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To describe the clinical profile of patients presented with Acanthamoeba keratitis (AK) to a multi-tier ophthalmology hospital network in India. This cross-sectional hospital-based study included 1945339 new patients registering between September 2016 and May 2022. Patients with clinically confirmed diagnosis of AK in one or both eyes were included in the study. All the relevant data were documented using an electronic medical record (EMR) system. A total of 245 (0.013%) patients were diagnosed with AK and majority were male (62.86%) with unilateral (99.59%) affliction. The most common age group was during the fourth decade of life, 65 (26.53%) patients and predominantly were adults (95.51%). The prevalence of the infection was higher in patients from a lower socioeconomic status (43.27%) from rural geography (52.24%) and in agriculture-related work (28.16%). The most common inciting factor was injury with vegetative matter (8.98%), dust (7.76%) and contact lens wear (4.49%). The majority of the eyes had blindness (20/400 to 20/1200) in 116 (47.15%) eyes with a presenting visual acuity (logMAR) of 2.14 ± 1.04. Among the surgical interventions, therapeutic keratoplasty was performed in 41 (16.67%) eyes, penetrating keratoplasty in 22 (8.94%) eyes, and evisceration in 2 (0.81%) eyes. AK more commonly affects males presenting during the fourth decade of life from lower socio-economic status and is predominantly unilateral. A fourth of the affected eyes underwent keratoplasty and the majority had significant visual impairment at presentation. [ABSTRACT FROM AUTHOR]

There is a lack of clinical guidelines in India for the prescription of blue-blocking lenses. Therefore, the practice trends will depend on practitioners' knowledge, attitude, and perception. Exposure to blue light with increased use of light-emitting diode (LED) lights and digital devices along with the commercial availability of blue blocking lenses has warranted the need to understand the factors that influence the prescription of blue blocking lenses among eye care practitioners. Hence, we aim to assess knowledge, perception, and practice pattern of blue blocking lenses among Indian optometrists. This cross-sectional online survey was conducted among Indian Optometrists. The survey was distributed through various social groups of optometrists and state associations. The questionnaire had four main domains with 29 items in total. The four major domains were knowledge, practice, perception and demographic details on education. Descriptive analysis and logistic regression were performed to study the impact of these domains on the prescription of blue block lenses. Out of 341 responses, 247 were included for analysis as per study criteria. About 50% (n = 123) of the participants had appropriate knowledge about blue light. Blue-blocking lenses were prescribed always or most of the time by 52% (n = 130) of the participants. The odds of prescribing blue blocking lenses were higher among practitioners who considered blue light as an important factor in causing computer vision syndrome (OR 3.77, 95% CI: 1.33–10.69, P = 0.01) or if they considered there is adequate published evidence (OR 3.95, 95% CI: 1.58–9.87, P = 0.003). The source of evidence for prescribing blue-blocking lenses for our participants was mainly from advertisements rather than from scientific studies. Factors such as awareness, knowledge, education, and nature of practice did not play a significant role in prescribing blue-blocking lenses. This raises the need for evidence-based practice and the development of practice guidelines for prescribing blue-blocking lenses. [ABSTRACT FROM AUTHOR]

Explore door-to-door eye screening in India as a model to reach school age children in need of eye care, especially during school closures due to the Covid-19 pandemic. Children between 5 and 18 years were screened in an urban-slum of Delhi from September 2020 to March 2021. Screening included capturing ocular complaints, visual acuity and conducting a torchlight examination. Children with any eye-related complaints, gross abnormality or a LogMAR acuity of more than 0.2 in either eye were referred to the nearby vision centre. Data were disaggregated by gender and age group. Reporting after referral and proportion of true positives referrals were used to assess the model. 32,857 children were screened. 55% were boys. Only 917 children (2.8%) had previous eye examinations. 1814 (5.5%) children were referred. Overall compliance rate amongst those referred was 59% (1070 of 1814) and compliance was significantly higher (72%) amongst those referred with poor vision as compared to those with only ocular morbidities (38%). Overall compliance was significantly higher amongst older age group (64% vs 50%) and amongst girls than boys (61% vs 56%). 3.9% children were detected with refractive error (RE) and 2.5% with uncorrected RE which was significantly higher in girls and in older age group. Of 1070 children reporting after referral, 85% had confirmed diagnosis for RE or other ocular pathology. Door-to-door screening had good referral compliance and positive predictive value. We recommend this model as a supplement to school screening especially in regions with low enrolment and high absenteeism in schools. [ABSTRACT FROM AUTHOR]

School eye screening is a crucial strategy in the elimination of childhood blindness because of its ability to reach out to children who are otherwise inaccessible to eye care needs. Comprehensive screening programs are recommended and are beneficial, but the economic aspects of such models remain to be understood. This study aimed to analyse the cost of a comprehensive school eye screening model while utilizing optometrists and optometry students. This cross-sectional study was conducted for 295 schools screened in the academic year 2018–2019. The analysis was performed from the service provider's perspective including only the direct costs. Financial records were used for cost estimates. The outcome measures were cost per school and child, predictors for the cost, DALYs averted, cost of childhood blindness, and Benefit–Cost Ratio. A total of 65 094 children underwent screening from 295 schools. The median (IQR) cost per school and child for screening was $29.65 (29.65–44.34) and $0.66 (0.32–1.13). The regression model predicted that the cost of screening was dependent on school strength, number of screening personnel, distance of the schools, and deliverables. With the interventions to improve compliance, 14686.30 DALYs have been averted. Loss of productivity due to childhood blindness was estimated to be $339070.83. Screening for colour vision also had a Benefit–Cost ratio of greater than one. Cost of screening was low and the benefits were high while utilising optometrist and optometry students along with a comprehensive screening protocol. [ABSTRACT FROM AUTHOR]

To study the clinical, microbiological profile and management outcomes of orbital abscess at a tertiary care center in South India. In a retrospective interventional case series, we reviewed all patients diagnosed with orbital cellulitis from 2000–2020. The data analyzed included demographic profile, clinical and radiological features, microbiological profile, and management outcome. A total of 921 cases of orbital and periorbital infections were reviewed. Seventy-two cases were diagnosed as orbital cellulitis. Thirty-four cases (47.22%) had radiological evidence of orbital abscess. The median age was 20.63 years. Three patients (8.82%) were neonates. A male preponderance was noted (23, 67.65%). Sinusitis (10, 29.41%) and diabetes (5, 14.7%), were the most common predisposing factors. Optic neuropathy was seen in 15 (44.11%) patients, cavernous sinus thrombosis in two patients (5.88%), and septicemia in one patient (2.94%) Multiple orbital abscesses were noted in 7 (20.59%) cases. All patients underwent surgical drainage. Methicillin-sensitive Staphylococcus aureus was the most common organism isolated in 14 patients (41.18%). Vision improvement or stabilization was seen in all except 3 (8.82%) Orbital abscess is a potential sight-threatening orbital infection. The infective process can spread and ascend up to involve cavernous sinus thereby becoming life-threatening. A timely diagnosis and intervention can halt the disease process and help restore vision in many cases. [ABSTRACT FROM AUTHOR]

To describe the socioeconomic profile, awareness level and reasons for the delay in accessing timely eye care for cataract surgery in patients of lens-induced glaucoma (LIG). This cross-sectional observational study included all patients with LIG who presented to a tertiary eye care centre in central rural India between March 2019 to February 2020. Data were collected through a questionnaire. Out of the 731 patients included in the study, the majority were females (69.36%). The mean age of the patients at presentation was 62.66 ± 10.37 years. Only a few participants, 193 (26.40%) were aware of LIG. Lower socioeconomic profile, older age, female gender and illiteracy were found to be strongly associated with awareness about LIG (p <.001). Patients waiting for the winter season (58.27%) to get operated was the major reason for delayed presentation to the hospital. Other reasons for the delayed presentation were – need not felt (feeling that intervention was not necessary) due to good vision in other eye (14.36%), financial issues (11.63%), long travelling distance (7.11%), no caretaker (6.89%), medical illness (1.78%) and fear of surgery (0.55%). Delayed reporting for eye healthcare in patients of LIG is found to be multifactorial. Most patients preferred waiting for the winter season to get their eyes operated, which throws light on the mindset and ignorance of the patients in this part of central rural India. We further emphasize on strengthening the education and counseling efforts in the community to enable patients to access services in a timely fashion. [ABSTRACT FROM AUTHOR]

Separating Isotope Facts from Fallacies compares how intelligence agencies have performed in assessing the nuclear proliferation intentions of other countries. Using original archival and declassified documents from the Cold War era, the study appraises the accuracy of American, British, and West German intelligence proliferation assessments of India and Argentina. Contrary to pervasive scepticism, the available historical documentation shows that intelligence agencies did not habitually inflate their assessments of proliferation risks unless they anticipated arms race dynamics. Second, target state attitudes toward the nonproliferation regime provide essential clues to their nuclear intent. Third, more information about intentions did not inherently improve accuracy. [ABSTRACT FROM AUTHOR]

Purpose: To report the clinical profile of cataract and its surgical management in a scleritis cohort from India. Methods: We conducted a retrospective review of medical records of 39 eyes of 32 consecutive patients with scleritis who underwent cataract surgery in a tertiary eye care institute. Results: The mean age at presentation was 50.9 ± 11.1 years and 65.6% of the patients were female. Five patients (15.6%) were ≤ 40 years of age. Necrotizing scleritis (56.4%) was the most common subtype of scleritis in this cohort followed by diffuse anterior scleritis (28.2%), nodular scleritis (12.8%). The preferred incision for phacoemulsification was clear corneal in 30 eyes (77%). In the immediate post-operative period, four eyes (10.2%) developed severe corneal edema, one eye had descemet membrane detachment. Anterior chamber reaction was observed in 18 eyes (46.1%). Fifteen eyes (38.4%) developed raised intraocular pressure and two required surgical intervention after 3 months of cataract surgery. Early posterior capsular opacification was observed in 5 eyes (12.8%) and cystoid macular edema in 2 eyes (5.1%). Conclusion: In addition to providing a distinct pattern of cataract, index study showed that long-term control of scleral inflammation prior to the cataract surgery remains the primary requisite for the successful outcome. [ABSTRACT FROM AUTHOR]

To investigate the prevalence, causes and risk factors for vision impairment (VI) among the elderly population in Telangana State, India. A population-based cross-sectional study were conducted in four districts. All participants had eye examinations including visual acuity assessment for distance and near, anterior segment examination and non-mydriatic fundus imaging by trained personnel. VI was defined as presenting visual acuity worse than 6/18 in the better eye. Individuals aged ≥60 years were considered as elderly. In total, 11,238/12,150 (92.5%) individuals aged ≥40 years were examined. Of this, the dataset of 3,640 individuals (32.4%) elderly participants was used for analysis. Among the 3,640 participants, 53.1% were women and 78.1% had no education. The mean age of the participants was 67.8 years (standard deviation: 7 years; range: 60 to 102 years). The age and gender-adjusted prevalence of VI was 32.1% (95% CI: 29.5–34.8). On multivariable analysis, the odds of VI was significantly higher in older age groups, and among those with no education. Gender and district of residence were not associated with the prevalence of VI. Cataract (54.8%) was the leading cause of VI followed by uncorrected refractive errors (37.6%). VI was common and largely avoidable in the elderly population in Telangana state in India. Elderly centric eye care including screening for vision loss, provision of cataract surgery and spectacles can be used as strategies to address VI in the elderly. [ABSTRACT FROM AUTHOR]

To estimate prevalence and causes of avoidable blindness among people ≥50 years and to assess willingness to pay (WTP) for cataract surgery in tribal region of south Gujarat, India. A cross-sectional population based survey was conducted with 44 randomly selected clusters each having 50 people aged ≥50 years selected by probability proportional to size of sampling. Adults identified with cataract causing visual loss (<6/18) in any eye were interviewed to assess their WTP for surgery. Total of 2137 examined out of 2200 people enumerated (response rate 97.1%). The prevalence of blindness (Presenting Visual Acuity (PVA)<3/60 in better eye) was 2.23% (95% CI: 2.95%–1.51%). Cataract was main cause of blindness (67.3%) followed by corneal scarring (8.2%). Major barrier to cataract surgery cited by bilaterally blind people was lack of escort to the surgical facility (34.3%). Cataract surgical coverage (CSC) was 84.9% (eyes) and 92% (persons). Of the 492 people interviewed to assess WTP for their surgery, only 36.4% people were willing to pay. The tribal population has a high poverty profile in India. Within this group, cataract remains the main treatable cause of blindness despite a high CSC. Assessment of barriers suggested that a well-coordinated outreach programme with free transport facilities to the surgical facility is required along with strategies to improve accessibility and prioritising cataract blind in the community. One-third of people were willing to pay for their surgeries implying that cross subsidization or tier system could be feasible for eye care programme sustainability. [ABSTRACT FROM AUTHOR]

Old age often marks a period of changed socioeconomic position and physical infirmity. Older adults make up a large and complex population sub-group where several identities and characteristics coalesce to create intersectional experiences. Visual impairment can be prevented or cured to a large extent. Globally, women's access to eye care is lower than that for men. We use the intersectionality lens to examine the experiences of women above the age of 50 years in an impoverished region of India. In-depth interviews were carried out with 12 women in the Indian Sundarbans. They have been categorised into three age groups: young-old, middle-old, and old-old. All of them had either low vision or high visual impairment. Our study shows that women's vulnerability gets compounded gradually. Gendered vulnerabilities such as women's restricted mobility and economic dependency continue with increasing age and visual impairment. Physical dependency worsens with time and increasing visual impairment. Women's gendered roles undergo a change. Their living arrangements may change. Such dynamism has a bearing on women's eye care-seeking behaviour. Our study calls for the recognition of intersectional gendered experiences during the provision of eye care services so that the needs of older women are met in an appropriate manner as they age. [ABSTRACT FROM AUTHOR]

The integration of primary eyecare into existing primary healthcare systems requires simple yet effective tools that do not overburden the grass-root level worker. The objective of this study was to test the accuracy of a questionnaire-based tool administered by trained community-based rehabilitation volunteers (CBRVs) in identifying persons with visual disability, proportions accessing referral pathway and barriers to uptake of eyecare services. CBRVs working in the urban-slum service area of a teaching hospital were trained in administering a questionnaire-based tool derived from the World Health Organization (WHO) "Training in the community for people with disabilities" to a responsible adult member of the household. Post-training, they screened and referred adults with perceived visual problems. This tool was tested against two reference standards: (i) history of visual disability elicited by ophthalmologist; (ii) pre-set visual acuity and diagnosis criteria. Ten CBRVs screened 950 individuals of whom 805 (84.7%) were examined by an optometrist and ophthalmologist. Sensitivity and specificity of this method were 75% (95% CI 72–78%), 95.8% (95% CI 94–98%) respectively, using history and 60.2% (95% CI 57–63%), 91.8% (95% CI 90–94%) using clinical criteria as reference standard. Referral pathway was used by 91/221 (41.2%) referred individuals. The commonest barriers to accessing eye care were 'did not feel the need' (32.2%) and 'busy with work/household responsibilities' (30.2%). This questionnaire-based tool administered by grass-root level health workers to a responsible adult member of the family may be a promising screening method for identification and appropriate referral of persons with visual disability in the community. [ABSTRACT FROM AUTHOR]

Purpose: Primary eye care services delivered through vision centres (VC) form an essential part of the national blindness control efforts, but systematic data on the outputs and cost of providing such services in India are not readily available for further planning and efficient use of resources. Methods: Detailed cost and output data were collected from written records for 2017–2018 fiscal year using standardized methods at nine VC in Kolkata city in West Bengal, India. The total economic cost for these VC was computed and the relation of unit cost of services per patient screened with VC scale was assessed using regression analysis. Break-even point was estimated from average and marginal cost functions. Results: 25,009 patients were screened at the 9 VC (range 709–5,717; median 2,826). The overall total economic cost was INR 7,304,172 (USD 113,306), ranging from INR. 509,618 (USD. 7,905) to INR. 1,390,855 (USD. 21,576). Personnel salaries made up 37.8% of the total cost. The unit economic cost of screening a patient was INR 292.1 (USD 4.4) and varied threefold between 9 VC. With a multiple regression model (p <.035, R2 = 0.797), apart from the fixed costs, the incremental cost for each patient screened was INR 81.33 (USD 1.26). Break-even analysis suggested that 44.4% of the VCs were functioning below optimal scale. Conclusion: A further reduction in the unit costs is possible if the optimal scale of services is achieved. These findings can inform resource requirement for the primary eye care services in India. [ABSTRACT FROM AUTHOR]

Purpose: To determine the repeatability and reproducibility of anterior segment optical coherence tomography (AS-OCT) and Scheimpflug photography for several measurements of corneal scars, including scar size, scar depth, and corneal thickness. Methods: A series of patients treated for fungal keratitis at a tertiary eye care center in South India were recalled two years after successful treatment. Eyes with corneal scars had a slit lamp examination performed by two ophthalmologists masked to the other's examination. For AS-OCT and Scheimpflug photography, each eye had two scans taken by one technician and a third scan taken by a separate technician. Scar measurements were subsequently assessed from AS-OCT images by three graders masked to each other's results. Repeatability and reproducibility were assessed by calculating the intra-class correlation coefficient (ICC) from mixed effects linear regression models. Results: Fifty eyes had all measurements taken. The corneal scar size, measured as the geometric mean of the two longest perpendicular meridians, ranged from 0.8 to 5.4 (mean 2.8 mm, 95%CI 2.6 to 3.1). Scar size measurements taken by two separate individuals were most reproducible when the border of the scar was traced from the OCT (ICC 0.90, 95%CI 0.86 to 0.94), and least repeatable when assessed from slit lamp examination (ICC 0.80, 95%CI 0.70 to 0.90). Conclusions: AS-OCT and Scheimpflug imaging of corneal scars produced measurements with acceptable reproducibility that could be useful as cornea-specific outcomes for clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: To analyse clinical profile of the patients with HLA B 27- associated uveitis in a tertiary care eye hospital in Eastern India Method: Retrospective analysis of 61 eyes of 43 patients with HLA B27- associated uveitis between 2015 and 2016. Result: We observed a male predominance (67%), and more unilateral involvement (58%) in our patients. The mean age of presentation was 44.7 ±11.7 years. Significant vitritis and macular edema were noted in 14 and 7 eyes respectively. In addition to topical therapy, oral steroid was required in 49% patients and 58% patients were treated with methotrexate. Five patients (12%) required biologicals. There was improvement in BCVA at final follow-up (p<0.001). Conclusion: Compared to the existing literature, the current study observed relatively high age of presentation and frequent posterior segment involvement with less systemic association. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical pattern of scleritis in patients ≤16 years of age at a tertiary care eye hospital in India. Methods: The medical records of 24 eyes of 20 children with scleritis were included in this retrospective study. Collected data included age, subsets of uveitis, best corrected visual acuities (BCVA), detailed laboratory investigations and treatment. Results: Mean age at presentation was 12.2 ± 2.5 years. Scleritis was unilateral in 80% patients and an equal gender distribution was observed. Posterior scleritis (41.7%) was the most common subtypes of scleritis and nodular scleritis was the most common type of anterior scleritis (33.3%). Necrotizing scleritis was seen in 16.7% eyes. Tuberculosis was the only systemic association and found in three (15%) patients. Conclusions: Clinical profile of scleritis in children can be different from that of adults. [ABSTRACT FROM AUTHOR]

Background: Contact lens fittings in a hospital-based practice are different from those in private practices because of specialised conditions. Few studies have been published on material preferences of such wearers, especially in long-term wearers. The aim of this study is to document contact lens prescribing trends in a hospital-based practice among long-term lens wearers and to identify their demographic profile.Methods: Subjects reporting to a contact lens clinic of a tertiary eye-care centre in India from 1 January 2014 to 31 December 2014, with a minimum of five years of lens wear, were included in the study. Data were collected retrospectively from the electronic medical charts of these subjects.Results: Three hundred and sixty subjects were included in the study. The average duration of contact lens wear among the subjects was 9 ± 5 years (range: 5-35 years). The average age of the subjects was 31.38 ± 11.75 years (age range: 5-78 years). Hydrogel material and soft spherical type were preferred by most of the soft lens wearers (53 per cent). Eighty per cent of subjects followed hand hygiene and cleaning regimen practices.Conclusion: The preference for monthly replacement lenses and silicone hydrogel material increased over the years. Regular after-care consultations could enforce the need for compliance with hand hygiene and cleaning regimens among lens wearers. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to develop and validate an instrument to measure job satisfaction in eye-care personnel and assess the job satisfaction of one-year trained vision technicians in India.Methods: A pilot instrument for assessing job satisfaction was developed, based on a literature review and input from a public health expert panel. Rasch analysis was used to assess psychometric properties and to undertake an iterative item reduction. The instrument was then administered to vision technicians in vision centres of Andhra Pradesh in India. Associations between vision technicians' job satisfaction and factors such as age, gender and experience were analysed using t-test and one-way analysis of variance.Results: Rasch analysis confirmed that the 15-item job satisfaction in eye-care personnel (JSEP) was a unidimensional instrument with good fit statistics, measurement precisions and absence of differential item functioning. Overall, vision technicians reported high rates of job satisfaction (0.46 logits). Age, gender and experience were not associated with high job satisfaction score. Item score analysis showed non-financial incentives, salary and workload were the most important determinants of job satisfaction.Conclusions: The 15-item JSEP instrument is a valid instrument for assessing job satisfaction among eye-care personnel. Overall, vision technicians in India demonstrated high rates of job satisfaction. [ABSTRACT FROM AUTHOR]

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

Purpose: To identify the patterns of ocular injury and to determine ocular morbidity resulting from the use of firecrackers.Methods: A prospective observational study of all patients presenting with ocular trauma consequent to fireworks usage in a tertiary eye care center in South India over a one-month period around the autumn festival of Diwali. We also reviewed the published literature from around the world reporting ocular injuries due to firecrackers.Result: 49 patients were included in the study, out of which the vast majority (40/81%) were males. The mean age was 17 years. Almost an equal number of bystanders (24/48.9%) was affected as compared to people handling the fireworks (25/51%). 13 (26.53%) patients had open-globe injury whereas 33 (67.34%) patients had closed-globe injury. Twenty-two (44.8%) patients underwent surgical intervention. Eighteen (36.7%) patients had final vision less then 20/40 (range = 20/50 to No Perception of Light) with eight patients having no perception of light in the affected eye.Conclusion: Unregulated use of firecrackers can lead to significant ocular morbidity, mainly involving children, young males, and even innocent bystanders. A combination of public awareness and appropriate legislative laws should be formulated regarding the use of fireworks to decrease the load of needless blindness on society. [ABSTRACT FROM AUTHOR]

Background Selection of a standard professional is crucial for assessing the clinical performance of other eye-care personnel. This paper describes the selection considerations and the clinical competency assessment of two optometrists required to select a 'standard optometrist' ( SO) for evaluating the clinical performance of vision technicians in India. Methods Two optometrists were short-listed from 21 optometrists who responded to an advertisement to be selected as a SO for the assessment of the performance of 24 vision technicians in rural vision centres. Each candidate optometrist performed a routine eye examination on 40 randomly selected, newly registered subjects in a tertiary hospital clinic. Their non-cycloplegic retinoscopic findings were compared with those of an experienced optometrist, while disease diagnoses were compared with the findings of an ophthalmologist. Results A comparison of retinoscopic findings showed that optometrist A produced retinoscopic values within ±0.50 D agreement for the spherical equivalent ( SE) 100 per cent of the time, while optometrist B obtained agreement 91.3 per cent of the time. Similarly, optometrist A's limits of agreement ( SE = -0.63 to +0.45 D) and reproducibility limits ( SE = 0.78 D) were better than those of optometrist B ( SE = -0.98 to +0.70 D and SE =1.18 D, respectively). Optometrist A demonstrated 89.2 per cent sensitivity in detecting ocular pathology compared to 76.3 per cent by optometrist B. Conclusions Optometrist A achieved consistent and reproducible retinoscopic findings as well as higher sensitivity in detecting ocular pathology and was selected as the SO for a study to assess the clinical performance of one-year trained vision technicians. The concept of a SO calibrated against an ophthalmologist for disease detection and diagnosis and an experienced optometrist for retinoscopy is a useful approach for the evaluation of eye-care personnel. [ABSTRACT FROM AUTHOR]

Purpose: This study is aimed to determine the utility of various polymerase chain reaction (PCR) methods in vitreous fluids (VFs) for detecting the infectious genomes in the diagnosis of infectious endophthalmitis in terms of sensitivity and specificity. Methods: This prospective and consecutive analysis included a total of 66 VFs that were submitted for the microbiological evaluation, which were obtained from 66 clinically diagnosed endophthalmitis patients presented between November 2010 and October 2011 at the tertiary eye care referral centre in South India. Part of the collected VFs were subjected to cultures and smears, and the remaining parts were utilized for five PCR methods: uniplex, nested, semi-nested, multiplex and nested multiplex after extracting DNA, using universal eubacterial and Propionibacterium acnes species-specific primer sets targeting 16S rRNA gene in all bacteria and P. acnes, and panfungal primers, targeting 28S rRNA gene in all fungi. Results: Of the 66 VFs, five (7.5%) showed positive results in smears, 16 (24%) in cultures and 43 (65%) showed positive results in PCRs. Among the 43 positively amplified VFs, 10 (15%) were positive for P. acnes genome, one for panfungal genome and 42 (62%) for eubacterial genome (including 10 P. acnes positives). Among 42 eubacterial-positive VFs, 36 were positive by both uniplex (first round) and multiplex (first round) PCRs, while nested (second round) and nested multiplex (second round) PCRs produced positive results in 42 and 41 VFs, respectively. Of the 43 PCR-positive specimens, 16 (37%) had positive growth (15 bacterial and one fungal) in culture. Of 50 culture-negative specimens, 27 (54%) were showed positive amplification, of which 10 were amplified for both P. acnes and eubacterial genomes and the remaining 17 were for eubacterial genome alone. Conclusions: Nested PCRs are superior than uniplex and multiplex PCR. PCRs proved to be a powerful tool in the diagnosis of endophthalmitis, especially for detecting uncultured microbes. [ABSTRACT FROM AUTHOR]

The VISION 2020 initiative aims to eliminate avoidable blindness by the year 2020. Cataract, the main cause of blindness and other visual impairment, is a main focus of this effort. In India, the Aravind Eye Care System provides an impressive model demonstrating how high quality eye care, including cataract surgery, can be delivered to large numbers and made affordable to all. Similarly, financially self-supporting systems have not been developed at this point in sub-Saharan Africa. This paper explores the factors that lead to success at Aravind, and compares and contrasts the conditions in India with those found in much of sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Purpose: To report the clinical profile and management of patients diagnosed to have ampiginous choroiditis in a tertiary care referral centre in India. Methods: Retrospective cohort study. Twenty-six eyes of 16 patients were included in the study, which was diagnosed as choroiditis, serpiginous choroiditis, and acute posterior multifocal placoid pigment epitheliopathy (APMPPE) or ampiginous choroiditis. Those who were initially diagnosed as having other forms of choroiditis were later classified as having ampiginous choroiditis clinically. Systemic steroids and immunosuppressives were the mainstay of therapy. Results: There was a male preponderance (7:3). Age at presentation ranged from 22 years to 57 years with a (median 34 years); 81% had bilateral involvement and 35% had recurrences. Vision improved or maintained in 24 eyes, whereas it deteriorated in 2 eyes due to subretinal fibrosis and macula involvement, respectively. Resolution of lesions and improvement or stability of vision can occur with administration of timely steroids and immunosuppressive therapy. Regular follow-up is necessary to monitor the disease progression, recurrences, and involvement of the other eye. Conclusion: Ampiginous choroiditis is a separate disease entity due to its distinct clinical features. It is a disease with multiple relapses, which can be effectively controlled with a combination of immunosuppressive therapy, and a good visual acuity can be maintained on long-term follow-up. [ABSTRACT FROM AUTHOR]

With a national population now estimated at 1.1 billion people (and growing!), it is often stated that India accounts for 1/3 of all blind and visually impaired individuals in this world! If this statement is correct, this means that there are 5-6 million visually impaired and blind individuals in India. Although certainly real progress is being made, one can reasonably ask, is the existing organizational structure designed to serve the needs of so large a number of people, and are the necessary care-providers available to provide for visual rehabilitation requirements of this very substantial cohort of affected patients? Both continuing growth and aging of the Indian population tend to challenge the capacity of that nation to meet demands for ophthalmic services, as well as their ability to meet the visual rehabilitation requirements of this populace. Modern optometry is, in many ways, a nascent profession in India. On behalf of the large cohort of visually impaired patients, I argue that a difference can be made through effective inter-professional cooperation between emerging modern optometry and more developed ophthalmology. I hope to see an increasing role for optometry in the provision of care for the visually impaired and blind in coming years. Here, I discuss a number of issues pertinent to the needs of the blind and visually impaired population, as well as means for enhancing applicable rehabilitation services. [ABSTRACT FROM AUTHOR]

Purpose: Prevalence of cataract related blindness and visual impairment is extremely high in India. Service utilization, on the contrary, is sub-optimal. Services offered through outreach screening are often not taken up. Against this background, the decision making processes leading to the uptake of cataract surgery services offered during outreach screening camps were investigated in people with cataract in India. Methods: The study used an exploratory, qualitative approach. Sixty one cataract patients from two eye hospitals in Hyderabad, India, were interviewed using convenience sampling. Two focus group discussions with cataract patients and interviews with seven key informants helped triangulate the information. Results: Lack of access to personal funds limited and delayed the utilization of offered services by patients who had been advised of surgery at outreach screening camps or eye hospitals. Stigma, fatalism and ageism were other limiting factors. The majority of patients did not make the decision regarding uptake of services themselves. Hearsay reports of the outcome of surgery and quality of services had a strong influence on service uptake. Women, particularly widows and those from rural areas, were least likely to use cataract surgery services. Conclusion: Provision of affordable and accessible eye care does not guarantee that the care or service will be utilized. Within the decision making process about cataract surgery, dependency on and importance of the wider family was found to be an often cited context of patients' decisions. Future research and programming activities need to put an emphasis on underserved groups, especially those who may be marginalized or disempowered. [ABSTRACT FROM AUTHOR]

The aim of the work was to compare the acceptance and feasibility of high add spectacles over other low vision aids (telescope and magnifiers) in patients in tertiary eye care centres in western India. Materials used included visual acuity charts, pinhole, retinoscope and trial lenses, slit lamp, indirect ophthalmoscope, low vision assessment equipment and high add spectacles and other optical low vision aids. Retrospectively, 128 eyes from patient prescriptions who reported to the OPD, in different ophthalmological and optical set-ups, of western India were studied. The subjects were enrolled irrespective of the cause of low vision. All patients underwent routine examination of vision and anterior segment of the eye in the OPD, followed by applanation tonometry and dilated retinal examination. The patients considered for low vision prescription underwent complete low vision assessment with both spectacles and other optical low vision aids. It was prescribed as per clinical acceptance. The number of accepted as spectacles and other low vision aids (telescopes and magnifiers) were analysed for acceptability and feasibility. The average age of presentation was 44.05 years and ranged from 6 to 84 years. There were 77 males. One prescription for each patient, either for a low vision or a spectacle was accepted. The complaints were mainly regarding distance and near vision. Only 54 (42.19%) subjects had a problem of mobility with the rest comfortable both in a known and unknown atmosphere. Near vision could be improved to N8, N6 in 74.2% with a good reading speed and acceptable field and reading distance. 53.12% subjects had a vision improvement of about Snellen's 6/24 to 6/9 partial though the field was constricted. 25.78% was overall clinical acceptance of the telescopic prescription; only five (15.15%) subjects bought the prescribed telescopes. The overall clinical acceptance for spectacle low vision aids prescription was 74.22% and acceptance level 94.7% (only five rejections). The statistical analysis was done by Chi-square test, standard error of proportion and z test to find the significance of difference in prescription and acceptance and the acceptability of spectacles over other low vision aids. The value for the Chi-square test was, p=<0.001, which showed that the difference between the prescription of both spectacles and other low vision aids and acceptance by patients for the same was of high statistical significance. The test of error of proportion followed by the z test showed a value of p< 0.01. It expressed that there was an absolute preference for high add spectacles over the other low vision aids which was of high statistical significance. The study reveals even though telescopes are absolute vision enhancers they are not readily acceptable to the patients though the vision is good with the low vision aids other than the high add spectacle aids. [ABSTRACT FROM AUTHOR]

Dr Abhay R Vasavada completed his FRCS in 1980 from the Royal College of Surgeons, England, and started Raghudeep Eye Clinic, as a cataract speciality clinic in 1984 in Ahmedabad, India. He has been instrumental in positioning cataract management as a subspeciality, and in raising the bar for management outcomes, be it the popularization of intraocular lens (IOLs) or establishing phacoemulsification as a standard of care, in the entire Asia-Pacific region. His expertise extends to managing the most complex and challenging cataracts in adults and children. He has made important contributions to the understanding and practise of cataract surgery like: emphasizing the role of balancing phaco fluidics (step-down technique); innovating a versatile chop technique (step-by-step chop in situ and lateral separation); defining paradigms for challenging cases like dense cataracts, small pupils and subluxated cataracts; devising the 'inside-out delineation' technique for posterior polar cataracts; recognizing the entity of 'cortico-capsular adhesions'; and many more. He firmly believes that quality care should extend to all strata of society. He runs a center in a small town, Dholka, where the highest quality of eye care is provided to lesser privileged sections of society at nominal charges. Research is his passion right from his early days. He set up the Iladevi Cataract & IOL Research Center (ICIRC), a center providing basic research facility in 1991. Today, ICIRC is a Government of India recognized research laboratory dedicated to basic research and translational research pertaining to commonly prevalent eye conditions. He is a distinguished member of different ophthalmic bodies, including the International Council of Ophthalmology (ICO), American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), European Society of Cataract and Refractive Surgeons (ESCRS), Academia Ophthalmologica Internationalis (AOI), Asia Pacific Academy of Ophthalmology (APAO), Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS) and others.His contribution to ophthalmology has been recognized worldwide. Some of the most prestigious awards he has received include the Binkhorst Medal lecture by the ASCRS. [ABSTRACT FROM AUTHOR]