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Vijendran S, Kamath YS, Alok Y, Kuzhuppilly NIR. Determination of Refractive Error Using Direct Ophthalmoscopy in Children. Clin Ophthalmol 2024; 18:989-996. [PMID: 38584720 PMCID: PMC10998502 DOI: 10.2147/opth.s453207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Refractive error is a major cause of visual impairment in children and its early detection can prevent ocular morbidity such as amblyopia and strabismus. Brückner test is a comprehensive test which can be easily administered in children using a direct ophthalmoscope. We aimed to determine refractive error in children by analysis of the red reflex using modified Brückner test. Patients and Methods This prospective observational study was conducted on 683 undilated eyes of 683 children aged four to 10 years. They were evaluated with a direct ophthalmoscope from one meter in a dimly lit room. The characteristics of the red reflex and crescent obtained were compared with photoscreener refraction value and analyzed. Results The presence of superior crescent was associated with hypermetropia (Chi square 37.11, p < 0.001, kappa = 0.15) and inferior crescent with myopia (Chi square 157.29, p < 0.001, kappa = 0.477). Superior crescent was 98.4% sensitive in detecting hypermetropia. Hypermetropia greater than +1.5D, was associated with larger superior crescent crossing horizontal midline of pupil (Chi square = 5.29, p = 0.021). Conclusion The modified Brückner test is useful in detection and quantification of refractive error in children. It is easy, simple, quick and can be employed in the community as a screening test to detect potentially amblyogenic refractive errors.
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Affiliation(s)
- Sruthi Vijendran
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Yogish S Kamath
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Yash Alok
- Department of Community Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Neetha I R Kuzhuppilly
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Saxena R, Dhiman R, Gupta V, Phuljhele S, Mahajan A, Rakheja V, Swaminathan M, Jethani J, Kesarwani S, Kekunnaya R, Sukhija J, Bhave S, Sharma P, Sinha R, Verma L, Sharma N. Prevention and management of childhood progressive myopia: National consensus guidelines. Indian J Ophthalmol 2023; 71:2873-2881. [PMID: 37417137 PMCID: PMC10491088 DOI: 10.4103/ijo.ijo_387_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: 02/07/2023] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023] Open
Abstract
Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country.
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Affiliation(s)
- Rohit Saxena
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS New Delhi, India
| | - Rebika Dhiman
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS New Delhi, India
| | - Vinay Gupta
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS New Delhi, India
| | - Swati Phuljhele
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS New Delhi, India
| | - Asmita Mahajan
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS New Delhi, India
| | - Vaishali Rakheja
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS New Delhi, India
| | | | - Jitendra Jethani
- Baroda Children Eye Care and Squint Clinic, Vadodara, Gujarat, India
| | | | | | - Jaspreet Sukhija
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Forrest SL, Mercado CL, Engmann CM, Stacey AW, Hariharan L, Khan S, Cabrera MT. Does the Current Global Health Agenda Lack Vision? GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00091. [PMID: 36853641 PMCID: PMC9972379 DOI: 10.9745/ghsp-d-22-00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023]
Abstract
Given increasing rates of visual impairment worldwide, we call on national health plans and global development agencies to urgently focus funding and resources toward vision and eye health, with an emphasis on data collection surrounding new and changing burden of eye disease.
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Affiliation(s)
- Sam L. Forrest
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Carmel L. Mercado
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.,Division of Ophthalmology, Department of Surgery, Seattle Children’s Hospital, Seattle, WA, USA
| | - Cyril M. Engmann
- Department of Global Health, University of Washington, Seattle, WA, USA.,Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA.,PATH, Seattle, WA, USA
| | - Andrew W. Stacey
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Luxme Hariharan
- Division of Pediatric Ophthalmology, Chief of Pediatric Ophthalmology, Nicklaus Children’s Pediatric Specialists, Nicklaus Children’s Hospital, Miami, FL, USA
| | | | - Michelle T. Cabrera
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.,Division of Ophthalmology, Department of Surgery, Seattle Children’s Hospital, Seattle, WA, USA.,Correspondence to Michelle Cabrera ()
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Murali K, Krishna V, Krishna V, Kumari B, Raveendra Murthy S, Vidhya C, Shah P. Effectiveness of Kanna photoscreener in detecting amblyopia risk factors. Indian J Ophthalmol 2021; 69:2045-2049. [PMID: 34304175 PMCID: PMC8482920 DOI: 10.4103/ijo.ijo_2912_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: Amblyopia is a significant public health problem. Photoscreeners have been shown to have significant potential for screening; however, most are limited by cost and display low accuracy. The purpose of this study was validate a novel artificial intelligence (AI) and machine learning–based facial photoscreener “Kanna,” and to determine its effectiveness in detecting amblyopia risk factors. Methods: A prospective study that included 654 patients aged below 18 years was conducted in our outpatient clinic. Using an android smartphone, three images of each the participants’ face were captured by trained optometrists in dark and ambient light conditions and uploaded onto Kanna. Deep learning was used to create an amblyopia risk score based on our previous study. The algorithm generates a risk dashboard consisting of six values: five normalized risk scores for ptosis, strabismus, hyperopia, myopia and media opacities; and one binary value denoting if a child is “at-risk” or “not at-risk.” The presence of amblyopia risk factors (ARF) as determined on the ophthalmic examination was compared with the Kanna photoscreener. Results: Correlated patient data for 654 participants were analyzed. The mean age of the study population was 7.87 years. The algorithm had an F-score, 85.9%; accuracy, 90.8%; sensitivity, 83.6%; specificity, 94.5%; positive predictive value, 88.4%; and negative predictive value, 91.9% in identifying amblyopia risk factors. The P value for the amblyopia risk calculation was 8.5 × 10−142 implying strong statistical significance. Conclusion: The Kanna photo-based screener that uses deep learning to analyze photographs is an effective alternative for screening children for amblyopia risk factors.
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Affiliation(s)
- Kaushik Murali
- Sankara Academy of Vision, Sankara Eye Hospital, Stanford, California, USA
| | | | | | - B Kumari
- Sankara Academy of Vision, Sankara Eye Hospital, Stanford, California, USA
| | | | - C Vidhya
- Sankara Academy of Vision, Sankara Eye Hospital, Stanford, California, USA
| | - Payal Shah
- Sankara Academy of Vision, Sankara Eye Hospital, Stanford, California, USA
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