, Tamils, Moors). Exophthalmometric values were significantly correlated with age, gender, height, weight, body mass index, base and axial length but not to refractive spherical equivalents. Only gender, weight, base and axial length were independent predictors for exophthalmometric values after adjusting for confounders. CONCLUSION: In this Sri Lankan population, our study provided the first reported estimates of a normal exophthalmometric range and determined gender, weight, base and axial length as its correlates. Sri Lankans are the first population to demonstrate this relationship between weight and exophthalmometric values and also showed that refraction is not a cause for pseudo-proptosis.

Prevalence and determinants of angle closure in central Sri Lanka: the Kandy Eye Study.

PURPOSE: To determine the prevalence and determinants of angle closure in the Kandy District of central Sri Lanka. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Inhabitants aged 40 years or more from villages in the Kandy District were selected by randomized cluster sampling; 1721 eligible participants were identified, and 1375 participated in the study. METHODS: The examination included slit-lamp examination of the anterior segment, applanation tonometry, static and dynamic gonioscopy, dilated stereoscopic optic disc examination, and ultrasonic ocular biometry. Eyes that were primary angle-closure suspects (PACS) or had primary angle closure (PAC) or primary angle-closure glaucoma (PACG) were identified. Definitions were based on recommendations from the International Society for Geographic and Epidemiological Ophthalmology (ISGEO). Univariate and multivariate logistic regression analyses were performed with angle closure as the outcome variable. MAIN OUTCOME MEASURES: Subjects with PACG, PACS, or PAC were pooled into a group considered to have angle closure. RESULTS: The prevalence of PACS, PAC, and PACG in at least 1 eye was 2.35% (95% confidence interval [CI], 0.0-4.7; 32 subjects), 1.86% (95% CI, 0.6-3.1, 25 participants), and 0.57% (95% CI, 0.0-1.2; 7 participants), respectively. The overall prevalence of angle closure was 4.7% (95% CI, 1.1-9.3; 64 participants). The mean axial length in those with angle closure (21.99 mm) was significantly shorter (P<0.001) than in those with open angles (22.47 mm), as was the mean anterior chamber depth (ACD) (2.47 mm compared with 2.81 mm), but the mean lens thickness in those with angle closure (4.51 mm) did not significantly differ (P = 0.44) from those with open angles (4.45 mm). Neither age nor nuclear opalescence was a significant predictor of angle closure in the multivariate model (P = 0.09 and 0.61, respectively); however, female gender was associated with a 9.2 times (P<0.001) increased risk of angle closure, and each millimeter decrease in ACD was associated with a 2.6 times increased risk of angle closure (P<0.001). CONCLUSIONS: The overall prevalence of angle closure was 4.7%. Female gender and shallow ACD were significant independent predictors of angle closure in this Sri Lankan population.

The prevalence and causes of visual impairment in central Sri Lanka the Kandy Eye study.

OBJECTIVE: To determine the prevalence and causes of uncorrectable visual impairment in the Kandy District of central Sri Lanka. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Inhabitants >or=40 years of age from villages in the Kandy District were selected by randomized cluster sampling; 1721 eligible participants were identified and 1375 participated in the study. METHODS: The ophthalmic examination included best-corrected logarithm of the minimum angle of resolution visual acuity (VA), slit-lamp examination of the anterior segment, and dilated stereoscopic fundus examination. The principal cause of visual impairment after best correction was recorded. MAIN OUTCOME MEASURES: Visual impairment (better eye <6/18) and blindness (better eye <3/60) after best correction. RESULTS: Comprehensive examinations, including VA, were performed on 1375 subjects (79.9% participation rate). The prevalence of blindness was 1.1% (95% confidence interval [CI], 0.002-0.020; 15 participants). The prevalence of visual impairment was 5.9% (95% CI, 0.043-0.075; 81 subjects). Cataract and age-related macular degeneration were the main causes of visual impairment. CONCLUSIONS: Visual impairment remains a major public health problem in central Sri Lanka. Specific programs directed at reducing the cataract burden need to be implemented. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.