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Retinopathy of prematurity (ROP) is a leading cause of childhood blindness affecting the retina of low birth weight preterm infants. Plus disease in ROP characterised by abnormal tortuosity and dilation of posterior retinal blood vessels, is a benchmark that identifies treatment-requiring ROP cases. A Plus disease classifier with zero false negatives is a major requirement of an ROP screening system. In this paper, an efficient Artificial Neural Network (ANN) architecture with an optimal feature set is proposed which meets the above requirement. A total of 178 images with 81(45%) Plus and 97 (55%) No Plus are used for the analysis. A feature set derived from transform domain representation of retinal funds images is used along with the existing vascular features in the proposed work. Wavelet and Curvelet transforms are considered for deriving the additional feature set in the experimental analysis. The feature set containing Curvelet transform energy coefficient along with the vascular features gave an Accuracy of 96% and Specificity of 93% with 100% Sensitivity. [ABSTRACT FROM AUTHOR]

Deregulation of vascular endothelial growth factor (VEGF) levels leads to retinopathy of prematurity (ROP). Vitamin D (VIT-D) is known to regulate VEGF in an oxygen dependent manner. The purpose of this study was to correlate tear levels of VEGF and VIT-D with different ROP stages in preterm infants. In this prospective cross-sectional study, we enrolled 104 pre-term infants. They were grouped into: Group-1 (Classical ROP) and Group-2 (Aggressive ROP), which were further subdivided into Group-1A (progressing), Group-1B (regressing), Group-2A (pre-treatment), and Group-2B (post-treatment). Tear VEGF and VIT-D levels and their association with different ROP stages were assessed. Stage 1 and stage 2 had higher whereas stage 3 had lower VEGF levels in Group-1B compared to Group-1A. Stage 1 and stage 3 showed higher levels of VIT-D with no difference in stage 2 in Group-1B compared to Group-1A., Group-2B showed higher VEGF and lower VIT-D levels compared to Group-2A. Presence of a positive correlation at an early stage (stage 1) of ROP and a negative correlation at a more advanced stage (stage 3) of ROP with VIT-D and VEGF implies stage-specific distinct signaling crosstalk. These findings suggest that VIT-D supplementation may have the potential to modify the course and outcome of ROP. [ABSTRACT FROM AUTHOR]

Purpose: Recent advances in sequencing technologies have enabled radical and rapid progress in the genetic diagnosis of inherited retinal disorders (IRDs). Although the list of gene variations continues to grow, it lacks the genetic etiology of ethnic groups like South Asians. Differences in racial backgrounds and consanguinity add to genetic heterogeneity and phenotypic overlaps. Methods: This retrospective study includes documented data from the Gen-Eye clinic from years 2014 to 2019. Medical records and pedigrees of 591 IRD patients of Indian origin and genetic reports of 117 probands were reviewed. Genotype–phenotype correlations were performed to classify as correlating, non-correlating and unsolved cases. Results: Among the 591 patients, we observed a higher prevalence of clinically diagnosed retinitis pigmentosa (38.9%) followed by unspecified diagnoses (28.5%). Consanguinity was reported to be high (55.6%) in this cohort. Among the variants identified in 117 probands, 36.4% of variants were pathogenic, 19.2% were likely pathogenic, and 44.4% were of uncertain significance. Among the pathogenic and likely pathogenic variants, autosomal recessive inheritance showed higher prevalence. About 35% (41/117) of cases showed genotype–phenotype correlation. Within the correlating cases, retinitis pigmentosa and Stargardt disease were predominant. Novel variants identified in RP, Stargardt, and LCA are reported here. Conclusion: This first-of-a-kind report on an Indian cohort contributes to existing knowledge and expansion of variant databases, presenting relevant and plausible novel variants. Phenotypic overlap and variability lead to a differential diagnosis and hence a clear genotype–phenotype correlation helps in precise clinical confirmation. The study also emphasizes the importance of genetic counselling and testing for personalized vision care in a tertiary eye hospital. [ABSTRACT FROM AUTHOR]

The sizeable proportion of LARCs placed within VA by primary care clinicians suggests that ongoing investment in LARC training for non-gynecologists or hiring of primary care clinicians with existing expertise in gynecologic procedures could be promising strategies for expanding access. Lower levels of LARC provision among urban CBOCs may reflect closer proximity to VAMCs and community clinicians offering the service. Within VA, LARC provision is of particular concern in facilities that have limited gynecology care, such as community-based outpatient clinics (CBOCs) which are primarily staffed by primary care clinicians, and rural VA Medical Centers (VAMCs).[4] Although VAMC or CBOC facilities may also contract with community care clinicians for LARC provision, many rural areas lack providers in the community who are skilled in LARC placement.[4],[5] As limited data have been published on LARC provision within VA to date, we used VA administrative data to examine variations in rates of LARC provision and clinician type placing LARC, comparing facilities by rurality and facility type. [Extracted from the article]

Using a primary care designation, 31.3% of urban and 18.6% of rural Veterans lacked adequate geographic access to care (compared to 0.2% and 10.2% using specialty care designations, respectively). With rising numbers of reproductive-age women using Veterans Health Administration (VA) services, demand for maternity services has increased.[1] Obstetric care is a VA benefit provided by contracted community providers.[2] Like other Americans, Veterans suffer from high rates of severe maternal morbidity and stark racial inequities in maternal health outcomes.[3] Geographic access to prenatal care is associated with lower risks of adverse pregnancy outcomes.[4] VA classifies geographic network adequacy using drive time between the Veteran's residence and VA-based or community-contracted care provider.[5] This measure of network adequacy for all eligible Veterans is distinct from community care eligibility standards under the MISSION Act. [Extracted from the article]

Background: The Veterans Health Administration (VA) refers patients to community providers for specialty services not available on-site. However, community-level specialist shortages may impede access to care.Objective: Compare gynecologist supply in veterans' county of residence versus at their VA site.Design: We identified women veteran VA patients from fiscal year (FY) 2017 administrative data and assessed availability of a VA gynecologist within 50 miles (hereafter called "local") of veterans' VA homesites (per national VA organizational survey data). For the same cohort, we then assessed community-level gynecologist availability; counties with < 2 gynecologists/10,000 women (per the Area Health Resource File) were "inadequate-supply" counties. We examined the proportion of women veterans with local VA gynecologist availability in counties with inadequate versus adequate gynecologist supply, stratified by individual and VA homesite characteristics. Chi-square tests assessed statistical differences.Participants: All women veteran FY2017 VA primary care users nationally.Main Measures: Availability of a VA gynecologist within 50 miles of a veteran's VA homesite; county-level "inadequate-supply" of gynecologists.Key Results: Among 407,482 women, 9% were in gynecologist supply deserts (i.e., lacking local VA gynecologist and living in an inadequate-supply county). The sub-populations with the highest proportions in gynecologist supply deserts were rural residents (24%), those who got their primary care at non-VAMC satellite clinics (13%), those who got their care at a site without a women's clinic (13%), and those with American Indian or Alaska Native (12%), or white (12%) race. Among those in inadequate-supply counties, 59.9% had gynecologists at their local VA; however, 40.1% lacked a local VA gynecologist.Conclusions: Most veterans living in inadequate-supply counties had local VA gynecology care, reflecting VA's critical role as a safety net provider. However, for those in gynecologist supply deserts, expanded transportation options, modified staffing models, or tele-gynecology hubs may offer solutions to extend VA gynecology capacity. [ABSTRACT FROM AUTHOR]

Purpose: To describe the foveal avascular zone (FAZ) and vessel density (VD) in the superficial and deep capillary plexus in children with a history of prematurity on optical coherence tomography angiography (OCTA) and their correlation with gestational age (GA) and birth weight (BW). Methods: We enrolled 81 preterm- and eight term-born children in this prospective observational study. The Optovue RTVue AVANTI (Optovue Inc., Fremont, CA) was used to procure the OCTA images. The 3 × 3 mm scan protocol centered on the fovea and the central 1 mm of the grid along with the FAZ of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was acquired. Results: The mean SCP-VD was comparable between the preterms and term controls (p = 0.315) in the central fovea (1-mm grid). However, the SCP-VD of the 3-mm grid was lower in the preterms born without ROP, with type 1 ROP, and with type 2 ROP (47.61, 47.90, and 48.82 respectively) compared to that in the term group (51.38; p = 0.031). The FAZ in the SCP (p = 0.003) and DCP (p = 0.003) was significantly smaller in the preterms compared to that in the controls. Based on the GA sub-analysis, the FAZ was significantly smaller in the SCP and DCP of preterms born < 31 weeks and > 31 weeks GA (p < 0.000, p < 0.035, respectively). Based on the BW, the difference between the FAZ in the SCP (p = 0.002) and DCP (p = 0.003) was significant. There was no association between the visual acuity and FAZ. Conclusion: Optical coherence tomography angiography findings in this study show an altered foveal morphology and vascularity in preterms with and without ROP. [ABSTRACT FROM AUTHOR]

Retinopathy of prematurity (ROP) is a sight threatening disorder that primarily affects preterm infants. It is the major reason for lifelong vision impairment and childhood blindness. Digital fundus images of preterm infants obtained from a Retcam Ophthalmic Imaging Device are typically used for ROP screening. ROP is often accompanied by Plus disease that is characterized by high levels of arteriolar tortuosity and venous dilation. The recent diagnostic procedures view the prevalence of Plus disease as a factor of prognostic significance in determining its stage, progress and severity. Our aim is to develop a diagnostic method, which can distinguish images of retinas with ROP from healthy ones and that can be interpreted by medical experts. We investigate the quantification of retinal blood vessel tortuosity via a novel U-COSFIRE (Combination Of Shifted Filter Responses) filter and propose a computer-aided diagnosis tool for automated ROP detection. The proposed methodology involves segmentation of retinal blood vessels using a set of B-COSFIRE filters with different scales followed by the detection of tortuous vessels in the obtained vessel map by means of U-COSFIRE filters. We also compare our proposed technique with an angle-based diagnostic method that utilizes the magnitude and orientation responses of the multi-scale B-COSFIRE filters. We carried out experiments on a new data set of 289 infant retinal images (89 with ROP and 200 healthy) that we collected from the programme in India called KIDROP (Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity). We used 10 images (5 with ROP and 5 healthy) for learning the parameters of our methodology and the remaining 279 images (84 with ROP and 195 healthy) for performance evaluation. We achieved sensitivity and specificity equal to 0.98 and 0.97, respectively, computed on the 279 test images. The obtained results and its explainable character demonstrate the effectiveness of the proposed approach to assist medical experts. [ABSTRACT FROM AUTHOR]

Objective: To report the incidence, spectrum and treatment outcome of Retinopathy of Prematurity (ROP) in a rural neonatal nursery.Methods: This Prospective, observational, non-randomized study was conducted in a level III Neonatal Intensive Care Unit (NICU) at district headquarters in South India. 118 babies with birth weight ≤2000 g and/or period of gestation (POG) ≤34 wk were included in the study. Eligible infants were screened with indirect ophthalmoscopy and wide-field digital imaging (Retcam) until retinal vascularization was complete or disease regressed. Early Treatment Retinopathy of Prematurity (ETROP) guidelines were followed for laser.Results: The overall incidence of ROP was 41.5% and treatable ROP was 26.4% (24/91) of eyes diagnosed with ROP and 10.2% (24/236) of the overall eyes screened. The mean birth weights and periods of gestation with and without ROP were 1555.9 vs. 1672.5 g (P 0.005) and 32.2 vs. 34.6 wk, respectively (P<0.001). Half of the treated eyes had aggressive posterior ROP in Zone 1. All treated eyes had a favorable outcome. Respiratory distress syndrome, oxygen therapy, neonatal Jaundice and sepsis were higher in the ROP group but was not statistically significant. Of the overall infants screened, 68 (57.6%) were heavier and older than the American screening cut-off. Of these, 36.8% had some stage ROP and 8% required treatment.Conclusions: This is the first prospective ROP study from a district NICU in India and compares with previously published urban data. If Western-screening guidelines are used in the rural scenario, we risk a significant proportion of infants being missed who may require treatment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the challenges of completing and improving follow-up in an retinopathy of prematurity (ROP) screening program in rural centers Methods: Reasons for dropout from a multi-center ROP screening program in rural Karnataka, over two six-month periods, were collected and categorized. Improvement measures introduced between the two periods and its impact was analyzed. Results: Reasons pertaining to travel and logistics (15 of 53, 28.3%) and those related to awareness, knowledge and attitude (30 of 53, 56.6%) were the two main categories of reasons for dropout. Following corrective measures, there was a reduction in attrition from 20.8% to 3.8% (P <0.001). Pediatricians' role in ensuring follow-up remained an important persisting reason. Conclusions: Customizing improvement measures addressing the challenges of rural geographical logistics and enhancing awareness among rural families can enhance participation and improve follow-up. [ABSTRACT FROM AUTHOR]

Objective: To compare the benefits of initiating Retinopathy of Prematurity (ROP) screening at first contact with the admitted infant prior to hospital discharge ('early screening') with screening performed between 21 and 28 days after birth ('conventional screening') in rural India. Design: Prospective study. Setting: Two Level II neonatal intensive care units (NICU), from two district headquarters in Karnataka state. Participants: 329 infants admitted in the two NICUs. Intervention: One NICU was randomly selected for 'early' and the other for 'conventional' screening. Infants <2000 g at birth were targeted for enrolment. Both centres were visited once a week by a dedicated ROP team. Main Outcome Measure(s): The yield of enrolment, and the magnitude of treatment-requiring cases that would be missed in each scenario were estimated and compared. Results: 107 of 329 admitted infants were eligible for ROP screening. In the study period of 4 months, 42 and 65 infants were eligible for enrolment in the early and conventional group, respectively. In the early group, 88.1% of eligible infants got screened, compared to 38.5% in the conventional group (P=0.03). Conclusion: Early enrolment of infants for ROP screening in the NICU itself ensures a superior yield compared to conventional age of initiating screening. The recorded information of mothers allowed pre-counselling, improved enrolment and better compliance to the scheduled examinations. These results suggest the need to re-look at the screening guidelines in India and other regions with similar demographics. [ABSTRACT FROM AUTHOR]

Retinopathy of Prematurity (ROP) is a retinal vascular disease of the premature infant. There have been significant advances in the understanding of the pathogenesis, prevention, detection and treatment of severe ROP. In developed countries, all premature infants at risk for ROP are screened routinely based on national guidelines and treatment is prompt, resulting in good visual outcomes. Blindness from ROP is a rare event in these countries. However, there is an ongoing epidemic of ROP- induced blindness in India. The reasons for this epidemic of ROP blindness are many and include increasing survival of premature infants, lack of equipment such as oxygenblenders and pulse oximeters that are necessary for safe use of supplemental oxygen in premature infants, lack of routine screening for ROP, lack of trained personnel for ROP screening, and lack of Ophthalmologists to promptly initiate treatment when infants develop severe ROP. All the identified causes can be resolved with a concerted national co-operative effort of Pediatricians, Neonatologists, Ophthalmologists, Indian Academy of Pediatrics, National Neonatology Forum, Indian Academy of Ophthalmologists, Government of India, and parents of premature infants. We feel that tt is possible to stop the current epidemic of preventable childhood blindness from ROP with concerted action by all stakeholders. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate aggressive posterior retinopathy of prematurity (AP-ROP) with regard to inter-expert diagnostic agreement and quantitative vascular features. Methods: Eight ROP experts interpreted 15 retinal images for AP-ROP and plus disease. Inter-expert agreement was calculated by absolute agreement for AP-ROP and plus, and kappa statistic for each expert was compared with others. Retinal vessels were analyzed by a computer-based system to calculate diameter and integrated curvature (IC). Consensus reference standards for images were developed, and quantitative parameters for arterioles and venules were compared among images with AP-ROP vs. not AP-ROP, plus vs. not plus, and AP-ROP vs. plus. Results: Mean kappa for each expert in AP-ROP diagnosis ranged from −0.15 (no agreement) to 0.42 (moderate agreement). Nine (30 %) of 30 total AP-ROP diagnoses were also classified as not plus disease. Analysis of images with AP-ROP vs. plus showed that images with AP-ROP had higher venular IC ( p = 0.04). Arteriolar IC was statistically significant between images with AP-ROP vs. not AP-ROP ( p = 0.01) and plus vs. not plus ( p = 0.00003). There were no statistically significant differences in diameter between image groups. Conclusions: Inter-expert agreement with regard to AP-ROP diagnosis is imperfect. Venular curvature may be a distinguishing characteristic between AP-ROP and plus. Future studies involving quantitative features of AP-ROP will have benefits for clinical diagnosis and management. [ABSTRACT FROM AUTHOR]

Purpose:To acquire high definition spectral domain optical coherence tomography (SD-OCT) images of supine, non-anesthetized infants in the office by a novel modification of a commercially available table-top, chin rest system.Method:Spectralis, a combined HRA+OCT device (Heidelberg Engineering, Heidelberg, Germany) was modified to convert the table-top system into a hand-held device using a two-step modification of the existing system. This device was used to obtain high-resolution OCT images of four infants with aggressive posterior retinopathy of prematurity (APROP) who required no general anesthesia.Results:Serial imaging at two time periods of the exact area of clinical interest were obtained and were comparable. The entire procedure was safely completed in the office. The obtained OCT images guided selective laser ablation of flat neovascularization which were missed on clinical examination.Conclusion:With this simple modification and technique, the ability of using the Spectralis, a popular combined angiography and OCT imaging device for imaging supine, non-anesthetized infants has been established. This possibility would allow the dual use of the table-top system to serve also as a hand-held device for paediatric cases that can be imaged in the office setting with limited operating room facility in a busy practice. [ABSTRACT FROM AUTHOR]

Background: Systemic diseases and their treatment influence aggressive posterior retinopathy of prematurity. Case characteristics: A premature infant with aggressive posterior retinopathy of prematurity underwent laser treatment with a favourable outcome. She was started on oral sidenafil citrate for pulmonary hypertension. Ten days later she developed neovascularization within the lasered retina. Intervention/Outcome: Considering the possible role of sildenafil in this unusual development, the drug was withdrawn resulting in regression of the neovascularization. Message: The clinician should be aware of this retinal adverse effect of sildanefil in neonates with aggressive posterior retinopathy of prematurity. [ABSTRACT FROM AUTHOR]

Unlabelled: We report for the first time monozygous twins with a microdeletion syndrome involving genes coding for Bruton's tyrosine kinase (Btk) and deafness-dystonia peptide 1 (DDP1), and two other genes. Apart from its essential role in B cell development, Btk is indicated to affect signaling mediated by toll like receptors (TLRs) and development of dendritic cells (DCs) but results are conflictive. The twins revealed normal numbers of plasmacytoid and myeloid DCs (pDCs and mDCs). Moreover, BTK null cells from these patients exhibited robust responses to TLR agonists, normal natural killer (NK) cell activity, and normal pDC functions.Conclusion: Our results do not indicate the essential role of Btk in TLR signaling and DC development. [ABSTRACT FROM AUTHOR]

In this study, we examined the effect of trauma exposure on substance use behaviors, specifically tobaccoand alcohol use, in a group of 84 individuals who sought supportive services after the 1995 Oklahoma City bombing. A self-report instrument was used to assess demographics, sensory exposure, injury,interpersonal exposure through relationship with victims, peritraumatic reaction, grief, posttraumaticstress, worry about safety, functional impairment, and changes in smoking and drinking. Those who reported increased smoking had higher scores on peritraumatic reaction, grief, posttraumatic stress, worry about safety, and trouble functioning. Those who reported increased alcohol intake had higherscores on injury, peritraumatic reaction, grief, posttraumatic stress, worry about safety, and troublefunctioning. Sensory exposure and interpersonal exposure were not significantly different between thosewith and without increased smoking or drinking. Although no causal relationship can be assumed, ourfindings indicate an association of grief and posttraumatic stress with increased substance usebehaviors in disaster victims. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding late functionally successful repair of Descemet's membrane detachment following phacoemulsification.

A letter to the editor on postoperative endophthalmitis is presented.