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We compared recruitment of participants at high risk for glaucoma and other eye diseases in three community-based studies designed to improve access to eye care in underserved populations in New York City, Alabama, and Michigan. We used (1) participant data collected at enrollment (e.g. demographic, medical conditions, healthcare access, and method of hearing about study) and (2) interviews with study staff to assess effective recruitment strategies in enrolling people at high risk for eye disease. We analyzed participant data using descriptive statistics and interview data using content analysis to categorize responses to questions. In these community-based studies, all sites recruited greater proportions of populations with increased risk of eye disease compared to their estimates in the US population. High-risk characteristics varied based on the setting (i.e. Federally Qualified Health Centers or affordable housing buildings). Older adults represented 35% to 57%; 43% to 56% identified as Black; 1% to 40% as Hispanic/Latino; 20% to 42% reported a family history of glaucoma; 32% to 61% reported diabetes; and 50% to 67% reported high blood pressure. Social risk factors for under-utilization of eye care due to poverty included that 43% to 70% of participants had high school or lower education; 16% to 40% were employed; and 7% and 31% had no health insurance. From a qualitative perspective, active, personalized, culturally sensitive methods were most effective in recruiting participants. Implementing eye disease detection interventions in community-based settings facilitated recruiting individuals at high risk for glaucoma and other eye diseases. [ABSTRACT FROM AUTHOR]

Inadequate public knowledge about eyes and eye care poses avoidable risks to vision-related quality of life. This study of eye care knowledge among Canadians extends earlier findings from focus groups. Perceptions about eyes and eye care were sought using a 21-item online survey and snowball sampling. Inclusion criteria were living in Canada and being at least 18-years old; eye care professionals and staff were excluded. Response frequencies were converted to percentages, with eye condition items analysed according to 'expected' or 'unexpected' eye impacts. Proportions selecting these impacts or 'unsure' were determined. There were 424 respondents: 83.0% aged 20-65 years and 69.6% female. Mismatches existed between perceived recommendations and behaviours for booking eye exams: within two years (86.7% vs. 68.4%) and symptom-driven (3.3% vs. 13.0%). First eye exams after age one year were deemed appropriate by 43.6%. Few respondents associated glaucoma with no symptoms (6.0%) or amblyopia with blurred vision (13.5%). A notable proportion incorrectly related tunnel vision with age-related macular degeneration (AMD, 36.8%) and cataract (21.9%). Identifying all 'expected' responses was unlikely for glaucoma (1.9%), amblyopia (6.7%), and cataract (12.0%). Most respondents identified no 'expected' effects for glaucoma (63.8%) and AMD (46.2%) and some 'expected' effects for cataract (59.5%) and amblyopia (72.6%). Selecting 'unsure' was 9-10 times more common among respondents choosing no 'expected' impacts than those choosing some. Awareness of thyroid-associated eye disease was lowest (32.4%) of seven conditions. Respondents were most likely to consult optometrists for routine eye exams, eye disease, diabetes eye checks and blurred vision but family physicians for red eyes and sore eyes. Respondents typically paid for their eye exams and eyewear but wanted government to pay. Vision-threatening knowledge gaps and misinformation about eyes and eye care among Canadian respondents highlight the need for accessible, targeted public education. [ABSTRACT FROM AUTHOR]

The key predictor variable for each model was whether the participant reported diagnosis of macular degeneration, diabetic retinopathy, glaucoma, or cataracts. In this study, we included adults (age>=40) who indicated having a previous diagnosis of ARMD, DR, glaucoma, or cataracts. [Extracted from the article]

Hydroxypropyl-guar (HPG) is a thickening agent first added to lubricating eye drops in 2003. This agent, which enhances viscosity, has been used in the SYSTANE® family of lubricant eye drops (Alcon Laboratories, Inc., Fort Worth, TX, USA). HPG forms a partially linked gel with borate to prolong the retention of demulcents, such as polyethylene glycol and propylene glycol, on the eye. This helps to protect the ocular surface, thereby reducing the symptoms of dry eye disease (DED). The definition of DED has evolved with advances in research, leading to changes in HPG-containing eye care solutions. This article reviews current knowledge on the use of HPG-containing lubricating eye drops in the management of DED. [ABSTRACT FROM AUTHOR]

Clinical relevance: This novel clinical model is the first of its kind in Australia and was designed to help reduce unnecessary referrals into overburdened public systems by utilising pre-existing community-based resources. Background: The Centre for Eye Health (CFEH) is an intra-professional optometry-led care clinic offering an alternative pathway to traditional ophthalmology-based pathways (public hospital clinics or private practices) for 'at-risk' patients requiring ocular imaging, diagnostic and management services. This study evaluates the CFEH integrated eye-care model in the identification of chronic eye diseases within the community. Methods: A retrospective random clinical audit of over 750 medical records of patients referred to the CFEH between July 2016 and June 2019 was conducted. Demographics of patients, referral type, final diagnosis and recommended management plans were extracted from this subset. Clinic key performance indicators (referral turnaround time, and net cost per patient appointment) were also extracted. Results: Of the 755 referrals associated with the audited records, 77.4% resulted in the identification of patients with or at-risk of developing eye diseases with 73.5% of this cohort requiring ongoing monitoring at CFEH or referral to ophthalmology. Although the CFEH model is not designed to diagnose or manage acute conditions, 1.5% of patients in this pathway required same day ophthalmological or medical intervention. The cost per patient was equivalent to hospital eye departments costs. Conclusion: This integrated care pathway has the potential to reduce unnecessary referrals from optometrists to hospital ophthalmological service by offering a safe and effective alternate pathway. The majority of patients seen within this pathway were able to be monitored within optometry-led services. This is a unique clinical model utilising inter-professional referrals within optometry which has the potential to reduce preventable blindness within the community through the early detection of eye diseases. [ABSTRACT FROM AUTHOR]

Preventable and treatable visual impairment affects more than 1 billion people worldwide. Rwanda has an estimated visual impairment prevalence of 3.7% amongst the 12 million inhabitants. Around one third of this demand could be addressed through a more integrated and collaborative approach, particularly in primary eye care services. Healthcare students, therefore, need to be prepared for collaborative practice in eye health through interprofessional learning. Interprofessional workshops were piloted with ophthalmic clinical officer, medical clinical officer, nursing and medical students from the University of Rwanda. The aim was to promote collaborative practice by teaching students how to assess and recognize common eye conditions using the Arclight; a low cost, solar powered, portable ophthalmoscope designed for use in low resource settings. Students reported that the workshop content was relevant to all professional groups. They valued the opportunity to learn interprofessionally, share their knowledge and perspectives, and acquire new knowledge and skills together. This pilot helped to identify the most relevant skills and knowledge for future interprofessional eye health training. It enabled the facilitators to reflect on how best to maintain a balance between a quality interprofessional experience and the more specific eye health related learning objectives. [ABSTRACT FROM AUTHOR]

The National Eye Institute was established by Congress in 1968 to support projects that research ways to prevent, treat, or reverse vision loss. The National Eye Institute is on the front lines of vision research and provides consumer health information to the public to educate users on vision problems and how to keep their eyes healthy. [ABSTRACT FROM AUTHOR]

Epidemiological information is expected to be used to develop key aspects of eye care such as to control and minimise the impact of diseases, to allocate resources, to monitor public health actions, to determine the best treatment options and to forecast the consequence of diseases in populations. Epidemiological studies are expected to provide information about the prevalence and/or incidence of eye diseases or conditions. To determine prevalence is necessary to perform a cross-sectional screening of the population at risk to ascertain the number of cases. The aim of this review is to describe and evaluate capture-recapture methods (or models) to ascertaining the number of individuals with a disease (e.g. diabetic retinopathy) or condition (e.g. vision impairment) in the population. The review covers the fundamental aspects of capture-recapture methods that would enable non-experts in epidemiology to use it in ophthalmic studies. The review provides information about theoretical aspects of the method with examples of studies in ophthalmology in which it has been used. We also provide a problem/solution approach for limitations arising from the lists obtained from registers or other reliable sources. We concluded that capture-recapture models can be considered reliable to estimate the total number of cases with eye conditions using incomplete information from registers. Accordingly, the method may be used to maintain updated epidemiological information about eye conditions helping to tackle the lack of surveillance information in many regions of the globe. [ABSTRACT FROM AUTHOR]

Purpose: To describe cataract services in Egypt and explore resources and practices in public and private sectors. Methods: The study was conducted between June and August 2015. All facilities in the country providing cataract services were contacted to obtain information on surgeries performed in 2014. Hospitals performing eye surgery in Quena, Sharkia, and Fayoum regions were visited and a questionnaire on resources for cataract surgery was completed. Results: Cataract surgery was offered in the public sector by 64 government and 16 university teaching hospitals and in the private sector by 101 hospitals. Over 90% of all facilities in the country contacted participated in the study. In 2014, the national cataract surgical rate (CSR) was 3674 varying in governorates from 7579 in Ismailia to 402 in Suez. The private sector performed 70% of cataract surgeries. Analysis of three regions showed an 11.7% increase in cataract output between 2010 and 2014. The average number of cataract surgeries per unit in 2014 was 2272 in private, 1633 in university, and 824 in government hospitals. Private hospitals had 60% of human resources for eye care. Phacoemulsification was the surgical technique in 85.6% of private, 72.1% of university, and 41% of government hospitals. Reasons explaining the differences in output between public and private sectors were the lack of trainers, supervisors, and incentives. Conclusion: The private sector provides most of the cataract services in Egypt, resulting in inadequate services for the poor. There is a 15-fold variation in CSR between the best and least served regions. The public sector could increase cataract output by improving training, supervision, and incentives. [ABSTRACT FROM AUTHOR]

Purpose: To explore the association among the metamorphopsia identified by Amsler grid test, orientation discrimination threshold (ODT), and retinal layer thickness in patients with idiopathic epiretinal membrane (ERM). Methods: A total of 48 ERM patients were divided into a fovea-spared (FS) group (n = 12) and a fovea-involved (FI) group (n = 36). A total of 23 visually normal people served as controls. Metamorphopsia was first assessed with an Amsler grid. The ODT was quantified with groups of briefly displayed short line segments. Inner and outer retinal layer thickness (IRLT and ORLT) was measured with spectral domain optical coherence tomography. Results: A total of 12 patients with ERM (1 in FS and 11 in FI) reported abnormalities in the Amsler grid test. The ODT values were significantly elevated in patients in both FS (7.48 ± 1.94°, p < 0.001) and FI groups (10.14 ± 2.28°, p < 0.001) when compared to normal (4.22 ± 0.80). Receiver operating characteristic (ROC) analyses of ODT to distinguish Amsler positive and negative patients yielded an area under the curve (AUC) of 0.829. The IRLT was significantly thicker (386.6 ± 95.1 µm vs. 127.5 ± 17.6 in normal) and ORLT were significantly thinner (88.11 ± 8.24 vs. 94.39 ± 5.66 in normal) in the FI group. ROC analyses to distinguish Amsler positive and negative patients yield an AUC of 0.917 using IRLT and 0.719 using ORLT. ODT correlated tightly with the thicker IRLT in both the FS and FI groups, and with the thinner ORLT in the FI group. Conclusions: In patients with ERM, ODT reflects functional changes that are not detected by the Amsler grid test and correlates with changes in inner retina layer thickness well. [ABSTRACT FROM AUTHOR]

Aim: Amplitude of accommodation (AoA) can be determined clinically using different methods. Some methods are known to be more reliable than others for measuring AoA in different age categories. The purpose of this study was to compare Hofstetter’s age-expected norms with five recommended methods of measuring AoA in order to determine age-appropriate techniques for a Ghanaian population. Materials and methods: AoA was measured using four subjective methods (push-up, push-down, minus lens, and modified push-up) and one objective method, the modified dynamic retinoscopy. The amplitudes obtained by each technique were compared to each other and also compared to the age-expected amplitudes as predicted by Hofstetter’s equations. Results: 352 non-presbyopes aged 10-39 years were included in this study. All five methods except the push-up (p = 0.089) and modified push-up (p = 0.081) differed significantly from Hofstetter’s data, while the modified dynamic retinoscopy recorded the strongest agreement with Hofstetter’s average (ICC = 0.78, p ˂ 0.001). With reference to Hofstetter’s expected AoA, the minus lens, push-down, modified dynamic retinoscopy, and modified push-up methods underestimated AoA by −4.18D, −1.99D, −0.48D, and −0.43D, respectively. As age increased, underestimated AoA values by the minus lens (10-19 years: −5.57D, 20-29 years: −3.50D, 30-39 years: −2.39D), modified push-up (10-19 years: −1.51D, 20-29 years: +0.40D, 30-39 years: +0.56D), and push-down (10-19 years: −2.90D, 20-29 years: −1.07D, 30-39 years: −1.46D) methods decreased but the modified push-up in relation to Hofstetter’s expected was most accurate for the older age. The push-up, on the other hand, overestimated accommodation in all age categories by +0.42D (10-19 years: +0.01D, 20-29 years: +0.82D, 30-39 years: 0.67D). Thus, the push-up method became more accurate as age decreased. Conclusion: This study suggested that Hofstetter’s formulae could be used to predict the amplitudes of Ghanaian non-presbyopes aged 10-39 years using the push-up and modified push-up. With regard to Hofstetter’s data, the push-up method was more accurate for the younger age-group 10-19 years while the modified push-up was more accurate for the older age-group 20-39. [ABSTRACT FROM AUTHOR]

Background: A questionnaire was designed to investigate the attitudes of parents toward eye care for their young children (4-6-year-olds) and possible barriers to accessing eye care for this age group. An exploration was undertaken to determine whether these beliefs and barriers are influenced by certain demographic factors such as ethnicity, level of parental income, level of parental education, confidence with speaking English and a reported family history of eye problems.Methods: A total of 1,317 questionnaires (hard copies) were distributed to parents of children in primary school reception and year one classes (ages four to six) from 14 schools across five London boroughs. Ninety online surveys were sent to parents at two further London schools. All questionnaires were anonymous.Results: A total of 384 completed questionnaires were analysed (27 per cent response rate). Three hundred and thirty-eight parents (24 per cent) completed the 'parental knowledge' section of the questionnaire. Of all responses, 65 per cent (n = 249) were from parents whose children attended a school where a program of school entry vision screening took place. Of these, 15 per cent (n = 36) of parents reported that they were aware of the screening program. Barriers to accessing eye care for their children were reported by 38 per cent (n = 153) of parents/carers who responded. Twelve per cent (n = 47) reported not knowing how to access an eye test for their child and 12 per cent (n = 47) reported that they were concerned their child would be given glasses that were not needed. When compared to parents from White ethnic groups, parents from African/Afro-Caribbean ethnic groups were more likely to report not knowing how to access an age-appropriate eye test for their child (p = 0.001). Parents of African/Afro-Caribbean ethnic origins were statistically more likely to report barriers to eye care (p = 0.001).Conclusion: The study provides evidence of some parental misconceptions around eye care for young children and some barriers to access. Possible solutions to this are discussed. [ABSTRACT FROM AUTHOR]

Background: The eye-care seeking behaviour of parents for their children has a role to play in increasing or reducing the prevalence of childhood blindness. In Nigeria, little or no work has been done in this area. Hence, this study was carried out with a view to assisting eye-care professionals plan better program regimens and also to help them identify various elements that either facilitate or hinder eye-care seeking behaviour of parents for their school age children.Methods: This was a qualitative narrative study. Data were collected using in-depth interviews (IDIs) and focus group discussions (FGDs). Thirty-five parents and 10 eye-care practitioners were selected by random sampling and homogenous sampling methods, respectively. Parents were selected, based on those who sought care and those who did not seek care for their children after a school screening exercise. Collected data were analysed qualitatively by transcribing the voice recordings of interview sessions into textual data and themes were raised.Results: Four FGDs and 13 IDIs were conducted. Parents were more likely to seek care for manifest conditions than for conditions they could not perceive. A family history of ocular disease and repetitiveness of complaints facilitated parents to seek eye care for their children. The cost of eye-care services was a major barrier. Logistics such as fixing a doctor's appointment, getting time off work and long waiting periods at the clinic were also reported as barriers. Fear of treatment options and family interferences were also mentioned.Conclusion: Parents have some concerns and challenges in seeking eye care for their children. This study recommends that more work be done through planned awareness programs to educate parents and help them overcome the concerns and barriers that hinder them from seeking eye care for their children. [ABSTRACT FROM AUTHOR]

Purpose: Gender and blindness initiatives continue to make eye care personnel aware of the service utilization inequity strongly favouring men, yet interventions to reduce that inequity, particularly for girls, are under developed. Methods: This descriptive study gathered quantitative data on the degree of gender equity at five Child Eye Health Tertiary Facilities (CEHTFs) in Asia and Africa and conducted in-depth interviews with eye care personnel to assess their strategies and capacity to reduce gender inequity. Cataract surgery was utilized to assess the degree of inequity and success of interventions to reduce inequity in case finding, service utilization, and follow-up. Results: CEHTF administrative data showed significant gender inequity in cataract surgical services favouring boys in all settings. CEHTFs actively seek children through community and school-based outreach, yet do not have initiatives to reduce gender inequity. Little gender inequity was found among children receiving surgical and follow-up care, although two out of three children were boys. CEHTF staff, despite being aware, offered no effective means to reduce gender inequity involving cataract surgical services. Interventions that successfully increased service utilization by girls came from individual cases, involving extraordinary effort by a single eye care programme person. Conclusion: Community-based case finders such as Anganwadi workers in India, Female Community Health Volunteers (FCHVs) in Nepal, and Key Informants (KIs) in Africa are necessary to identify children in need of cataract services, but insufficient to increase service utilization by girls. Secondary, often extra-ordinary community-based interventions by eye care personnel are needed in all settings. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the mydriatic effect of proparacaine hydrochloride (PH) in children undergoing strabismus surgery under general anesthesia (GA).Methods: This was a pilot, prospective, non-randomized, self-controlled interventional study. Nine children with esotropia or exotropia undergoing horizontal muscle squint surgery under GA at a tertiary eye care center were included. The six Group 1 patients underwent both eye surgeries, while the three Group 2 patients underwent single eye surgery. PH was instilled in one eye of Group 1 patients and both eyes of Group 2 patients. Change in pupil diameter (PD) was analyzed as the main outcome measure.Results: Mean age of the patients was 4.67 ± 2.64 years. In the study eyes, mean average baseline PD was 1.59 ± 0.40 mm (range: 1.06-2.37), while postoperative average PD was 3.99 ± 1.34 mm (range: 1.79-6.02). The mean baseline PC had increased from 5.51 ± 1.09 mm to 12.6 ± 3.58 mm at the end of the surgery. PD and PC increased in all of the study eyes while no change in PD or PC was seen in the control eyes of either of the groups. The dilated pupil was skewed horizontally towards the muscle being operated upon in all of the study eyes.Conclusions: PH has a mydriatic effect of its own. It penetrates through the bare sclera and leads on to skewed dilation of the pupil. Surgeons should consider this effect while judging pupil alignment at the end of the surgery. [ABSTRACT FROM AUTHOR]

Purpose: Myopia is a complex condition leading to visual impairment and blindness. This study assessed the prevalence of and risk factors for myopia among schoolchildren in urban and rural areas of Armenia. Methods: A cross-sectional interviewer-administered survey together with eye screenings was conducted among schoolchildren in the capital Yerevan and in Gegharkunik Province. The study used multi-stage random sampling to obtain the sample of 1260 schoolchildren. Study questionnaires were developed based on the Sydney Myopia Study questionnaire. Continuous reading was defined as the average number of hours spent reading or on near work without a break. Children underwent measurements of visual acuity using a Golovin-Sivtsev eye chart, cycloplegic retinoscopy, and dilated fundus examination. Results: The mean age of the children was 13 years, and myopia was present in 18.1%. The prevalence of myopia was higher among Yerevan children (23.3%) than those living in Gegharkunik Province (12.5%). In the adjusted model, myopia was significantly associated with age (odds ratio, OR, 1.11, 95% confidence interval, CI, 1.04–1.18), region (OR 2.40, 95% CI 1.62–3.57), school achievement (OR 1.62, 95% CI 1.05–2.51), parental myopia (OR 2.89, 95% CI 1.79–4.69), and continuous reading (OR 1.99, 95% CI 1.31–3.02), but not near work (OR 0.97, 95% CI 0.89–1.05). Conclusion: The study found that a positive family history of myopia and environmental factors had independent associations with myopia. The number of near work hours did not play a major role in the development of myopia, but length of time of focused continuous reading did. [ABSTRACT FROM AUTHOR]

Purpose: This paper describes the rationale, study design and procedures of the National Eye Survey of Trinidad and Tobago (NESTT). The main objective of this survey is to obtain prevalence estimates of vision impairment and blindness for planning and policy development. Methods: A population-based, cross-sectional survey was undertaken using random multistage cluster sampling, with probability-proportionate-to-size methods. Eligible participants aged 5 years and older were sampled from the non-institutional population in each of 120 cluster segments. Presenting distance and near visual acuity were screened in their communities. People aged 40 years and older, and selected younger people, were invited for comprehensive clinic assessment. The interview included information on potential risk factors for vision loss, associated costs and quality of life. The examination included measurement of anthropometrics, blood glucose, refraction, ocular biometry, corneal hysteresis, and detailed assessment of the anterior and posterior segments, with photography and optical coherence tomography imaging. Adult participants were invited to donate saliva samples for DNA extraction and storage. Results: The fieldwork was conducted over 13 months in 2013–2014. A representative sample of 10,651 individuals in 3410 households within 120 cluster segments identified 9913 people who were eligible for recruitment. Conclusion: The study methodology was robust and adequate to provide the first population-based estimates of the prevalence and causes of visual impairment and blindness in Trinidad and Tobago. Information was also gathered on risk factors, costs and quality of life associated with vision loss, and on normal ocular parameters for the population aged 40 years and older. [ABSTRACT FROM AUTHOR]

Purpose: To examine whether the local availabilities of ophthalmologists and optometrists were associated with outcomes related to the prevention and timely treatment of vision conditions. Methods: Data on adults from the 2008 National Health Interview Survey were linked to county-level information on the numbers of ophthalmologists and optometrists per capita from the Area Health Resources File. Multivariate logistic regression models were estimated for whether individuals likely to perceive themselves as being at lower risk of vision conditions had undergone a dilated eye exam in the previous 2 years, whether individuals with diabetes had a dilated eye exam in the previous year, and whether individuals with an age-related eye disease (ARED) had lost vision due to the condition. The models included measures of local eye care provider availability and additional explanatory variables. Results: The county-level availabilities of ophthalmologists and optometrists were positively and significantly related to the likelihood that perceived lower-risk individuals had undergone a dilated eye exam in the previous 2 years. Local eye care provider availability was not significantly related to whether individuals with diabetes had a dilated eye exam in the previous year. Greater county-level availability of ophthalmologists, but not optometrists, was associated with a significantly lower likelihood that individuals with an ARED had lost vision due to the condition. Conclusion: Public health interventions may be needed in order to increase access to preventive eye care in areas with limited overall eye care provider availability and to improve the treatment of vision conditions in areas with limited ophthalmologist availability. [ABSTRACT FROM AUTHOR]

The elderly population in the United States (age 65 and older) is growing rapidly, estimated by the U.S. Census Department to reach 83.7 million by 2050.(1) Visual impairment increases with age among all racial and ethnic groups.(2) In the elderly, the most common culprits for vision loss are cataract, glaucoma, and age-related macular degeneration (AMD).(2) In the developed world, vision loss from cataract has been dramatically reduced by increased access to cataract surgery. However, AMD and glaucoma lead to irreversible vision loss without early diagnosis and intervention. In the U.S., cases of AMD are expected to double by 2050, reaching 17.8 million among patients age 50 or older.(3) Similarly, cases of glaucoma are expected to reach 5.5 million by 2050, an increase of over 90% from 2014.(3) The visually impaired elderly face disparities in access to eye care, and subsequent general medical and psychosocial complications. [ABSTRACT FROM AUTHOR]

Purpose: A centralized eye donation registry for research could help to bridge the gap between patients interested in donating their eyes to science and scientists who conduct research on human eye tissue. Previous research has demonstrated patient and family support for such a registry. In this study, we assessed the views that eye care professionals have toward an eye donation registry for research. Materials and methods: Surveys were distributed to all 46 clinical faculty members of the Duke University Eye Center. In addition to collecting demographic information, the surveys assessed clinicians’ experience with discussing eye donation with patients, described the proposed eye donation registry for research and asked how the registry would affect the clinicians’ practice. Results: A total of 21 eye care professionals returned the survey. Thirty-three percent reported discussing eye donation with patients, and 43% reported that a patient has asked about donating their eyes for research on their disease. Eighty-six percent of eye care professionals reported that a centralized registry would improve the way they work with patients who express a desire to donate their eyes for research. Conclusions: The majority of eye care professionals at our academic institution indicated that an eye donation registry for research would improve how they work with patients who are interested in donating their eyes for research on their disease. Future research should examine how best to communicate this registry to ophthalmic patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence of childhood blindness and ocular morbidity in a rural pediatric population in South India. Methods: A population-based, cross-sectional survey of children was conducted in three phases in Pavagada and Madhugiri taluks (subdivisions) of Tumkur district in the state of Karnataka, India. In the first phase, trained fieldworkers screened 23,100 children. In the second phase, children with eye diseases were referred to the peripheral hospital to be examined by a general ophthalmologist. In the third phase, children with major eye diseases were examined by a pediatric ophthalmologist. Results: The prevalence of ocular morbidity was 2.66% (95% confidence interval, CI, 2.46–2.87%). The most commonly observed ocular morbidity was Bitot spots (1%) followed by refractive error (0.6%). In total, 18 children were blind and the prevalence of childhood blindness (best-corrected visual acuity <3/60) was 0.08% (95% CI 0.04–0.11%); 8 (44.44%) had retinal blindness, 5 (27.76%) had lens-related blindness, 2 (11.11%) had bilateral microphthalmos, 1 (5.56%) was blind due to anterior staphyloma in the right eye and anophthalmos in the left eye, 1 (5.56%) had bilateral uveal coloboma and 1 (5.56%) had cortical visual impairment. Conclusions: Nearly half of the blindness in the population was due to unavoidable causes (retinal). In addition to providing eye care services, an appropriate service delivery model would include the provision of rehabilitative and low vision services and implementation of genetic studies to understand the causes and increase awareness of inherited eye diseases. [ABSTRACT FROM PUBLISHER]

Background: Lions Outback Vision provides a telehealth service ('the telehealth service') to rural and remote communities in Western Australia aiming to deliver timely ophthalmic care to this underserved population. A number of barriers to its use were identified by an initial prospective audit. A multifaceted intervention was designed to increase the use of the telehealth service by optometrists.Methods: Optometrists referred patients from rural and remote Western Australia to the telehealth service. Two five-month prospective audits of the telehealth service were compared. The first, in 2012, was prior to the implementation of the intervention. The second, in 2014, was during the period of the intervention, which included logistical support, remuneration to optometrists, a more user-friendly referral pathway and awareness raising. The outcome measures were the number of consultations conducted during the two audit periods and other quantitative changes to the telehealth service.Results: After implementation of the intervention, use of the telehealth service increased 3.5 fold. A greater percentage of referrals were for non-urgent conditions (145 [69 per cent] versus 16 [32 per cent], p < 0.001) and less consultations recommended follow up with an ophthalmologist in clinic (42 [20 per cent] versus 17 [28 per cent], p = 0.04). Imaging studies were frequently used to supplement information provided by the referrer to the specialist during both audit periods.Conclusions: Optometrists used the telehealth service more frequently after the implementation of an intervention that addressed the barriers to its use. This has a number of potential benefits to rural and remote ocular health service provision in Australia. [ABSTRACT FROM AUTHOR]

This paper was an experiment presented on the “Organizing Care” panel of the 2014 conference of the North American Society for the Study of Romanticism. It deals with a variety of kinds of blindness, not least those of the literary critic. It reflects upon an overlooked episode in the annals of British medical history, illustrating substantive changes in the understanding of eye disease and eye care, as well as the discrepancy in visual health between rural areas and the metropolis. Additionally, the episode raises important questions about seeing and its relationship to reading – or what we care to read. The partial or “pur”-blindness of readers haunts literary criticism. In advocating “surface reading,” for instance, Stephen Best and Sharon Marcus suggest “that what lies in plain sight has been overlooked or cannot easily be seen” by scholars of literature. The oral presentation of this paper shifted the terms from visual to aural: sections of the audience heard distinctly different papers and understood questions and answers according to disparate sets of concerns. They did not see (or hear) the parenthetical references or footnotes of the printed paper: this experiment would work best if the reader also could ignore these additions. [ABSTRACT FROM PUBLISHER]

Objectives: To evaluate the suitablity of commercially available moisture retention eyewear for treating evaporative dry eye. Methods: Eleven patients with evaporative dry eyes were prescibed moisture retention eyewear for 3 months in addition to regular lubricant eye drops. Frequency and severity of dry eye symptoms, corneal fluorescein staining and tear break up time (TBUT) were evaluated at baseline and 3-month post-treatment. Main outcome measure was global symptom score (based on severity and frequency of dry eye symptoms on a visual analog scale) and secondary outcomes were changes in sectoral corneal fluorescein staining and tear break up time (TBUT) from pre-treatment level. Results: There was a significant improvement in dry eye symptoms after using moisture retention eyewear for 3 months ( p < 0.05). Corneal fluorescein staining in all five zones of the cornea in both eyes improved significantly ( p < 0.05). There was no significant improvement in TBUT. Patients used ocular lubricants less frequently ( p < 0.05) compared to the commencement of the study. Patients found moisture retention eyewear to be useful in relieving dry eye symptoms in windy, air-conditioned environments or when doing vision-related daily tasks. Conclusions: This study shows that moisture retention eyewear might be a valuable adjunct in management of evaporative dry eye and this new design of commercially available eyewear could have a good acceptability rate. [ABSTRACT FROM AUTHOR]

Background: Genetic eye pathology represents a significant percentage of the causes of blindness in industrialized countries. This study explores the level of understanding and perceptions of genetics and inherited eye diseases and the attitudes to genetic testing and gene therapy. Methods: The study was conducted in two parts. Participant groups included were: undergraduate students of optometry, primary eye care professionals and members of the general public. A preliminary study aimed to understand perceptions and to explore the level of knowledge about genetics in general, eye genetics and gene therapy. A second survey was designed to explore attitudes to genetic testing and gene therapy. Results: The majority of participants (82%) perceived genetics as an important science. However, none of them showed a high level of understanding of genetics and inherited eye diseases. Undergraduate students and primary eye care professionals were better informed about inherited eye diseases than the general public ( p = 0.001). The majority (80%) across all three groups had a positive attitude to genetic testing and gene therapy. There was a lack of knowledge about the genetic services available among all groups of participants. Conclusion: This calls for serious thinking about the level of dissemination of information about genetics and inherited eye diseases. It shows a broadly supportive attitude to genomic medicine among the public. Improving public awareness and education in inherited eye diseases can improve the utility of genetic testing and therapy. [ABSTRACT FROM AUTHOR]

Cocoa farming provides employment for over 800,000 households in rural Ghana, with the country currently touted as the second largest producer of cocoa worldwide. Agriculture is one of the riskiest occupations for the eyes due to the numerous ocular hazards on farms. The authors conducted an ocular health assessment among cocoa farmers at Mfuom, a rural community in the Central Region of Ghana, to examine the ocular health status and the ocular safety measures used by cocoa farmers. A structured questionnaire was used to evaluate demographic characteristics, ocular injuries, and utilization of eye care services and ocular protection, and a clinical examination was used to evaluate their ocular status. Cocoa farmers were at high risk for ocular injuries and farm-related vision disorders and utilized eye care services and ocular protection poorly. Ocular condition identified were mainly refractive error (28.6%), cataract (20.0%), glaucoma (11.7%), conjunctivitis (13%), pterygium (2.7%), and cornea opacity (2.2%). There is a need for the introduction of an interventional eye care program to help address the ocular health challenges identified among the farmers. This can be done through collaborative efforts by educational institutions, government, and other role players in the agricultural industry to improve the quality of life of the vulnerable cocoa farmers in rural Ghana. [ABSTRACT FROM AUTHOR]

Purpose: To describe the trend of Acanthamoeba keratitis case reports following an outbreak and the recall of a multipurpose contact lens disinfection solution. Acanthamoeba keratitis is a serious eye infection caused by the free-living amoeba Acanthamoeba that primarily affects contact lens users. Methods: A convenience sample of 13 ophthalmology centers and laboratories in the USA, provided annual numbers of Acanthamoeba keratitis cases diagnosed between 1999-2009 and monthly numbers of cases diagnosed between 2007-2009. Data on ophthalmic preparations of anti- Acanthamoeba therapies were collected from a national compounding pharmacy. Results: Data from sentinel site ophthalmology centers and laboratories revealed that the yearly number of cases gradually increased from 22 in 1999 to 43 in 2003, with a marked increase beginning in 2004 (93 cases) that continued through 2007 (170 cases; p < 0.0001). The outbreak identified from these sentinel sites resulted in the recall of a contact lens disinfecting solution. There was a statistically significant (p ≤ 0.0001) decrease in monthly cases reported from 28 cases in June 2007 (following the recall) to seven cases in June 2008, followed by an increase (p = 0.0004) in reported cases thereafter; cases have remained higher than pre-outbreak levels. A similar trend was seen in prescriptions for Acanthamoeba keratitis chemotherapy. Cases were significantly more likely to be reported during summer than during other seasons. Conclusion: The persistently elevated number of reported cases supports the need to understand the risk factors and environmental exposures associated with Acanthamoeba keratitis. Further prevention efforts are needed to reduce the number of cases occurring among contact lens wearers. [ABSTRACT FROM AUTHOR]

Background: The optometrist's role in primary eye care is expanding to include not only diagnosis but also management and co-management of a range of eye diseases and visual disorders. This role calls for evidence-based practice, including an ability to source and reliably assess the various forms of evidence, on which eye care might be based. It is not known whether optometrists registered to practise in Australasia use high or low quality evidence as a basis for their clinical decisions. Methods: The present study addressed this question by surveying 3,589 optometrists registered to practise in Australia and New Zealand. A 16-item questionnaire was made available for completion online. Results: Responses from the 279 optometrists who completed the questionnaire (response rate 7.8 per cent) indicate that, after the patient's history, symptoms and signs, optometrists in our sample place most weight on knowledge and information gained via undergraduate and postgraduate education, including continuing education, as a basis for clinical decision-making. Conclusion: These findings highlight the need for current, critically evaluated content in optometric education and suggest that optometrists currently prefer to receive information and knowledge from an educator rather than sourcing and assessing the material independently. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have examined factors affecting the position of the eyeball to the orbit. This study examined the role of effective orbital volume (EOV), defined as the difference between orbital and eyeball volume, as a determinant of eyeball position, using MRI scans. Methods: Forty-six patients were recruited from the Department of Ophthalmology of the University Hospital of Heraklion, Crete Greece. Patients with a history of orbital disease were excluded. Distances between eyeball poles and orbital landmarks were measured in T1 weighted transverse, sagittal and coronal orbital images. The protrusion of the eyeball in the sagittal and transverse planes was recorded. The volume of the eyeball and bony orbit, the EOV, the volume of the extraocular muscles as well as clinical information (age, gender, Hertel exophthalmometry) were also recorded. Results: EOV was significantly associated with orbital volume but not with eyeball volume. EOV was also significantly associated with transverse and sagittal globe ptotrusions. Females displayed significantly lower orbital and eyeball volumes as well as EOV than males but higher transverse globe protrusion than males. Conclusions: Variations in EOV are associated with orbital volume rather than with eyeball volume. EOV is associated with globe protrusion and may be taken into account in the planning of various procedures, including orbital decompression, treatment of enophthalmos or the size of orbital implants following enucleation. [ABSTRACT FROM AUTHOR]

Aim: To report the ocular and systemic features in patients with definite and presumed sarcoidosis presenting to a tertiary referral eye center in south India. Materials and Methods: Retrospective observational case series. Records of 51 patients with diagnosis of sarcoidosis were retrieved. A complete ophthalmic evaluation and systemic examination by a pulmonologist with appropriate laboratory investigations were done in all patients. Results were statistically analyzed using SPSS software. Results: The mean age group was 45.14 ± 10.91 years. Females were more common and 31 cases were biopsy proven. Panuveitis and thoracic involvement was the most common ophthalmic and systemic manifestations of sarcoid respectively. Posterior synechiae, granulomatous keratic precipitates, increased anterior chamber reaction, and cystoid macular edema were significantly more common in those presenting initially to an ophthalmologist. Conclusions: Sarcoidosis is increasingly recognized in south India as well. A complete review of systems with appropriate investigations is essential to prevent ocular or systemic morbidity. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics which include the knowledge and practices regarding ocular diseases, efficacy of low vision devices for patients with age-related macular degeneration, and analysis of patients with low vision.

Blepharitis is a chronic inflammatory process of the eyelid margin. It is a common eye disorder throughout the world and can affect any age group. It may be associated with several systemic diseases, particularly rosacea and seborrheic dermatitis, and is related to other ocular conditions like dry eye, chalazion, conjunctivitis, and keratitis. Common symptoms associated with blepharitis are burning sensation, irritation, tearing, photophobia, blurred vision, and red eyes. Clinical examination reveals the presence of scurf, telangiectatic vascular changes of the eyelid margin, inspissated meibomian glands, conjuntival hyperemia, punctuate keratopathy, cornea vascularization, and ulceration. Patients with longstanding chronic blepharitis may present hypertrophy of the lid margin, scars, madarosis, trichiasis, and poliosis. Treatment of blepharitis is long and unsatisfactory. Long-term commitment to eyelid hygiene is essential. Other treatment options are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Current knowledge of ethnic variability in the epidemiology of major eye diseases in Asia is limited. This report summarizes the rationale and study design of the Singapore Indian Chinese Cohort (SICC) Eye Study, a population-based study of ethnic South Asian (Indians) and East Asian (Chinese) older adults in Singapore. Methods: The SICC examined a population-based cross-sectional sample of 3,300 ethnic Indians and 3,300 ethnic Chinese aged 40–80+ years residing in the South-Western part of Singapore. Results: From two lists of 12,000 names of each ethnic group provided by the Ministry of Home Affairs, age-stratified random sampling was used to select 6,350 names in each group, with a target sample size of 3,300. Invitations were sent to attend a central clinic using letters, telephone calls and home visits. Examination procedures included interviews, measurement of blood pressure, anthropometry, presenting and best-corrected visual acuity, subjective refraction, ocular biometry, Goldmann applanation tonometry, slit-lamp biomicroscopy, optic disc imaging and digital photography of the lens and retina, using a standardized protocol. Selected participants underwent gonioscopic examination, visual field testing, and anterior and posterior segment optical coherence tomography. Blood, tear, and urine samples were collected for biochemical analyses, and stored for genetic and proteomic studies. Conclusions: In conjunction with the Singapore Malay Eye Study, the SICC study will permit an in-depth evaluation of the prevalence, risk factors, and impact of major eye diseases in Chinese, Indians and Malays, three distinct Asian ethnic groups, whose combined numbers represent half the world’s population. [ABSTRACT FROM AUTHOR]

Purpose: To study the effect of chloral hydrate in the eye lens in mice. Methods: We instilled tropicamide in the eyes of two groups of eight 129 strain wild-type mice and injected chloral hydrate intraperitoneally (400 mg/kg). A drop of hypromellosum solution was additionally instilled in the eye of the second group to reduce corneal dehydration. The lens was inspected at several time intervals with a standard slit lamp biomicroscope after the injection. Results: No lens opacification was found in any animal after the topical administration of tropicamide. On the contrary, the intraperitoneal administration of chloral hydrate produced lens opacification in both groups of animals. Conclusions: We show that chloral hydrate, when used intraperitoneally, induces acute and reversible lens opacification in all animals. In addition, we found that instillation of hypromellose solution does not prevent the lens opacification caused by chloral hydrate injection. We hypothesized some plausible explanations for these findings. [ABSTRACT FROM AUTHOR]

One way of ensuring effective cleaning in the pharmaceutical industry is to analyze the batch of a product for a potential carry over contamination from a previously manufactured one. The potential cross contamination of timolol maleate (TM) eye drops with cortisone compounds, deserves special consideration, due to the well known deleterious effect of cortisones on glaucoma. Therefore, it was the objective of this study to develop and validate a HPLC method for the detection and quantitative determination of cortisones in TM eye drop preparations. The chromatographic behaviors of the five cortisones that were most likely to be present as contaminants in TM eye drops were characterized on different HPLC stationary phases (normal silica, C18, C8, and CN). Mobile phase and buffer constituents were further optimized on the best stationary phase material (C18). The final recommended mobile phase consisted of a mixture of THF:methanol:0.01M phosphate buffet at ratios of 15:25:60 and containing 0.01 M camphore sulfonic acid (pH adjusted to 4.2). The method was validated in light of ICH guidelines and applied to commercial samples with satisfactory results. [ABSTRACT FROM AUTHOR]

Purpose: Evisceration is an alternative treatment modality to enucleation for many end-stage eye diseases. No study has addressed the indications for evisceration of eyes in Saudi Arabia. The aim of this study was to determine the current clinical indications for evisceration in patients at a tertiary eye care center and attempt clinicopathological correlation. Methods: Clinical records of patients who had undergone evisceration at a tertiary eye care center over a 4-year period were reviewed retrospectively. The patients' demographic data and clinical indications for evisceration were studied, and the results from histopathological findings were correlated with the clinical diagnosis. Results: Evisceration of the eyes was performed in 187 patients. Males outnumbered females in a ratio of 1.3:1 (105 males and 82 females). Blind painful eye was the primary presenting symptom in 117 (62.6%) patients and unsightly eye in 38 (20.3%) patients. Clinical indications for evisceration included endophthalmitis in 85 (45.5%), phthisis bulbi in 38 (20.3%), traumatic injury in 36 (19.2%), and glaucoma in 14 (7.5%) patients. Sixty-three patients (33.7%) had prior history of cataract surgery, penetrating keratoplasty, glaucoma surgery, or retina surgery. Clinicopathological correlation was 100% in cases with definite clinical diagnosis of endophthalmitis. Conclusion: Blind painful eye, endophthalmitis, phthisis bulbi, severe traumatic injury, and glaucoma were the major indications for eviscerations in a tertiary eye care center. [ABSTRACT FROM AUTHOR]

Cicatricial pemphigoid is the most common of the immunobullous disorders causing conjunctival cicatrization and is an autoimmune disease in which the ocular component of the immunopathology is directed at the conjunctival basement membrane. The disease is usually bilateral and more common in females, with most cases occurring between 30–90 years, and most often in the seventh decade. The disease occasionally occurs in children. Tear deficiency is a major cause of symptoms, although loss of vision is usually due to surface failure before the onset of aqueous tear deficiency, which occurs late in the progression of the disease. Management of the dry eye must be integrated with the management of the other components of both the ocular surface disease and inflammation. Management requires plastic surgery for the lid and lash malposition, tetracyclines and lid hygiene for the accompanying blepharitis. For the dry eye, the use of lubricants without preservatives is important, to avoid toxicity, and lubricant ointment is helpful for the relief of symptoms in terminally dry eyes without the capacity for surface wetting. Contact lenses, either large limbal diameter rigid gas permeable or gas permeable scleral lenses, are useful for treating dry eye and improving vision in some patients. Control of the conjunctival inflammation is mandatory to prevent disease progression and usually requires systemic immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

An accurate measurement of tear production is clinically important in the diagnosis and monitoring of dry eye conditions. Re-examination of the results of Schirmer test indicated that the rate of tear secretion decreased with advancing age. Fluorophotometry revealed that the tear turnover rate also decreased with age. Then reappraisal was made on the clinical tests for dry eye syndrome. The non-invasive tear film breakup time (NIBUT) showed a resonable level of accuracy with a cut-off value of 5 seconds (sensitivity 95.9% and specificity 90.8%). The concentration of lactoferrin showed an optimal level of accuracy with a cut-off value of 1.1 mg/ml (sensitivity 79.4% and specificity 78.3%). A study of the ocular surface area revealed that the decrease of ocular surface area was related to the values of NIBUT in normal subjects younger than 50 years of age. The present findings suggested that a combination of these clinical tests was needed for the diagnosis of dry eye syndrome. [ABSTRACT FROM AUTHOR]

purpose To determine the prevalence of non-vision-impairing ocular conditions (NVIC) and estimate the number of primary eye care treatments per 1000 population per month. methods A cross-sectional study in a random sample of 1670 people was done to determine the load of NVIC in a village in Chakwal district. results The prevalence of NVIC was 30.6% (306 per 1000 population). NVIC with the exclusion of presbyopia accounted for 14.6%. The main NVIC were allergic conjunctivitis (3.7%), bacterial conjunctivitis (3.5%), pterygium/pinguicula (2.6%) and acute/chronic dacryocystitis (1%). The average Complaint Frequency (CF) per month/1000 population was 55, excluding complaints of near vision and watery eyes. conclusions The foundation of a comprehensive district eye care strategy in the light of VISION 2020 - the Right to Sight - remains an effective primary eye care service whose elements are treatment of NVIC, detection and referral of cataracts and refractive errors, and promotion of eye health. [ABSTRACT FROM AUTHOR]

Offers views on the care and management of patients with thyroid eye disease. Goal of the treatment of ocular problems related to thyroid-associated ophthalmology; Usual tests done in the work-up of patients with thyroid myopathy; Factor to consider in managing the strabismus related to thyroid myopathy.

A 31-year-old Black man presented with two oval masses in his right conjunctiva. The tumors were completely excised and histology showed that the inferior lesion was a conjunctival squamous papilloma with pigmentation while the superior one was an inverted conjunctival papilloma, which grew in an endophytic manner. Follow up examination one year later showed no recurrence. Literature search revealed no previous report of simultaneous appearance of these types of papilloma in the same eye. Management of conjunctival squamous papillomas is difficult and is complicated by multiple recurrences in contrast to inverted conjunctival papillomas where no recurrences have been reported after complete excision. Thus, histopathology is an absolute necessity even when papillomas appear in the same eye. [ABSTRACT FROM AUTHOR]

Purpose: To report on the occurrence of tubulointerstitial nephritis and uveitis (TINU) and HLA typing in two siblings. Design: Retrospective case study. Methods: HLA typing from two siblings with TINU syndrome and their parents was performed on DNA from peripheral blood mononuclear cells (PBMC). Results: The boy developed TINU syndrome in 2001, his sister 5 years later. Both siblings inherited the HLA alleles HLA-DRB1*1401 and HLA-DQB1*0503 on the maternal haplotype, a haplotype that had rarely been observed in patients with TINU. Conclusions: The observations support inheritance of HLA-linked risk factors of TINU, but indicate heterogeneity of the risk phenotype due to linkage with different reported haplotypes. [ABSTRACT FROM AUTHOR]

The author reflects on issues concerning the American Orthoptic Council (AOC). She notes the efficient and excellent care to children and adults with eye problems delivered by the AOC. She suggests the leadership and management skills of orthoptists. She also cites how the AOC is preparing for the future.

An introduction is presented in which the editors discuss various reports within the issue on topics such as racial and ethnic disparities, genetic differences, and socioeconomic disparities in eye health and care.

Purpose: The study investigated whether dorzolamide influences the autoregulatory behavior of major retinal arterioles in glaucoma patients via a moderate perfusion pressure reduction. Methods: The study included one eye each of 12 untreated patients with a primary open-angle glaucoma (POAG) (age 60.8 &PlusMinus; 8.3, IOP 22.3 &PlusMinus; 6.5 mmHg). Changes in the diameter of a retinal artery segment before (120 s), during (100 s), and after (380 s) artificial IOP elevation to 38 mmHg for 100 s were recorded continuously by means of a Retinal Vessel Analyzer. The measurement was repeated after 4-week treatment with dorzolamide eye drops t.i.d. Results: Ocular perfusion pressure (mmHg) was reduced by the intraocular pressure (IOP) elevation from 58 (&PlusMinus; 10) to 41 (&PlusMinus; 11) in the pretreatment examination and from 60 (&PlusMinus; 8) to 40 (&PlusMinus; 8) posttreatment (differences between the examinations n.s.). Before IOP elevation, the arterial diameter was found to be +1.7 &PlusMinus; 3.5% greater in the posttreated eyes than in the pretreated eyes (p < 0.02). During IOP elevation, the arterial diameter decreased by -1.8% &PlusMinus; 3.8 in the pretreated eyes, whereas dilatation by +1.4% &PlusMinus; 2.5 was observed in the posttreated eyes (p = 0.02). At the end of the observation period following IOP elevation, the vessel diameter in the pretreated eyes had increased by +1.8% &PlusMinus; 4.2, whereas in the posttreated eyes it had decreased by -1.7% &PlusMinus; 3.0. On average, dorzolamide reduced IOP by -5.6 mmHg (p = 0.001). Conclusions: The arterial diameter dilatation during IOP elevation in dorzolamide-treated eyes could be an accelerated counter-regulation on the induced elevated IOP and could constitute an additional therapeutic effect. [ABSTRACT FROM AUTHOR]