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Purpose: In this study, we examined the current status of myopia among primary and secondary school children in northeastern Sichuan to analyze the factors connected to myopia and provide data support and a theoretical foundation for the prevention and control of myopia. Methods: Using a cross-sectional study and a comprehensive sampling survey, 34,138 students aged 5-19 years were screened for refraction in 22 primary and secondary schools in Langzhong, and 4000 behavioral questionnaires were delivered at random. After evaluation and rational problem-solving, a total of 3764 valid questionnaires were obtained. SPSS 23.0 statistical software was used for data analysis. Results: The percentage of myopia among primary and secondary school students in Langzhong was 65.61%, with female students having a higher rate than male students (P < 0.05); 52.81% of primary school students, 86.26% of secondary school students, and 88.17% of high school students had myopia. The incidence of myopia detection increased with school age (P < 0.001), indicating a correlation between age and myopia prevalence. The prevalence of myopia was mainly low (40.53%) and moderate myopia (19.89%). The prevalence of high myopia (5.19%) was relatively high. The prevalence of myopia among female students (5.54%) was greater than that in male students (P < 0.05) and increased with age (P < 0.001). The proportion of students who wore eyeglasses was 24.36%, with a larger proportion of female students (25.93%) than male students (22.61%) (P < 0.001). In addition, the rate of eyeglass use increased with school age (P < 0.001). A logistic regression analysis revealed that higher grade point averages, female gender, and long-term usage of electronic items were risk factors for myopia. The results of the questionnaire survey revealed that students in this region were under immense pressure to perform well academically, spent a lot of time engaged in near-work activities, and had a low rate of myopia awareness; 24.43% of the students had not had a vision examination in the previous year, indicating that parents did not pay sufficient attention to eye health. Conclusion: The incidence of myopia among children and teenagers is high in Northeast Sichuan, and the outlook for addressing the problem is bleak. Therefore, it is critical to improve vision monitoring and eye health education. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the myopia risk in school-aged children one year after lifting a pandemic-related lockdown and develop a tool to identify high-risk groups. Methods: In total, 38,079 children without myopia from 38 schools were included. The outcomes were myopia incidence and progression in 1 year after the COVID-19 lockdown was lifted, both obtained by the spherical equivalent refraction (SER). We separated the population into an exploratory (75%) and a validation sample (25%) to construct the risk score model. Results: In total, 9811 (29.57%) students became myopic, and the overall myopia progression was 0.22 ± 0.62 D. Even less myopia progression was noted in the pre-myopia group at baseline (All: P = 0.045, Boy: P = 0.005). The risk score model included seven predictors: gender, grade, SER at baseline, residence, parental myopia, eye discomfort symptoms, and online courses. The model had a score range of 0–46 and an optimal cutoff of 34. The area under the receiver operating curve of the model was 0.726 (0.719–0.732) for the exploratory sample and 0.731 (0.720–0.742) for the validation sample. Conclusions: The risk score can serve as a practical tool for classifying the risk of myopia in school-aged children. [ABSTRACT FROM AUTHOR]

Purpose: Uncorrected refractive error is one of the most important causes of visual impairment worldwide. Addressing childhood vision impairment (VI) is one of the main goals of the World Health Organization (WHO) to combat blindness strategies. Objective: To ascertain the prevalence and pattern of refractive errors among children aged 10 to 16 years in Baramulla district, Kashmir. Methods: A cross-sectional study was carried out among 680 school children during an eye camp under the school health program of the national program for control of blindness. The screening was conducted in four schools in Baramulla district, Kashmir. The schools were selected using the non-probability convenient sampling technique. Results: A total of 680 school children from classes sixth to tenth aged 10–16 years participated in the study. Out of 680 students, 545 (80%) had normal vision, 97 (14%) had impaired visual acuity ranging between 6/9 and 6/24, and 38 (6%) had severe VI ranging from 6/36 to 6/60. Among the various types of refractive errors, myopia was the most prevalent affecting 54 children. Age distribution of refractive errors showed myopia to be more prevalent in the age group 13–14 years (16, 14 cases), hypermetropia was more prevalent in the age group 14–15 years (10, 8 cases), and astigmatism 5 cases in the age group 14–15 years. Conclusion: The study provides useful and baseline data about the refractive error amongst the school children of the Baramulla district. A larger study needs to be conducted in all schools of the state to get a clear picture of RE and other eye-related problems to detect vision problems earlier. [ABSTRACT FROM AUTHOR]

Purpose: Undetected vision impairment (VI) could negatively affect the overall development in children. School vision screening program is a viable and cost-effective approach for the early identification and management of VI. Aim: This study aims to estimate the prevalence of VI, its risk factors, and ocular morbidity among school children in Telangana, South India. Methods: Children aged 4-15 years attending schools in the study area were screened in this study. The vision screenings were performed in schools by trained community eye health workers using 6/12 tumbling E optotypes. Children who failed the test and/or presented with other eye conditions were referred to vision centers or secondary and tertiary eye care centers. A comprehensive eye examination was conducted in these centers, including cycloplegic refraction and fundus examination. Results: A total of 774,184 children, with a mean age of 9.4 ± 3.27 years, were screened. Overall, 51.49% (N = 398,596) were male. In total, 4.33% [N = 33,528; 95% confidence interval (CI): 4.29-4.38] required referral services, while 1.16% (N = 9,002) had a presenting visual acuity of < 6/12. Multivariate analysis showed a high risk of VI among older children [Adj. odds ratio (OR): 5.75; 95% CI: 5.18-6.38], those with disabilities (Adj. OR: 5.12; 95% CI: 4.14-6.33), female gender (Adj. OR: 1.29; 95% CI: 1.24 - 1.35), and those residing in the urban areas (Adj. OR: 2.87; 95% CI: 2.42-3.39). The main cause of VI was uncorrected refractive errors (74.14%). Conclusion: The prevalence of VI among school children was 1.16% in Telangana, South India, and refractive error was the leading cause of VI among this population. Increasing age, urban location, female gender and other disabilities increase the risk of VI among children. [ABSTRACT FROM AUTHOR]

Context: Cerebral visual impairment (CVI) is an overarching term, defined as a brain-based visual impairment with onset in childhood, unexplained by an ocular disorder and associated with unique visual and behavioral characteristics. Good vision and awareness of visual function in a child are highly essential as neuroplasticity is maximum in the first three years of life and response to intervention is utmost in this period. Awareness is lacking regarding CVI, and the diagnosis is largely missed. This can be easily addressed if a structured approach is employed. Purpose: This study aims to evaluate the etiology and radiological correlation with the severity of CVI and outcome after structured intervention in children with CVI. Settings and Design: Prospective--interventional study. Methods and Material: Children attending the Child Development Centre (CDC) of a tertiary care hospital in North Karnataka and diagnosed with CVI in the age group of six months to 12 years and meeting the sampling criteria were screened and enrolled consecutively after obtaining parental consent/assent. Statistical analysis used is nonparametric test with SPSS software. Results: Age showed a significant association with the phase of CVI. Perinatal insult was associated significantly with the severity of CVI. Magnetic resonance imaging (MRI) findings did not hamper the recovery of CVI. Conclusions: Enrolment in early intervention programs tailored according to child's specific needs should be encouraged, with stress on ophthalmic screening of preterm and high-risk babies with perinatal hypoxia and history of convulsions, as early as six months. [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]

Purpose: Novel coronavirus has brought huge changes in lifestyle, especially among children. Reports indicate that the prevalence of refractive errors among children has increased due to home confinement. Hence, this study was done to understand the current status of refractive errors among children from public schools in southern India. Methods: This cross-sectional study was conducted as part of school eye screening conducted between September and October 2021. Children between 14 and 17 years of age from public schools underwent a three-phased comprehensive eye examination. Children identified with refractive errors and an equal proportion of children without any refractive errors underwent a survey on outdoor activities. Prevalence estimates and 95% confidence interval were calculated. Chi-square tests and regression analysis were used to understand the association between refractive error and other variables. Results: From the data of 3,850 (90.69%) children, the prevalence of vision impairment, refractive errors, and myopia in at least one eye was found to be 12.83% (n = 494), 21.51% (n = 828), and 19.53% (n = 752), respectively. The average myopic spherical equivalent error was found to be -2.17 ± 1.11D (range:-0.50 D to -14.00 D). Almost 96.82% of girls had less than 3 h of outdoor activities. Refractive errors were 7.42 and 2.77 times more (95% CI: 3.51-15.70), P < 0.001) among children who had outdoor activities less than 3 h per day and sleep less than 7 h per day. Conclusion: Comparing to previous studies from North Indian and South Indian public schools, this study reports a three- to six-fold rise in myopia post-home confinement among public school children from India.

Purpose: To profile the presentation of ocular conditions among school children aged 6 to 17 years from the south Indian state of Tamil Nadu. Methods: The study was conducted as part of a school eye health program in Kanchipuram district, Tamil Nadu that aimed to address the refractive needs of children (6–17 years) between July 2016 and June 2019. The study followed a three-phase protocol, which included visual acuity test, modified clinical test, color vision test, binocular vision assessment, objective and subjective refraction, dispensing spectacles, posterior segment evaluation using direct ophthalmoscopy, and referral to the base hospital. The demographics, clinical details, and ocular conditions (classified under 16 categories) were analyzed. Profiling and association of ocular conditions among different locations, types of schools, class grades, and gender were presented. Results: Data of 2,45,565 children were analyzed from 1,047 schools, of which 4,816 (1.96%) children were identified with ocular conditions other than refractive errors. The common reasons for referral were high myopia 901 (0.37%), strabismus 819 (0.33%), and amblyopia 691 (0.28%). Retinal problems (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.22–2.22, P = 0.001) and strabismus (OR: 1.41, 95% CI: 1.21–1.65, P < 0.001) were the conditions prevalent in the rural location. Cataract and related conditions (OR: 5.73, 95% CI: 4.10–8.01, P < 0.001) and retinal problems (OR: 4.76, 95% CI: 3.37–6.72, P < 0.001) were common in children studying in public schools. Of the 16 categories, 13 conditions were seen among primary school children. Vernal keratoconjunctivitis (OR: 3.64 95% CI: 2.12–6.23 P < 0.001) was common among males. Conclusion: The study profiled ocular conditions among school children. Most ocular conditions warrant prolonged care and specialty eye care services. Ensuring the availability of such services and follow-up after school eye screening would safeguard the visual development of these children.

Purpose: The study aimed to estimate the prevalence of subnormal stereoacuity in school children and to assess the factors associated with it. Methods: In this prospective cross-sectional study, a total of 2,376 school children without amblyopia and manifest squint were screened by the titmus fly test, Snellen chart, tests for heterophoria, anterior segment examination, and fundoscopy. Children with a manifest squint, amblyopia (best-corrected visual acuity [BCVA]

Purpose: Novel coronavirus has brought huge changes in lifestyle, especially among children. Reports indicate that the prevalence of refractive errors among children has increased due to home confinement. Hence, this study was done to understand the current status of refractive errors among children from public schools in southern India. Methods: This cross-sectional study was conducted as part of school eye screening conducted between September and October 2021. Children between 14 and 17 years of age from public schools underwent a three-phased comprehensive eye examination. Children identified with refractive errors and an equal proportion of children without any refractive errors underwent a survey on outdoor activities. Prevalence estimates and 95% confidence interval were calculated. Chi-square tests and regression analysis were used to understand the association between refractive error and other variables. Results: From the data of 3,850 (90.69%) children, the prevalence of vision impairment, refractive errors, and myopia in at least one eye was found to be 12.83% (n = 494), 21.51% (n = 828), and 19.53% (n = 752), respectively. The average myopic spherical equivalent error was found to be -2.17 ± 1.11D (range:-0.50 D to -14.00 D). Almost 96.82% of girls had less than 3 h of outdoor activities. Refractive errors were 7.42 and 2.77 times more (95% CI: 3.51-15.70), P < 0.001) among children who had outdoor activities less than 3 h per day and sleep less than 7 h per day. Conclusion: Comparing to previous studies from North Indian and South Indian public schools, this study reports a three- to six-fold rise in myopia post-home confinement among public school children from India. [ABSTRACT FROM AUTHOR]

Purpose: To profile the presentation of ocular conditions among school children aged 6 to 17 years from the south Indian state of Tamil Nadu.Methods: The study was conducted as part of a school eye health program in Kanchipuram district, Tamil Nadu that aimed to address the refractive needs of children (6-17 years) between July 2016 and June 2019. The study followed a three-phase protocol, which included visual acuity test, modified clinical test, color vision test, binocular vision assessment, objective and subjective refraction, dispensing spectacles, posterior segment evaluation using direct ophthalmoscopy, and referral to the base hospital. The demographics, clinical details, and ocular conditions (classified under 16 categories) were analyzed. Profiling and association of ocular conditions among different locations, types of schools, class grades, and gender were presented.Results: Data of 2,45,565 children were analyzed from 1,047 schools, of which 4,816 (1.96%) children were identified with ocular conditions other than refractive errors. The common reasons for referral were high myopia 901 (0.37%), strabismus 819 (0.33%), and amblyopia 691 (0.28%). Retinal problems (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.22-2.22, P = 0.001) and strabismus (OR: 1.41, 95% CI: 1.21-1.65, P < 0.001) were the conditions prevalent in the rural location. Cataract and related conditions (OR: 5.73, 95% CI: 4.10-8.01, P < 0.001) and retinal problems (OR: 4.76, 95% CI: 3.37-6.72, P < 0.001) were common in children studying in public schools. Of the 16 categories, 13 conditions were seen among primary school children. Vernal keratoconjunctivitis (OR: 3.64 95% CI: 2.12-6.23 P < 0.001) was common among males.Conclusion: The study profiled ocular conditions among school children. Most ocular conditions warrant prolonged care and specialty eye care services. Ensuring the availability of such services and follow-up after school eye screening would safeguard the visual development of these children. [ABSTRACT FROM AUTHOR]

Purpose: To understand/assess ocular and functional vision impairment in children with multiple disabilities with a functional vision assessment battery in addition to standard ophthalmic examinations in an outreach setting.Methods: Seven schools for children with special needs, 243 children in total, were screened for ocular disorders and functional vision impairment through school camps.Results: Among them, 37% had refractive errors needing spectacle correction. With standard ocular testing methods, the visual impairment was around 32%, but when functional vision was assessed, the functional vision impairment amounted to 70% in these children. The presence of functional vision impairment was found to be independent of the associated disability. Assessment of visual capacities such as visual closure, saccade pursuits, optic ataxia, and developmental milestones early on can help in suspecting the presence of CVI.Conclusion: Children with multiple disabilities are more at risk of functional vision impairment, which significantly impairs their ability to function in daily life. A complete functional vision assessment becomes essential to plan early intervention for these children. The significant proportion of vision impairment and functional vision loss in our study indicates the need for coordinated structured programs to address vision-related problems in children with multiple disabilities. [ABSTRACT FROM AUTHOR]

Purpose: Global trends show a high prevalence of refractive errors among children. The prevalence of vision impairment due to uncorrected refractive errors among school children is increasing and the need for management of other ocular conditions is also reported. This study presents the status of eye health and pattern of daily activities among the school children of a tribal location in Tamil Nadu, South India. Methods: A cross-sectional study was conducted in 13 schools of Karumandurai cluster, Salem district in Tamil Nadu, India. A three-phased comprehensive school screening protocol was conducted to understand the prevalence of vision impairment, refractive error, and other ocular conditions along with a survey about the daily activities of the children at school and home. Results: Among the 3655 children screened, the prevalence of vision impairment was found to be 0.62% (n = 23, 95% confidence interval [CI] 0.42–0.94) and prevalence of refractive error was 0.30% (n = 11, 95%CI 0.17–0.54), among which 0.11% (n = 4) were already wearing spectacles. A total of 44 children (1.20%; 95%CI 0.90–1.61) were found to have other ocular problems and among them, 14 (0.38%) had visual acuity less than 20/30 (6/9). Almost 84% of children required surgical or specialty eye care services. Vision impairment was more in children with other ocular conditions compared to refractive errors (P < 0.001). Conclusion: The prevalence of vision impairment and refractive errors in this tribal area was less. Ocular conditions were more prevalent than refractive errors in this tribal region with the majority of children needing specialty or surgical eye care services. This implies the need for access to secondary or tertiary eye care centers.

Purpose: Impact of color vision deficiency (CVD) on activities at school and productivity at work and consequential psychosocial difficulties has been reported. Although early detection and awareness help in overcoming these difficulties, screening for CVD is not a part of the school eye-screening initiatives in many countries. This study aimed at reporting the prevalence of CVD among school-going boys in Kanchipuram district, South India. Methods: The study was carried out as part of a school eye-screening program (SES) conducted in Kanchipuram district, Tamil Nadu, India for children between 6 and 17 years. The SES followed a three-phased protocol, which also included screening for CVD for all the boys between 11 and 17 years. The boys underwent CVD screening with Dalton's pseudo isochromatic plates (PIPs) followed by confirmation with Ishihara's PIP. The data were analyzed and the proportion of CVD in boys among different class grades, type of schools, location of schools, blocks of the district, and other clinical characteristics are presented. Results: Totally 250,052 children were screened in 1047 schools of which 74986 (60.61%) were boys between 11 and 17 years (mean age: 13.75 ± 1.91). The overall prevalence of CVD was found to be 2.76% (n = 2073; 95% confidence interval [CI]: 2.65–2.88). CVD was associated with urban locations (3.17% odds ratio [OR]: 1.90 95%CI: 1.69–2.13 P < 0.05) and public schooling (2.87%) (OR: 1.29 95%CI: 1.17–1.43 P < 0.05). Boys with CVD were less likely to have vision impairment (P = 0.002) and myopia (P < 0.001) as compared with boys with normal color vision. There was no significant difference in the proportion of other ocular conditions between children with and without CVD (P > 0.05). Conclusion: The study shows a significant proportion of CVD among boys in Kanchipuram district, India and its association with various demographic and clinical characteristics. Identification of CVD and counseling the stakeholders earlier through school children screening is crucial.

Purpose: To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India.Methods: Children aged <16 years, enrolled in the schools for the blind in Maharashtra state, India were examined between October 2018 and December 2019. The anatomical sites and etiology for blindness were recorded using the World Health Organization's standard reporting form. Causes of blindness were compared among different regions of the state and also by different age groups.Results: Of the 1,969 students examined from 39 schools for the blind, 188 children (9.5%) had severe visual impairment and 1,666 children (84.6%) were blind. Whole globe anomalies (794, 42.8%) were the most common anatomical site of vision loss in children, followed by corneal (289, 15.6%) and retinal abnormalities (280, 15.2%). Corneal causes were second most common in the poorer districts of Vidarbha (15.3%) and Marathwada (14.6%), whereas retinal causes were second most common in the wealthier regions of western Maharashtra (18.3%) and Khandesh (24.1%). Nearly one-third (593, 32%) of children were blind from potentially avoidable causes. Preventable blindness consisting of corneal causes and retinopathy of prematurity was seen in 281 (15.2%) cases, whereas treatable causes comprising of lens-related causes, glaucomas, refractive errors, amblyopia, and uveitis accounted for another 311 (16.8%). Among the younger children (≤10 years), the proportion of corneal blindness was lower (83/623, 13.3% vs. 206/1232, 16.7%) and that of retinal blindness was higher (119/623, 19% vs. 163/1232, 13.2%) than the older children.Conclusion: Whole globe anomalies constitute a major cause of SVI and blindness in Maharashtra. There seems to be an increase in the proportion of retinal blindness, especially retinopathy of prematurity, suggesting a need for increased screening coverage. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to estimate the prevalence of subnormal stereoacuity in school children and to assess the factors associated with it.Methods: In this prospective cross-sectional study, a total of 2,376 school children without amblyopia and manifest squint were screened by the titmus fly test, Snellen chart, tests for heterophoria, anterior segment examination, and fundoscopy. Children with a manifest squint, amblyopia (best-corrected visual acuity [BCVA] <6/18), and history of ocular trauma or surgery, and one-eyed children were excluded. Cycloplegic refraction was done in children with uncorrected or undercorrected refractive errors, and stereoacuity was assessed again with spectacle correction.Results: The prevalence of normal stereoacuity by titmus fly test was 93.18% with correction of refractive errors. Girls had slightly better stereopsis compared with boys. The subnormal stereoacuity was significantly associated with refractive error (P < 0.00001, significant at P < 0.05), unilateral refractive error (P < 0.00001, significant at P < 0.05), bilateral refractive error (P < 0.00001, significant at P < 0.05), anisometropia (P < 0.00001, significant at P < 0.05), ametropia (P < 0.00001, significant at P < 0.05), lower BCVA (P < 0.00001, significant at P < 0.05), hyperopia (P < 0.05, significant at P < 0.05), and heterophoria (P = 0.014, significant at P < 0.05). The subnormal stereoacuity was positively correlated with the magnitude of refractive error of the eyes.Conclusion: This study underlines the significant impact of identification and correction of refractive errors and squints in school children. The measurement of stereoacuity will be of immense importance and must be included in the screening programs for children. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of COVID-19 lockdown restrictions on lifestyle of school-going children. Methods: This was a questionnaire-based prospective study of 1237 school children aged 9-14 years enrolled from various private and government schools across Delhi in October-December 2020. These children were being followed-up over the previous 2 years (before pandemic) with details of their lifestyle like near/outdoor/reading activities using a questionnaire as a part of another study. The data during the COVID-19 lockdown was collected by telephonic interview. This was compared to similar information collected from this cohort in the pre-Covid period in 2019 when the students had a regular physical school curriculum. Results: A significant decline was noted in time spent on outdoor activity (from 8.5 hours/week in pre-COVID-19 time to 1.6 hours/week during COVID-19 lockdown; P < 0.001) and doing homework offline (from 15.3 hour/week to 14 hours/week; P < 0.001). A significant increase was noted in screen time spent on digital devices (from 6.2 hours/week to 19.8 hours/week; P<0.001), and watching television (from 12.2 hours/week to 13.4 hours/week; P < 0.001). The rise in the digital on-screen time was significantly more in boys (P < 0.001) and in students from private schools (P < 0.001). The rise in the duration of watching television was significantly more in girls than boys (P < 0.05). Conclusion: COVID-19 lockdown has markedly impacted the lifestyle of school children by significantly decreasing the outdoor activity and increasing the screen time, thereby pre-disposing them to ocular ill-health and myopia. This necessitates the adoption of guidelines for promoting healthy digital habits in children. [ABSTRACT FROM AUTHOR]

Purpose: To describe the prevalence of refractive error in school children in a tribal district, Rayagada, Odisha state, India. Methods: In a cross-sectional school eye health study, the students with diminished vision and other ocular abnormalities were referred for a further eye examination to the vision technicians after initial screening by the trained school teachers. The examination by vision technicians consisted of an external eye examination, photorefraction using a Spot screener and subjective correction. Those not improving with subjective correction were referred to the ophthalmologist for further examination. Results: The school teachers measured vision in 153,107 children; 5,990 students reached a vision technician. There was a near equal number of boys (50.06%) and girls (49.94%). The average age was 10.5 ± 2.63 (range: 5–15) years. The prevalence of refractive error was 9.7% (95% [CI]; 9.0–10.5%) in the vision technician-examined children. Myopia (4.9%) and astigmatism (5.4%) were more common than hyperopia (0.2%). The presenting visual acuity (PVA) was worse in children with hypermetropia (PVA 20/100-20/200 in 40% of children). Spherical equivalent of refractive error did not have a good correlation with age (R2 = 1.3); but increasing age was associated with increased risk of myopia (odds ratio 1.14; 95% CI 1.09–1.20; P < 0.001). Conclusion: The quantum of refractive error was close to other similar studies in India but the prevalence of myopia was relatively less.

Purpose: The aim of this study was to describe causes of severe visual impairment and blindness (SVI/BL), and assess the mental health and quality of life of children in schools for the blind in North-East India in two phases.Methods: A total of 515 children were examined in 17 schools for the blind in the first phase of study across eight states in North-East India, 6 in Assam, 2 each in Meghalaya, Manipur, Mizoram, and Tripura, 1 each in Arunachal Pradesh, Nagaland, and Sikkim. WHO/PBL eye examination record was used to document findings. In the second phase of study, mental health and quality of life were objectively measured using depression anxiety stress scales (DASS) and low-vision quality of life (LVQOL) questionnaires in 442 children.Results: Approximately 3.1% of children had SVI and 71.84% of children were blind. Anatomical sites of SVI/BL were the whole globe in 44.85%, cornea in 17.66%, and retina in 11.65% of children. The underlying cause of visual loss was undetermined in 55% of children. Hereditary pattern was observed in 1.35% of cases. Approximately 74.94% of children were either blind or severely visually impaired since birth. DASS score revealed that 56.56% of children manifested some levels of anxiety and stress while 85.52% had some reduction in quality of life.Conclusion: A large significant number of these children suffered from potentially preventable and/or treatable cause of SVI/BL. Though nonvisual factors such as physical and mental health were strong predictors of quality of life, this study proves that visual impairment also plays a considerable role in one's quality of life in a population with low vision. [ABSTRACT FROM AUTHOR]

Purpose: Impact of color vision deficiency (CVD) on activities at school and productivity at work and consequential psychosocial difficulties has been reported. Although early detection and awareness help in overcoming these difficulties, screening for CVD is not a part of the school eye-screening initiatives in many countries. This study aimed at reporting the prevalence of CVD among school-going boys in Kanchipuram district, South India.Methods: The study was carried out as part of a school eye-screening program (SES) conducted in Kanchipuram district, Tamil Nadu, India for children between 6 and 17 years. The SES followed a three-phased protocol, which also included screening for CVD for all the boys between 11 and 17 years. The boys underwent CVD screening with Dalton's pseudo isochromatic plates (PIPs) followed by confirmation with Ishihara's PIP. The data were analyzed and the proportion of CVD in boys among different class grades, type of schools, location of schools, blocks of the district, and other clinical characteristics are presented.Results: Totally 250,052 children were screened in 1047 schools of which 74986 (60.61%) were boys between 11 and 17 years (mean age: 13.75 ± 1.91). The overall prevalence of CVD was found to be 2.76% (n = 2073; 95% confidence interval [CI]: 2.65-2.88). CVD was associated with urban locations (3.17% odds ratio [OR]: 1.90 95%CI: 1.69-2.13 P < 0.05) and public schooling (2.87%) (OR: 1.29 95%CI: 1.17-1.43 P < 0.05). Boys with CVD were less likely to have vision impairment (P = 0.002) and myopia (P < 0.001) as compared with boys with normal color vision. There was no significant difference in the proportion of other ocular conditions between children with and without CVD (P > 0.05).Conclusion: The study shows a significant proportion of CVD among boys in Kanchipuram district, India and its association with various demographic and clinical characteristics. Identification of CVD and counseling the stakeholders earlier through school children screening is crucial. [ABSTRACT FROM AUTHOR]

Purpose: In India, school eye screening is an important component of the National Programme for the Control of Blindness providing spectacles free of cost to children from primary section. The primary aim of this study was to know the compliance of wearing spectacles provided during school screening program and to find out reasons for noncompliance. The secondary aim of this study was to get information regarding the types of modifications required in the school eye screening program to improve the compliance level.Methods: It was a cross-sectional follow-up study involving school children of age group 10-16 years, class 5-9 from different parts of the country. Public or private schools were randomly selected based on their distance from the base hospitals/partner organizations. Data were collected by standard format directly from the students after informed written consent from school principal or class teacher.Results: The utilization of spectacles was found to be only 29.8% (n = 289) within 2 years of receiving the spectacles. Thirty-five percent (n = 108) students were using spectacles with less than 0.75 D. Appearance of the frame was a deciding factor. It was observed that the frames provided by the DBCS were especially not liked by the children. Twenty-five percent (n = 79) children were found to be wearing adult frames.Conclusion: Less than a third of the students were compliant with their spectacle prescription in this study. To improve the compliance, children should not be prescribed spectacles for nonsignificant refractive errors, should be given choices for frames and quality of work being conducted under school screening program needs a review. [ABSTRACT FROM AUTHOR]

Purpose: Global trends show a high prevalence of refractive errors among children. The prevalence of vision impairment due to uncorrected refractive errors among school children is increasing and the need for management of other ocular conditions is also reported. This study presents the status of eye health and pattern of daily activities among the school children of a tribal location in Tamil Nadu, South India.Methods: A cross-sectional study was conducted in 13 schools of Karumandurai cluster, Salem district in Tamil Nadu, India. A three-phased comprehensive school screening protocol was conducted to understand the prevalence of vision impairment, refractive error, and other ocular conditions along with a survey about the daily activities of the children at school and home.Results: Among the 3655 children screened, the prevalence of vision impairment was found to be 0.62% (n = 23, 95% confidence interval [CI] 0.42-0.94) and prevalence of refractive error was 0.30% (n = 11, 95%CI 0.17-0.54), among which 0.11% (n = 4) were already wearing spectacles. A total of 44 children (1.20%; 95%CI 0.90-1.61) were found to have other ocular problems and among them, 14 (0.38%) had visual acuity less than 20/30 (6/9). Almost 84% of children required surgical or specialty eye care services. Vision impairment was more in children with other ocular conditions compared to refractive errors (P < 0.001).Conclusion: The prevalence of vision impairment and refractive errors in this tribal area was less. Ocular conditions were more prevalent than refractive errors in this tribal region with the majority of children needing specialty or surgical eye care services. This implies the need for access to secondary or tertiary eye care centers. [ABSTRACT FROM AUTHOR]

Purpose: Assessment of pupil diameter in various light conditions and the corresponding corneal spherical aberrations in a cohort of Indian eyes with bilateral senile cataracts and the possible use of this data in aberrometric customization of intraocular lenses (IOLs).Methods: In this prospective observational study done at a tertiary eye care centre in India, the selected patients were subjected to measurement of their pupil diameters in scotopic, mesopic, and photopic conditions as well as the corresponding corneal spherical aberrations, using the Sirius Topographer (Costruzione Strumenti Oftalmici, Florence, Italy). Shapiro-Wilk test, Independent t-test, ANOVA with Bonferroni correction on post-hoc testing were used for statistical analysis.Results: 104 eyes of 52 patients were enrolled for the study. The mean age was 53 ± 11.88 years. The mean scotopic, mesopic, and photopic pupil sizes were 4.37 mm (4.11-4.63 mm), 3.92 mm (3.71 mm-4.15 mm), and 3.37 mm (3.18-3.67 mm), respectively. There was a statistically significant difference (P = <0.001) in the mean corneal spherical aberration measured at the 6 mm zone (0.23 ± 0.02 microns) and at the 4 mm zone (0.06 ± 0.01 microns).Conclusion: The mean corneal spherical aberration corresponding to the average mesopic pupil size of our patient population was substantially lower than that of the scotopic pupil size and also less than the amount corrected by most of the negative aspheric IOLs. This perhaps indicates the need for customising IOLs based on the spherical aberrations of cornea at the zone corresponding to the mesopic pupil diameter for optimal residual total postoperative spherical aberrations. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate visual quality after high-frequency transepithelial photorefractive keratectomy (t-PRK) by assessing the relationship between the operational parameters and the first-year postoperative corneal higher-order aberrations (HOAs).Methods: This was a retrospective study of low-to-moderate myopic eyes treated with t-PRK. The files of 46 low-to-moderate myopic patients (90 eyes; myopia up to -5D) were included in the study. Eyes having a cylindrical refractive error more than 2D and the patients not having completed a 1-year follow-up were excluded from the study. Factors including age, preoperative mean spherical equivalent (MSE), mean keratometry (Km), central corneal thickness (CCT), scotopic pupil, optical zone (OZ), transition zone (TZ), ablation zone (AZ), central ablation depth (CAD), and static cyclotorsion correction (SCC) were analyzed for association with the first-year postoperative corneal HOAs.Results: Corneal HOAs were found to be increased postoperatively with a 6-mm pupil (P < 0.05). The increased spherical aberration had a positive correlation with patient age, preoperative MSE, Km, TZ, and CAD, whereas it had a negative relationship with OZ and AZ (P < 0.05). The corneal coma had a significantly positive correlation with preoperative MSE and a significantly negative relationship with OZ (P < .05).Conclusion: Postoperatively induced corneal HOAs may affect patients' scotopic vision (night time driving, cinema) when the pupils get larger. The relationship between patient age, preoperative MSE, Km, CAD, TZ, OZ, AZ, and postoperative corneal HOAs underlines the need to consider the effects of these parameters on the final vision quality. [ABSTRACT FROM AUTHOR]

Purpose: To describe the prevalence of refractive error in school children in a tribal district, Rayagada, Odisha state, India.Methods: In a cross-sectional school eye health study, the students with diminished vision and other ocular abnormalities were referred for a further eye examination to the vision technicians after initial screening by the trained school teachers. The examination by vision technicians consisted of an external eye examination, photorefraction using a Spot screener and subjective correction. Those not improving with subjective correction were referred to the ophthalmologist for further examination.Results: The school teachers measured vision in 153,107 children; 5,990 students reached a vision technician. There was a near equal number of boys (50.06%) and girls (49.94%). The average age was 10.5 ± 2.63 (range: 5-15) years. The prevalence of refractive error was 9.7% (95% [CI]; 9.0-10.5%) in the vision technician-examined children. Myopia (4.9%) and astigmatism (5.4%) were more common than hyperopia (0.2%). The presenting visual acuity (PVA) was worse in children with hypermetropia (PVA 20/100-20/200 in 40% of children). Spherical equivalent of refractive error did not have a good correlation with age (R2 = 1.3); but increasing age was associated with increased risk of myopia (odds ratio 1.14; 95% CI 1.09-1.20; P < 0.001).Conclusion: The quantum of refractive error was close to other similar studies in India but the prevalence of myopia was relatively less. [ABSTRACT FROM AUTHOR]

We describe the successful use of the B-HEX pupil expansion device in four cases of combined phacovitrectomy with significant cataract, non-dilating pupil, and surgical vitreoretinal pathologies including vitreous hemorrhage, inferior retinal detachment (RD) with proliferative vitreoretinopathy in an oil filled eye, recurrent rhegmatogenous RD, and macular hole with RD localized to the posterior pole in an eye with uveitic sequelae. The B-HEX remained well engaged and maintained excellent mydriasis throughout the surgery despite wide fluctuations in intraocular pressure and anterior chamber fluidics. This is the first series describing use of B-HEX for combined phacovitrectomy due to myriad causes. [ABSTRACT FROM AUTHOR]

Purpose: Zernike polynomials for describing ocular higher order aberrations are affected by pupil aperture. The current study aimed to validate Mahajan's formula for scaling Zernike polynomials by pupil size.Methods: Higher order aberrations for 3 intraocular lens models (AcrySof IQ IOL SN60WF, Technis ZA9003, Adapt Advanced Optics) were measured using the Zywave aberrometer and a purpose-built physical model eye. Zernike coefficients were mathematically scaled from a 5 mm to a 3 mm pupil diameter (5:3 mm), from a 5 mm to a 2 mm pupil diameter (5:2 mm), and from a 3 mm to a 2 mm pupil diameter (3:2 mm). Agreement between the scaled coefficients and the measured coefficients at the same pupil aperture was assessed using the Bland-Altman method in R statistical software.Results: No statistically significant mean difference (MD) occurred between the scaled and measured Zernike coefficients for 21 of 23 analyses after Holm-Bonferroni correction (P > 0.05). Mean differences between the scaled and measured Zernike coefficients were clinically insignificant for all aberrations up to the fourth order, and within 0.10 μm. Oblique secondary astigmatism (Z-24) was significantly different in the 5:3 mm comparison (MD = -0.04 μm, P < 0.01). Horizontal coma (Z13) was significantly different in the 3:2 mm comparison (MD = -0.07 μm, P = 0.03). There were borderline statistical differences in both vertical (Z-13) and horizontal coma (Z13) in the 5:3 mm comparison (MD = 0.02 μm, -0.09 μm, P = 0.05, 0.05, respectively).Conclusion: A formula for the scaling of higher order aberrations by pupil size is validated as accurate. Pupil scaling enables accurate comparison of individual higher order aberrations in clinical research for situations involving different pupil sizes. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the prevalence of various ocular morbidities in school children (5-15 years) utilizing a comprehensive mobile eye unit in Central India.Methods: A prospective, cross-sectional, school-based observational study was carried out in Raipur, Chhattisgarh, India between December 2017 and September 2018. A total of 1557 eligible school-going children in the age group 5-15 years were evaluated. Random sampling was done to allocate schools (n = 29) and children from various urban and rural (836 vs 721) schools. The primary objective was to estimate the prevalence of ocular morbidities in school-going children in Raipur district, India. The secondary objective was to analyze whether geographical location (rural vs urban), age group, and gender led to any differences in ocular morbidity patterns.Results: The mean age of the study population was 10.3 ± 2.4 years. There were 691 (44.4%) boys and 866 (55.6%) girls. Ocular morbidity was present in a total of 331 (21.2%) children. Vitamin A deficiency was the most common cause of ocular morbidity, noted in 156 (10%) children, followed by refractive error (81, 5.2%). Myopia was significantly higher in urban school children (4.3%) compared to rural children (1.9%) (P = 0.002). The older age group had a higher prevalence (7.6%) of refractive error, especially myopia, compared to the younger age group (2.2%) (P < 0.001).Conclusion: Vitamin A deficiency prevalence was much higher indicating missed opportunities for vitamin A supplementation at a younger age. Refractive error was more prevalent in the urban population as well in the older age group (11-15 years), indicating a need for frequent eye screening. [ABSTRACT FROM AUTHOR]

Purpose: Vision plays an important role in child's development for learning and communication. Uncorrected refractive error (URE) has become a major challenge to health care policy makers especially in school going children. We aim to report the prevalence of refractive error among the school students of the east district of Sikkim, India.Methods: A cross-sectional study was carried out among 15,954 school children under school health program of national program for control of blindness. The screening was conducted in 40 schools of east district which included primary, higher secondary, monastic and private schools.Results: The prevalence of refractive error was 6.7% among which myopia was the most common error present in 335 (31.1%) children, followed by astigmatism in 317 (29.4%) and the remaining 29 (2.6%) with hyperopia. The age group between 14-17 years had high prevalence of refractive error (9.2%). Females had slightly higher refractive error (6.93%) than males (5.9 %). Most backward classes were found to be highest suffering from refractive error (26.65%) and the least seen was found in schedule tribe (11.6%).Conclusion: The study provides a useful and baseline data about the refractive error amongst the school children of east Sikkim. A larger study needs to be conducted in all the schools of the state to get a clearer picture of RE and other eye related diseases to detect vision problem as early as possible. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relation between erectile dysfunction (ED) severity and pupillary functions in patients with diabetes mellitus (DM).Methods: This prospective and observational study included 90 patients with type 2 DM and ED. Patients divided into three subgroups according to severity of ED: (i) Mild ED, (ii) Moderate ED and (iii) Severe ED groups. Thirty age-matched healthy subjects formed the control group. Main outcome measures were pupil diameter and average speed of pupil dilation. Static and dynamic pupillometry analysis was performed using the Sirius Topographer (CSO, Firenze, Italy).Results: Mean pupil diameter during static and dynamic pupillometry analysis were significantly greater in the control group than in the all study groups (P < 0.05). Mean pupil diameter in static pupillometry analysis was significantly different in each study group and pupil was more miotic in the Severe ED group than in the both Moderate and Mild ED groups (P < 0.05 for each). Dynamic pupillometry analysis revealed that mean pupil diameter and mean average dilation speed were significantly different in each study group throughout measurement period and the highest speed was observed in the Mild ED group and the lowest speed was observed in the severe ED group (P < 0.005 for each).Conclusion: Our study results suggest that abnormal pupil functions due to diabetic autonomic neuropathy may indicate the associated ED in patients with DM. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the prevalence, causes, and risk factors for visual impairment (VI) among children of school for hearing-impaired (HI) in Guntur district of Andhra Pradesh, India.Methods: Children between 6 and 16 years of age available in all the 12 special schools for HI were examined. Visual acuity (VA) testing, ocular motility, and examination of anterior and posterior segment for all children were done. Those having VA of less than 6/12 in better eye underwent cycloplegic refraction. For definition of VI, as per World Health Organization (WHO), VA of better eye was considered. HI was also classified as mild, moderate, severe, and profound as per WHO definitions. Examination for systemic diseases and other associated disabilities was also done.Results: In all, 402 children underwent examination. Ophthalmic abnormality was seen in 64 children with a prevalence of 15.9% [95% confidence interval (CI) 14.9%-16.8%], and VI was seen in 29 children with a prevalence of 7.2% (95% CI 4.9%-10.2%). Refractive errors [29 (7.2%)], retinitis pigmentosa (RP) [16 (4%)], and squint [8 (2%)] were the major ophthalmic abnormalities. Thirty-five (54.7%) of the abnormalities were either preventable or treatable. The major cause of VI was refractive error (18) followed by RP (5). Twenty of them (69%) with VI in this study group were treatable. Twenty-two (75.9%) children with eye problem were newly diagnosed. The only risk factor for VI was being mentally challenged (odds ratio: 5.63; 95% CI: 1.89-16.8).Conclusion: The prevalence of ophthalmic abnormalities and VI in school for HI was high, and the majority of them were not detected so far. As most of them are easily treatable, it is highly recommended to conduct regular eye examinations in these schools. [ABSTRACT FROM AUTHOR]

Purpose: To identify children with low vision from two local schools for the blind, to provide low vision devices (LVD) to those who may benefit from it, and to encourage them to learn print.Methods: A prospective study was conducted among children from two local schools for the blind. Best-corrected visual acuity (BCVA) was done using the Snellen chart. Children with BCVA of counting finger (CF) 1/2 meter or more in the better eye underwent low vision assessment. Distant vision was assessed using the Feinbloom chart and near vision was assessed using the Lea symbol chart. Low vision devices (LVD) were prescribed as required.Results: Among 185 children enrolled, 31 children had BCVA of >CF ½ meter. Using a telescope, distant vision was better than 3/36 in 48.4%, 3/36-3/12 in 16.2%, and 3/9.5 to 3/3 in 35.4%. Among 23 children who read 1M at <10 cm, 22.6% could read 0.6-0.8M, and 25.8% could read 1M using LVD.Conclusion: Regular screening of children in schools for the blind could identify children who might benefit from LVD. A review of protocols for the entry of children in schools for the blind by screening these children by a specialist team prior to admission should be made mandatory. [ABSTRACT FROM AUTHOR]

A young lady presented with very high vault and fixed dilated pupil along with optic capture of the implantable collamer lens (ICL). After thorough evaluation and ruling out the ICL sizing error, the optic capture was relieved and the ICL was rotated into vertical position. Single-pass four throw pupilloplasty was performed for the fixed dilated pupil. Postoperatively the ICL vault and the pupil size decreased and patient was asymptomatic. This case highlights a successful outcome of rotation of a nontoric ICL to reduce the high vaulting and optic capture along with single-pass four throw pupilloplasty. [ABSTRACT FROM AUTHOR]

Aim : To evaluate the efficacy of modified temporalis muscle transfer (TMT) by silicone sling for the management of paralytic lagophthalmos. Settings and Design: Prospective interventional study. Materials and Methods : Ten patients of lagophthalmos due to facial palsy underwent modified TMT using silicone sling. The patients were followed-up for a period of 3 months. Palpebral aperture in primary gaze and during eye closure were assessed both pre- and postoperatively along with problems associated with lagophthalmos like exposure keratopathy and lacrimation. Statistical Analysis : Paired t-test was applied to measure the statistical outcome. Results : Eight patients achieved full correction of lagophthalmos with no lid gap on closing the eye. The mean (standard deviation (SD)) lid gap on eye closure was 7.7 (0.86) mm preoperatively, 0.5 (0.47) mm at 1 st postoperative day, and 0.7 (0.75) mm at 3 rd month. There was a reduction in mean lid gap on eye closure of 7 mm at 3 months (P < 0.0001) which is highly significant. The mean (SD) vertical interpalpebral distance during primary gaze was 12.05 (1.12) mm preoperatively, 10 (0.94) mm at 1 st postoperative day, and 10.35 (1.08) mm at 3 rd month. There was a reduction in mean vertical inter palpebral distance of 1.7 mm at 3 months (P = 0.001) which is significant. Exposure keratitis decreased in five out of six patients at 3 months. Conclusion : Modified TMT by silicone sling is a useful procedure with lesser morbidity and good outcomes for the treatment of paralytic lagophthalmos due to long standing facial palsy.

Purpose: To evaluate the role of echography in diagnosis and management of a diverse array of choroidal masses. Materials and Methods: Sixty-two cases of clinically suspected choroidal masses were prospectively analyzed with B-scan (10 Hz), A-scan, and ultrasound biomicroscopy (UBM) (50 Hz) after a meticulous history and ocular examination. Ancillary investigations and systemic evaluation were also done. Results: Based on clinical suspicion, acoustic features, response to treatment, and other ancillary tests combined together, the various masses were differentiated. The cases included in the study were as follows: n = 10 malignant melanomas, n = 16 metastasis and infiltrations, n = 9 hemangioma, n = 7 tuberculoma, n = 8 nonspecific inflammatory masses, n = 2 disciform plaques, n = 4 macular cysts or retinoschisis, n = 2 Coat′s disease, n = 1 melanocytoma, and n = 2 osteomas. Ultrasonography (USG) alone could identify n = 51 lesions, while UBM in combination with USG was needed in remaining 11 masses. Conclusion: Standardized echography is an important adjunct in the diagnosis and management of eyes with intraocular masses. A better understanding of the clinicopathological and echographic picture of the diverse lesions can help in detection, differentiation, diagnosis, proposing a therapeutic approach, and also monitoring response to treatment. Echography is essential to evaluate tumors for extrascleral and anterior segment extension.

Aim: To determine profiles of non-chlamydia conjunctival bacteria and their antimicrobial susceptibility from adults who underwent trachomatous trichiasis surgery in rural areas of Ethiopia. Materials and Methods: A cross-sectional study was conducted in rural districts in West Gojjam administrative zone. Conjunctival swabs were collected during surgery and transported using Stuart transport broth (Oxoid, UK). Antibiotic susceptibility of conjunctival isolates was determined using the Kirby-Bauer disc-diffusion method. Results: Non-chlamydia pathogenic bacteria were recovered from conjunctiva of 438 (31%) participants before treatment. The isolated conjunctival bacteria were Staphylococcus aureus, coagulase-negative Staphylococci, Streptococcus group (A, C, F and G), Enterococci, Streptococcus pneumoniae, Moraxella spp., Escherichia coli, Citrobacter spp., Proteus spp., Klebsiella spp., Pseudomonas spp. and Enterobacter spp. Overall, resistance rates of 57.8% to azithromycin and 68.5% to chloramphenicol were found. However, 86-94.4% sensitivity was demonstrated to ciprofloxacin and norfloxacin. Moderate sensitivity rates (61.8-78.4%) were observed to ceftriaxone, tetracycline and cotrimoxazole. Conclusion: Fluoroquinolones that have activity against the majority of bacterial isolates were potent at in vitro. However, unacceptably high levels of resistance to azithromycin and chloramphenicol in rural community indicated a need for further study and antimicrobial resistance surveillance.

Purpose: The purpose of our study is to present a surgical technique of primary porous orbital ball implantation with overlying mucus membrane graft (MMG) for reconstruction of severely contracted socket and to evaluate prosthesis retention and motility in comparison to dermis fat graft (DFG). Study Design: Prospective comparative study. Materials and Methods: A total of 24 patients of severe socket contracture (Grade 2-4 Krishna′s classification) were subdivided into two groups, 12 patients in each group. In Group I, DFG have been used for reconstruction. In Group II, porous polyethylene implant with MMG has been used as a primary procedure for socket reconstruction. In Group I DFG was carried out in usual procedure. In case of Group II, vascularized scar tissues were separated 360° and were fashioned into four strips. A scleral capped porous polyethylene implant was placed in the intraconal space and four strips of scar tissue were secured to the scleral cap and extended part overlapped the implant to make a twofold barrier between the implant and MMG. Patients were followed-up as per prefixed proforma. Prosthesis motility and retention between the two groups were measured. Results: In Group I, four patients had recurrence of contracture with fall out of prosthesis. In Group II stable reconstruction was achieved in all the patients. In terms of prosthesis motility, maximum in Group I was 39.2% and Group II, was 59.3%. The difference in prosthesis retention (P = 0.001) and motility (P = 0.004) between the two groups was significant. Conclusion: Primary socket reconstruction with porous orbital implant and MMG for severe socket contracture is an effective method in terms of prosthesis motility and prosthesis retention.

Purpose: This study was aimed at reporting the outcomes of trabeculectomy in primary juvenile open angle glaucoma (JOAG). Design: This study was a retrospective noncomparative case series. Materials and Methods: We included 60 eyes of 41 JOAG patients who underwent primary trabeculectomy without mitomycin-C (MMC) between 1995 and 2007. The primary outcome was success, defined as complete, if intraocular pressure (IOP) was >5 and ≤21 mmHg without medications or qualified if IOP was >5 and ≤21 mmHg with or without antiglaucoma medications. Secondary outcome measures were mean and percentage IOP reduction, complications, and risk factors for the failure of trabeculectomy. Results: The mean (±standard deviation) age at presentation was 24.1 ± 6.8 years (range, 12-35). Mean follow-up was 67 ± 41 months (range, 12-156). At 1 year, the probability of complete success was 92% (n = 56, 95% CI: 81-96%), at 3 years it was 89% (n = 47, 95% CI: 78-95%), and at the end of 5 years, it was 80% (n = 34, 95% CI: 65-89%). The probability of qualified success was 100% (n = 60) at 1 year, 98% (n = 51, 95% CI: 87-100%) at 3 years, and 96% (n = 36, 95% CI: 84-99%) at the end of 5 years. The mean IOP reduced from 35 ± 10 to 13 ± 2.5 mmHg (P < 0.001) after trabeculectomy. There was no serious postoperative complication. Young age was the only significant risk factor associated with the failure (odds ratio = 0.89, P = 0.03). Conclusion: Primary trabeculectomy without MMC has good success rates in JOAG.

In this retrospective case series, we report the spectrum and outcomes of aggressive posterior retinopathy of prematurity (APROP) in infants ≥1500 g birth weight. Twenty-nine eyes of 15 infants are included. All infants were referred from level I or II nurseries, received supplemental unmonitored oxygen for prolonged duration (>1 week) and had multiple systemic co-morbidities. Of the 29 eyes, 10 (34.5%) had zone 1 and 19 (65.5%) had posterior zone 2 disease. Twenty-five (86.2%) eyes had flat neovascularization and 4 (13.8%) eyes had brush like proliferation. We noticed large vascular loops in 10 (34.5%) eyes. After confluent laser photocoagulation, 22 (75.9%) eyes had a favorable outcome. The study concludes that APROP in heavier (≥1500 g birth weight) premature infants occurs mostly in posterior zone 2 with flat neovascularization and atypical features like large vascular loops. Supplemental unmonitored oxygen for prolonged duration and multiple systemic co-morbidities could be a contributing factor.

Purpose: The purpose of this study is to evaluate the lateral rectus periosteal fixation and partial vertical rectus transpositioning (VRT) as treatment modalities to correct exotropic Duane retraction syndrome (Exo-DRS). Materials and Methods: Prospective interventional case study of cases of Exo-DRS with limitation of adduction. A total of 13 patients were subdivided into two groups. Six patients underwent only lateral rectus periosteal fixation (group A) and seven patients also underwent partial VRT (group B). Assessment involved prism bar cover test, abduction and adduction range, extent of binocular single visual field and exophthalmometry. These tests were repeated at 1 week, 1 month and 3 months post-operatively and data analyzed. Results: The pre-operative mean values and ranges were 26.2 Δ (22-35) exotropia for group A and −21.3 Δ (14-30) exotropia for group B. The post-operative mean and range was +0.6 Δ esotropia (+20 to −8) for group A and 8 Δ (−2 to −20) exotropia for group B. Mean grade of limitation of abduction changed from −3.8 to −3.6 versus −3.6 to −2.8 and mean grade of limitation of adduction changed from −1.9 to −0.7 versus −1.5 to −0.5 in the groups A and B respectively. Mean binocular single visual field changed from 14.7° to 23.3° in group A and 11.8° to 26.4° in the group B respectively. Conclusion: Lateral rectus periosteal fixation is an effective surgery to correct the exodeviation, anomalous head posture and improving adduction in Exo-DRS and partial VRT in addition is effective in improving abduction and binocular single visual fields.

Purpose: To compare the outcome of Collagen cross-linking (CXL) with that following topography-guided customized ablation treatment (T-CAT) with simultaneous CXL in eyes with progressive keratoconus. Materials and Methods: This was a prospective, non-randomized single centre study of 66 eyes with progressive keratoconus. Of these, 40 eyes underwent CXL and 26 eyes underwent T-CAT + CXL. The refractive, topographic, tomographic and aberrometric changes measured at baseline, 1, 3 and 6 months post-operatively were compared between both groups. Results: After a mean follow-up of 7.7 ± 1.3 months, the mean retinoscopic cylinder decreased by 1.02 ± 3.16 D in the CXL group ( P = 0.1) and 2.87 ± 3.22 D in the T-CAT + CXL group ( P = 0.04). The Best corrected visual acuity increased by 2 lines or more in 10% of eyes in the CXL group and in 23.3% of eyes in the T-CAT + CXL group. The mean steepest-K reduced by 0.40 ± 3.71 D ( P = 0.77) in the CXL group and by 2.91 ± 2.01D ( P = 0.03) in the T-CAT + CXL group. The sag factor and surface asymmetry index showed no significant change in the CXL group but reduced by 3.59 ± 5.94 D ( P = 0.01) and 0.72 ± 1.18 ( P = 0.02) respectively in the T-CAT + CXL group. There was a significant increase in the highest posterior corneal elevation in both groups (9.57 ± 14.93 μ in the CXL group and 7.85 ± 9.25 μ in the T-CAT + CXL group, P ≤ 0.001 for both). There was significantly greater reduction of mean coma ( P < 0.001) and mean higher-order aberrations ( P = 0.01) following T-CAT + CXL compared to CXL. Conclusions: CAT + CXL is an effective approach to confer biomechanical stability and to improve the corneal contour in eyes with keratoconus and results in better refractive, topographic and aberrometric outcomes than CXL alone.

We performed endothelial keratoplasty (EK) in three eyes of two siblings (2.5 years, male and 3.5 years, female) with congenital hereditary endothelial dystrophy (CHED) and report the intraoperative and postoperative difficulties. Repeated iris prolapse, apprehension of crystalline lens touch due to positive vitreous pressure, and need for frequent air injections to attach the graft were intraoperative challenges in all three eyes. These were addressed by use of Sheet′s glide instead of Busin′s glide during graft insertion and suturing of main and side ports before air injection. One eye had graft dislocation on second postoperative day due to eye rubbing by the child. Graft was repositioned with air and a venting incision was created. Postoperative examination required repeated general anesthesia. Corneal edema resolved completely in all three eyes. Present case series highlights the possible intraoperative and postoperative challenges and their solutions in pediatric EK for CHED.

Purpose: To analyze the complications and their managements in Descemet′s stripping endothelial keratoplasty (DSEK) in consecutive 430 cases by single surgeon in a tertiary eye hospital. Materials and Methods: 430 eyes of 366 patients with endothelial dysfunctions scheduled for DSEK, were analyzed retrospectively. In all cases donor dissection was performed manually, and ′Taco′ insertion and unfolding technique was used. Intra-operative and postoperative complications with their managements and outcomes were reviewed retrospectively. Periodic endothelial cell density was analyzed for each patient till the last visit. Follow-up period was between 3 to 60 months (mean 18.7 months). Results: 13 (3.0%) eyes had operative complications during donor dissection and 16 (3.7%) had during recipient procedure. In 7 (1.6%) eyes, donor lenticule was replaced with a new one during the surgery. In early postoperative period, 21 (4.9%) eyes had donor dislocation and 12 (2.8%) eyes had air-induced pupillary block; and they were managed immediately. 2 cases had primary graft failure and in 1 case had postoperative bacterial endophthalmitis requiring evisceration. In late postoperative period, 48 (11.3%) eyes had secondary glaucoma and 14 (3.3%) eyes had late secondary graft failure. Endothelial rejection occurred in 5 (1.2%) cases. Mean endothelial cell loss was 19.7% after 3 months and 54.2% after 5 years. Total graft failure in this series was 31 (7.2%) and in 17 cases re-DSEK was performed successfully. Conclusions: Both operative and postoperative complications do occur in DSEK. Most of these complications can be managed by medical or appropriate surgical means. Some of the complications can be avoided and reduced with experience.

Context: The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers. Aims: We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts. Settings and Design: We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group. Materials and Methods: The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item "True/False/I don′t know" quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively. Statistical Analysis Used: Scores on the quiz were compared across groups and time-points using paired t-tests. Results: Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10 -6 ) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10 -16 ). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes. Conclusion: Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.

Background : Konkan coast of India is geographically distinct and its pattern of blindness has never been mapped. Aim : To study the prevalence and causes of blindness and cataract surgical services in Sindhudurg district of West Coast. Subjects : Individual aged > 50 years. Materials and Methods: Rapid assessment of avoidable blindness used to map blindness pattern in the district. Statistical analysis: SPSS version 19. Results: Amongst those examined 1415 (51.7%) had visual acuity (VA) >20/60, 924 (33.8%, confidence interval (C.I) 30.5%-36.8%) had VA 20/200-

Context: Children with learning disabilities might have difficulties to communicate effectively and give reliable responses as required in various visual function testing procedures. Aims: The purpose of this study was to compare the testability of visual acuity using the modified Early Treatment Diabetic Retinopathy Study (ETDRS) and Cambridge Crowding Cards, stereo acuity using Lang Stereo test II and Butterfly stereo tests and colour perception using Colour Vision Test Made Easy (CVTME) and Ishihara′s Test for Colour Deficiency (Ishihara Test) between children in mainstream classes and children with learning disabilities in special education classes in government primary schools. Materials and Methods: A total of 100 primary school children (50 children from mainstream classes and 50 children from special education classes) matched in age were recruited in this cross-sectional comparative study. The testability was determined by the percentage of children who were able to give reliable respond as required by the respective tests. ′Unable to test′ was defined as inappropriate response or uncooperative despite best efforts of the screener. Results: The testability of the modified ETDRS, Butterfly stereo test and Ishihara test for respective visual function tests were found lower among children in special education classes ( P < 0.001) but not in Cambridge Crowding Cards, Lang Stereo test II and CVTME. Conclusion: Non verbal or "matching" approaches were found to be more superior in testing visual functions in children with learning disabilities. Modifications of vision testing procedures are essential for children with learning disabilities.

Aim : To study long term outcome of bilateral congenital and developmental cataract surgery. Subjects: 258 pediatric cataract operated eyes of 129 children. Materials and Methods: Children who underwent pediatric cataract surgery in 2004-8 were traced and examined prospectively in 2010-11. Demographic and clinical factors were noted from retrospective chart readings. All children underwent visual acuity estimation and comprehensive ocular examination in a standardized manner. L. V. Prasad Child Vision Function scores (LVP-CVF) were noted for before and after surgery. Statistics: Statistical analysis was done with SPSS version 16 including multi-variate analysis. Results: Children aged 9.1 years (std dev 4.6, range 7 weeks-15 years) at the time of surgery. 74/129 (57.4%) were boys. The average duration of follow-up was 4.4 years (stddev 1.6, range 3-8 years). 177 (68.6%) eyes had vision 6/18 and 157 (60.9%) had BCVA >6/60 3-8 years after surgery. 48 (37.2%) had binocular stereoacuity

Aim of Study: The aim of current work was to evaluate in vitro anticataract potential of Moringa oliefera extract. Materials and Methods: Goat eye lenses were divided into 4 groups; Group served as control, Group II as toxic control, Group III and Group IV were incubated in extract (250 μg/ml and 500 μg/ml of extract of M. oliefera) Group II, III and IV were incubated in 55 mM glucose in artificial aqueous humor to induce lens opacification. Estimation of total, water soluble protein, catalase, glutathione and malondialdehyde along with photographic evaluation of lens was done. Results: Group II (toxic control) lenses showed high amount of MDA (Malondialdehyde), soluble, insoluble protein, decreased catalase and glutathione levels, while lenses treated with Moringa oliefera extract (Group III and Group IV) showed significant (FNx01 P < 0.05) reduction in MDA and increased level of catalase, glutathione, total and soluble protein. Conclusion: Results of present findings suggest protective effect of Moringa oliefera in prevention of in vitro glucose induced cataract.