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Objective:Visual acuity (VA) testing is crucial for early intervention in cases of visual impairment, especially in rural health care. This study aimed to determine the potential of a web-based VA test (PocDoc) in addressing the unique health care needs of rural areas through the comparison in its effectiveness against the conventional VA test in identifying visual impairment among an Indian rural population. Methods:Prospective comparative study conducted in December 2022 at a tertiary referral eye care center in central India. We evaluated all patients with the PocDoc VA tests using three device types, and the conventional VA test. Bland–Altman plot (BAP) compared PocDoc and conventional VA tests. Fisher's exact tests evaluated associations between categorical parameters. Kruskal–Wallis tests followed by post hoc Dunn's tests identified association between categorical parameters and numerical parameters. Results:We evaluated 428 patients (792 measurements of VA) with mean age 36.7 (±23.3) years. PocDoc resulted in slightly worse VA scores (mean logMAR: 0.345) than conventional (mean logMAR: 0.315). Correlation coefficient between the conventional and PocDoc logMAR VA values was rho = 0.845 and rho2 = 0.7133 (p = 6.617 × 10–215; adjusted p = 2.205 × 10–214). Most data points fell within the interchangeable range of ±0.32 on BAP. Difference between the two methods increased with higher logMAR values, indicating poorer agreement for worse VA scores. Conclusions:Identifying and addressing the unique health care needs of rural populations is critical, including access to appropriate and effective VA testing methods. Validating and improving VA testing methods can ensure early intervention and improve the quality of life for individuals with visual impairment. [ABSTRACT FROM AUTHOR]

Objective To assess how the returns on investment from correcting refractive errors and cataracts in low- and middle-income countries compare with the returns from other global development interventions. Methods We adopted two complementary approaches to estimate benefit-cost ratios from eye health investment. First, we systematically searched PubMed® and Web of Science™ on 14 August 2023 for studies conducted in low-and-middle-income countries, which have measured welfare impacts associated with correcting refractive errors and cataracts. Using benefit-cost analysis, we compared these impacts to costs. Second, we employed an economic modelling analysis to estimate benefit-cost ratios from eye health investments in India. We compared the returns from eye health to returns in other domains across global health and development. Findings We identified 21 studies from 10 countries. Thirteen outcomes highlighted impacts from refractive error correction for school students. From the systematic review, we used 17 out of 33 outcomes for benefit-cost analyses, with the median benefit-cost ratio being 36. The economic modelling approach for India generated benefit-cost ratios ranging from 28 for vision centres to 42 for school eye screening, with an aggregate ratio of 31. Comparing our findings to the typical investment in global development shows that eye health investment returns six times more benefits (median benefit-cost ratio: 36 vs 6). Conclusion Eye health investments provide economic benefits with varying degrees based on the intervention type and location. Our findings underline the importance of incorporating eye health initiatives into broader development strategies for substantial societal returns. [ABSTRACT FROM AUTHOR]

Introduction: Endophthalmitis is a serious, sight-threatening purulent inflammation of the intraocular cavities of the eyeball. It greatly affects vision and can lead to severe complications such as panophthalmitis. The prevalence of endophthalmitis varies from one place to another. Aim: To identify the various aetiological and predisposing factors that contribute to endophthalmitis and to assess the visual outcomes following medical intervention (intravitreal antibiotics only) and surgical intervention (both intravitreal antibiotics and pars plana vitrectomy). Materials and Methods: The present study was conducted in the Department of Ophthalmology at Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India between January 2023 and February 2023. Demographic and clinical data of patients diagnosed with endophthalmitis over a two year period from October 2020 to September 2022 were collected from the Medical Records Department of the Institution for analysis. A total of 50 case records were selected using convenience sampling. Demographic details such as age, gender, predisposing risk factors, visual acuity, microbiological profiles, treatment modalities, and final visual acuity were collected from the present study. Quantitative data was presented as Mean and Standard Deviation (SD), while qualitative data was presented as frequencies and percentages. Summary statistics were analysed using Microsoft Excel version 2018. Results: In present study, 29 (58%) were males and 21 (42%) were females, with the majority falling within the age group of 50-70 years. The mean age of the sample was 53.8±16.1 years. Postoperative causes accounted for 39 (78%) of the cases, with phacoemulsification surgery with foldable intraocular lens implantation being the leading cause in 23 (58.7%) cases. Culture positivity was observed in only 22 (44%) cases, with Staphylococcus (Staph) epidermidis as the major causative organism. The best visual acuity achieved was 6/12 for two patients. Conclusion: Postoperative endophthalmitis remains the most common cause of endophthalmitis. Additionally, patients who presented with better visual acuity had a better visual outcome after treatment. Therefore, patients should be educated about the early signs of endophthalmitis to ensure prompt medical attention and improve visual recovery. [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 examine the eye care practice in the Mumbai Metropolitan Region (MMR). Methods: This study consisted of primary and secondary research conducted in five zones of MMR. The primary research included interviews with the patients, eye care providers, and key opinion leaders. The secondary research included analyzing data from the professional ophthalmology societies, public health domain, and health insurance providers. We divided people into three economic classes by annual income – low (1.8 m). We analyzed the collected data to estimate the eye care demand–supply, quality of eye care, health-seeking behavior, gap in eye care delivery, and eye care expenditure. Results: We examined 473 key eye care facilities and interviewed 513 people. The ophthalmologist density in MMR was 80/million, and it was the highest in North MMR. Most ophthalmologists visited several facilities. Cataract surgery and glaucoma care coverage were better than other specialties; it was poor for oncology and oculoplastic services. Annual eye examination practice was poor in the low- and middle-income groups than in the high-income group (48%–50% vs. 85%). Most people preferred visiting eye care facilities within 5 km of their residence. Out-of-pocket spending was between 60% and 83%. Lower-income group people preferred public facilities. Conclusion: MMR eye care needs further improvement in affordable and accessible eye care, health literacy, public health surveillance, research into the application of newer technologies to provide less-expensive home care for the elderly and minimize their hospital visits, and collection and analysis of big data to address city-specific eye health issues. [ABSTRACT FROM AUTHOR]

Purpose: The study intends to evaluate the demographic and clinical profile of pediatric patients (0–18 years) attending six vision centers (VCs) of a tertiary eye care facility in south India. Methods: This is a cross-sectional observation study conducted at six major peripheral VCs of a tertiary eye care facility in South India from June 20 to Dec 20. All children presenting at the VCs under a base hospital (BH) in Pondicherry, whose parents gave consent were included. Data were entered by the ophthalmic assistants in the VC and cross checked by the principal investigator at the BH. Results: A total of 250 pediatric patients were brought to the VCs during the study period, predominantly males (60.8%), with a mean age of 8.2 ± 4.5 years (0–18 years). Half of them were staying within 5 km from the VCs. Most children were escorted by their parents (88%), and the expenditure of travel to the VC was affordable for most of the parents (75%). Also, 53.6% of patients were in their primary school, while schooling had not started for 28% of children. Visual acuity (VA) could be assessed only for school-going children and older children due to lack of age-matched VA assessment tools. Most children (91.3%) had uncorrected VA better than or equal to 6/18 in the better eye, and approximately 3% had VA worse than 6/60. All patients had best corrected VA of 6/6–6/18 after cycloplegic refraction. Most children reported to the VC for allergic conjunctivitis (25%), followed by refractive error (13%) and squint (10.4%). Urgent referral to the BH was made for 47 children. Conclusion: Primary eye care in pediatric population-I (PREPP-I) showed that most children can be treated at the VCs and only one-fifth of the children require active intervention at higher referral centers. Further study on satisfaction of services provided for pediatric patients in these VCs and barriers of not reporting to the BH when referred are considered for the PREPP-II study. [ABSTRACT FROM AUTHOR]

Purpose: To study the clinical and demographic profile of patients less than 40 years of age presenting to glaucoma services including the reasons for referral.Methods: Patients in the age group of 5 to 39 years, visiting the glaucoma clinic, who were either suspected to have glaucoma or who had been newly/previously diagnosed with glaucoma were included in the study. After informed written consent, basic demographic details of the participants including age, gender, education, socioeconomic status, and family history were obtained. A comprehensive ophthalmological evaluation was performed by glaucoma specialists.Results: The proportion of glaucoma in the study population (n = 384) was found to be 31.25%, and the incidence of glaucoma among new patients was found to be 11.9%. Among all glaucomas (n = 120), 44.2% of patients had secondary glaucomas, 27.5% had primary glaucomas, and 28.3% had congenital glaucomas. Also, 67.3% of all glaucoma patients were males. Newly diagnosed glaucoma patients presented with a mean intraocular pressure (IOP) of 32.9 mmHg and mild-moderate disc damage with a mean cup-disc ratio of 0.65. Nearly one-third of them had a presenting visual acuity worse than 5/60. The most common reason for referral was raised IOP. Univariate and multivariate analysis revealed that the odds of developing glaucoma were less in females (P = 0.04) and in patients with a higher standard of living index (P < 0.001).Conclusion: One-third of the patients had glaucoma and another one-third were suspects. Secondary glaucomas are more common than primary/congenital glaucomas. A comprehensive eye evaluation is a must, especially in those with predisposing factors. [ABSTRACT FROM AUTHOR]

Purpose: To report the ocular features of patients with PD who presented with visual complaints to a tertiary eye care center.Methods: This was a retrospective study carried out between January 2015 and March 2020 at the Neuro-Optometry clinic of a tertiary eye care center in Southern India. All PD patients with ocular complaints examined by the neuro- ophthalmologists were referred to Neuro-Optometry Clinic for detailed evaluation. Patients with other neurodegenerative disorders, brain injury, and other causes of vision loss or extraocular motility disorders were excluded.Results: A total of 43 patients (7 females, 36 males) between 50 and 86 years of age (mean: 70 ± 8.9 years) with a mean duration of PD of 4.5 ± 4.5 years were studied. Decreased vision associated with reading difficulty (40%) was common in PD patients. In terms of gaze restriction, vertical gaze involvement (35%) was more than horizontal involvement (7%). Convergence insufficiency (CI) was the most common binocular vision dysfunction (30%), followed by CI with oculomotor dysfunction (14%) and vertical gaze palsy (18%). Ground prisms were recommended for 26 patients (61%) and home vision therapy for 5 patients (12%) as corrective measures.Conclusion: Binocular vision dysfunction is highly prevalent among PD patients. This could potentially contribute to the reading difficulties and double vision encountered by these patients. Assessment of binocular vision and oculomotor parameters thus becomes important to understand and manage the reading difficulties in patients with PD. [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]

Introduction: Visual impairment has a silent chronic course which has a significant impact on the quality of life but is often a preventable community problem. Comprehensive assessment of ophthalmic outcomes should include not only the objective measurement but also the subjective perception of vision loss on vision function. Aim: To estimate the proportion of visual impairment and perceived visual functioning and also to find out the factors, if any associated with it, among women aged18-59 years in a slum of Kolkata. Methodology: It was a community-based cross-sectional study conducted among 153 women aged 18-59 years residing in a slum of Chetla, which is under the urban field practice area of All India Institute of Hygiene & Public Health, Kolkata within 3 months of duration (Mar - May 2017). Results: In the present study, 49(32%) study subjects were visually impaired among which 3(2%) were blind. 42.4% of study subjects' perceived poor visual function. Logistic regression showed aged 40 years and above, below and primary educational level, non-working, who had eye checkup and diabetic had higher odds of visual impairment and perceived poor visual function whereas after adjustment, diabetic status lost its significance. Conclusion: Eye care programmes in our country still have curative approach; it must shift towards preventive approach. [ABSTRACT FROM AUTHOR]

Aims To assess the willingness to utilise follow-up eye care services among participants of community vision screenings in rural villages surrounding Chennai. Methods Vision screening participants aged ⩾40 years were selected by systematic sampling and were invited to respond to a pretested verbal survey with close-ended questions before undergoing screening. Results Two hundred and ninety-two people responded. Among the respondents, 50.3% reported experiencing an eye problem, and 53% of these individuals had never had an eye examination. Acceptance rate for eye surgery, medications, and eyeglasses among the respondents was 59.2%, 52.7% and 90.8%, respectively. These acceptances were not associated with sex, age, or employment; medication acceptance was inversely associated with literacy. Surgery acceptance and medication acceptance were associated with area of residence. Presence of another chronic disease was a predictor for surgery acceptance among respondents experiencing eye problems. Conclusions Maintaining consistent quality of services delivered is crucial for increasing uptake of existing eye care services. Educational interventions may increase eye care service usage by targeting all demographic subgroups of rural populations equally. Additional interventions should be offered to patients without previous exposure to the healthcare system. [ABSTRACT FROM AUTHOR]