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Purpose: To evaluate rural community-based eye care models from the perspective of community ophthalmology experts and suggest sustainable technological solutions for enhancing rural eye care delivery. Methods: A semi-structured descriptive survey, using close-ended and open-ended questions, was administered to the experts in community ophthalmology sourced through purposive sampling. The survey was self-administered and was facilitated through online platforms or in-person meetings. Uniform questions were presented to all participants, irrespective of their roles. Results: Surveyed participants (n = 22 with 15 from India and 7 from Nepal) in high-volume tertiary eye hospitals faced challenges with resources and rural outreach. Participants had mixed satisfaction with pre-operative screening and theatre resources. Delayed presentations and inexperienced surgeons contributed to the surgery complications. Barriers to rural eye care included resource scarcity, funding disparities, and limited infrastructure. In rural/peri-urban areas 87% of participants agreed with providing primary eye care services, with more than 60% of the experts not in agreement with the makeshift center model of eye care delivery. Key components for an effective eye care model are sustainability, accessibility, affordability, and quality. These can be bolstered through a healthcare management platform and a human-chain supply distribution system. Conclusion: Tailored interventions are crucial for rural eye care, emphasizing the need for stronger human resources, optimized funding, and community awareness. Addressing challenges pertinent to delayed presentation and surgical training is vital to minimizing complications, especially with advanced cataracts. Enhancements in rural eye care demand a comprehensive approach prioritizing accessibility, affordability, and consistent quality. [ABSTRACT FROM AUTHOR]

Aim: To analyze the incidence of sight-threatening retinopathy of prematurity (ROP) in premature infants in rural Tamil Nadu and Andhra Pradesh from 2018 to 2021, and to analyze its association with birthweight (BW), gestational age (GA), and postconceptional age (PCA). Methods: Project Vision on Wheels is a free ROP screening and treatment program initiated by a tertiary eye care center in South India in June 2018 to screen preterm infants in rural areas in 11 centers in Tamil Nadu and Andhra Pradesh by trained technicians. Infants with sight-threatening ROP were immediately shifted for vision-preserving laser. Results: Of the 18,117 infants screened from 2018 to 2021, 1046 infants underwent laser, with the majority being bigger and more mature when compared to Western data. There was a yearly increase in the number of infants with sight-threatening ROP in the lower BW, GA, and PCA categories. The timely detection of the condition by committed screening led to salvage of vision by timely laser in 100% of the treated babies in all the years. The incidence of sight-threatening ROP had a yearly decrease in higher BW, GA, and PCA categories. These trends were statistically significant (P = 0.001 for ROP and BW, P = 0.037 for ROP and GA, and P = 0.001 for ROP and PCA). Conclusion: The statistically significant trend of decreasing sight-threatening ROP in babies with higher BW, GA, and PCA and increasing treatable ROP in younger and smaller babies (with lower BWs, GAs, and PCAs) in rural India, over time, is a hitherto unreported finding. This is the first such study in rural Tamil Nadu and Andhra Pradesh combined, with the largest data to date (as per MEDLINE search) to document this healthier trend. [ABSTRACT FROM AUTHOR]

Purpose: To study the clinical and tomographic characteristics and associations of keratoconus (KC) patients visiting a tertiary eye care hospital. Methods: This was a cross-sectional, observational study that included 242 newly diagnosed clinical KC patients. Detailed ocular and systemic history, visual complaints, habit of eye rubbing, best spectacle-corrected visual acuity (BSCVA), retinoscopy reflex, detailed slit-lamp examination and tomographic findings, and presence of any ocular and systemic associations were documented for the included patients. Severity of KC was further graded into stages 0, 1, 2, 3, and 4 according to the ABCD grading system. Results: The most common visual complaint was blurred vision (82.64%), followed by itching (48.76%), tearing (43.80%), and photophobia (41.32%). A total of 44.62% of patients had the habit of eye rubbing and 4.54% had a family history of KC. Most common clinical signs were scissor reflex (94.21%), Rizutti's sign (77.27%), corneal protrusion (69.83%), and Fleischer ring (67.35%). A total of 14.05% of patients had stage 0, 42.15% had stage 1, 19.83% had stage 2, 18.60% had stage 3, and 5.37% had stage 4 KC. Of these patients, 70.25% had a BSCVA visual acuity of ≥6/12 or better; 26.45% had a BSCVA of ≥6/60 to <6/12; and 3.30% had a BSCVA of <6/60. Ocular allergies, atopy, and asthma were found in 32.32%, 4.96%, and 2.48% cases, respectively. Conclusion: This study gives an overview of the clinical findings of KC cases in western India. Our results suggest that use of retinoscopy should be promoted in early KC detection in primary eyecare screening programs. [ABSTRACT FROM AUTHOR]

Purpose: To report clinical profiles of multiple sclerosis (MS)-associated uveitis in seven cases from a single tertiary eye care center in South India. Methods: Retrospective case series 2013-2023. Results: Seven cases of MS-associated uveitis were retrieved from our databases. There were five females and two males. The diagnosis of MS was made by the neurologist in all cases. Bilaterality was seen in all cases. Intermediate uveitis was the most common presentation (five cases). It was associated with peripheral retinal vasculitis (two cases) and disc pallor (two cases). Fuchs heterochromic iridocyclitis (one case) and incomplete Vogt-Koyanagi-Harada (VKH)-like presentation with a peripapillary choroidal neovascular membrane (one case) were the other presentations. In the case with incomplete VKH-like presentation, whole genome sequencing revealed a heterozygous non-synonymous variation (c.1228C>T) in exon 10 of TNFRSF1A, suggestive of susceptibility to multiple sclerosis 5 due to mutation in the TNFRS1A gene on chromosome 12p13.31. All cases received systemic steroids. Azathioprine (three cases) and rituximab (three cases) were the commonly used immunomodulatory drugs. The visual outcome was good in all cases at the last follow-up. Conclusion: MS-associated uveitis is underreported in India. This series highlights the clinical profile of MS-associated uveitis in India. [ABSTRACT FROM AUTHOR]

Purpose: To describe the subretinal hyporeflective globule in cases of central serous chorioretinopathy (CSC). Methods: A retrospective analysis of consecutive cases of CSC presenting to a tertiary eye care center in eastern India was conducted. Subretinal hyporeflective globules were identified as small globular lesions below the external limiting membrane/ellipsoid zone, but above the RPE layer. They had a hyperreflective border with a hyporeflective core and a clear posterior tail of hyper-transmission. Results: The present study analyzed 137 eyes of 137 patients. Eighty (58.4%) eyes had acute disease at presentation, 48 (35%) eyes had chronic disease, and eight (5.8%) eyes had resolved CSC. Subretinal hyporeflective globules were seen in 27 (21.8%) eyes, of which choroidal caverns were seen in seven (5.1%) eyes. Twenty-five eyes with chronic CSC and only two eyes with acute CSC had subretinal hyporeflective globules. Three eyes with resolved CSC had subretinal hyporeflective globules. Conclusion: We describe subretinal hyporeflective globule as a novel optical coherence tomography (OCT) finding in cases of CSC and describe its clinical correlates. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical profile and management of patients with ocular superglue injury (OSI). Methods: This retrospective study included all patients with OSI who presented at a tertiary eye care institute between 2016 and 2020. Data regarding demographics, clinical profile, and management were collected. Results: A total of 66 eyes of 58 patients (24 children, 34 adults) with a median age of 22.5 years [interquartile range (IQR): 11.3-31] were included. All cases sustained accidental injuries, with domestic injury at home being the most common location of injury among children (79%) and adults (53%) (P = 0.39). The median visual acuity at presentation was worse in children [0.3 logMAR (IQR: 0.2-0.4)] as compared to adults [0.1 logMAR (IQR: 0.1-0.3)] (P = 0.03)]. The most common clinical sign at presentation was conjunctival congestion in 77% of eyes (51/66) followed by polymerized glue stuck to the eyelashes and eyelids in 52% of eyes (34/66). The median duration from the time of injury to presentation was 2 hours in both groups. All eyes resolved with medical management. Examination under anesthesia was required in three children (13%) to evaluate the extent of OSI. None of the patients had long-term ocular complications. Conclusion: Improper and careless handling of superglue in the domestic setting may cause accidental ocular injuries that require immediate medical attention. OSI represents less severe ocular injuries that respond to medical therapy alone and is not associated with long-term visual morbidity. Modifications in the packaging of superglue containers and awareness about their deleterious effects could prevent these injuries. [ABSTRACT FROM AUTHOR]

Context: Various systems are available to stage glaucomatous field defects into different severity grades. Still, the preference for such systems among Indian eye care practitioners (ECPs) and the consensus between them are not explored. Purpose: To compare the clinical performance of perimetric glaucoma staging systems and to assess their preference patterns among Indian ECPs. Setting and Design: Retro-prospective cross-sectional study. Methods: Three investigators stratified 400 perimetry reports using four systems: Hodapp Anderson Parrish (HAP), enhanced Glaucoma Severity Staging (eGSS), Advanced Glaucoma Intervention Study (AGIS), and Collaborative Initial Glaucoma Treatment Study (CIGTS). Their performance was compared in terms of agreement and association. Following this, 30 ECPs from across the country segregated a subset of reports (n = 20) into different stages based on their system of choice, and their preferences/perceptions about the available perimetry staging systems were enquired and documented. Statistical Analysis Used: Descriptive statistics, Kruskal–Wallis, Cohen's kappa, and Spearman's correlation. Results: For the consolidated severity stages, substantial agreements (K ranging from 0.61 to 0.75) were found between all the systems, except for HAP–CIGTS (K = 0.58) and AGIS–CIGTS (K = 0.51). All ECPs were aware of perimetry staging systems, and a high preference was reported for HAP (97%) due to ease of implementation and interpretation. Conclusion: Among the four staging systems, the highest agreement was found between HAP and eGSS. A majority of ECPs proposed the need for a uniform classification system across the practices for clinical comparisons and patient education. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to assess the effect of hypertension, and use of systemic beta blockers (BB) and other antihypertensives on ocular perfusion by optical coherence tomography angiography (OCTA) in normal, suspect, and glaucomatous eyes. Methods: Cross-sectional study in tertiary eye care center. Prospectively recruited consenting subjects between 18 and 90 years with or without glaucoma. Measured the optic nerve peripapillary perfusion and flux and macular vessel density (MVD: 6 × 6 and 3 × 3 mm) in the superficial retinal layer using OCTA. Results: Included 200 eyes (112 patients). Compared to nonhypertensives or those on non-BB antihypertensives (NBB), hypertensives on BB had lower peripapillary perfusion (43.45,43.40, 42.05%, P = 0.003), and MVD (6 × 6 mm: 16.65, 16.70,15.75 mm/mm2, P = 0.002; 3 × 3 mm: 18.70, 18.50, 18.00 mm/mm2, P = 0.025). Those on systemic BB with vasodilatory properties had similar perfusion parameters as nonhypertensives and NBB. Those on systemic BB without vasodilating properties had significantly lower peripapillary perfusion (42.05 vs 43.30%, P = 0.011) and MVD (6 × 6 mm: 15.15 vs 16.60 mm/mm2, P < 0.001; 3 × 3 mm: 17.40 vs 18.70 mm/mm2, P = 0.005) compared to nonhypertensives. On multivariate analysis, peripapillary perfusion increased with increase in diastolic blood pressure (β:0.051, p: 0.04) and increasing age was the only factor found to be significantly associated with decreased peripapillary and macular perfusion parameters. Conclusion: Systemic BB users have worse ocular perfusion parameters compared to those on other medications or nonhypertensives on univariate analysis but similar perfusion on multivariate analysis. Those on BB with vasodilation have better ocular perfusion parameters. All BB cannot be considered equally detrimental to ocular perfusion. Further well-controlled prospective studies are needed to reassess the effects of BB with or without vasodilation on ocular perfusion. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical profile, demographics, and management of Posner–Schlossman syndrome (PSS) in patients presenting to a multitier ophthalmology hospital network in India. Methods: This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PSS in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 130 eyes of 126 (0.004%) patients were diagnosed with PSS. The majority of the patients were male (81.75%) and had unilateral (96.83%) affliction. The most common age group at presentation was during the fourth decade of life, with 46 (36.5%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.005%) presenting from the metropolitan geography (0.008%) and in professionals (0.014%). A significant number of patients (108; 83.08%) had a raised intraocular pressure of >30 mm of Hg. The majority of the eyes had mild or no visual impairment (better than 20/70) in 99 (76.15%) eyes. Keratic precipitates were found in 59 (45.38%) eyes, anterior chamber cells in 43 (33.08%) eyes, and iris atrophy in seven (5.38%) eyes. The majority of eyes (127; 97.69%) had open angles on gonioscopy. The average duration of use of topical steroids was 1.70 ± 0.76 months, and the average duration of use of topical antiglaucoma medications (AGMs) was 1.66 ± 0.81 months, with 35 eyes (26.92%) requiring continued AGMs. Among the surgical interventions, trabeculectomy was performed in nine (6.92%) eyes and cataract surgery in five (3.85%) eyes. Conclusion: PSS more commonly affects males presenting during the fourth decade of life from higher socioeconomic status and is predominantly unilateral. The majority of the eyes have mild or no visual impairment, open angles, and require surgical intervention in a tenth of the eyes. [ABSTRACT FROM AUTHOR]

Context: This study adds to the existing body of literature on the role of optical coherence tomography (OCT) parameters in active thyroid eye disease (TED) among the Indian population. Purpose: Comparison of choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) in active and inactive TED. Settings and Design: An observational, cross-sectional analytical study conducted at a tertiary eye care hospital in North India that included patients with active and inactive TED. Methods: Demographic details and clinical evaluation were performed for all TED patients. SFCT was determined with OCT by using the Cirrus linear measurement tool. CVI was calculated using Image J software. The SFCT and CVI measurements were compared between both groups. Statistical Analysis Used: Comparison between active and inactive TED groups was done using Mann–Whitney U test for non-parametric data and Student t test for parametric data. Multivariate regression analysis was performed with SFCT and CVI as dependent variables. Results: Sixty-two eyes of 31 patients were included. Thirteen eyes had active TED, and 49 eyes had inactive TED. SFCT was significantly lower in eyes with higher clinical activity score (CAS) and older age. No significant difference was found in CVI between active and inactive TED eyes. Conclusion: SFCT was lower in eyes with higher CAS and older age. Our findings differ from previous studies, which showed a positive correlation between SFCT and CAS. There was no significant difference in CVI between active and inactive TED eyes. [ABSTRACT FROM AUTHOR]

Purpose: To study the epidemiological profile of various pediatric orbital tumors and determine their clinicopathological correlation over 20 years. Methods: A retrospective analysis of all pediatric patients with orbital tumors from the medical records between 1995 and 2015 was done. Tumors were categorized based on their cellular origin. Demographic details, clinical and histopathological diagnoses, frequency, and clinicopathological correlation were studied. Results: A total of 265 pediatric patients with orbital tumors were analyzed, of which 145 (54.7%) patients were males and 120 (45.3%) were females. The mean age was 7 years (median: 6 years; range: 10 days–16 years). The distribution of lesions in each group was as follows: vasculogenic, 76 (28.7%); lipogenic and myxoid, 66 (25%); myogenic, 31 (11.7%); optic nerve and meningeal, 22 (8.3%); lymphoid and lymphoproliferative, 18 (6.8%); secondary orbital tumors, 14 (5.2%); histiocytic, 9 (3.4%); miscellaneous, 9 (3.4%), lacrimal gland, 8 (3%); mesenchymal with neural differentiation, 6 (2%); osseous, 4 (1.5%), and fibrocystic, 2 (0.8%). The most common benign and malignant pediatric orbital tumors were dermoid cysts (65, 24.5%) and rhabdomyosarcoma (31, 11.7%). A statistically significant (P < 0.0001) clinicopathological correlation was observed in 208 (83.2%) out of 250 biopsy-proven cases. Conclusion: Pediatric orbital neoplasms include a broad spectrum of benign and malignant lesions. Vasculogenic tumors constitute the majority of them, followed by lipogenic and myxoid tumors. A thorough knowledge of the incidence, clinical profile, imaging features, and histopathology of specific orbital tumors aids in accurate diagnosis and their successful management. [ABSTRACT FROM AUTHOR]

Purpose: The World Report on Vision highlights that health information systems (HIS) should collect information on the determinants of eye conditions and vision impairment (VI) as a step toward integrated people-centered eye care (IPEC). Thus, this retrospective study aims to elucidate VI trends across age and gender of the patients who visited our centres in southern and eastern India. Methods: Electronic medical records of all new patients who visited the network were included. VI was defined as visual acuity less than 6/12; unilateral VI was based on the worse presenting eye (the other eye being normal), and bilateral VI was based on the better eye. "Total VI" includes both unilateral and bilateral VI. Results: The records of 7,31,307 patients from January to December 2019 were extracted. Males were 54%. The mean age was 40 years (SD: 19.16 years). The majority of patients (46.54%) visited a primary care centre. Centres in Andhra Pradesh saw the largest number of patients (46%). Approximately 65% of all patients presented had no VI in either eye. Total VI was 23.5% at the primary-centre level and approximately 45% at other levels, the highest being in Odisha. More females accessed care at primary and secondary centres (46.6%) than at higher levels of care (44%). Odisha had the lowest number of females accessing care (43.01%). Conclusion: Non-visually impairing conditions form an important reason for patients visiting our eye care facilities. Strategies focusing on improving access to eye care for females should be planned at all levels, especially in Odisha. [ABSTRACT FROM AUTHOR]

Purpose: To report the seroprevalence of bloodborne viral infection (BBVI) in patients undergoing ophthalmic surgeries and assess the utility and feasibility of preoperative screening for BBVI in India's current eye care system. Methods: This retrospective, hospital-based, descriptive study included data from patients undergoing preoperative screening for Hepatitis B virus (HBV), Hepatitis C virus (HCV), and human immunodeficiency virus (HIV) at a tertiary eye care institute from 2018 to 2022. Rapid diagnostic tests (RDTs) were performed on the blood samples after obtaining informed consent from the patients. Seroreactive patients underwent surgery with additional safety precautions. The demographic data and surgical details of these patients were collected and analyzed. ANOVA was used to carry out statistical analysis between groups. During the study period, the number of healthcare workers (HCWs) sustaining needle stick injury (NSI) and accidental sharp injury (ASI) in the operating theater (OT) and details of these injuries were recorded. Results: Samples from 28,563 patients were included. The seroprevalence of BBVI was 1.87% (536/28563). Hepatitis B virus (322, 60.1%) was the most commonly detected infection, and HIV (59, 11%) was the least detected infection. The mean age of the seroreactive patients was 60.3 ± 30.8 years. The incidence of NSI was 0.49/1000 surgeries. Nurses (11) and technicians (4) in the OT sustained maximum NSI. None of the HCWs had seroconversion after NSI. Conclusion: The overall seroprevalence of BBVI in the current study is lower than that reported in previously published studies from eye care organizations. Currently, mandatory preoperative screening for BBVI to prevent transmission of these infections to HCWs working in the eye care sector in India appears to be less cost-effective. [ABSTRACT FROM AUTHOR]

Purpose: Visual snow syndrome is a debilitating neurological condition. A comprehensive eye examination may not detect any abnormalities in this condition. Presently the condition is recognized only through the history elicited. Hence, it becomes important to understand the presenting complaints and profile of these patients. A retrospective study at a tertiary eye care center was undertaken to achieve this goal. Methods: Electronic medical records of patients presenting to a Binocular Vision and Orthoptics clinic were reviewed. Records of the patients containing keywords such as "light sensitivity, shadowing, visual snow, multiple images, and night vision" were retrieved and inspected. Those matching the diagnostic criteria of visual snow syndrome were included in the study. Results: A total of 33 patients (average age ± standard deviation: 29.7 ± 9.8 years) were identified. Majority of the patients were males (69%). All the patients had logMAR visual acuity 0 or better in each eye. The most prominent (84.4%) presenting symptom was palinopsia (or afterimage or trailing). About 34.4% complained of floaters (including snow-like appearance). More than half (54.6%) of the patients also had binocular dysfunction. Conclusion: Visual snow syndrome is a relatively new condition on the rise, with unclear pathology. The symptoms of this condition can easily be confused with regular floaters or black spots seen in vitreous and retinal pathologies. In the absence of such pathology, an elaborate history should be elicited, and the distress of the patient should be acknowledged. The patient should also be reassured that this is not a blinding condition. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the incidence of Ocular Surface Disorders (OSDs), including Dry Eye Disease, Chemosis, and Exposure Keratitis, among patients admitted to the Neurocritical Care Unit (NCC). Additionally, we sought to assess the correlation between these OSDs, the length of hospitalization at NCC, and the Glasgow Coma Score (GCS). The heightened risk of OSD development in the NCC environment, coupled with pre-existing neurological impairments, can lead to conditions like dry eye disease, chemosis, corneal abrasions, and infectious keratitis, ultimately resulting in corneal opacities and perforations that significantly impact visual acuity and overall quality of life. Methods: In this observational cross-sectional study, we examined the ocular health of all patients admitted to an NCC unit from February to May 2022. We assessed the presence of Conjunctivitis, chemosis, Keratitis, and Dry Eyes in relation to the duration of stay at NCC, GCS, lagophthalmos, adherence to the prescribed eye care protocol in NCC, and the use of mechanical ventilation. Our study comprised one hundred subjects over a four-month period, with a mean age of 51.92 ± 18.73 years (ranging from 17 to 89), including 70% males and 30% females (gender ratio of 2.33). Results: Our findings revealed that 26 eyes (13%) exhibited Conjunctival Hyperemia, 23 eyes (11.5%) displayed Chemosis, and severe dry eye was prevalent in 41 (20.5%) eyes. A statistically significant association was observed between GCS (p-value <0.001) and Keratitis (p-value 0.0035) with dry eyes (Chi-Square Test). Notably, the incidence of dry eyes was significantly higher among patients with a prolonged stay of ≥10 days (p-value 0.003). Conclusions: Patients admitted to Neurocritical Care Units necessitate meticulous eye care and structured protocols to mitigate the risk of long-term ocular complications such as exposure keratitis. Given their heightened susceptibility to these conditions, proactive measures are imperative to ensure optimal ocular health among NCC patients. [ABSTRACT FROM AUTHOR]

Purpose: To report the indications for keratoplasty and analyze trends in two decades in India. Methods: This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and northern India from 2005 to 2021. The patterns of corneal pathology and changes in trends were analyzed. Results: Between 2005 and 2021, 13223 corneal grafts were performed in the six collaborating tertiary eye care centers. The most common indication for keratoplasty in both decades was corneal ulcer (41.1%), followed by corneal scar (25.5%), failed graft (12.0%), post-cataract surgery corneal edema (11.7%), corneal dystrophies (3.1%), corneal ectasia (1.8%), corneal trauma (0.3%), congenital corneal opacity (0.3%), and others (4.1%). An increasing trend was seen in corneal ulcers, failed grafts, and keratoconus. A reducing trend was seen in corneal scar and aphakic bullous keratopathy. There was no change in pseudophakic bullous keratopathy and Fuchs endothelial corneal dystrophy. Conclusion: Corneal ulcers, corneal scars, failed grafts, and post-cataract surgery corneal edema remained the foremost indications for keratoplasty in two decades in India. An increasing trend was seen in corneal ulcers and failed grafts which are of concern as these indications carry a poorer outcome. Capacity building in lamellar keratoplasty techniques is the need of the hour as pseudophakic bullous keratopathy was an important indication, and an increasing trend was noticed in keratoconus. [ABSTRACT FROM AUTHOR]

Purpose: To assess the long-term safety and stability of visual outcomes following the modified technique of collagen crosslinking (CXL) using refractive lenticule in eyes with thin corneas (<400 μm) and progressive keratoconus. Setting: A tertiary eye care hospital in India. Design: Prospective, interventional case series. Methods: Eyes with progressive keratoconus and thin corneas (<400 μm) underwent CXL with intraoperative stromal augmentation using a refractive lenticule obtained from small-incision lenticule extraction (SMILE). Preoperative and postoperative evaluation (3 months, and then yearly thereafter) included corneal tomography (Oculus Pentacam), uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively), manifest refraction, and endothelial cell count (specular microscopy), and adverse events, if any, were noted. The patients were followed up for a period of 5 years. Results: Seven eyes were included in the analysis. Mean corneal flattening of -4.29 D was noted from preoperative maximum keratometry (P = 0.018). An improvement in UDVA and CDVA of 0.38 logarithm of minimum angle of resolution (logMAR) and 0.36 logMAR, respectively, was noted at 5 years postoperative visit. Four eyes demonstrated a gain of two lines in CDVA. Mean spherical equivalent improved from −6.85 D preoperatively to −6.05 D at 5 years postoperatively. Clear demarcation line was noted between 230 to 270 μm on anterior segment optical coherence topography. No significant endothelial cell loss was noted postoperatively. Conclusion: Long-term outcomes demonstrated safety and disease stability following lenticule-assisted CXL. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the influence of infiltrate size, depth, and organism on the outcome of microbial keratitis. Design: Retrospective comparative study. Methods: Medical records of patients with infective keratitis, who reported from January 2015 to December 2019 to a tertiary eye care center, were analyzed. Size and depth of ulcer at presentation were the factors used to group patients, and the influence on the outcome of the organism causing it was analyzed. Grouping was as follows: group A: ulcer size <6 mm/anterior to midstromal infiltrate, group B: ulcer < 6 mm/full-thickness infiltrate, group C: ulcer >6 mm/anterior to midstromal infiltrate, group D: ulcer > 6 mm/full-thickness infiltrate. Patients with viral keratitis or unidentified organism were excluded. Response to treatment and best-corrected visual acuity (BCVA) at the final follow-up were the outcome measures. Results: In the study, 1117/6276 patients were included, with 60.8% patients in group A. A significant improvement in visual acuity was noted in groups A/B compared to groups C/D. Group A had the best response to medical management, irrespective of the organism. Higher risk for surgery was noted in group C compared to group B, with group A as the reference. Overall resolution with medical treatment was noted in 70% miscellaneous keratitis, 64.8% bacterial keratitis, 64.3% mixed keratitis, 62.5% acanthamoeba keratitis, 52.6% fungal keratitis, and 12.1% Pythium keratitis. Bacteria and acanthamoeba responded better to medical management than fungal keratitis, whereas Pythium had the highest risk for surgery. Conclusion: An interplay between virulence of the organism along with depth and size of the infiltrate determines the outcome of microbial keratitis. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to report practice patterns in the management of keratoconus in India. Methods: An e-survey was conducted among members of the Cornea Society of India to assess preferred practice patterns for keratoconus. Results: Of the 912 members, 234 (25.7%) completed the survey. About 88.4% worked in private eye care facilities and 76.1% in cities. Of all the respondents, 91.5% had access to a Scheimpflug-based device or an Orbscan II®; 71.4% of the respondents dispensed scleral contact lenses, and 66.7% dispensed Rose K contact lenses; 92.7% of the respondents performed corneal cross-linking (CXL); and 73.1% of the respondents performed deep anterior lamellar keratoplasty (DALK). A Scheimpflug device or Orbscan II®, Rose K or scleral contact lenses, and CXL were more readily available (P < 0.05) in private eye care facilities. The diagnostic criteria for keratoconus followed by the majority of the respondents (52.1%) were increase in corneal curvature, elevation, and thickness. An increase in keratometry values greater than 0.5 or 1.0D in a 6-month to 1-year period was considered the most favored criterion for keratoconus progression. Epithelium-off, 0.1% riboflavin solution in dextran, and accelerated protocol were the more commonly reported techniques in CXL. About 77.2% of the respondents routinely performed CXL in corneas <400 microns thick. Spectacles (91.0% of the respondents) and topography-guided photorefractive keratectomy (37.6% of the respondents) were, respectively, the preferred optical and surgical methods used to improve vision. Conclusion: While keratoconus management in India is comparable to other developed healthcare systems, the concentration of trained corneal surgeons in cities and private eyecare facilities may lead to less equitable distribution of treatment across the country. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the reasons for declining corneal refractive laser correction procedures in patients presenting to tertiary eye care centers in Tamil Nadu, Southern India, and review the literature. Methods: Retrospective case records of subjects presenting from January 2019 to December 2021 for refractive surgery workup were analyzed. Demographic details and refractive parameters of patients rejected for corneal refractive laser corrections (CRLC) were documented and reviewed. Results: A total of 2358 patients presented for refractive surgery evaluation during the study period, and out of them, 395 patients (16.8%) were not considered ideal candidates for undergoing CRLC. The common reasons for rejecting the patients were unfit topography (n = 110, 27.8%), unstable refraction over a one-year duration (n = 9, 2.27%), low corneal thickness (n = 85, 21.5%), keratoconus (n = 5, 12.9%), and other ocular and systemic disorders (n = 48, 12.1%). Conclusion: There was a marked change in magnitude and rationalization for not performing either laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy in our study. The reasons are unfit topography, keratoconus, and systemic disorders, which were diagnosed during pre-LASIK screening workup, being the most common cause for rejecting patients for corneal refractive corrections. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate factors associated with the occurrence of ROCM in COVID-19 patients and to compare its related parameters and outcomes between active and recovered COVID-19 groups. Methods: A total of 35 patients of ROCM associated with COVID-19 (active and post-COVID-19) were included. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessments of ROCM-associated COVID-19 during the second wave of the COVID-19 pandemic. The demographic data, clinical parameters, and outcome were recorded on MS excel sheet, and various parameters were compared between active and recovered COVID-19 groups. Results: ROCM in recovered COVID-19 group was higher (57.1%) as compared to active COVID-19 (42.9%) (P = 1.00). High occurrence of ROCM was seen in those who had a history of hospitalization due to severity of COVID-19 (n 33, 94.28%), oxygen support (77.14), and received systemic steroids (82.9%). The most common comorbidity was diabetes mellitus (82.9%), and new-onset hyperglycemia was noticed in 17.1% of patients. Exenteration (28.6%) was performed in severe cases who had stage IV ROCM, bilateral, and CNS involvement (RR = 7.2, 95% CI: 2.91 to 18.00). The risk of globe exenteration was 1.35 (0.7-2.29) times higher in recovered COVID-19 group, and mortality was 1.76 (0.72-3.36) times higher in active COVID-19 group. Conclusion: Monitored use of systemic steroids and the prompt management of hyperglycemia in COVID-19 patients are important factors for favorable outcomes with reference to globe salvage and life-saving in ROCM associated with COVID-19. Even recovered COVID-19 patients should be observed for persistent hyperglycemia and occurrence of ROCM. [ABSTRACT FROM AUTHOR]

Purpose: To identify different types of exotropia in children less than 16 years and their clinical presentation. The secondary objective is to identify the age of onset, age of presentation, birth history, and ocular and systemic associations as well as to evaluate their motor and sensory status. Methods: This hospital-based descriptive observational study was conducted from September 2018 to December 2019. Patients with a clinical diagnosis of exotropia of age less than 16 years, and exotropia of ≥10 PD were included in the study. Data were collected using a structured proforma. All statistical calculations were performed using Microsoft Excel Office version 2016 and R version 4.0.2. Results: Two hundred eighty-six (286) consecutive children with exotropia were analyzed. Intermittent exotropia (72%) was the most common form of exotropia, followed by exotropia with a neurological association (11%), infantile (8%), sensory (6%), restrictive (2%), and paralytic (1%) types. Exotropia with neurological association had a significantly earlier age of presentation (median = 42months) as compared to other types (P = 0.039). Conclusion: We recorded a huge amount of cases of exotropia associated with neurological abnormalities and this group of patients had significantly more number of preterm and low birth weight children. This study has its limitations as it is not a population-based study and prevalence rates could not be calculated. [ABSTRACT FROM AUTHOR]

Purpose: To assess clinical features, visual outcomes, and setting of mobile battery blast-induced eye injuries in children. Methods: Retrospective case sheets of children with mobile battery blast injuries were reviewed at a tertiary eye care center from January 2015 to March 2022. We noted the mode of injury, battery status, and clinical presentation and analyzed the treatment outcomes. Results: The study included 14 eyes of 11 patients. Three patients (27%) had bilateral ocular injuries. The most common reasons for the blast were wiring a bulb to the battery or charging the battery with a universal mobile charger, seen in four cases each. Three eyes had closed-globe injuries (CGIs), whereas 11 had open-globe injuries (OGIs). Of the 11 eyes with OGI, four also had a retained intraocular foreign body (IOFB). Only four (36%) eyes having OGI could achieve vision better than 6/60. All three eyes with CGIs developed secondary glaucoma, and two underwent trabeculectomy. However, the visual prognosis was better (>6/36) in eyes with CGI. Overall, mean visual acuity at the final follow-up was improved to 1.41 ± 1.14 logMAR from 2.32 ± 0.76 logMAR at presentation. This was also found to be statistically significant with a P value of 0.02. Conclusion: Battery blast-induced ocular injuries, although rare, often lead to poor outcomes. Apart from charging, playing with discarded or damaged batteries was a common reason for battery blasts in our series. [ABSTRACT FROM AUTHOR]

To study the acute central serous chorioretinopathy (CSC) management strategies practiced at a tertiary eye care center in eastern India. Methods: In a retrospective chart review study, the clinical outcomes of three different management approaches to treating acute CSC were analyzed. Individuals with follow-ups of fewer than 6 months were excluded. Logistic regression analysis was performed to identify the prognostic markers of CSC resolution. Results: In the 10-year study period (January 2013-July 2022), 206 eyes were included. Placebo treatment was the preferred practice (48.5%; n = 100 eyes). Watchful observation without placebo was the management strategy in 30.6% (n = 63) of the eyes, and 20.9% (n = 43) of eyes received focal lasers. Risk factor modification was attempted in all. There was no significant difference in the resolution rate (P = 0.819), time to resolution (P = 0.331), and disease recurrence (P = 0.067) among the groups. Univariate logistic regression analysis did not favor any of the treatment strategies predicting resolution and recurrence. Conclusion: Alternative treatment modes did not score over the natural history of acute CSC regarding disease resolution, vision gain, and disease recurrence. The study reaffirms observation as the standard of care for acute CSC. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical outcome of a series of seven eyes with an explanation of an original Glaucoma Drainage Device (GDD) arising from the complication of plate exposure and consequent reimplantation of another GDD at a second setting. Methods: This was a retrospective, interventional, and non-comparative study at two tertiary eye care hospitals in eastern and southern India. Electronic medical record data of the seven eyes where a GDD was explanted and a 2nd GDD was reimplanted over October 2010 and May 2021 was analyzed. Statistical analysis was done by SPSS (ver. 26). Results: The first GDD survived for a mean of 168 days only till the plate got exposed and thereby got explanted. Possible predisposing factors noted were conjunctival and scleral thinning, ischemic conjunctiva, etc., The reimplantation surgery was technically easy in the absence of hypotony--opposite to what is reported in the literature. The final IOP (mean +/- SD) values (mm Hg) were 18.9 (+/-7.9), range = 10-30. The mean number of glaucoma medications reduced from 3.9 (+/-1.2; range, 2 to 5) after the explanation to 3.1 (+/-0.7; range, 2 to 4) after the 2nd GDD implantation, in the final follow-up. The second GDD was found to be stable till the last follow-up (mean = 1149 days). No other significant intraoperative or postoperative complications were seen. Conclusions: Reimplantation of a second GDD in a separate setting after explanations of an original implant due to exposure-related complication is both a safe and effective method. [ABSTRACT FROM AUTHOR]

Purpose: To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India. Methods: A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow up of one year were included. Postoperative best corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow up were noted. Results: Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 ± 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80. Conclusion: Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis. [ABSTRACT FROM AUTHOR]

Purpose: To study posterior capsular opacification (PCO) and neodymium doped yttrium aluminum garnet (Nd:YAG) capsulotomy rates in patients implanted with square edged and non square edged intraocular lenses (IOLs) in manual small incision cataract surgery (MSICS). Setting: Tertiary eye care center. Design: Prospective, comparative, and randomized controlled study. Methods: This study included patients with senile cataracts scheduled for MSICS and IOL implantation. One eye of each patient was randomized to the implantation of square edged (S group) or non square edged IOL (NSQ group). An independent observer analyzed PCO at 6, 12, 18, and 24 months under slit lamp illumination. Results: A total of 104 eyes were included in this study. The mean age of the participants in the two groups was 63.2 (±8.2) years, and there were 65 (62.5%) men and 39 women (37.5%). The mean best corrected visual acuity (BCVA) values at 6, 12, and 18 months were 0.157 (±0.10), 0.11 (±0.12), and 0.12 (±0.11), respectively, in the S group and 0.17 (±0.10), 0.17 (±0.12), and 0.20 (±0.17), respectively, in the NSQ group. At 12 (P = 0.03) and 18 months (P = 0.01) follow up, the BCVA of the S group was significantly better than that of the NSQ group. Four eyes in the NSQ group and one eye in the S group required Nd:YAG. Conclusion: Evaluation of PCO and Nd:YAG capsulotomy rates showed that the 360° square of the posterior IOL edge plays a role in the prevention of PCO. Owing to the low cost of the material and the easy availability of IOLs manufactured from it, square edged IOL has a definite role in the prevention of PCO in MSICS. [ABSTRACT FROM AUTHOR]

Eye care programs, in developing countries, are often planned using the prevalence of blindness and visual impairment, often estimated from Rapid Assessment of Avoidable Blindness (RAAB) surveys. A limitation of this planning approach is that it ignores the annual overall eye care requirements for a given population. Moreover, targets set are arbitrary, often influenced by capacity rather than need. To address this lacunae, we implemented a novel study design to estimate the annual need for comprehensive eye care in a 1.2 million populations. We conducted a population based longitudinal study in Theni district, Tamil Nadu, India. All permanent residents of all ages were included. We conducted the study in three phases, (i) household level enumeration and enrollment, (ii) basic eye examination (BEE) at household one year post enrollment, and (iii) assessment of eye care utilization and full eye examination (FEE) at central locations. All people aged 40 years and above were invited to the FEE. Those aged <40 years were invited to the FEE if indicated. In the main study, we enrolled 24,327 subjects (58% aged below 40 years and 42% aged 40 years and above). Of those less than 40 years, 72% completed the BEE, of whom 20% were referred for FEE at central location. Of the people aged ≥40 years, 70% underwent FEE. Our study design provides insights for appropriate long term public health intervention planning, resource allocation, effective service delivery, and designing of eye care services for resource limited settings. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to review the demographics, clinical characteristics, and long term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital. Methods: Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes. Results: The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6 month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three year follow up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty. Conclusion: Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome. [ABSTRACT FROM AUTHOR]

Purpose: To observe the trends of various types of keratoplasties in different etiologies over a period of 10 years (2011 2020) in a tertiary eye care center of eastern India. Methods: A retrospective review of patients undergoing keratoplasties from 2011 to 2020 was performed in a tertiary eye care hospital situated in eastern part of India. Apart from demographic data, primary indication for each surgery and type of procedure carried out was recorded. For comparison, data were divided into two time periods: Group I: Jan 2011 to Dec 2015 and Group II: Jan 2016 to Dec 2020. Results: Over a period of 10 years, a total of 2365 (Group I: 902, Group II: 1463) keratoplasties were performed. The average age of patients was 45.8 ± 19.9 and 46.9 ± 20.9 years in Group I and Group II, respectively. Among all the corneal grafts, 1747 (74%) surgeries were full thickness. Although optical penetrating keratoplasty (OPK) was most the common indication for full thickness keratoplasties, Descemet's stripping endothelial keratoplasty (DSEK) remained most performed lamellar keratoplasty. Keratitis, corneal scars, and bullous keratopathies remain to be most common indications in both groups. Number of lamellar keratoplasties increased significantly from Group I to Group II for corneal scars (P = 0.02), bullous keratopathies (P = 0.01), and endothelial dystrophies (P = 0.00). Conclusion: With change in time, the indication and technique of keratoplasty has witnessed a changing trend from full thickness keratoplasty to lamellar keratoplasty. There is rise in trend of lamellar keratoplasties over the period. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the efficacy of a deep learning (DL)-based artificial intelligence (AI)-based algorithm in detecting the presence of diabetic retinopathy (DR) and glaucoma suspect as compared to the diagnosis by specialists secondarily to explore whether the use of this algorithm can reduce the cross-referral in three clinical settings: a diabetologist clinic, retina clinic, and glaucoma clinic. Methods: This is a prospective observational study. Patients between 35 and 65 years of age were recruited from glaucoma and retina clinics at a tertiary eye care hospital and a physician's clinic. Non-mydriatic fundus photography was performed according to the disease-specific protocols. These images were graded by the AI system and specialist graders and comparatively analyzed. Results: Out of 1085 patients, 362 were seen at glaucoma clinics, 341 were seen at retina clinics, and 382 were seen at physician clinics. The kappa agreement between AI and the glaucoma grader was 85% [95% confidence interval (CI): 77.55-92.45%], and retina grading had 91.90% (95% CI: 87.78-96.02%). The retina grader from the glaucoma clinic had 85% agreement, and the glaucoma grader from the retina clinic had 73% agreement. The sensitivity and specificity of AI glaucoma grading were 79.37% (95% CI: 67.30-88.53%) and 99.45 (95% CI: 98.03-99.93), respectively; DR grading had 83.33% (95 CI: 51.59-97.91) and 98.86 (95% CI: 97.35-99.63). The cross-referral accuracy of DR and glaucoma was 89.57% and 95.43%, respectively. Conclusion: DL-based AI systems showed high sensitivity and specificity in both patients with DR and glaucoma; also, there was a good agreement between the specialist graders and the AI system. [ABSTRACT FROM AUTHOR]

Purpose: Early detection of sight-threatening disorders by technological applications like teleophthalmology and prompt treatment can help decrease visual impairment. This study evaluated the role of teleophthalmology in underserved rural areas along with cost-saving estimates for the end user. Methods: A prospective, observational, cross-sectional hospital-based study was conducted over 3 months. First 1000 teleconsultations were included. None of the patients denied providing informed consent. The patients were consulted at the eight vision centers and three satellite centers of the hospital in the nearby rural and tribal regions closer to their residential places. These vision and satellite centers were connected to the base hospital like a hub and spoke model with a teleophthalmology network. Results: Cataract (n = 301, 30.1%) and refractive error (n = 290, 29%) were the most common diagnosis. 42.1% of patients were referred to base hospital for further evaluation. Thus, a total of 57.9% of patients were not required to visit the base hospital for initial consultation, saving time and money. Furthermore, 15.1% of patients were provided medical treatment at the vision center and satellite center, which helped in making teleophthalmology cost-saving for the patients. An average of Rs. 621/- were saved per patient for the community in our study. Conclusion: Networked teleophthalmology model can be an affordable and feasible tool for providing eye care delivery services in rural and tribal regions of Gujarat and the whole country, especially for the end user. Thus, it may be a workable model in ophthalmology practice with substantial cost saving to the community. [ABSTRACT FROM AUTHOR]

Purpose: To study the impact of the novel coronavirus disease-2019 (COVID-19) pandemic on incidence, seasonal variation, clinical presentation, and disease outcome of epidemic retinitis (ER) and to compare clinical outcomes with positive and negative COVID-19 serology. Methods: This is a retrospective, observational study conducted at a tertiary eye care hospital from August 2020 to June 2022. A graph of ER cases against the month of presentation was compared with the graph of the COVID-19 pandemic in the same region. Cases presented before COVID-19 vaccination, with positive COVID-19 serology (Group 1) were compared with cases with negative serology (Group 2). Results: One hundred and thirty-two cases of ER were seen. The least number of cases were seen during and immediately after the peak of the pandemic (May 2021-August 2021). COVID-19 serology was positive in 13 (22 eyes)/60 (21.6%) unvaccinated cases. Along with COVID-19, positive serology for other ER etiologies was seen in 5/13 cases (38.4%). All patients received oral doxycycline with/without steroids. Groups 1 and 2 included 22 and 21 eyes of 13 cases each. Macular edema resolved in 43.6 and 32 days in groups 1 and 2, respectively. Retinitis resolved at 1 month in both groups. Corrected distant visual acuity was 20/50 and 20/70 at the presentation, which improved to 20/20 and 20/25 in groups 1 and 2, respectively. Mean and median follow-up was 6 months and 4.5 months, respectively, in both groups. No complications or recurrences were seen. Conclusion: No significant impact of the COVID-19 pandemic on ER was observed. [ABSTRACT FROM AUTHOR]

Purpose: To describe the demographics and clinical profile of pseudoexfoliation syndrome (PXF or PES) in patients presenting to a multi-tier ophthalmology hospital network in India. Methods: This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PXF in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 23,223 (0.75%) patients were diagnosed with PXF. The majority of the patients were male (67.08%) and had unilateral (60.96%) affliction. The most common age group at presentation was during the seventh decade of life with 9,495 (40.89%) patients. The overall prevalence was higher in patients from a lower socio-economic status (1.48%) presenting from the urban geography (0.84%) and in retired individuals (3.61%). The most common location of the PXF material was the pupillary margin (81.01%) followed by the iris (19.15%). The majority of the eyes had mild or no visual impairment (<20/70) in 12,962 (40.14%) eyes. PXF glaucoma was documented in 7,954 (24.63%) eyes. Krukenberg's spindle was found in 64 (0.20%) eyes, phacodonesis in 328 (1.02%) eyes, and lens subluxation in 299 (0.93%) eyes. Among the surgical interventions, cataract surgery was performed in 8,363 (25.9%) eyes, trabeculectomy was performed in 966 (2.99%) eyes, and a combined procedure in 822 (2.55%) eyes. Conclusion: PXF more commonly affects males presenting during the seventh decade of life from lower socio-economic status and is predominantly unilateral. A quarter of the affected eyes are associated with glaucoma and the majority of the eyes have mild or no visual impairment. [ABSTRACT FROM AUTHOR]

Purpose: To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults. Methods: This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed. Results: Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work-place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV-VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV-VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04). Conclusion: The findings clearly delineate the at-risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data-driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB. [ABSTRACT FROM AUTHOR]

Purpose: Understanding the association between social determinants of health (SDoHs) and microbial keratitis (MK) can inform underlying risk for patients and identify risk factors associated with worse disease, such as presenting visual acuity (VA) and time to initial presentation. Methods: This was a cross-sectional study was conducted with patients presenting with MK to the cornea clinic at a tertiary care hospital in Madurai, India. Patient demographics, SDoH survey responses, geographic pollution, and clinical features at presentation were collected. Descriptive statistics, univariate analysis, multi-variable linear regression models, and Poisson regression models were utilized. Results: There were 51 patients evaluated. The mean age was 51.2 years (SD = 13.3); 33.3% were female and 55% did not visit a vision center (VC) prior to presenting to the clinic. The median presenting logarithm of the minimum angle of resolution (logMAR) VA was 1.1 [Snellen 20/240, inter-quartile range (IQR) = 20/80 to 20/4000]. The median time to presentation was 7 days (IQR = 4.5 to 10). The average particulate matter 2.5 (PM2.5) concentration, a measure of air pollution, for the districts from which the patients traveled was 24.3 µg/m3 (SD = 1.6). Age- and sex-adjusted linear regression and Poisson regression results showed that higher levels of PM2.5 were associated with 0.28 worse presenting logMAR VA (Snellen 2.8 lines, P = 0.002). Patients who did not visit a VC had a 100% longer time to presentation compared to those who did (incidence rate ratio = 2.0, 95% confidence interval = 1.3--3.0, P = 0.001). Conclusion: Patient SDoH and environmental exposures can impact MK presentation. Understanding SDoH is important for public health and policy implications to mitigate eye health disparities in India. [ABSTRACT FROM AUTHOR]

Purpose: The study was conducted to compare the compliance to intravitreal injection treatment and follow-up in patients with center-involving diabetic macular edema (CI-DME) and treatment outcomes between a tertiary eye care facility and a tertiary diabetes care center. Methods: A retrospective review was conducted on treatment naïve DME patients who had received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in 2019. Participants were people with type 2 diabetes who were under regular care at the eye care center or the diabetes care center in Chennai. The outcome measures were noted at months 1, 2, 3, 6, and 12. Results: A review of 136 patients treated for CI-DME (72 from the eye care center and 64 from a diabetes care center) was carried out. The severity of diabetic retinopathy (DR) was similar in both centers. There was no statistically significant (P > 0.05) difference in the choice of initial intravitreal drug in the two centers. At 12-month follow-up, only 29.16% came for a follow-up in the eye center vs. 76.56% in a diabetes care center (P = 0.000). The multivariate logistic regression showed increasing age was associated with non-compliance in both the groups (eye care center: odds ratio [OR] 0.91; 95% confidence interval [CI] 0.82-1.21; P = 0.044) and diabetes care center (OR 1.15; 95% CI 1.02-1.29; P = 0.020). Conclusion: The follow-up rate between eye care and diabetic care center with DME showed a significant disparity. By providing comprehensive diabetes care for all complications under one roof, compliance with follow-up can be improved in people with DME. [ABSTRACT FROM AUTHOR]

Purpose: To compare the visual outcomes following topography-guided laser in situ keratomileusis (LASIK) treatment using manifest refraction versus a new topography analysis software. Methods: A prospective, randomized, observer-masked contralateral study was conducted in the refractive services of a tertiary eye care hospital in South India. Analysis of visual outcomes, corneal higher-order aberrations, and contrast sensitivity were performed at 3 months postoperative visit following uneventful topography-guided LASIK using the Wavelight EX500. One eye was treated with the Contoura platform using manifest refraction (Contoura), while the contralateral eye was treated using an ablation profile planned by the Phorcides Analytic Engine (Phorcides). Results: Sixty eyes of 30 patients were included in the study. At 3 months postoperative visit, the uncorrected distance visual acuity (UDVA) in the Contoura and Phorcides groups was logarithm of the minimal angle of resolution (logMAR) 0.04 ± 0.07 and logMAR 0.06 ± 0.1, respectively (P = 0.483). Postoperative manifest refractive spherical error (MRSE) was 0.12 ± 0.22 and - 0.06 ± 0.20 D in the Contoura and Phorcides groups, respectively (P = 0.338). Although higher number of eyes demonstrated a gain in one or more lines of corrected distance visual acuity (CDVA) in the Contoura group (16.6% vs. 6.6%), the difference was not statistically significant (P = 0.361). Vector analysis (Alpins criteria) for postoperative cylinder, contrast sensitivity measurement, and corneal higher-order aberration profile showed no significant difference between the two groups at 3 months postoperative visit (P = 0.213, 0.514, and 0.332, respectively). Conclusion: Quantitative and qualitative visual outcomes with the Phorcides Analytic Software were similar to the Contoura treatment using manifest refraction. [ABSTRACT FROM AUTHOR]

Purpose: To compare the visual outcomes in patients undergoing small-incision lenticule extraction (SMILE) for correction of myopic astigmatism (≥-1.50 D) with or without manual cyclotorsion compensation. Methods: A prospective, double-blinded, randomized, contralateral study was conducted in the refractive services of a tertiary eye care center. Eligible patients with bilateral high myopic astigmatism (≥1.5 D) and intraoperative cyclotorsion (≥5°) undergoing SMILE between June 2018 and May 2019 were included. Cyclotorsion compensation was performed using triple centration method before femtosecond laser delivery. Uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) measurement, manifest refraction, slit-lamp biomicroscopy, and corneal tomography were performed preoperatively and at 1 and 3 months' postoperative visit. Astigmatic outcomes were analyzed using Alpins criteria. Results: A total of 30 patients (60 eyes) were included in this study. The patients underwent bilateral SMILE surgery, with manual cyclotorsion compensation in one eye (CC group, n = 30 eyes) and no cyclotorsion compensation in the other eye (NCC group, n = 30 eyes). Preoperative astigmatism and intraoperative cyclotorsion were -2.0 D and 7.03° ± 1.06° (CC) and -1.75 D and 7.24° ± 0.98° (NCC) (P = 0.472 and 0.240, respectively). No significant differences were noted in mean refractive spherical equivalent (MRSE), UDVA, CDVA, and refractive error between the two groups at 3 months' postoperative visit. Astigmatic outcomes measured using Alpins criteria demonstrated no significant difference between the two cohorts. Conclusion: The cyclotorsion compensation technique provided no additional advantage in terms of astigmatic outcomes or postoperative visual quality, in eyes with high preoperative astigmatism and intraoperative cyclotorsion. [ABSTRACT FROM AUTHOR]

Purpose: To compare visual outcomes of early enhancement following small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK). Methods: Retrospective analysis of eyes (patients operated in the setting of a tertiary eye care hospital between 2014 and 2020) requiring early enhancement (within one year of primary surgery) was conducted. Stability of refractive error, corneal tomography, and anterior segment Optical Coherence Tomography (AS-OCT) for epithelial thickness was performed. The correction post regression was done using photorefractive keratectomy and flap lift in eyes, wherein the primary procedure was SMILE and LASIK, respectively. Pre- and post enhancement corrected and uncorrected distance visual acuity (CDVA and UDVA), mean refractive spherical equivalent (MRSE), and cylinder were analyzed. IBM SPSS statistical software. Results: In total, 6350 and 8176 eyes post SMILE and LASIK, respectively, were analyzed. Of these, 32 eyes of 26 patients (0.5%) post SMILE and 36 eyes of 32 patients (0.44%) post-LASIK required enhancement. Post enhancement (flap lift in LASIK, and PRK in SMILE group) UDVA was logMAR 0.02 ± 0.05 and 0.09 ± 0.16 (P = 0.009), respectively. There was no significant difference between the refractive sphere (P = 0.33) and MRSE (P = 0.09). In total, 62.5% of the eyes in the SMILE group and 80.5% in the LASIK group had a UDVA of 20/20 or better (P = 0.04). Conclusion: PRK post SMILE demonstrated comparable results to flap lift post LASIK and is a safe and effective approach for early enhancement post SMILE. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on compliance to amblyopia therapy from the perspective of parents of amblyopic children. Methods: The participants for the qualitative study were enrolled from the medical records of a tertiary eye care center during the COVID-19 pandemic. The trained researcher conducted telephonic interviews consisting of validated 15 open-ended questions for 15 min. The questions were related to patients' compliance toward amblyopia treatment and the date of follow-up with their practitioners. The data collected were entered on Excel sheets in the participant's own words and later converted to a transcript for analysis. Results: A total of 217 parents of children with amblyopia who were due for follow-up were contacted through telephone. The response rate for willingness to participate was only 36% (n = 78). Of these, 76% (n = 59) of parents reported that their child was compliant toward the treatment during the therapy period and 69% reported that their child was currently not on treatment for amblyopia. Conclusion: In the current study, we have observed that although reported compliance by parents during the therapy period was good, around 69% of patients had discontinued amblyopia therapy. The main reason for the discontinuation of therapy was the failure to visit the hospital during the scheduled follow-up with the eye care practitioner. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to analyze the pattern of follow-ups and the reasons for follow-up loss in keratoplasty cases in a tertiary eye care center. Methods: This is a single-center retrospective cross-sectional study. During the study period, 165 eyes underwent corneal transplantation. The data on the demographic features of the recipients and the indications of keratoplasty, including visual acuity before and after surgery, duration of follow-up, and the condition of the graft at the last follow-up, were collected. The primary outcome was to determine the factors causing lost-to-follow-up (LTFU) among graft recipients. LTFU was defined when a patient failed to adhere to any of the following seven follow-up visits since the surgery: 4 ± 2 weeks, 3 ± 1 months, 6 ± 1 months, 12 ± 2 months, 18 ± 2 months, 24 ± 3 months, and 36 ± 6 months. The secondary outcome was to analyze the best-corrected visual acuity (BCVA) among patients available for the final follow-up. Results: The recipient follow-up rates at 6, 12, 18, 24, and 36 months were 68.5%, 57.6%, 47.9%, 42.4%, and 35.2%, respectively. Old age and distance to the center were significant factors for lost-to-follow-up. A failed graft as an indication for transplantation and those undergoing penetrating keratoplasty for optical purposes were significant factors for completing follow-up. Conclusion: The inability to follow-up after corneal transplantation is a common challenge. Elderly patients and those living in remote areas must be prioritized for follow-ups. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the visual outcome and complications of Descemet stripping endothelial keratoplasty (DSEK) with their management in 256 eyes at a tertiary eye care center in southern India. Methods: This is a retrospective interventional study of 62 months duration conducted at a tertiary eye care center in southern India. Two hundred and fifty-six eyes of 205 patients were included in the study after obtaining written informed consent from the patients. All cases of DSEK were performed by a single experienced surgeon. In all cases, donor dissection was performed manually. A Sheet's glide was inserted through the temporal corneal incision and donor button was placed on the Sheet's glide with the endothelial side down. The lenticule was separated and inserted into the anterior chamber by pushing the lenticule into the anterior chamber using Sinskey's hook. Any complication, either intraoperative or postoperative, was recorded and managed either medically or by appropriate surgical means. Results: The mean best corrected visual acuity (BCVA) before surgery was CF-1 m, which improved to 6/18 after surgery. Intraoperative donor graft perforation during dissection was seen in 12 cases, thin lenticule in three eyes, and repeated artificial Anterior Chamber (AC) collapse in three eyes. Dislocation of lenticule was the most common complication seen in 21 eyes, which was managed by graft repositioning and rebubbling. Eleven cases had minimal separation of the graft and seven cases had interface haze. Pupillary block glaucoma was seen in two cases that resolved with partial release of bubble. Surface infiltrate was seen in two cases, which was managed with topical antimicrobial agents. Primary graft failure was seen in two cases. Conclusion: DSEK is a promising alternative to penetrating keratoplasty for corneal endothelial decompensation, but it also has its own merits and limitations, and most often, merits overweigh limitations. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to understand the clinical profile and anatomical and visual outcome in Tractional/Combined (Tractional + Rhegmatogenous) Retinal Detachment due to vasculitis after surgical intervention. Methods: It was an interventional retrospective study of all cases who underwent surgery for RD with vasculitis at a single tertiary eye care center for over a period of 6 years. Patients with retinal detachment due to vasculitis were included in the study. All patients underwent the following surgical procedures: 240 belt buckle with three-port pars plana vitrectomy with membrane dissection and peeling with fluid gas exchange/with endolaser with silicon oil/C3 F8 gas injection. Results: In our study, 83.33% had preoperative vision of less than 6/60, whereas postoperatively 66.66% had vision of less than 6/60. Postoperatively 33.33% patients had vision better than 6/36. Of the six eyes operated for vasculitis with RD, retina was attached in five eyes following surgery. One patient had recurrent retinal detachment due to extensive proliferative vitreoretinopathy changes, and he was advised re-procedure but was lost for follow-up. The anatomical success was 83.33% on the first surgery. Conclusion: The overall anatomic success rate of retina reattachment surgery in vasculitis patient was good, and the visual outcome following the surgery can improve in majority of the cases. Hence, timely intervention is advocated. [ABSTRACT FROM AUTHOR]

Purpose: To report the clinical profile of Behcet's disease and its management with immunosuppressants and biologics in a cohort of 25 patients from a tertiary eye care center in South India. Methods: This was a retrospective, observational study. Records of 45 eyes of 25 patients between January 2016 and December 2021 were retrieved from the hospital database. Complete ophthalmic evaluation and systemic examination by the rheumatologist with appropriate investigations had been done. Results were analyzed using Statistical Package for the Social Sciences (SPSS) software. Results: Males (19, 76%) were found to be more affected than females (6, 24%). Mean age of presentation was 27.68 ± 11.08 years. Twenty patients had bilateral involvement (80%), and unilateral involvement was seen in five patients (20%). Seven eyes of four patients (16%) had isolated anterior uveitis, out of which one patient had unilateral and three patients had bilateral involvement. Twenty-six eyes of 16 patients (64%) had posterior uveitis, out of which six patients had unilateral and 10 had bilateral involvement. Twelve eyes of seven patients (28%) had panuveitis, out of which two patients had unilateral and five had bilateral involvement. Hypopyon was seen in five eyes (11.1%) and posterior synechiae in seven eyes (15.55%). Posterior segment findings included vitritis (24.44%), vasculitis (17.78%), retinitis (17.78%), disc hyperemia (11.11%), and disc pallor (8.89%). Steroids alone were given in five patients (20%) and intravenous methylprednisolone (IVMP) was given in four patients (16%). Immunosuppressive agents along with steroids were given in 20 patients (80%), of which azathioprine alone was given in seven patients (28%), cyclosporin alone was given in two patients (8%), mycophenolate mofetil alone was given in three patients (12%), combination of azathioprine and cyclosporin was given in six patients (24%), and combination of methotrexate and mycophenolate mofetil was given in one patient (4%). Biologics were given in 10 patients (40%) -- adalimumab in seven patients (28%) and infliximab in three patients (12%). Conclusion: Behcet's disease is an uncommon uveitis in India. Addition of immunosuppressants and biologics to conventional steroid therapy gives better visual outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To find out parents' knowledge, attitude, and treatment practice (KAP) toward pediatric eye problems and to assess the effect of demographic factors such as gender, age, educational status, and number of children on KAP. Methods: A cross-sectional descriptive study was conducted in a hospital setting. Two hundred parents were randomly selected for the questionnaire. All parents had children who were included in Systematic Pediatric Eye Care Through Sibling Screening Strategies (SPECSSS) study. A survey with 15 questions on KAP of pediatric eye diseases was prepared and administered to parents coming to a tertiary eye hospital with varied experience and education qualifications. Results: The mean age of 200 patients was 9.6 (3.4) years, with the majority of them male (n = 110; 55.0%). The majority of the children (n = 91, 45.5%) were between the age group of 6-10 years. Knowledge of visual problems among parents was of a good grade in 9% only. The attitude of the parents toward the visual problem was positive at 17%, and the responses regarding the practice were of excellent grade at 46.5% and good at 26.5%. Analysis suggests that the level of knowledge and practice were not significantly associated with the demographic factors (p > 0.05). The positive attitude toward the visual problems of the children was associated with education of the parents (p < 0.05) and the father occupation (p < 0.05). Conclusion: Knowledge about pediatric eye diseases was poor among parents and it was significantly affected by education and occupation of parents. The parents have positive attitude toward enhancing their attitude in treatment. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate presence of perilimbal pigmentation (PLP) in Indian patients with vernal keratoconjunctivitis (VKC). Methods: A cross sectional study was conducted from 2019 to 2020 at a tertiary eye care center in Western Maharashtra, India. In this study, 152 cases of VKC were identified. The presence, type, color, and extent of PLP were recorded. The incidence of presence of PLP was calculated. Its correlations with severity and duration of VKC were analyzed using Wilcoxon--Mann--Whitney U test and Chi square test. Results: Of 152 cases, 79.61% were males. Mean age at presentation was 11.4 ± 5.6 years. The characteristic PLP was present in 81 cases (53.29%; 95% confidence interval [CI]: 45.03%--61.42%; P < 0.001), of which 15 cases (18.5%) had this pigmentation in all the four quadrants. There was a significant difference between the groups with respect to quadrants involvement in terms of the extent of PLP in clock hours (χ² = 73.85, P < 0.001). However, the extent did not correlate with age (rho = 0.08, P = 0.487), sex (P = 0.115), time since onset in months (rho = 0.03, P = 0.77), duration of VKC and type or color of PLP (P = 0.12). Conclusion: Perilimbal pigmentation seems to be a consistent clinical finding seen in a significant number of VKC cases. It may benefit ophthalmologists in treating VKC cases when the palpebral/ limbal signs are elusive. [ABSTRACT FROM AUTHOR]

Purpose: To assess the knowledge of nursing staff on ocular care in medical intensive care unit (ICU) and to compare the incidence of ocular surface disorders in patients of medical ICU pre‑ and post‑training. Methods: Two hundred patients admitted in medical ICU for more than 24 h underwent a detailed ocular examination along with documentation of ICU stay, ventilation status, and Glasgow coma scale (GCS) scoring. An assessment on ocular care knowledge among the nursing staff of medical ICU was done. They were further given training in the form of audio‑visuals and demonstration, and an eye care protocol was given to them. The second phase of the study was carried out in the same manner. A comparison was made between pre‑training and post‑training incidence of ocular surface disorders among ICU patients. Results: Ventilated patients had more eye discharge. Incidence of eye discharge was more in patients with duration of stay of more than 7 days in ICU. Ocular surface disorders closely correlated with the degree of lagophthalmos. There was significant reduction in ocular morbidity following ocular care training of the nursing staff. Conclusion: Eye care is a very important part of nursing care in sedated and ventilated patients in the ICU. Ophthalmic consultations are routinely needed in ICU subjects who are hospitalized for more than 1 week or if the ICU staff suspects any eye problems. Purpose: To assess the knowledge of nursing staff on ocular care in medical intensive care unit (ICU) and to compare the incidence of ocular surface disorders in patients of medical ICU pre‑ and post‑training. Methods: Two hundred patients admitted in medical ICU for more than 24 h underwent a detailed ocular examination along with documentation of ICU stay, ventilation status, and Glasgow coma scale (GCS) scoring. An assessment on ocular care knowledge among the nursing staff of medical ICU was done. They were further given training in the form of audio‑visuals and demonstration, and an eye care protocol was given to them. The second phase of the study was carried out in the same manner. A comparison was made between pre‑training and post‑training incidence of ocular surface disorders among ICU patients. Results: Ventilated patients had more eye discharge. Incidence of eye discharge was more in patients with duration of stay of more than 7 days in ICU. Ocular surface disorders closely correlated with the degree of lagophthalmos. There was significant reduction in ocular morbidity following ocular care training of the nursing staff. Conclusion: Eye care is a very important part of nursing care in sedated and ventilated patients in the ICU. Ophthalmic consultations are routinely needed in ICU subjects who are hospitalized for more than 1 week or if the ICU staff suspects any eye problems. [ABSTRACT FROM AUTHOR]

Purpose: To determine the pattern of pediatric ocular morbidities in western India. Methods: This was a retrospective longitudinal study that included all consecutive children aged ≤15 years who presented to the outpatient department of a tertiary eye center for the first time. Patient demographics, best-corrected visual acuity (BCVA), and ocular examination data were compiled. Subgroup analysis was also performed based on age group (years): ≤5, 5–10, and >10–15. Results: A total of 11,126 eyes of 5563 children were included in the study. The mean age of the study population was 5.15 (±3.32) years with males (57.07%) being predominant. Approximately half of the patients (50.19%) were under the age of 5 years, followed by those aged 5–10 years (45.1%) and >10–15 years (4.71%). Among the study eyes, the BCVA was ≥20/60 in 58.57%, indeterminable in 35.16%, and <20/60 in 6.71%. The commonest ocular morbidity noted was refractive error (28.97%) followed by allergic conjunctivitis (7.64%) and strabismus (4.95%) in the total study cohort and also after age stratification. Conclusion: Refractive error, allergic conjunctivitis, and strabismus are the major causes of ocular morbidity in pediatric eyes at a tertiary care center. Planning screening programs at the regional and national levels is crucial to decreasing the burden of eye disorders. These programs also need to have a suitable referral mechanism established and be smoothly connected to primary and secondary health-care centers. This will help to assure quality eye care delivery, while also reducing the strain of overworked tertiary centers. [ABSTRACT FROM AUTHOR]

Purpose: India has the largest population of youth in the world, thereby making them important contributors to the "India of Tomorrow". Over 80% of knowledge gained is by the visual sense, thereby making school screening programs a necessity in our country. Data from the pre-COVID era, that is, 2017–18 was collected from close to 19,000 children in Gurugram, Haryana, a tier two city in National Capital Region, India. A similar prospective observational study is planned post COVID-19 (2022–23) for further analysis to depict the impact of COVID-19 in these areas. Methods: The program They See, They Learn was set at government schools in the area of operations (district of Gurgaon, Haryana), where the children and their families were unable to afford eye care services. All children who were screened underwent a comprehensive eye examination at the school premises itself. Results: A total of 18,939 students were screened over a period of 18 months, covering a total of 39 schools in the Gurugram belt, in the first phase of the program. Eleven point eight percent (n = 2254) of all school students had some form of refractive error. Girl students were found to have a higher refractive error rate (13.3%) compared to boy students (10.1%) across the schools screened. Myopia was the most common type of refractive error. Conclusion: School students require perfect vision or else they can be discouraged and may become a major burden to the economy of any developing nation. A school screening program aiming at populations that cannot afford such basic needs like spectacles is a must in all zones of the country. [ABSTRACT FROM AUTHOR]