Eye Care Facilities Research Articles

Comparison of contrast sensitivity among strabismic and anisometropic amblyopes and its association with disease-related parameters.

To evaluate and contrast the contrast sensitivity defects present in strabismic and anisometropic amblyopes. And to find out the association of contrast deterioration with the visual acuity of the amblyopic eye, the magnitude of strabismus, and the amount of anisometropia in both groups. This cross-sectional study was carried out in the orthoptics unit of a tertiary eye care facility between October 2021 and December 2021. There were 45 patients altogether. In the first phase, the patient's history and ocular examination data were recorded after informed consent. The Pelli-Robson chart was used to measure contrast sensitivity. In the second phase, results were interpreted using the SPSS (Statistical Package for the Social Sciences) version 26.0. Strabismic amblyopes were 24 and anisometropic amblyopes were 21. A significant positive association existed between both groups' contrast sensitivity and visual acuity (P = 0.000). A moderately negative correlation between contrast and anisometropia was statistically significant (P = 0.025) in anisometropic amblyopes. However, no association (P > 0.050) existed between the contrast and magnitude of strabismus in any group. The study concluded that contrast sensitivity decreases in both groups, whereas anisometropic amblyopes have poorer contrast than strabismic amblyopes. Excessively decreased contrast sensitivity among anisometropic amblyopes was solely because of the worst amblyopia in this group, whereas the magnitude of strabismus does not affect contrast sensitivity.

Factors influencing the need and willingness for presbyopic correction: a cross sectional study from south India

Presbyopia is an age-related physiological phenomenon in which eye gradually losses its ability to accommodate. It is one of the leading causes of visual impairment worldwide, especially in adults above the age of 40. If uncorrected, it can significantly impair a patient's quality of life. This study aims to evaluate the factors which affects patient’s need and willingness to accept presbyopic correction. This cross-sectional analytical study was carried out in a semi urban tertiary care hospital from Jan 2021 to June 2022 among patients aged 40 and above who presented to Outpatient department (OPD). Demographic details, medical history, presenting ocular complaints pertaining to presbyopia, spectacle use and decision regarding using near vision correction were noted. Ocular examination included refraction and ocular biometry. Factors that may have influenced complaints of presbyopia or willingness to accept presbyopic correction were analysed. Three hundred and forty two patients with a mean age of 48.55 ± 6.68 years were included. Of these, 262 (76.61%) patients presented with chief complaints related to presbyopia. Those with higher educational qualification (p = 0.031), hypermetropia (p = 0.021), shallower AC depth (p = 0.028) and on medications for systemic ailments (p = 0.01), were more likely to present with chief complaints attributable to presbyopia. Among them, those with higher educational qualifications (p = 0.02) and skilled workers were more likely to accept near vision glasses (p = 0.02), while those with lower Hb (p = 0.01) and myopia (p = 0.01) were less likely to accept correction for presbyopia. Among the 80 patients without chief complaints related to presbyopia, 35 (43.75%) were not willing to accept near vision glasses. Those with higher BMI (p = 0.04) and hypermetropes (p = 0.05) were more willing to accept presbyopic correction. Presbyopia constitutes a significant reason for patients above the age of 40 visiting eye care facility. Multiple socio-economic, systemic and ocular factors influenced both the chief complaints related to presbyopia and willingness to accept presbyopic correction.

Vision impairment and access to eye care in an integrated network of eye care system in Southern and Eastern India.

The World Report on Vision highlights that health information systems (HIS) should collect information on the determinants of eye conditions and vision impairment (VI) as a step toward integrated people-centered eye care (IPEC). Thus, this retrospective study aims to elucidate VI trends across age and gender of the patients who visited our centres in southern and eastern India. Electronic medical records of all new patients who visited the network were included. VI was defined as visual acuity less than 6/12; unilateral VI was based on the worse presenting eye (the other eye being normal), and bilateral VI was based on the better eye. "Total VI" includes both unilateral and bilateral VI. The records of 7,31,307 patients from January to December 2019 were extracted. Males were 54%. The mean age was 40 years (SD: 19.16 years). The majority of patients (46.54%) visited a primary care centre. Centres in Andhra Pradesh saw the largest number of patients (46%). Approximately 65% of all patients presented had no VI in either eye. Total VI was 23.5% at the primary-centre level and approximately 45% at other levels, the highest being in Odisha. More females accessed care at primary and secondary centres (46.6%) than at higher levels of care (44%). Odisha had the lowest number of females accessing care (43.01%). Non-visually impairing conditions form an important reason for patients visiting our eye care facilities. Strategies focusing on improving access to eye care for females should be planned at all levels, especially in Odisha.

Eye Care Utilization among Older Subjects with Visual Impairment in Northwest Ethiopia.

To find out the level of eye care service utilization and its determinants among the elderly visually impaired populations while visiting ophthalmic outreach locations in North-Western Ethiopia, 2021. An ophthalmic outreach-based cross-sectional study was conducted on 852 visually impaired older people. Participants were selected by using a systematic random sampling method from January to July 2021. Data were collected by using an interviewer-administered questionnaire and an ocular examination. The collected data were entered into the Epi Info 7, and analyzed using SPSS 20. A binary logistic regression was fitted. A total of 821 participants, with a response rate of 96.5%, were included in the study. The utilization of eye care services within the past two years prior to the study was 21.1% (95 % CI: 18.2-23.9). Having systemic disease (AOR = 3.2, 95% CI: 1.5-7.0), being a spectacle wearer (AOR = 4.5, 95% CI: 2.0-9.4), having visual impairment at distance (AOR = 2.9; 95% CI: 1.5-5.6), being blind (AOR = 2.9; 95% CI: 1.5-5.6), duration of visual impairment 1 year (AOR = 2.5; 95% CI: 1.3-4.9) were all significantly associated. In this study, utilization of eye care services was low. Being visually impaired at distance, being blind, recent onset of visual impairment, being a spectacle wearer, and having systemic disease were all related to the use of eye care services. The commonest barriers to utilization of eye care services were financial scarcity and long distances between eye care facilities.

Experiences of keratoconus patients attending public eye care facilities in South Africa

Experiences of keratoconus patients attending public eye care facilities in South Africa

An Empirical Survey on Eye Care Services in Bengaluru

The eye care industry in India is growing at a rapid pace, and Bengaluru is one of the fastest- growing cities in the country with a significant demand for quality eyecare services. The purpose of this research paper is to provide a comprehensive market study of the eyecare services market in Bengaluru, including an overview of the market size, growth potential, competition, and prospects. The study reveals that the market is growing at a significant rate due to the rising prevalence of eye disorders and diseases, growing awareness about eye health, and increasing disposable incomes. The market is highly competitive, with both domestic and international players competing for market share. The future of the eyecare services market in Bengaluru looks promising, with a focus on providing affordable and accessible eyecare services to the masses. The city is home to a large number of eye care facilities, ranging from small clinics to multi-specialty hospitals, providing a wide range of services including routine eye check-ups, cataract surgery, LASIK, corneal transplantation, and glaucoma treatment, among others. With the use of advanced technology and skilled professionals, the industry is poised for further growth and innovation, making it a key player in the healthcare landscape of Bengaluru.

Compliance with follow-up in patients with diabetic macular edema: Eye care center vs. diabetes care center.

The study was conducted to compare the compliance to intravitreal injection treatment and follow-up in patients with center-involving diabetic macular edema (CI-DME) and treatment outcomes between a tertiary eye care facility and a tertiary diabetes care center. A retrospective review was conducted on treatment naïve DME patients who had received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in 2019. Participants were people with type 2 diabetes who were under regular care at the eye care center or the diabetes care center in Chennai. The outcome measures were noted at months 1, 2, 3, 6, and 12. A review of 136 patients treated for CI-DME (72 from the eye care center and 64 from a diabetes care center) was carried out. The severity of diabetic retinopathy (DR) was similar in both centers. There was no statistically significant (P > 0.05) difference in the choice of initial intravitreal drug in the two centers. At 12-month follow-up, only 29.16% came for a follow-up in the eye center vs. 76.56% in a diabetes care center (P = 0.000). The multivariate logistic regression showed increasing age was associated with non-compliance in both the groups (eye care center: odds ratio [OR] 0.91; 95% confidence interval [CI] 0.82-1.21; P = 0.044) and diabetes care center (OR 1.15; 95% CI 1.02-1.29; P = 0.020). The follow-up rate between eye care and diabetic care center with DME showed a significant disparity. By providing comprehensive diabetes care for all complications under one roof, compliance with follow-up can be improved in people with DME.

Commentary: Impact of manual small-incision cataract surgery on outreach and training curriculum across the world.

Commentary: Impact of manual small-incision cataract surgery on outreach and training curriculum across the world.

Ocular care for unconscious patient in ICU

Patient requiring ICU support may be conscious or unconscious. Unconscious person has no control upon him orherself or environment. Patients who have much chance for recovery from their illness should be monitored forapparently minor disabilities or ICU related opportunistic diseases. It is also applicable for an unconsciousness state.In ICU 24-hours special health care to be provided with trained person. Extended stay in an ICU is one of the majorissues for development of ocular problems. Lac of eye care facilities or negligence or ignorance, prevents earlydetection. The key to the treatment in ICU is understanding of the underlying pathophysiology of general and ocularproblems.
 Bangladesh Crit Care J March 2023; 11 (1): 31-35

Evaluating the Efficacy of Teleophthalmology in Delivering Ophthalmic Care to Underserved Populations: A Literature Review.

Technological advancement has brought commendable changes in medicine, advancing diagnosis, treatment, and interventions. Telemedicine has been adopted by various subspecialties including ophthalmology. Over the years, teleophthalmology has been implemented in various countries, and continuous progress is being made in this area. In underserved populations, due to socioeconomic factors, there is little or no access to healthcare facilities, and people are at higher risk of eye diseases and vision impairment. Transportation is the major hurdle for these people in obtaining access to eye care in the main hospitals. There is a dire need for accessible eye care for such populations, and teleophthalmology is the ray of hope for providing eye care facilities to underserved people. Numerous studies have reported the advantages of teleophthalmology for rural populations such as being cost-effective, timesaving, reliable, efficient, and satisfactory for patients. Although it is being practiced in urban populations, for rural populations, its benefits amplify. However, there are certain obstacles as well, such as the cost of equipment, lack of steady electricity and internet supply in rural areas, and the attitude of people in certain regions toward acceptance of teleophthalmology. In this review, we have discussed in detail eye health in rural populations, teleophthalmology, and its effectiveness in rural populations of different countries.

The Unmet Challenge of Diagnosing and Treating Photophobia in Children (P2-9.010)

<h3>Objective:</h3> The purpose of this study was to determine the most common causes of photophobia in the pediatric population in order to address this knowledge gap. <h3>Background:</h3> Photophobia, an abnormal sensitivity to light, is associated with a number of ophthalmic and neurologic conditions. Because photophobia is often perceived as an “eye problem,” patients with photophobia may first present to an optometrist or ophthalmologist for care. We’ve previously found that nearly 70% of pediatric patients presenting to a tertiary eye care facility with a chief complaint of photophobia leave their evaluation without a diagnosis. <h3>Design/Methods:</h3> This study was approved by the University of Utah IRB. We identified patients aged less than 18 years who presented with a chief complaint of photophobia, but who had left the visit without a diagnosis. The families were then contacted and the patients were brought back to the Eye Center to be evaluated by a neuro-ophthalmologist with expertise in the diagnosis and treatment of photophobia. <h3>Results:</h3> We identified 47 children for inclusion in the study. Twenty-six families did not respond to our invitation or declined to participate. Seven families reported that their child’s photophobia had spontaneously resolved. Four children were diagnosed by our team with migraine, one child was diagnosed with dry eye syndrome, and one child was diagnosed with misuse of atropine drops. An additional 8 children have not yet been evaluated. <h3>Conclusions:</h3> Photophobia is associated with several ophthalmic conditions, but in the pediatric population, photophobia can be caused by undiagnosed migraine. Our long-term goal is to better educate eye care professionals about the causes of photophobia in the pediatric population. We are developing a curriculum to address this knowledge gap, with a special emphasis on teaching eye care professionals how to identify undiagnosed migraine. <b>Disclosure:</b> Miss Shapiro has nothing to disclose. Mrs. Keeney has nothing to disclose. Dr. Caskey has nothing to disclose. Mr. Arbon has nothing to disclose. Dr. Seay has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for various attorneys. Dr. Warner has received intellectual property interests from a discovery or technology relating to health care. The institution of Dr. Digre has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Invex therapeutics. Dr. Digre has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for American Headache Society. The institution of Dr. Digre has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Neuro-ophthalmology. The institution of Dr. Digre has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Utah Womens Health Review. Dr. Digre has received intellectual property interests from a discovery or technology relating to health care. Dr. Digre has received intellectual property interests from a discovery or technology relating to health care. Dr. Digre has received intellectual property interests from a discovery or technology relating to health care. Dr. Digre has received publishing royalties from a publication relating to health care. Dr. Digre has received publishing royalties from a publication relating to health care. Bradley J. Katz, MD, PhD has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for axon optics, LLC. Bradley J. Katz, MD, PhD has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for self employed. Bradley J. Katz, MD, PhD has received stock or an ownership interest from Pfizer. Bradley J. Katz, MD, PhD has received intellectual property interests from a discovery or technology relating to health care.

INFLUENCE OF VISUAL FIELD TESTING ON INTRAOCULAR PRESSURE IN PATIENTS WITH GLAUCOMA SUSPECTS ATTENDING TERTIARY CARE CENTER IN KATHMANDU

Background: The evaluation of glaucoma includes measurement of the intraocular pressure and Visual field. Both procedures frequently take place on the same appointment. A rise in intraocular pressure brought on by either internal or external sources could change the recommended course of treatment. The management of patients, therefore, benefits from understanding intraocular pressure changes and their implications. The goal of this study was to determine how visual field testing affected intraocular pressure in glaucoma suspects and glaucoma patients. Methods: The study’s cross-sectional design was carried out from October 15, 2020, to September 15, 2021, in a tertiary eye care facility. Intraocular pressure was measured before and after the visual field test. Data entry, as well as data analysis, was done on IBM SPSS 20. For comparisons of the intraocular pressure, the Wilcoxon signed-ranks test was used. A P ≤0.05 was considered statistically significant. Results: The Analysis of the data set showed no statistical significance difference between the intraocular pressures obtained before and after the test in each of the eyes and regarding the test duration Conclusions: Short-duration visual field testing did not significantly influence intraocular pressure, according to the study. This finding suggests that when clinically evaluating both the glaucoma patients and suspects, the visual field test may be done concurrently with the intraocular pressure measurement.

Mumbai metropolitan region eye care facility survey: Mumbai Eye Disease Study (MEDiS) report #1.

To examine the eye care practice in the Mumbai Metropolitan Region (MMR). 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 (<INR 0.3 m), middle (INR 0.31-1.8 m), and high (>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. 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. 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.

Ophthalmic services utilisation and associated factors in the Ashanti region, Ghana.

This survey determined the utilisation of eye care services and associated factors among adults in the Ashanti region of Ghana. A population-based cross-sectional descriptive study. Data for this study was collected from 1615 randomly selected individuals in the Ashanti region of Ghana, using a structured, pretested interviewer-guided questionnaire. Information regarding the accessibility and determinants of, and barriers to, eye care services was based on self-reports, using the WHO Eye Care Services Assessment Questionnaire. Inferential analyses were performed using the chi-square test for statistical significance, set at p=0.05. Ashanti Region, Ghana. One thousand six hundred and fifteen randomly selected adults. Public eye care facilities were used by 58.2% of the participants for their last eye exam. Of the participants, 47.0% had travelled less than five kilometres for their last eye exam. Waiting time and service cost were participants' most frequently cited challenges in seeking care. No need felt (40.1%), self-medication (37.7%) and cost (22.2%) were the most frequently mentioned barriers to seeking ophthalmic services. The major challenges encountered in seeking eye care services were waiting time and cost of service. Major barriers to ophthalmic services utilisation were no need felt, self-medication and cost. Factors such as cost, lack of felt need and self-medication, which serve as barriers to utilising eye care services, should be addressed by stake-holders through eye health education and promotion. None declared.

Primary eye care in pediatric population-I study (PREPP-I study): Demographic and clinical profile of pediatric patients treated in six major vision centers of a tertiary eye care facility in South India.

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. 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. 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. 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.

Prevalence of ocular manifestations and related morbidity in severely malnourished children in a tertiary eye care center

Abstract Background: Ocular involvement is relatively common in malnourished children, and the consequences of malnutrition on the eye are frequently more severe during the formative years of life. This is a significant cause of avoidable blindness that has to be addressed with affordable methods. This study aims to determine the nature, extent, and seriousness of ocular manifestations in malnourished children and to evaluate the current prevalence given improving nutritional parameters through increased public awareness, education, and knowledge of vaccination and nutrition. Materials and Methods: This study was carried out in the department of ophthalmology of a tertiary eye care center for 1 year. Eye camps were held close by in urban shantytowns. We considered 518 kids between the ages of 6 months and 5 years who lived in those slums. The patient was subjected to a general, systemic, and ocular examination, including a vision and fundus examination. Results: A total of 100 children aged 6 months and 5 years (60 months) who were severely critically malnourished were enrolled and given an eye examination. In this study, 72% of very acutely malnourished children had ocular involvement. Conjunctival pallor was the most general observation in the anterior segment in 179 of the eyes (71.5% of the eyes). Retinal hemorrhage was the most pervasive posterior segment findings in 19 eyes (36.8%). Conclusion: This study is aimed to determine how frequently ocular symptoms occurred in malnourished children who visited tertiary eye care facilities. A vital target population that requires comprehensive screening to avoid vitamin A deficiency (VAD) and detect eye problems early is preschoolers. Every child should also receive an immunization and vitamin A prophylaxis. Low socioeconomic position, illiterate parents, and inadequate sanitation were determined to be the key risk factors for VAD.

Visual Acuity Improvement of Cataract Patients After Cataract Surgery at Sumbawa Hospital in 2018

A cataract is the most common cause of vision impairment and blindness worldwide. The Rapid Assessment of Avoidable Blindness survey held in 2014 - 2016 showed that the prevalence of blindness in West Nusa Tenggara was the second highest in Indonesia. This prevalence was expected to be higher in rural areas due to cultural barriers, patient education, and accessibility to eye-care facilities. This study aims to evaluate visual acuity improvement after cataract surgery and observe the sight restoration rate. The participants of this study were cataract patients who underwent surgery at Sumbawa Hospital West Nusa Tenggara between 27 - 30 August 2018 in a social service program held by the Sanglah General Hospital team. Surgery was not performed on patients who did not desire surgery, in cases where the surgery would not improve visual function, and on patients who were known to be medically unfit for safe surgical intervention. Demographic data and visual acuity at admission and postoperative day one were recorded and analyzed. The output of this program was qualitatively measured by analyzing the SRR. A total of 86 patients were included in this study. Visual acuity postoperative day one showed improvement, and the blindness percentage dropped to 51.16%. The sight restoration rate observed in this study was 58.14%. Although the benefits of cost-effective cataract surgery are straightforward, challenges to executing the procedure remain high, such as unaffordability surgery costs and accessibility to eye-care facilities and infrastructures. Equitable growth in other fields can automatically increase healthcare services in rural areas and encourage healthcare workers to spread evenly.

Strategies for cataract and uncorrected refractive error case finding in India: Costs and cost-effectiveness at scale.

India has the largest number of individuals suffering from visual impairment and blindness in the world. Recent surveys indicate that demand-based factors prevent more than 80% of people from seeking appropriate eye services, suggesting the need to scale up cost-effective case finding strategies. We assessed total costs and cost-effectiveness of multiple strategies to identify and encourage people to initiate corrective eye services. Using administrative and financial data from six Indian eye health providers, we conduct a retrospective micro-costing analysis of five case finding interventions that covered 1·4 million people served at primary eye care facilities (vision centers), 330,000 children screened at school, 310,000 people screened at eye camps and 290,000 people screened via door-to-door campaigns over one year. For four interventions, we estimate total provider costs, provider costs attributable to case finding and treatment initiation for uncorrected refractive error (URE) and cataracts, and the societal cost per DALY averted. We also estimate provider costs of deploying teleophthalmology capability within vision centers. Point estimates were calculated from provided data with confidence intervals determined by varying parameters probabilistically across 10,000 Monte Carlo simulations. Case finding and treatment initiation costs are lowest for eye camps (URE: $8·0 per case, 95% CI: 3·4-14·4; cataracts: $13·7 per case, 95% CI: 5·6-27·0) and vision centers (URE: $10·8 per case, 95% CI: 8·0-14·4; cataracts: $11·9 per case, 95% CI: 8·8-15·9). Door-to-door screening is as cost-effective for identifying and encouraging surgery for cataracts albeit with large uncertainty ($11·3 per case, 95% CI: 2·2 to 56·2), and more costly for initiating spectacles for URE ($25·8 per case, 95% CI: 24·1 to 30·7). School screening has the highest case finding and treatment initiation costs for URE ($29·3 per case, 95% CI: 15·5 to 49·6) due to the lower prevalence of eye problems in school aged children. The annualized cost of operating a vision center, excluding procurement of spectacles, is estimated at $11,707 (95% CI: 8,722-15,492). Adding teleophthalmology capability increases annualized costs by $1,271 per facility (95% CI: 181 to 3,340). Compared to baseline care, eye camps have an incremental cost-effectiveness ratio (ICER) of $143 per DALY (95% CI: 93-251). Vision centers have an ICER of $262 per DALY (95% CI: 175-431) and were able to reach substantially more patients than any other strategy. Policy makers are expected to consider cost-effective case finding strategies when budgeting for eye health in India. Screening camps and vision centers are the most cost-effective strategies for identifying and encouraging individuals to undertake corrective eye services, with vision centers likely to be most cost-effective at greater scale. Investment in eye health continues to be very cost-effective in India. The study was funded by the Seva Foundation.

A Descriptive Analysis of Unique Disability Identification Card (UDID)-Certified Visually Disabled Patients at a Tertiary Eye Care Center in Central India.

Objective In this study, we aimed to examine the demographic characteristics, causes, and severity of visual disability and the reasons for seeking disability certificates among Unique Disability Identification Card (UDID)-certified visually disabled patients at a tertiary eye care center in central India. Materials and methods A retrospective observational analysis of medical records and data from the UDID portal involving 600 visually disabled individuals who were certified between February 2019 to March 2022 was performed.Demographic characteristics, diagnosis of the ocular disease, primary etiology, and percentage and grade of visual disability, as well as the main reasons for seeking a visual disability certificate, were analyzed statistically. Best-corrected visual acuity of less than 6/24 to 3/60 or a visual fieldless than 40 degrees to 10 degrees around the center of fixation or hemianopia involving the macula in the better eye were included in the low-vision category. Best corrected visual acuity of less than 3/60 to "no light perception" or visual field less than 10 degrees around the center of fixation in the better eye were included in the blindness category. Results Out of the total 600 patients, 214 (35.67%)were in the age group of 11-30 years. There were more males (63.67%)than females(36.33%) in the study. Four hundred patients (66.67%) had 100% disability. Retinal diseases (n=229, 48.50%)including retinitis pigmentosa (RP) (n=130, 21.67%) were the most common cause of visual disability. Travel concessions and Government allowances were the most common reasons for seeking a disability certificate. Conclusion The study highlights the leading causes of visual disability, and RP was found to be the most common one. Avoidance of consanguineous marriages and genetic counseling should be made mandatory to prevent blindness due to RP.We recommend the widespread institution of eye care facilities, increasing the availability of healthcare facilities to all, and community education to eliminate avoidable blindness. This study provides key data to the Government to implement new policies or changethe existing ones, plan for future strategies, and prioritize the rehabilitation of visually disabled individuals. Government programs to increase awareness among unregistered visually disabled patients regarding the benefits and rehabilitative measures like UDID card and low vision aids is the need of the hour.

Assessment of genotypes, endosymbionts and clinical characteristics of Acanthamoeba recovered from ocular infection

IntroductionAcanthamoeba is an emerging pathogen, infamous for its resilience against antiprotozoal compounds, disinfectants and harsh environments. It is known to cause keratitis, a sight-threatening, painful and difficult to treat corneal infection which is often reported among contact lens wearers and patients with ocular trauma. Acanthamoeba comprises over 24 species and currently 23 genotypes (T1-T23) have been identified.AimsThis retrospective study was designed to examine the Acanthamoeba species and genotypes recovered from patients with Acanthamoeba keratitis (AK), determine the presence of endosymbionts in ocular isolates of Acanthamoeba and review the clinical presentations.MethodologyThirteen culture-confirmed AK patients treated in a tertiary eye care facility in Hyderabad, India from February to October 2020 were included in this study. The clinical manifestations, medications and visual outcomes of all patients were obtained from medical records. The Acanthamoeba isolates were identified by sequencing the ribosomal nuclear subunit (rns) gene. Acanthamoeba isolates were assessed for the presence of bacterial or fungal endosymbionts using molecular assays, PCR and fluorescence in situ hybridization (FISH).ResultsThe mean age of the patients was 33 years (SD ± 17.4; 95% CI 22.5 to 43.5 years). Six (46.2%) cases had AK associated risk factors; four patients had ocular trauma and two were contact lens wearers. A. culbertsoni (6/13, 46.2%) was the most common species, followed by A. polyphaga and A. triangularis. Most of the isolates (12/13) belonged to genotype T4 and one was a T12; three sub-clusters T4A, T4B, and T4F were identified within the T4 genotype. There was no significant association between Acanthamoeba types and clinical outcomes. Eight (61.5%) isolates harboured intracellular bacteria and one contained Malassezia restricta. The presence of intracellular microbes was associated with a higher proportion of stromal infiltrates (88.9%, 8/9), epithelial defect (55.6%, 5/9) and hypopyon (55.6%, 5/9) compared to 50% (2/4), 25% (1/4) and 25% (1/4) AK cases without intracellular microbes, respectively.ConclusionsGenotype T4 was the predominant isolate in southern India. This is the second report of T12 genotype identified from AK patient in India, which is rarely reported worldwide. The majority of the Acanthamoeba clinical isolates in this study harboured intracellular microbes, which may impact clinical characteristics of AK.