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Vanathi M. Prioritize pediatric eye health: What makes it challenging? Indian J Ophthalmol 2024; 72:1383-1384. [PMID: 39331423 DOI: 10.4103/ijo.ijo_2214_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024] Open
Affiliation(s)
- Murugesan Vanathi
- Professor of Ophthalmology, Cornea and Ocular Surface, Cataract and Refractive Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Ibukun FA, Ugalahi MO, Bekibele CO. Unilateral visual impairment and blindness in school children - prevalence and aetiology in Saki-East LGA of Oyo State, Nigeria. Eye (Lond) 2024; 38:2117-2123. [PMID: 38448733 PMCID: PMC11269637 DOI: 10.1038/s41433-024-02960-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE This study determined the prevalence and aetiology of unilateral visual impairment (VI) and blindness and its associated factors in school children. METHODS We conducted a multistage, cross-sectional study in primary and secondary schools of Saki-East Local Government Area of Oyo State, Nigeria. Unilateral VI was defined as presenting visual acuity (PVA) worse than +0.3 LogMAR (6/12) and unilateral blindness as PVA worse than +1.3 LogMAR (3/60) in the worse eye. Detailed ocular examinations were performed for students with unilateral VI, and Logistic regression analysis was performed to explore associations with independent variables. RESULTS The mean age of participants was 11 ± 3.2 years. Thirty-six (0.98%) of 3671 children had unilateral VI, and fifteen children had unilateral blindness (0.41%), giving a combined prevalence of 1.39 ± 0.5%. History of ocular trauma was reported by 14 (27.5%) participants with unilateral VI and blindness. In addition, those with a history of ocular trauma were 6.5 times more likely to be blind or have a severe VI (95% CI 1.5-2.8) than those without a history of ocular trauma. Uncorrected refractive error was the major cause of unilateral VI in 26 (51%) participants, while traumatic cataract was the main cause of unilateral blindness seen in 5 (9.8%) participants, none of whom had a previous eye examination. CONCLUSION Fourteen per thousand school children had unilateral VI in this study; the major causes were refractive error and cataract, which are treatable. Ocular trauma was a significant risk factor for unilateral VI and blindness.
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Affiliation(s)
- Folahan Adesola Ibukun
- Department of Ophthalmology, University College Hospital, Queen Elizabeth Road, Oritamefa, Ibadan, Oyo State, Nigeria.
| | - Mary Ogbenyi Ugalahi
- College of Medicine, University of Ibadan and Department of Ophthalmology, University College Hospital, Queen Elizabeth Road, Oritamefa, Ibadan, Oyo State, Nigeria
| | - Charles Obu Bekibele
- College of Medicine, University of Ibadan and Department of Ophthalmology, University College Hospital, Queen Elizabeth Road, Oritamefa, Ibadan, Oyo State, Nigeria
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Alrasheed SH, Mohamed ZD, Alluwimi MS. Childhood visual impairment causes and barriers to accessing eye care: A suggested approach for Africa. Afr J Prim Health Care Fam Med 2024; 16:e1-e7. [PMID: 39099279 PMCID: PMC11304197 DOI: 10.4102/phcfm.v16i1.4556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/15/2024] [Accepted: 06/25/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Childhood vision impairment (VI) has a significantly harmful effect on both health and social outcomes. AIM To assess the causes of childhood VI, to determine obstacles to accessing eye care services and to develop a strategy for the childhood eye care system in African nations. METHOD This systematic review was conducted by searching several online databases, including; Scopus, PubMed, ProQuest, Web of Science, Google Scholar, Ebsco and Medline. They focussed on articles available between 2003 and 2023. These studies were conducted to evaluate the causes of childhood VI and to assess obstacles to accessing eye care services in African countries. RESULTS The main causes of childhood VI in African nations can be avoided with timely diagnosis and an appropriate management strategy. The leading obstacles to accessing childhood eye care services were a lack of availability, accessibility and affordability. In addition to these barriers, we found that there are concerns with quality of services, primary health care system, geographic barriers, incorrect health beliefs, inappropriate parental perception, a lack of knowledge, attitudes and inadequate practices related to paediatric eye care. CONCLUSION The main causes of childhood VI were uncorrected refractive error (RE), amblyopia, cataract and corneal opacities that can be avoided with timely diagnosis and an appropriate management strategy. While the main obstacles to accessing childhood eye care services were a lack of availability, accessibility, affordability and healthcare system.Contribution: The recommended strategy for childhood eye-care services includes models for delivery and training.
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Affiliation(s)
- Saif H Alrasheed
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia; and, Department of Binocular Vision, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum.
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Bhartiya S, Wadhwani M, Ichhpujani P, Parmar UPS. Ocular morbidity profiles of out-of-school children in a North Indian urban slum. Indian J Ophthalmol 2024; 72:S617-S622. [PMID: 38622857 PMCID: PMC11338416 DOI: 10.4103/ijo.ijo_622_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 04/17/2024] Open
Abstract
PURPOSE This study evaluates the recent trends in ocular morbidities and vision-related practices in "out-of-school" children in urban slums of Gurugram in North India. METHODS In this observational study, a validated questionnaire was administered to 161 students from two nonformal slum schools. Sociocultural, demographic data, vision-related practices, and visual acuity with subjective refraction of the children were recorded. RESULTS A total of 80 boys and 81 girls (9.17 ± 2.58 years) participated in this study. About 40% of the children were from lower socioeconomic status. The visual acuity recorded for all the children, except three children, was 6/6 in both eyes. One child had a pre-phthisical eye with no light perception, following a childhood trauma, with the other eye having 6/6 vision. Two children had refractive errors (myopia and compound myopic astigmatism), with a best corrected visual acuity (BCVA) of 6/6. Thirteen children (8%) had Bitot's spots and 67 (35.4%) had allergic conjunctivitis. Eight (5%) children complained of dry eye-related symptoms like redness and watering of eyes, while 19 (11.8%) had diffuse headache. Average number of years spent in school for these children was less than 1.7 years (range: 1 month-6 years). Only 10.5% of the children gave the history of watching television more than 30 h/week. Significant association was found between the income of father and use of digital devices in children below 10 years ( P = 0.003) and children playing outdoors ( P = 0.001). There was a significant association noted for age and use of digital devices ( P = 0.037). CONCLUSION The prevalence of refractive errors in "out-of-school" children of urban slum was much less than the national average. Almost one in three children suffered from eye allergies, while 8% children had Bitot's spots. The data about the prevalence of ocular comorbidities in underserved areas like urban slums can be used to update and strategize eye health-care delivery models for out-of-school children.
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Kemmanu V, Khanum A, Madhavrao B, Raghunandan N, Muthu S, Venkatesh R, Shetty BK. Outcome of pediatric cataract surgery including color vision, stereopsis, and cognition in a tertiary eye care center in India. Oman J Ophthalmol 2024; 17:237-244. [PMID: 39132104 PMCID: PMC11309545 DOI: 10.4103/ojo.ojo_225_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 04/07/2024] [Accepted: 05/15/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Pediatric cataract is an important cause of avoidable childhood blindness in India. Although there are studies on clinical features and visual acuity outcomes of pediatric cataract surgery, there are no studies that look into aspects of color vision, stereopsis, and cognitive functions in children with cataracts. Studying these parameters pre- and postsurgery will help us assess the overall components of visual function that are critical for the child's development. With this in mind, we aimed to study the clinical features, outcome of treatment, color vision, stereopsis, and cognitive functions in children with cataracts. MATERIALS AND METHODS Design: Hospital-based prospective descriptive study. Data of 68 children (0 < 18 years) were collected, on the clinical features, visual acuity, color vision, stereopsis, and social and intelligence quotient before and after surgery. Data analysis was performed using Graph Pad Prism software version 9.4.0 (673). RESULTS Ninety eyes of 68 children (36-bilateral/32-unilateral) were operated. A total of 46 children were available at 6 months' follow-up (28 bilateral cataracts (46 eyes) and 18 unilateral cataracts). Nineteen (67.8%) of the bilateral, had a best corrected visual acuity of 6/6-6/18 in the better eye and nine (50%) of the unilateral had a visual acuity of 6/18-6/6 in the operated eye. Preoperatively, 61.5% of the children had a stereopsis of 100-600 arc-secs. Post-operatively, 84.4% of the children had a stereopsis in the range <50-600 arc-secs. All children had color vision deficiency. Preoperatively, 62% of the children had strong and moderate deficiency, whereas postoperatively, 66.6% had mild deficiency. We found negative correlation (r = -0.503) between social quotient and percentage of visual impairment indicating that when visual impairment increases social quotient decreases. The mean IQ preoperatively was 94.36 ± 2.98 and postoperatively 101.38 ± 2.77, with 95% confidence interval P value was statistically significant (P = 0.0001). This shows better and faster performance postoperatively. CONCLUSION Majority of the children had improved visual acuity after surgery. This outcome can be extrapolated to the overall improvement in stereopsis, color vision, and higher cognitive functions.
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Affiliation(s)
- Vasudha Kemmanu
- Department of Pediatric Ophthalmology and Strabismus Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Aayesha Khanum
- Department of Vitreo-retinal Services Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Bhanumathi Madhavrao
- Department of Pediatric Ophthalmology and Strabismus Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Nithya Raghunandan
- Department of Pediatric Ophthalmology and Strabismus Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sumitha Muthu
- Department of Pediatric Ophthalmology and Strabismus Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Ramesh Venkatesh
- Department of Vitreo-retinal Services Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Bhujanga K. Shetty
- Department of Cataract Services Narayana Nethralaya, Bengaluru, Karnataka, India
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Rogerson T, Ath SS, Meng N, Casson R. A 12-year follow up survey of childhood blindness at schools for the blind in Cambodia. BMC Ophthalmol 2024; 24:62. [PMID: 38350914 PMCID: PMC10863079 DOI: 10.1186/s12886-024-03285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Cambodia is a low-income country in South East Asia with a population of 15.5 million people of whom 4.9 million (38%) are under the age of 16. The causes of childhood blindness in Cambodia have not been investigated since the first survey of schools for the blind done in 2009 by our group. Given the large demographic and economic shifts in Cambodia since 2009 it is important to determine if these causes have changed in order to ensure intervention programmes are appropriately targeted. The purpose of the present study is to investigate the prevalence of causes of childhood blindness at schools for the blind in Cambodia. METHODS Students between the ages of 5 and 16 years who were attending schools for the blind in Cambodia were examined by a consultant paediatric ophthalmologist and had clinical photographs taken. Distance visual acuity was measured using a logMAR tumbling E chart and the WHO definitions of blindness and severe visual impairment were used. The examining ophthalmologist recorded the anatomical site and aetiology of vision loss using the WHO Prevention of Blindness eye examination record for children. Collected data were compared to a previous survey from 2009. RESULTS Data from 73 students were included for analysis. The most common anatomical location of abnormality causing vision loss was the cornea (n = 20, 33.9%) followed by the lens and retina (n = 11, 18.64% each). Hereditary factors (n = 29, 49.15%) and childhood diseases (n = 27, 45.76%) were the most common aetiological causes of childhood blindness. The majority (71.19%) of childhood blindness was avoidable. The present study did not demonstrate 0a significant difference in the causes of childhood blindness compared to 2009. CONCLUSIONS Corneal pathologies continue to represent the most common cause of vision loss amongst the surveyed population and the majority of causes of childhood blindness continue to be avoidable. These findings will facilitate the development of evidence-based targeted interventional programmes in Cambodia.
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Affiliation(s)
- Thomas Rogerson
- Sight For All Foundation, Adelaide, South Australia, Australia.
- Department of Ophthalmology, The Royal Adelaide Hospital, Port Road, 5000, Adelaide, South Australia, Australia.
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia.
| | - Sith Sam Ath
- Sight For All Foundation, Adelaide, South Australia, Australia
- National Programme for Eye Health, Ministry of Health, Phnom Penh, Cambodia
| | - Ngy Meng
- National Programme for Eye Health, Ministry of Health, Phnom Penh, Cambodia
| | - Robert Casson
- Sight For All Foundation, Adelaide, South Australia, Australia
- Department of Ophthalmology, The Royal Adelaide Hospital, Port Road, 5000, Adelaide, South Australia, Australia
- Discipline of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia, Australia
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Pallerla SR, Pallerla MR, Krishnaiah S. Trends in the Ophthalmic Workforce and Eye Care Infrastructure in South India: Cross-Sectional Questionnaire Study. Online J Public Health Inform 2024; 16:e50921. [PMID: 38261522 PMCID: PMC10805243 DOI: 10.2196/50921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/14/2023] [Accepted: 11/23/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND This study is part of broad-based research to determine the impact of blindness control activities in general and with special reference to the Andhra Pradesh Right to Sight Society (APRTSS) activities in the southern Indian states of Andhra Pradesh and Telangana. As part of the global "VISION 2020: The Right to Sight" initiative, the APRTSS was established in the undivided state of Andhra Pradesh in 2002. Since then, the APRTSS has been actively implementing the strategies of VISION 2020 to reduce visual impairment and blindness in the state. OBJECTIVE The availability and distribution of the eye care workforce are essential to reach the goals of VISION 2020: The Right to Sight, the global initiative to eliminate avoidable blindness. This study assessed the trends in the availability and distribution of eye health professionals and eye care infrastructure in 2 southern Indian states: Andhra Pradesh and Telangana. METHODS This cross-sectional study used a pretested questionnaire to gather data for the year from 2012 to 2013. Data for 2002 to 2003 were collected from available historical records. The questionnaires were pretested in a pilot study conducted before the main survey. Pretested questionnaires were administered to all eye care professionals-ophthalmologists (n=1712) and midlevel ophthalmic personnel (MLOP; n=1250)-eye care facilities with ≥10 inpatient beds or performing ≥100 cataract surgeries per annum (n=640), local nongovernmental eye care organizations (n=182), and international eye care organizations (n=10). Data were collected for 2 different time periods: the baseline year of 2002 to 2003 and the target year of 2012 to 2013. Data analysis was conducted using SPSS version 19.0. RESULTS The response rates were 81.1% (519/640) for eye care facilities, 96.1% (1645/1712) for ophthalmologists, and 67.6% (845/1250) for MLOP. From 2002-2003 to 2012-2013, there has been an increase in eye care facilities, from 234 to 519 (121.8%); ophthalmologists, from 935 to 1712 (83.1%); and MLOP, from 767 to 1250 (63%). The ophthalmologist:population ratio improved from 1:88,260 in 2002-2003 to 1:51,468 in 2012-2013. The MLOP:population ratio improved from 1:168,283 in 2002-2003 to 1:138,117 in 2012-2013 but still falls short of the ideal number. CONCLUSIONS Both southern Indian states are able to meet the requirements for ophthalmologists and eyecare infrastructure as per the goals of VISION 2020. However, the number of MLOP falls short of the ideal ratio for the population. This study has some limitations. For example, most of the data collected through questionnaires were based on self-report, which might introduce bias due to memory recall or over or under-reporting of certain information. However, this was addressed by cross-checking the collected data with information from supplementary sources.
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Jain B, Sethi NK, Sethi A, Arora R, Gupta T, Kaur H. Usefulness of Children's Hospital of Philadelphia ROP (CHOP ROP) model in the prediction of type 1 ROP. Indian J Ophthalmol 2023; 71:3473-3477. [PMID: 37870009 PMCID: PMC10752303 DOI: 10.4103/ijo.ijo_415_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose Children's Hospital of Philadelphia retinopathy of prematurity (CHOP ROP) model can be used to predict ROP, a leading cause of childhood blindness, using risk factors such as postnatal weight gain, birth weight (BW), and gestation age (GA). The purpose of this study was to determine the usefulness of the CHOP ROP for the prediction of treatable ROP. Methods This was a prospective observational study. Babies <34 weeks of GA, BW <2000 grams, and GA 34-36 weeks with risk factors such as respiratory distress syndrome (RDS) were included; ROP screening, follow-up, and treatment were performed based on national guidelines. The average daily postnatal weight gain was measured, and the CHOP nomogram was plotted. Babies were categorized as high risk or low risk based on the "CHOP" alarm. The sensitivity and specificity of the CHOP ROP for the detection of treatable ROP were determined. In case of poor sensitivity, a new cutoff alarm level was planned using logistic regression analysis. Results Of 62 screened infants, 23 infants did not fulfill the criteria of the CHOP algorithm and were excluded. Thus, in the study on 39 infants, the predictive model with an alarm level of 0.014 had 100% specificity and 20% sensitivity. With the "new" alarm level (cutoff) of 0.0003, the CHOP nomogram could detect all the infants who developed treatable ROP, that is, sensitivity increased to 100% but specificity decreased to 10.5%. Conclusion The CHOP ROP model with a cutoff point (0.014) performed poorly in predicting severe ROP in the study. Thus, there is a need to develop inclusive and more sensitive tailor-made algorithms.
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Affiliation(s)
- Barkha Jain
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Neha K Sethi
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Amanpreet Sethi
- Department of Pediatrics, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Rhythm Arora
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Twinkle Gupta
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Harnoor Kaur
- Department of Ophthalmology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
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Prakash WD, Marmamula S, Mettla AL, Keeffe J, Khanna RC. Variations in the prevalence of vision impairment across regions among school children in Telangana State, South India. Indian J Ophthalmol 2023; 71:3322-3327. [PMID: 37787229 PMCID: PMC10683682 DOI: 10.4103/ijo.ijo_215_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose Undetected vision impairment (VI) could negatively affect the overall development in children. School vision screening program is a viable and cost-effective approach for the early identification and management of VI. Aim This study aims to estimate the prevalence of VI, its risk factors, and ocular morbidity among school children in Telangana, South India. Methods Children aged 4-15 years attending schools in the study area were screened in this study. The vision screenings were performed in schools by trained community eye health workers using 6/12 tumbling E optotypes. Children who failed the test and/or presented with other eye conditions were referred to vision centers or secondary and tertiary eye care centers. A comprehensive eye examination was conducted in these centers, including cycloplegic refraction and fundus examination. Results A total of 774,184 children, with a mean age of 9.4 ± 3.27 years, were screened. Overall, 51.49% (N = 398,596) were male. In total, 4.33% [N = 33,528; 95% confidence interval (CI): 4.29-4.38] required referral services, while 1.16% (N = 9,002) had a presenting visual acuity of < 6/12. Multivariate analysis showed a high risk of VI among older children [Adj. odds ratio (OR): 5.75; 95% CI: 5.18-6.38], those with disabilities (Adj. OR: 5.12; 95% CI: 4.14-6.33), female gender (Adj. OR: 1.29; 95% CI: 1.24 - 1.35), and those residing in the urban areas (Adj. OR: 2.87; 95% CI: 2.42-3.39). The main cause of VI was uncorrected refractive errors (74.14%). Conclusion The prevalence of VI among school children was 1.16% in Telangana, South India, and refractive error was the leading cause of VI among this population. Increasing age, urban location, female gender and other disabilities increase the risk of VI among children.
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Affiliation(s)
- Winston D Prakash
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Asha Latha Mettla
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jill Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
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Deb D, Annamalai R, Muthukumar M. Incidence, risk factors, progression, and involution in retinopathy of prematurity at a tertiary care center in South India. Oman J Ophthalmol 2023; 16:452-460. [PMID: 38059079 PMCID: PMC10697252 DOI: 10.4103/ojo.ojo_239_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/09/2022] [Accepted: 03/25/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a vasculoproliferative disorder of immature retina, seen in preterm babies. Multiple risk factors attribute to this condition. Our aim was to correlate the role of any early neonatal surgeries with low gestational age (GA) and birth weight (BW) on preterm babies as a risk factor on the progression of ROP. METHODS A prospective, cohort study conducted in a hospital in South India over 3 years, including 600 babies with GA <35 weeks and BW <2500 g. Babies were divided into Group A (ROP) and Group B (no ROP). Group A included A1 (severe ROP) and A2 (nonsevere ROP) based on early treatment of ROP classification. We compared various risk factors of ROP, specifically the association of any early neonatal surgery undergone by these babies, on progression of ROP. The Chi-square test, unpaired t-test, and one-way analysis of variance tests were used for the comparisons and considered statistically significant if P < 0.05. RESULTS 28.7% babies developed ROP, with 37.6% requiring treatment (Aggressive ROP in 2.1% of babies). Low GA and BW, longer duration on ventilator, respiratory distress syndrome, apnea of prematurity, Patent Ductus Arteriosus, sepsis, anemia, thrombocytopenia, history of blood transfusion, and history of early neonatal surgery under GA were associated with babies with ROP (P < 0.005), strongly with severe ROP. The most common surgeries undergone by the babies developing ROP were inguinal herniotomy under general anesthesia. CONCLUSION The study predicts preterm babies undergoing early surgical interventions are at risk of progressing to severe ROP, hence warranting frequent follow-ups.
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Affiliation(s)
- Debolina Deb
- Department of Ophthalmology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Radha Annamalai
- Department of Ophthalmology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Muthayya Muthukumar
- Department of Ophthalmology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Monye HI, Olawoye OO, Ugalahi MO, Oluleye TS. Nigerian parents' perspectives on genetic testing in their children with genetic eye diseases. J Community Genet 2023; 14:387-394. [PMID: 37498433 PMCID: PMC10444708 DOI: 10.1007/s12687-023-00658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023] Open
Abstract
The decision for genetic testing in children is usually taken by their parents or caregivers, and may be influenced by sociocultural and ethical concerns. This study evaluateds the perspectives of Nigerian parents towards genetic testing of their children with genetic eye diseases parental willingness for genetic testing in their children, and its determinants, in a hospital setting in Nigeria. This cross-sectional, hospital-based study was conducted at the Eye clinic, University College Hospital, Ibadan. The participants were 42 parents of children with genetic eye diseases purposively recruited from April to July 2021. The main variables of interest were overall willingness to test, and willingness to test given ten different scenarios. Summary statistics were performed, and determinants of willingness to test (parental sociodemographic and children's clinical characteristics) were assessed using Fischer's exact test. All the participants expressed willingness to test when presented with six of the ten scenarios.However, slightly fewer (83-95%) proportions were willing to test for the other four scenarios (out-of-pocket payment, if test will reveal a systemic association, if test may confirm a diagnosis with no current treatment, and prenatal testing). Willingness to test was not significantly associated with the determinants tested. Thirty-nine (93%) would join a support group, 38 (91%) would inform a family member at risk, and 28 (67%) would be unwilling to have more children if there wais a risk to future offspring. This study demonstrated a high degree of parental willingness for genetic testing of their children. This is important evidence that can guide policy and planning of ophthalmic genetics services.
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Affiliation(s)
- Henrietta Ifechukwude Monye
- Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
- Eleta Eye Institute, Ibadan, Nigeria
| | - Olusola Oluyinka Olawoye
- Department of Ophthalmology, University College Hospital, Ibadan, Nigeria.
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Mary Ogbenyi Ugalahi
- Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tunji Sunday Oluleye
- Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Agarwal K, Das AV, Padhi TR, Jayanna S, Panchal B, Nayak S, Das T, Jalali S. Electronic medical records driven big data analytics in retinal diseases, report number 1: non-oncological retinal diseases in children and adolescents in India. Int Ophthalmol 2023; 43:2833-2839. [PMID: 36892735 DOI: 10.1007/s10792-023-02682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/25/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE To describe the spectrum and demographic distribution of non-oncological retinal diseases in children and adolescents presenting to a multi-tier ophthalmic hospital network in India. METHODS This is a cross-sectional hospital-based retrospective study over nine years (March 2011-March 2020) from a pyramidal eye care network in India. The analysis included 477,954 new patients (0-21 years), collected from an International Classification of Diseases (ICD) coded electronic medical record (EMR) system. Patients with a clinical diagnosis of retinal disease (non-oncological) in at least one eye were included. Age-wise distribution of these diseases in children and adolescents was analysed. RESULTS In the study, 8.44% (n = 40,341) of new patients were diagnosed with non-oncological retinal pathology in at least one eye. The age group-specific distribution of retinal diseases was 47.4%, 11. 8%, 5.9%, 5.9%, 6.4%, 7.6% in infants (< 1 year), toddlers (1-2 years), early childhood (3-5 years), middle childhood (6-11 years), early adolescents (12-18 years) and late adolescents (18-21 years), respectively. 60% were male, and 70% had bilateral disease. The mean age was 9.46 ± 7.52 years. The common retinal disorders were retinopathy of prematurity (ROP, 30.5%), retinal dystrophy (19.5%; most commonly, retinitis pigmentosa), and retinal detachment (16.4%). Four-fifth of the eyes had moderate to severe visual impairment. Nearly one-sixth of patients needed low vision and rehabilitative services, and about 1 in 10 patients required surgical intervention (n = 5960, 8.6%). CONCLUSION AND RELEVANCE About 1 in 10 children and adolescents seeking eye care in our cohort had non-oncological retinal diseases; the common ones were ROP (in infants) and retinitis pigmentosa (in adolescents). This information would help future strategic planning of eye health care in the institution in pediatric and adolescent age groups.
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Affiliation(s)
- Komal Agarwal
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, 500034, India.
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Tapas Ranjan Padhi
- Vitreoretinal and Uveitis Services, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Sushma Jayanna
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Bhavik Panchal
- Vitreoretinal and Uveitis Services, L V Prasad Eye Institute, Granthi Mallikarjun Rao Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India
| | - Sameera Nayak
- Vitreoretinal and Uveitis Services, L V Prasad Eye Institute, Kode Venkatadri Chowdhary Campus, Vijayawada, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, 500034, India
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Deshpande AP, Ankola AV, Sankeshwari R, Jalihal S, Bhat DV, Choudhury AR, Kumar RS, Khot AP. Unleashing the most effective oral health education intervention technique for improving the oral hygiene status and oral health knowledge in visually impaired young individuals: A systematic review and meta-analysis. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:9. [PMID: 37034845 PMCID: PMC10079208 DOI: 10.4103/jehp.jehp_419_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/01/2022] [Indexed: 05/29/2023]
Abstract
Appropriate oral health education (OHE) plays a vital role in prevention of oral diseases and would bridge the gap between dentists and visually impaired individuals. Hence, this systematic review was planned with an aim to evaluate effectiveness of various OHE techniques on the oral hygiene status and oral health knowledge of visually impaired young individuals. An electronic search extended to September 30, 2020 was conducted on PubMed, Wiley, ProQuest, ScienceDirect, Cochrane library, EBSCO, and Google Scholar. Two independent reviewers assessed the studies using a two-stage process; data were extracted according to PRISMA statement. Risk of bias assessment of selected studies was executed according to the study designs. Meta-analysis using the random-effects model was conducted for the outcomes for all oral health education techniques using STATASE 16.1 software. Hand and electronic search identified 3829 articles. After screening for titles and duplicates, 37 articles were retrieved, which were screened through abstract and full text. Of the 37 articles, 17 articles were included for qualitative synthesis, and out of that, 13 were for meta-analysis. Ten variations in oral health education (OHE) techniques were used in the included 17 studies to impart oral health education to visually impaired young individuals. Overall, all OHE techniques demonstrated a positive impact on oral hygiene status. The pooled overall cumulative mean difference of the oral hygiene status after imparting education in ATP, Audio, and Braille was 1.33 [1.06, 1.59], 1.76 [1.11, 2.42], and 1.96 [1.40, 2.55], respectively. An appropriate OHE technique boosts confidence in visually impaired young individuals, making the learning process an enjoyable experience. Use of either Braille or the ATP OHE technique was found to be a reliable and useful method to improve oral hygiene of visually impaired young individuals.
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Affiliation(s)
- Apurva P Deshpande
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Anil V Ankola
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Roopali Sankeshwari
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Sagar Jalihal
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Deepika V Bhat
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Abhra Roy Choudhury
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Ram Surath Kumar
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Atrey Pai Khot
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
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Reliability of Smart Phone Photographs for School Eye Screening. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101519. [PMID: 36291455 PMCID: PMC9601144 DOI: 10.3390/children9101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/05/2022]
Abstract
Smartphone photographs capturing Bruckner’s reflex have demonstrated reliability in identifying amblyogenic conditions in children. Assessing visual acuity for screening has been the traditional method since the inception of school screening. The present study aims to assess the reliability of smartphone photographs in detecting ocular morbidities in school children and to compare it with traditional vision screening. Two thousand five hundred and twenty school children underwent vision screening and smartphone cameraphotography by a trained research assistant followed by a comprehensive eye examination of all children by an ophthalmologist. Children with unaided visual acuity less than 6/12 in either of the eyes were graded as abnormal. Based upon the characteristics of the Bruckner’s reflex, the photographs were graded as normal or abnormal by two investigators blinded to the clinical findings. Statistical analysis was performed to compare the sensitivity and specificity of traditional vision screening and photograph based screening, considering comprehensive eye examination as the gold standard. The sensitivity and specificity of vision screening was 81.88% and 97.35% whereas for photographs it was 94.69% and 98.85% respectively. When the two methods were compared, the p value was <0.05. We conclude that smartphone photography is better than traditional vision screening for detecting ocular morbidities in school children.
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Sabherwal S, Sood I, Siddiqui Z, Majumdar A, Singh BP, DasGupta S, Ganesh S. Door-to-door Screening as a New Model Augmenting School Eye Screening: Reaching Out to School Age Children in the Midst of a Pandemic. Ophthalmic Epidemiol 2022:1-9. [PMID: 36121011 DOI: 10.1080/09286586.2022.2123003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE Explore door-to-door eye screening in India as a model to reach school age children in need of eye care, especially during school closures due to the Covid-19 pandemic. METHODS Children between 5 and 18 years were screened in an urban-slum of Delhi from September 2020 to March 2021. Screening included capturing ocular complaints, visual acuity and conducting a torchlight examination. Children with any eye-related complaints, gross abnormality or a LogMAR acuity of more than 0.2 in either eye were referred to the nearby vision centre. Data were disaggregated by gender and age group. Reporting after referral and proportion of true positives referrals were used to assess the model. RESULTS 32,857 children were screened. 55% were boys. Only 917 children (2.8%) had previous eye examinations. 1814 (5.5%) children were referred. Overall compliance rate amongst those referred was 59% (1070 of 1814) and compliance was significantly higher (72%) amongst those referred with poor vision as compared to those with only ocular morbidities (38%). Overall compliance was significantly higher amongst older age group (64% vs 50%) and amongst girls than boys (61% vs 56%). 3.9% children were detected with refractive error (RE) and 2.5% with uncorrected RE which was significantly higher in girls and in older age group. Of 1070 children reporting after referral, 85% had confirmed diagnosis for RE or other ocular pathology. CONCLUSION Door-to-door screening had good referral compliance and positive predictive value. We recommend this model as a supplement to school screening especially in regions with low enrolment and high absenteeism in schools.
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Affiliation(s)
- Shalinder Sabherwal
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Ishaana Sood
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Zeeshan Siddiqui
- Department of Community Outreach, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Atanu Majumdar
- Biostatistician, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Birendra Pratap Singh
- Department of Community Ophthalmology and Public Health Research, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Shantanu DasGupta
- Department of Community Operations and Strategic Planning, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Suma Ganesh
- Department of Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Rangavittal S, Krishnamurthy SS, Chandrasekar A, Narayanan A. Vision Impairment among Children in South India: Results from a Large-Scale School Eye Screening. Ophthalmic Epidemiol 2022; 30:268-275. [PMID: 35757928 DOI: 10.1080/09286586.2022.2090006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To provide the prevalence of vision impairment and blindness among 250,000 school children aged 6 to 17 years, screened in Tamil Nadu, India. METHODS The study was conducted between 2016 and 2019 as a part of the school eye screening program in Kanchipuram district, Tamil Nadu. The clinical examination included basic vision testing, objective refraction, subjective acceptance, spectacle dispensing, and a posterior segment evaluation. The prevalence of vision impairment, blindness, low vision, and the association with other demographic variables using logistic regression were calculated. RESULTS A total of 250,052 children were screened in 1047 schools and the prevalence of vision impairment, blindness, and low vision in Kanchipuram district was 3.83%, 0.01%, 0.19%, respectively. The major causes for vision impairment, blindness, and low vision were refractive errors (3.05%), high myopia (0.002%), and refractive amblyopia (0.04%), respectively. Vision impairment was significantly associated with urban location (OR = 1.42, 95% CI 1.36-1.48, p < .0001), females (OR = 1.11, 95%CI - 1.08-1.15, p < .0001), private schools (OR = 2.43, 95%CI - 2.35-2.42, p < .0001), higher secondary class grade (OR = 1.69, 95%CI - 1.61-1.77, p = .001), high-school class grade (OR = 1.65, 95%CI - 1.58-1.72, p = .001) and middle school class grade (OR = 1.53, 95%CI - 1.47-1.59, p = .001). CONCLUSION This large-scale school eye screening reports a comparatively lower prevalence of vision impairment, blindness, and low vision when compared to other studies conducted around the world. Although the overall prevalence is relatively low, the causes are mostly refractive. Urban, female, private school-going children aged 11-17 are at higher risk.
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Affiliation(s)
| | | | - Ambika Chandrasekar
- Elite School of Optometry, Unit of Medical Research Foundation Chennai, India
| | - Anuradha Narayanan
- Elite School of Optometry, Unit of Medical Research Foundation Chennai, India
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“Patterns of occurrence and management abilities of birth defects: A study from a highly urbanized coastal district of India”. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Wadhwani M, Vashist P, Singh SS, Gupta V, Gupta N, Saxena R. Myopia prevalence in a population-based childhood visual impairment study in North India - CHVI-2. Indian J Ophthalmol 2022; 70:939-943. [PMID: 35225546 PMCID: PMC9114607 DOI: 10.4103/ijo.ijo_974_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: The aim of the study was to determine the prevalence of myopia at the community level. Methods: A population-based, cross-sectional study was planned in 40 clusters among children identified with subnormal vision in the urban community of Delhi. House-to-house visits were conducted for visual acuity screening of 20,000 children aged 0–15 years using age appropriate visual acuity charts. All the children with visual acuity of < 6/12 in any eye in the age group between 3 and 15 years and inability to follow light in age group 0–3 years were referred for detailed ophthalmic examination. Results: A total of 13,572 (64.7%) children belonged to the age group of 6–15 years. Of these, a total of 507 (3.7%) were found to be having myopia (spherical equivalent of -0.50 DS or worse in one or both eyes) with positive association with higher age groups. Conclusion: The estimated prevalence of myopia is 3.7%; the proportion of uncorrected myopia was 45%, which reflects that refractive error services need to be improved further.
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Affiliation(s)
| | - Praveen Vashist
- Community Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Suraj Senjam Singh
- Community Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Vivek Gupta
- Community Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Noopur Gupta
- Cornea and Anterior Segment, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rohit Saxena
- Neurophthalmology and Strabismus, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Wadhwani M, Vashist P, Singh SS, Gupta V, Saxena R, Kalaivani M, Tandon R. Development of age appropriate vision function questionnaire for children with visual impairment (CHVI-VFQ). Indian J Ophthalmol 2022; 70:930-938. [PMID: 35225545 PMCID: PMC9114577 DOI: 10.4103/ijo.ijo_1177_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/20/2021] [Accepted: 09/28/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To develop a new age-appropriate visual function questionnaire for visually impaired children. METHODS The study was conducted in north India in 20,955 (97.3%) children ≤15 years who underwent visual acuity examination. Of these 20,955 children, a total of 722 children were referred with unaided visual acuity less than 6/12 in any eye. Among these referred children, parents in the age group of 5-9 years and children between 10 and 15 years underwent interviews using LV Prasad Functional Visual Questionnaire-20 (LVP FVQ 20) and Indian Visual Functioning Questionnaire-33 (IND VFQ-33). Following this, multiple steps were undertaken that involved expert opinion for the removal of items on basis of zero variance and factor analysis along with calculation of Cronbach's alpha. RESULTS : A Cronbach' alpha of 0.834 was calculated for the younger age group and 0.931 for the higher age group of children. CONCLUSION : A new robust age-appropriate questionnaire was developed and it was observed that there was a significant change in median score (that was derived for various domains after calculating the median for the items in various domains asked pre- and post-intervention in the form of glasses or surgery) for quality of visual function in the visually impaired children. A significant change in functional vision of visually impaired children (P < 0.005) was observed in both age groups.
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Affiliation(s)
- Meenakshi Wadhwani
- Assistant Professor, Pediatric Ophthalmology, Chacha Nehru Bal Chikitsalya, New Delhi, India
| | - Praveen Vashist
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Suraj S Singh
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Vivek Gupta
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rohit Saxena
- Neurophthalmology and Strabismus, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | - Radhika Tandon
- Head Cornea and Anterior Segment, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Kulkarni S, Gilbert C, Giri N, Hankare P, Dole K, Deshpande M. Visual impairment and blindness among children from schools for the blind in Maharashtra state, India: Changing trends over the last decade. Indian J Ophthalmol 2022; 70:597-603. [PMID: 35086244 PMCID: PMC9023984 DOI: 10.4103/ijo.ijo_1930_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India. Methods: Children aged <16 years, enrolled in the schools for the blind in Maharashtra state, India were examined between October 2018 and December 2019. The anatomical sites and etiology for blindness were recorded using the World Health Organization’s standard reporting form. Causes of blindness were compared among different regions of the state and also by different age groups. Results: Of the 1,969 students examined from 39 schools for the blind, 188 children (9.5%) had severe visual impairment and 1,666 children (84.6%) were blind. Whole globe anomalies (794, 42.8%) were the most common anatomical site of vision loss in children, followed by corneal (289, 15.6%) and retinal abnormalities (280, 15.2%). Corneal causes were second most common in the poorer districts of Vidarbha (15.3%) and Marathwada (14.6%), whereas retinal causes were second most common in the wealthier regions of western Maharashtra (18.3%) and Khandesh (24.1%). Nearly one-third (593, 32%) of children were blind from potentially avoidable causes. Preventable blindness consisting of corneal causes and retinopathy of prematurity was seen in 281 (15.2%) cases, whereas treatable causes comprising of lens-related causes, glaucomas, refractive errors, amblyopia, and uveitis accounted for another 311 (16.8%). Among the younger children (≤10 years), the proportion of corneal blindness was lower (83/623, 13.3% vs. 206/1232, 16.7%) and that of retinal blindness was higher (119/623, 19% vs. 163/1232, 13.2%) than the older children. Conclusion: Whole globe anomalies constitute a major cause of SVI and blindness in Maharashtra. There seems to be an increase in the proportion of retinal blindness, especially retinopathy of prematurity, suggesting a need for increased screening coverage.
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Affiliation(s)
- Sucheta Kulkarni
- Department of Community Ophthalmology and Retina, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Clare Gilbert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Nilesh Giri
- Department of Community Ophthalmology and Retina, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Pravin Hankare
- Department of Community Ophthalmology and Retina, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Kuldeep Dole
- Department of Community Ophthalmology and Retina, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - M Deshpande
- Department of Community Ophthalmology and Retina, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
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Wangtiraumnuay N, Trichaiyaporn S, Lueangaram S, Surukrattanaskul S, Wongkittirux K. Prevalence of Prescription Glasses in the First-Grade Thai Students (7-8 Years Old). CLINICAL OPTOMETRY 2021; 13:235-242. [PMID: 34377043 PMCID: PMC8349202 DOI: 10.2147/opto.s323999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To study the prevalence of the prescription glasses given to first-grade students due to the "Good Sight for Thai Children" (GSTC) policy. METHODS This was a cross-sectional study that examined all prescription glasses given to first-grade students throughout Thailand, after visual screening due to the GSTC policy between 2016 and 2017. Trained class teachers screened their students' visual acuity and referred children who had less than 20/40 visual acuity in either eye to a hospital for an eye examination and prescription glasses. RESULTS A total of 786,729 students were screened. Of these, 20,401 (2.59%) students were referred to hospital. However, only 9867 (48.37%) students presented to a hospital. Glasses were prescribed for 5324 (53.96%) students following cycloplegic refraction by ophthalmologists or trained refractionists. The mean spherical equivalent was -1.08 (-19.00 to +10.00, SD 2.32) diopters. There were 1626 (30.54%) children at amblyopic risk without glasses. A 5.49% had high myopia (< -6 diopters), 5.22% had high hyperopia (> +5 diopters) and 27.82% had high astigmatism (>2 diopters). A cylindrical lens analysis showed that 81.53% had with-the-rule astigmatism, 4.07% had against-the-rule astigmatism, and 14.40% had oblique astigmatism. CONCLUSION Although the reliable prevalence of refractive error cannot be estimated, the prevalence of visual impairment may be estimated. There were a number of students who required glasses. The astigmatism was the most common refractive error on prescription glasses for first-grade children. With-the-rule astigmatism was the most prevalent. The visual screening program of school children proved to be valuable and should be continued and developed.
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Affiliation(s)
- Nutsuchar Wangtiraumnuay
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Sumalin Trichaiyaporn
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Sirin Lueangaram
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Supawan Surukrattanaskul
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Kwanjai Wongkittirux
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
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Chakrabarty S, Desai R, Ravindran M, Chandrashekharan S, Pawar N, Allapitchai F. A Survey of Visual Impairment in Children Attending a Blind School in South India. Indian J Community Med 2021; 46:327-328. [PMID: 34321755 PMCID: PMC8281874 DOI: 10.4103/ijcm.ijcm_209_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/04/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Sabyasachi Chakrabarty
- Department of Paediatric Ophthalmology, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Rishabh Desai
- Department of General Ophthalmology, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Department of Paediatric Ophthalmology, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Shivkumar Chandrashekharan
- Department of Cataract Services, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Neelam Pawar
- Department of Paediatric Ophthalmology, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Fathima Allapitchai
- Department of Paediatric Ophthalmology, Aravind Eye Hospital and PG Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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Wadhwani M, Vashist P, Senjam SS, Gupta V, Saxena R, Tandon R. A population-based study on the prevalence and causes of childhood blindness and visual impairment in North India. Indian J Ophthalmol 2021; 69:1381-1387. [PMID: 34011705 PMCID: PMC8302266 DOI: 10.4103/ijo.ijo_2408_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/27/2020] [Accepted: 01/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This was a population-based study to determine the prevalence and causes of visual impairment in children less than 16 years in Urban North India. Methods This cross-sectional study was conducted in 40 clusters of urban Delhi. 20,955 children aged less than 16 years underwent visual acuity screening using age-appropriate visual acuity charts. Unaided visual acuity of enumerated children aged over 2 years was assessed by using Lea symbols chart in 3-5 years age group and logMAR tumbling E charts for the 6-15 years age group. For children aged 0-2 years, fixation and following to torch light was assessed. All the children with unaided visual acuity of <6/12 in any eye in age group 3-15 years and inability to follow the light in age <3 years were referred for detailed ophthalmic examination. Results Amongst 20,955 children examined for visual acuity a total of 789 children were referred to the central clinic for detailed ophthalmic examination. Of these referred children, a total of 124 had presenting visual acuity <6/18 in the better eye. The prevalence of visual impairment (VI) was 5.92 per thousand (95% CI: 4.96-7.05). The prevalence of moderate to severe visual impairment was maximum in the age group of 11 to 15 years. The main cause of avoidable VI in these children was a refractive error (75.7%). The prevalence of blindness was 0.42 per thousand. Conclusion Optic nerve abnormalities were the most important cause of blindness in children. Refractive error is the most important cause of visual impairment amongst children and needs to be addressed.
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Affiliation(s)
- Meenakshi Wadhwani
- Department of Pediatric Ophthalmology, Chacha Nehru Bal Chikitsalya, Geeta Colony, New Delhi, India
| | | | | | - Vivek Gupta
- Community Ophthalmology, RP Center, AIIMS, New Delhi, India
| | - Rohit Saxena
- Squint and Neuro Ophthalmology Unit, RP Center, AIIMS, New Delhi, India
| | - Radhika Tandon
- Head, Cornea Services, RP Center, AIIMS, New Delhi, India
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Jain M, Anjani P, Krishnamurthy G, Sachdeva V, Kekunnaya R. One-year Profile of Eye Diseases in Infants (PEDI) in secondary (rural) eye care centers in South India. Indian J Ophthalmol 2021; 69:906-909. [PMID: 33727457 PMCID: PMC8012936 DOI: 10.4103/ijo.ijo_1084_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: The aim of this study was to report the proportion and patterns of eye diseases observed among infants seen at two rural eye care centers in South India. Methods: A retrospective review of case records of infants seen between January 1, 2017 and December 31, 2017 at two rural secondary eye care centers attached to L V Prasad Eye Institute, Hyderabad. Data were collected regarding their demographic profile, the pattern of eye problems observed, management at the facility itself, and need for referrals. Results: During this period, a total of 3092 children were seen. Among them, 141 were infants (4.56%, 71 boys: 70 girls, median age: 8 months). Twenty-five percent of infants were less than 6 months of age. The most common eye problem was congenital nasolacrimal duct obstruction (n = 76, 53.90%), followed by conjunctivitis (n = 33, 23.40%), retinopathy of prematurity (n = 4, 2.84%) and strabismus (n = 3, 2.13%). One case each of congenital cataract and suspected retinoblastoma were identified. Majority of the cases (58.8%) belonged to the oculoplastic and orbital surgery sub-specialty. Sixteen percent of the infants (n = 23) had sight-threatening eye problems. Twenty percent (n = 28) were referred to tertiary care hospital for further management. Conclusion: Profile of eye disease in infants in secondary or rural eye care centers ranged from simple to complex, including sight-threatening diseases. While our study concluded that nearly 4/5th of these eye problems were simple and could be managed by a well-trained comprehensive ophthalmologist, 20% of these cases required a referral to a tertiary care center.
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Affiliation(s)
- Mayank Jain
- L V Prasad Eye Institute, KAR Campus, Banjara Hills, Hyderabad, Telangana, India
| | - Pratap Anjani
- L V Prasad Eye Institute, KAR Campus, Banjara Hills, Hyderabad, Telangana, India
| | | | - Virender Sachdeva
- L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Ramesh Kekunnaya
- L V Prasad Eye Institute, KAR Campus, Banjara Hills, Hyderabad, Telangana, India
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Dogra M, Singh SR. Commentary: Looking beyond anti-vascular endothelial growth factor - Novel therapeutic targets for retinopathy of prematurity. Indian J Ophthalmol 2021; 69:374-375. [PMID: 33463596 PMCID: PMC7933870 DOI: 10.4103/ijo.ijo_3272_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mohit Dogra
- Advanced Eye Centre, PGIMER, Chandigarh, India
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Agarwal K, Vinekar A, Chandra P, Padhi TR, Nayak S, Jayanna S, Panchal B, Jalali S, Das T. Imaging the pediatric retina: An overview. Indian J Ophthalmol 2021; 69:812-823. [PMID: 33727440 PMCID: PMC8012979 DOI: 10.4103/ijo.ijo_1917_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.
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Affiliation(s)
- Komal Agarwal
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anand Vinekar
- Department of Pediatric Retina, Narayana Nethralaya Eye Institute, New Delhi, India
| | - Parijat Chandra
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Tapas Ranjan Padhi
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Sameera Nayak
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Kode Venkatadri Chowdhary Campus, Vijaywada, Andhra Pradesh, India
| | - Sushma Jayanna
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Bhavik Panchal
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Granthi Mallikarjun Rao Varalaksmi Campus, Visakhapatnam, Andhra Pradesh, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Bhor KB, Vinay V, Ambildhok K, Shetty V. Effectiveness of oral health educational interventions on oral health of visually impaired school children: A systematic review and meta-analysis. SPECIAL CARE IN DENTISTRY 2021; 41:291-308. [PMID: 33471416 DOI: 10.1111/scd.12567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effect of newer and traditional oral health education (OHE) methods in improving oral health knowledge, oral hygiene status and practices, plaque, gingival, and dental caries status of visually impaired children. METHODOLOGY Comprehensive literature search was performed by using PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google scholar, and Open Gray from 2010 to 2020 for studies in English language. Two reviewers critically assessed the studies for eligibility criteria, and data extraction was performed. Quality assessment of selected studies was executed according to the study designs. A meta-analysis was carried out using Review Manager 5.3 software. RESULTS Twenty-four articles were included for qualitative synthesis and out that 11 in meta-analysis. Cumulative standardized mean difference for plaque (Silness and Loe, 1964) and gingival index (Loe and Silness, 1963) was -0.45 (-0.88, -0.02, p = 0.04) and -0.54 (-1.10, 0.03, p = 0.06), respectively favoring newer OHE group as compared to traditional OHE group. Comparison of different newer OHE methods had similar effects on the oral health of visually impaired children. CONCLUSION The study period of included studies was short-term, so long-term effectiveness could not be assessed, however newer OHE methods were effective in improving plaque and gingival scores over a short period.
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Affiliation(s)
- Ketaki B Bhor
- Department of Public Health Dentistry, Sinhgad Dental College and Hospital, Pune, India
| | - Vineet Vinay
- Department of Public Health Dentistry, Sinhgad Dental College and Hospital, Pune, India
| | - Kadambari Ambildhok
- Department of Public Health Dentistry, Sinhgad Dental College and Hospital, Pune, India
| | - Vittaldas Shetty
- Department of Public Health Dentistry, Sinhgad Dental College and Hospital, Pune, India
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Ademola-Popoola DS, Olatunji VA, Obajolowo TS, Akande TM, Mokuolu OA. Outcome of vision screening by community health workers at immunization outlets in Nigeria to support access to early visual evaluation in children aged 0-2 years. Taiwan J Ophthalmol 2020; 11:77-85. [PMID: 33767959 PMCID: PMC7971434 DOI: 10.4103/tjo.tjo_39_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/06/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE: Routine eye examination in early life is not the practice in most resource-limited countries. Delay in the presentation for eye problems is typical. Community health officers are often consulted by caregivers for all health problems during routine immunization and well-baby clinics in primary healthcare for children aged 0–2 years. This study evaluated the value and limitation of interview, Bruckner red reflex test, and instrument vision screener by noneye care middle-level staff of rural and urban well-baby immunization clinics, in early detection and referral for childhood eye disorders. MATERIALS AND METHODS: This was a cross-sectional study. Middle-level community health workers (CHWs) working at well-baby/immunization clinics were trained to perform vision screening using interview of caregivers, red reflex eye examination with ophthalmoscope, and instrument vision screener (Welch Allyn SPOT™ Vision Screener) without mydriatic drugs during routine immunization of children aged 0–2 years. IRB approval was obtained. RESULTS: Over a 6-month period in 2017, the CHWs screened 5609 children. Overall, 628 (11.2%) patients were referred to the tertiary child eye care unit. Referred cases included cataract, glaucoma, congenital nasolacrimal duct obstruction, ophthalmia neonatorum, retinoblastoma, and significant refractive errors. Referral from the interview of mothers was enhanced if specific questions to elicit visual function were asked. Bruckner red reflex test was more effective than instrument vision screener in the detection of cataract and life-threatening diseases such as retinoblastoma. Instrument vision screener was preferred by parents and better at detecting amblyopic risk factors. CONCLUSION: Preschool vision screening during routine immunization by primary healthcare workers in resource-limited settings was effective. Whenever instrument vision screener does not give any recommendation during screening, consider vision- or life-threatening pathology and refer.
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Affiliation(s)
- Dupe S Ademola-Popoola
- Department of Ophthalmology, University of Ilorin Teaching Hospital, University of Ilorin, Ilorin, Nigeria
| | - Victoria A Olatunji
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Tokunbo S Obajolowo
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Tanimola M Akande
- Department Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olugbenga A Mokuolu
- Pediatrics and Child Health, University of Ilorin Teaching Hospital, University of Ilorin, Ilorin, Nigeria
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Senjam SS, Chandra P. Retinopathy of prematurity: Addressing the emerging burden in developing countries. J Family Med Prim Care 2020; 9:2600-2605. [PMID: 32984093 PMCID: PMC7491791 DOI: 10.4103/jfmpc.jfmpc_110_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 11/04/2022] Open
Abstract
Retinopathy of prematurity has emerged and continues to be one of the leading causes of avoidable childhood blindness in low- and middle-income countries over the past few years. A major reason is the lack of adoption of effective and efficient screening for retinopathy of prematurity in various neonatal or newborn units across the countries. At the same time, there is an improvement in the survival rate of high-risk newborn babies which causes a further rise in retinopathy of prematurity. Most of the associated risk factors for retinopathy of prematurity are avoidable, therefore, various preventive strategies can be developed at various levels of healthcare facilities ranging from primary to tertiary level. The integration of appropriate retinopathy of prematurity intervention programs between healthcare departments and partnerships with other non-governmental eye care institutions would be an important as well as critical step to prevent blindness and visual impairment due to retinopathy of prematurity in India and other developing nations.
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Affiliation(s)
- Suraj Singh Senjam
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Vitreoretina and ROP Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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