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Lapam Panda,1 Taraprasad Das,1 Suryasmita Nayak,1 Umasankar Barik,2 Bikash C Mohanta,1 Jachin Williams,3 Vivekanand Warkad,4 Guha Poonam Tapas Kumar,5 Rohit C Khanna3 1Indian Oil Center for Rural Eye Health, GPR ICARE, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India; 2Naraindas Morbai Budhrani Eye Centre, L V Prasad Eye Institute, Rayagada, India; 3Gullapalli Pratibha Rao International Center for Advancement of Rural Eye Care, L V Prasad Eye Institute, KAR Campus, Hyderabad, India; 4Miriam Hyman Children Eye Care Center, L V Prasad Eye Institute, MTC Campus, Bhubaneswar, India; 5District Administration, Government of Odisha, Rayagada, India Purpose: To describe program planning and effectiveness of multistage school eye screening and assess accuracy of teachers in vision screening and detection of other ocular anomalies in Rayagada District School Sight Program, Odisha, India.Methods: This multistage screening of students included as follows: stage I: screening for vision and other ocular anomalies by school teachers in the school; stage II: photorefraction, subjective correction and other ocular anomaly confirmation by optometrists in the school; stage III: comprehensive ophthalmologist examination in secondary eye center; and stage IV: pediatric ophthalmologist examination in tertiary eye center. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of teachers for vision screening and other ocular anomaly detection were calculated vis-à-vis optometrist (gold standard).Results: In the study, 216 teachers examined 153,107 (95.7% of enrolled) students aged 5–15 years. Teachers referred 8,363 (5.4% of examined) students and 5,990 (71.6% of referred) were examined in stage II. After prescribing spectacles to 443, optometrists referred 883 students to stage III. The sensitivity (80.51%) and PPV (93.05%) of teachers for vision screening were high, but specificity (53.29%) and NPV (26.02%) were low. The specificity and NPV, in general, were higher in ocular anomaly detection but varied from disease to disease.Conclusion: Multistage school screening is rapid and comprehensive in a resource-limited community. Regular training and periodic reinforcement of teachers for vision assessment and other ocular anomaly identification are required for further success of the strategy. Keywords: vision screening, school children, sensitivity, specificity, tribal, ocular anomalies

Hrishikesh Kaza,1 Vivekanand U Warkad1,2 1Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, L V Prasad Eye Institute, 2Miriam Hyman Children’s Eye Care Centre, Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, L V Prasad Eye Institute, Bhubaneswar, IndiaIt is with great interest that we read the paper published by Okamoto et al.1 In this paper, the authors retrospectively evaluated 135 cases who underwent inferior rectus nasal transposition for acquired or decompensated superior oblique palsy. The authors concluded that inferior rectus nasal transposition decreased the excyclotorsion effect with the added advantage of long-term stability and also allowing for simultaneous correction of the vertical deviation.View original paper by Okamoto et al.

Purpose: The purpose of this study was to assess fine motor skills and reading proficiency in adults with amblyopia and/or strabismus, and to determine how these relate to clinical measures of vision and self-reported vision-related quality of life., Methods: Fine motor skills (Manual dexterity - Bruininks-Oseretsky Test of Motor Proficiency [BOT-2]) and reading performance (International Reading Speed Texts [IReST]) were assessed in 23 adults with non-strabismic amblyopia, 20 with non-amblyopic strabismus, 52 with both amblyopia and strabismus, and 19 with normal visual development. Visual acuity and binocular function score (BFS), obtained from stereoacuity and presence/absence of suppression, were also determined. Vision-related quality of life was assessed with the Amblyopia and Strabismus Questionnaire (A&SQ) in those with amblyopia and/or strabismus. Statistical analysis included ANOVA and multiple regression models., Results: Participants with amblyopia and/or strabismus exhibited poorer performance in all five manual dexterity sub-items and the overall standardized score (P < 0.05). The reading rate was significantly slower across all amblyopia/strabismus groups (P < 0.05). Poorer fine motor skills and slower reading performance were associated with each other (R = 0.29). Clinical visual characteristics (visual acuity [VA], BFS, and presence of strabismus) explained 39% of the variance in fine motor skills score (R2 = 0.39), however, these explained only 6% of the variance in reading speed (R2 = 0.06). Self-report of functional ability related most to BFS, whereas psychosocial impact related to the presence of strabismus. The clinical and functional characteristics predicted 4% of the variance in functional impact score (R2 = 0.038) and explained 16% of the variance in psychosocial impact score (R2 = 0.16)., Conclusions: The functional and psychosocial effects of amblyopia and strabismus are common and persist into adulthood, with outcomes inadequately accounted for by clinical measures of vision.

Purpose: To study the clinical presentations, visual, and refractive profiles of children with congenital ectopia lentis in a large cohort of patients from a tertiary eye care network in India., Materials and Methods: A retrospective review of electronic medical records from December 2012 to December 2020 was conducted. Two hundred and ninety-seven consecutive children ≤18 years of age at presentation were identified and analyzed for demographic details, patient distribution, lens subluxation, visual, and refractive profiles before and after the interventions., Results: Five hundred and ninety-four eyes of 297 (male 56%; n = 166) patients were analyzed. The mean age at presentation was 8.74 ± 3.89. Best-corrected visual acuity (BCVA) at presentation ranged from 0.3 logMAR to 3.5 logMAR; (Snellen: 6/9 - close to face [CF]) (mean 0.89 ± 0.68). High myopia ( n = 201; 33.83%) and mild astigmatism ( n = 340; 57.23%) were more frequent. Temporal ( n = 108; 18.18%) subluxation was most common followed by superior. Lensectomy with limited vitrectomy was performed in 243 eyes of 127 patients (40.90%). Median preoperative BCVA was 1.0 (range: 0.3-3.5 logMAR; 20/40 - CF). Median postoperative BCVA was 0.5 logMAR (6/18) in the pseudophakic group and 0.6 logMAR (6/24) in the aphakic group. Spherical equivalent in myopic children reduced from -12.06 ± 6.84D to -1.57D (-0.25D to - 5.5D) in the pseudophakic group and +9.3D (+5.5D to 15.5D) in the aphakic group., Conclusion: This study is a large cohort of children presenting with ectopia lentis. Following intervention, an improvement in the median BCVA and refractive correction was noted in the entire cohort., Competing Interests: The authors declare that there are no conflicts of interest in this paper., (Copyright: © 2024 Taiwan J Ophthalmol.)

Competing Interests: None

A toddler with bilateral retinoblastoma (Rb) received intravenous chemotherapy for advanced tumours in both eyes. The right eye required enucleation due to a poor response, but the left eye was salvaged by additional treatment with intravitreal chemotherapy for tumour vitreous seeds. Though the vitreous seeds regressed, a gradually progressive cataract developed likely due to drug toxicity. On ensuring continued regression of tumour within the eye, cataract extraction was performed. Surgery was uneventful and the child recovered good functional vision in the left eye. Salvaging the eyeball followed by vision restoration through cataract surgery in the only remaining eye of the child necessitated a multidisciplinary approach involving the ocular oncologist, the paediatric medical oncologist and the paediatric ophthalmologist. Ensuring tumour quiescence within the eye clinically before cataract surgery was the most crucial element of management. Additionally, close monitoring of the progress of the cataract to decide when to intervene was also necessary to keep the risk of amblyopia at bay. The patient recovered good functional vision in the left eye after the surgery and remained free of any tumour recurrence or systemic metastasis at 10 months of follow-up., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To report our operative experience with precision pulse capsulotomy (PPC) for anterior capsulotomy in a paediatric cataract series., Methods and Analysis: This study is a retrospective interventional, descriptive series of consecutive paediatric eyes (≤16 years) undergoing cataract surgery using PPC. Surgical time and the time required to perform PPC was recorded. Any intraoperative and postoperative adverse events were noted. Postoperatively, visual acuity, anterior segment examination and intraocular pressure (IOP) were recorded for all children at day 1, 1 week and 1 month., Results: 21 eyes of 14 patients were included in the study, with the median age at surgery of 6.0 years (IQR; 5-7.75, range=1-16 years). Male to female ratio was 11:3. 13 eyes had lamellar cataract, 3 eyes had total cataract, 2 had posterior subcapsular cataract, 2 had traumatic cataract, while 1 eye had sutural cataract. Median surgical time was 26 min (IQR 21-32) and median PPC time was 75.0 secs (IQR 56-86.5). The anterior capsulotomy was round and complete in most cases, except in one case due to faulty suction. All patients underwent a successful in the bag implantation of intraocular lens with capsulotomy margins overlapping the optic edges in 19 eyes (90%). Median PPC size was 5.54 mm (n=9, IQR 5.39 -5.75) which was slightly larger than expected. None of the cases had any intraoperative or postoperative adverse events with no radial tears of capsulotomy. Postoperatively, the mean final follow-up was 5.71+3.20 weeks., Conclusion: To conclude PPC can be used as an alternative to manual continuous curvilinear capsulorhexis in paediatric cataract surgery producing round well- centred and strong capsulotomy with an easier learning curve., Competing Interests: Competing interests: None declared.

Purpose: To evaluate the surgical outcome of augmented superior rectus transposition (SRT) and medial rectus recession (MRc) in patients with abducens nerve palsy., Methods: The medical records of consecutive patients with abducens nerve palsy who underwent unilateral or bilateral simultaneous SRT with MRc from January 2012 to December 2014 were analyzed. Patients with previous strabismus surgery or botulinum toxin injection were excluded. Primary outcome measures were esotropia in primary position and abduction deficit. Data collected included age, sex, etiology, pre- and postoperative deviation, pre- and postoperative abduction deficit, anomalous head posture, induced vertical or torsional deviations postoperatively, reoperations, and details of other complications. Success was defined as postoperative alignment within 10 Δ of orthotropia; failure, as residual esotropia of ≥20 Δ ., Results: A total of 15 eyes of 13 patients were included. The most common cause of abducens nerve palsy was trauma (10 patients). The mean preoperative esotropia was 55.4 Δ ± 24 Δ , which improved postoperatively to 9.9 Δ ±10 Δ (P = 0.0000). The mean preoperative abduction deficit was -5 units, decreasing postoperatively to -3.1 (P = 0.000). Nine patients (69%) achieved success; 2 were classified as failures. One patient each developed postoperative hypotropia and intorsion; however, these were transient and did not require additional procedures. No patients developed anterior segment ischemia., Conclusions: Augmented SRT with MRc is effective in the management of abducens nerve palsy; however, its success in large deviations remains variable. Long-term follow-up is essential to determine the incidence of vertical and torsional deviations., (Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)