Ophthalmology Research Articles

Patient-centered medical homes and vision care for children: a cross-sectional analysis with data from the national survey of children's health 2018-2019.

Vision screening as part of well-child visits is recommended annually for US children 3 to 6 years. However, 63% of children do not get a vision screening in well-child visits. The Patient-Centered Medical Home (PCMH) improves the receipt of preventive care visits in other medical specialties but it is unknown if it improves receipt of vision screening. The objective of this study is to determine whether caregiver-reported receipt of care in a PCMH is associated with receiving a vision screening test in a well-child visit for children 3 to 6 years in a pediatrician/general doctor's office ('primary care'). Population-based data for US children aged 3 to 6 years was derived from the National Survey of Children's Health (2018-2019). Children were excluded if they did not have a well-child visit in the previous 12 months. The primary exposure was receipt of care in a PCMH ('PCMH care'), and the primary outcome was receipt of a vision screening in primary care. Adjusted odds ratios (aOR) and predicted probabilities were computed for children with and without PCMH care. Among 9,587 children with well-child visits, 4,984 (50.9%) were males. There were 1,107 (23.3%) Hispanic, 6704 (52.8%) White/Non-Hispanic and 545 (11.8%) Black/Non-Hispanic children. There were 5,482 (51.8%) children who received PCMH care. Of those with PCMH care, 2,629 (52.2%) received a vision screening in primary care. Those with PCMH care (52.2%) had a higher odds of receiving a vision screening (aOR, 1.31; 95% CI 1.11, 1.55) in primary care compared to children without PCMH care (42.8%). The predicted probability of vision screening in primary care was 50.8% (95% CI 48.2, 53.5) for children that received PCMH care, and 44.3% (95% CI 41.3, 47.3) without PCMH care. Caregiver-reported receipt of PCMH care was associated with a greater likelihood of vision screening for children 3 to 6 years in a well-child visit. Further studies are needed to understand the mechanisms through which PCMH care contributes to the greater odds of vision screening in primary care to inform the creation of strategic interventions to prevent vision loss and its long-term implications.

Electronic Documentation of Findings in Visual Impairment Counselling Using FIDUS Software

The increasing use of electronic documentation extends to consultation for the visually impaired. The aim of this project was to develop a set of forms and electronic patient records specifically for low vision care, giving equal consideration to ophthalmological, orthoptic, and optometric specialities, as well as teaching aspects. FIDUS software (FIDUS Arztservice Wente GmbH, Darmstadt, Germany) is a well-established tool in ophthalmology practices and clinics. The software was used as a basis to develop digital entry forms with features such as auto-fill, selection recommendations, and inventory management for visual aids. The aim of the project was to maximise clarity and ease of use while also saving time during consultation with visually impaired patients. This article presents the implementation of these criteria using the electronic FIDUS record card with the corresponding electronic forms for electronic patient records taken during consultation with visually impaired patients. The index card visualises the patient's most important data and findings at a glance. Specifically designed for low vision consultation, the examination form documents visual aids prescribed to the patient in detail while also saving time. Other forms enable direct printing of prescription recommendations, test reports, and certificates. Entry forms can also be printed out for conventional handwritten records. We have achieved an electronic patient record system specifically geared to ophthalmological and optical care requirements including local inventory for visually impaired patients. Determining the level of acceptance on the part of examiners, patients, and students and optimising the software will require follow-up studies.

A review of UK primary care pathways for acute ophthalmic conditions.

Care pathways for the management of acute ophthalmic conditions have developed and transformed significantly over recent years, owing to a combination of legislative changes, policy implementation and the pressing requirement to redistribute increased demand away from traditional secondary care providers through collaboration with primary care. Following UK healthcare devolution in 1999, each nation has developed and implemented their own strategies for managing the growing demands on acute ophthalmology services. Local commissioning across England has seen Enhanced Service Pathways develop to provide acute eye care by primary care optometrists, with provision and access dependent upon locality. Northern Ireland has seen the implementation of a nationwide Primary Eyecare Acute Referral Service, whilst in Scotland and Wales, the respective Governments have redesigned primary care optometry General Ophthalmic Service contracts to incorporate provision of extended investigations and management of acute conditions by optometrists across the nation, recognising the added benefit of optometrists with higher qualifications. This narrative review summarises both peer reviewed and appropriate grey literature articles reporting on acute eye care pathways in primary care. Despite significant progress, particularly during the global COVID-19 pandemic, there is arguably still a great deal of further research and evaluation required relating to pathway innovation, the role of professionals with higher qualifications, including independent prescribing, the role of telemedicine, reassurance around clinical safety, and how digital interconnectivity could potentially add value to collaborative schemes to meet the growing demand on acute eyecare.

An international survey of optometric management of stroke survivors

Objectives A survey was conducted to describe the current status of optometric awareness and involvement regarding post-stroke management as literature suggests that visual impairment often goes undiagnosed and unmanaged in stroke survivors. Materials and methods A questionnaire was developed by the researchers, pilot tested by 5 other optometric researchers and 15 optometrists and modified based on the feedback. Practicing optometrists were invited to complete the anonymous online survey through optometric organizations in Canada, Hong Kong, India, UK, and US. Results Results showed that the majority of optometrists (61%) see 1–5 post-stroke patients per month, although 15% report seeing none. In all cases, optometrists referred stroke patients to other health care professionals more often than receiving incoming referrals from them. About 21% of all respondents were already fully involved in post-stroke vision care and 57% were interested in being more involved. Limiting factors to seeing more post-stroke patients included resources (29.8%), funding (25.8%), awareness (25.1%), and interest (9.8%). There was consensus among respondents in all countries that optometrists should be members of post-stroke care teams. Conclusion Optometrists are well suited to provide post-stroke visual rehabilitation but are often not included in care teams for these patients. As a result, the visual management of post-stroke patients often is unaddressed.

Associations between School-Based Vision Program Outcomes and School Characteristics in 410 Schools.

School-based vision programs (SBVPs) deliver vision care services directly to students at school, helping address disparities in access to pediatric vision care. We aim to evaluate the associations between SBVP outcomes and school-level characteristics. Retrospective cross-sectional data analysis PARTICIPANTS: Public schools with at least 50 SBVP-enrolled students 5 to 22 years old with complete demographic data. Schools with fewer than 60% of total grade levels served by the SBVP were excluded, resulting in a sample of 410 schools. Vision screening and eye exam data were extracted from Helen Keller International's United States Vision Program dataset from 2016 through 2022. Individual student data were aggregated to characterize each school's SBVP outcomes and analyzed with schools' publicly available socioeconomic and demographic data (student body race and ethnicity composition, proportion of students qualifying for free and reduced-price meals [FARM%], and proportion of English Language Learners). Descriptive statistics summarized SBVP outcomes. Fractional regression models were utilized to understand associations between SBVP outcomes and school characteristics. SBVP outcomes were rates of vision screening failure, eyeglasses prescription, and community eye care referral among each school's SBVP-enrolled students. We evaluated 151 (36.8%) elementary, 155 (37.8%) middle, and 104 (25.4%) high schools, with a median FARM% of 87.4% and a plurality of Hispanic students in 61.0% of schools. Overall median rates of vision screening failure, eyeglasses prescription, and referral were 38.4%, 25.2%, and 5.4%, respectively. High schools were associated with increased screening failure and eyeglasses prescription rates and a decrease in referral rate, compared with elementary schools. In multivariate analysis, each 10% increase in FARM% was associated with a 2.6% (95% confidence interval [CI]: 1.54-3.65), 1.8% (CI: 0.87-2.74), and 0.86% (CI: 0.36-1.36) increase in screening failure, eyeglasses prescription, and referral rates, respectively. There is significant vision care demand among public schools, especially those with student populations from lower socioeconomic backgrounds. SBVPs are important in bridging the gap in pediatric vision care access in such populations. Our findings demonstrated opportunities to allocate program staffing and equipment resources according to schools' anticipated needs, thus maximizing SBVPs' impact in delivering pediatric vision care.

Artificial intelligence applications in ophthalmic surgery.

Technologies in healthcare incorporating artificial intelligence tools are experiencing rapid growth in static-image-based applications such as diagnostic imaging. Given the proliferation of artificial intelligence (AI)-technologies created for video-based imaging, ophthalmic microsurgery is likely to experience significant benefits from the application of emerging technologies to multiple facets of the care of the surgical patient. Proof-of-concept research and early phase clinical trials are in progress for AI-based surgical technologies that aim to provide preoperative planning and decision support, intraoperative image enhancement, surgical guidance, surgical decision-making support, tactical assistive technologies, enhanced surgical training and assessment of trainee progress, and semi-autonomous tool control or autonomous elements of surgical procedures. The proliferation of AI-based technologies in static imaging in clinical ophthalmology, continued refinement of AI tools designed for video-based applications, and development of AI-based digital tools in allied surgical fields suggest that ophthalmic surgery is poised for the integration of AI into our microsurgical paradigm.

Accuracy of 7 artificial intelligence based intraocular lens power calculation formulas in extremely long Caucasian eyes: Short title: AI-based IOL calculation in extra-long eyes

To compare 7 AI-based IOL power calculation formulas in extremely long eyes DESIGN: : Retrospective accuracy and validity analysis. SETTING: Kyiv Clinical Ophthalmology Hospital Eye Microsurgery Center, Ukraine STUDY POPULATION: : Patients with highly myopic eyes, who underwent uneventful phacoemulsification OBSERVATION PROCEDURES: Prior to cataract surgery IOL power was calculated. The power of the implanted IOL was randomly selected from the outcomes of SRK/T, Holladay 2 or Barrett Universal II. Three months after phacoemulsification, refraction was measured. Post-surgery IOL power calculations were performed utilizing the following formulas: Hill-RBF 3.0, Kane, PEARL-DGS, Ladas Super Formula AI (LSF AI), Hoffer QST, Karmona and Zhu-Lu. root mean square absolute error (RMSAE), median absolute error (MedAE) and percentage of eyes with prediction error (PE) within ±0.50 D RESULTS: : Forty eight eyes with axial length exceeding 30.00 mm were studied. Hill-RBF 3.0 yielded the lowest RMSAE (0.788) with statistical superiority only over Karmona (0.956, p=0.021). In terms of MedAE, outcomes obtained by Hoffer QST (0.442) and Hill-RBF (0.490) were statistically significant vs LSF AI (0.800, p=0.013, p=0.008, respectively). The highest percentage of eyes with PE within ±0.50 D was achieved by Hill-RBF 3.0, Kane and Hoffer QST (54.17% each) statistically significant as follows: both Hill-RBF and Kane vs LSF AI (27.08%) and Karmona (39.58%), and Hoffer QST vs LSF AI. All tested formulas demonstrated comparable trueness, with Hill-RBF 3.0 being more accurate than Karmona (RMSAE), and LSF AI being less accurate than Hoffer QST and Hill-RBF 3.0 (MedAE).

Access to vision care for children from immigrant and nonimmigrant households: evidence from the National Survey of Children's Health 2018-2019.

To investigate whether immigrant generation is associated with caregiver-reported receipt of vision testing. Nationally representative data from the 2018-2019 National Survey of Children's Health was used. The primary exposure was immigrant generation, with first generation defined as child and all reported parents born outside the United States; second generation, as child born in the United States but at least one parent born outside the United States; and third generation, as all parents in the household born in the United States. The main outcome was caregiver-reported vision testing during the previous 12 months. Odds ratios adjusted for sociodemographic characteristics and 95% confidence intervals were computed based on immigrant generation. The sample included 49,442 US children 3-17 years of age. The proportion of children who had vision testing in any setting was lower for first- (60.3%) than third-generation children (74.6%; aOR = 0.54; 95% CI, 0.41-0.71). This association remained after excluding children without health coverage. For Hispanic children, both first- (aOR = 0.58; 95% CI, 0.36-0.94) and second-generation children (aOR = 0.73; 95% CI, 0.55-0.96) had lower odds of a vision test in any setting compared with third-generation Hispanic children. First-generation children had lower odds of vision testing than third-generation children, even when adjusting for sociodemographic characteristics, especially in Hispanic households.

Exploring Spectacle Usage Patterns: A Thematic Analysis of Refractive Disorder Patients in Medan, Indonesia

Objectives: This study explores the behavioral patterns of spectacle users with refractive errors in Medan City, Indonesia, and identifies the key factors influencing the decision-making process in choosing and using glasses, contributing to SDG 3 (Good Health and Well-being) by addressing vision health. Theoretical Framework: The research is guided by the Precede-Proceed model and the Theory of Planned Behavior, which provide a framework for understanding health-related behaviors, including spectacle usage and its impact on overall well-being. Method: A qualitative methodology was employed, involving in-depth interviews with 30 Medan City residents diagnosed with refractive errors. This was supplemented by focus group discussions and consultations with eyewear experts. Data were analyzed using a descriptive-analytical approach. Results and Discussion: Key themes influencing spectacle usage behavior were identified, including needs, comfort, fashion, quality, perception, economy, and knowledge. Among these, needs, comfort, and quality emerged as the most significant factors influencing users’ choices of glasses. The findings suggest that people with refractive errors should prioritize glasses that meet health standards to ensure comfort and improve visual impairments, aligning with the goals of SDG 3 to promote health and well-being. Research Implications: Health practitioners, particularly optometrists, play a critical role in educating the community about the importance of using high-quality eyewear and addressing common misconceptions related to spectacle use, thus contributing to SDG 3 (Good Health and Well-being). Originality/Value: This study provides novel insights into the behavioral patterns of spectacle users in a specific cultural context, offering valuable information for health professionals and policymakers to improve vision care services in Medan City in support of SDG 3.

Telemedicine in Eye Care During the COVID-19 Pandemic: A Review of Patient & Physician Perspectives.

There has been an increase in the adoption of telemedicine during the COVID-19 pandemic. This review used systematic search and review criteria to assess the literature on patient and physician perspectives toward telemedicine for vision care during the pandemic. We conducted a comprehensive search on PubMed, Embase, and Scopus using relevant MeSH terms to identify peer-reviewed studies examining telemedicine use in eye care during the pandemic. The search strategy encompassed three key concepts: COVID-19 or pandemic, telehealth or telemedicine, and eye care. Further screening of references and similar articles was conducted to identify additional relevant studies. We identified 24 relevant studies published between 2020 and 2022. Of these, 15 focused on patients' perspectives, while 12 explored physicians' perspectives. Predominantly cross-sectional in design, these studies were mainly conducted during the initial wave of the pandemic (March 2020 to June 2020), primarily in urban locations and hospital settings. Patients were satisfied with telemedicine and considered it equally effective to in-person visits. Patients believed telemedicine was convenient, improved eye care access, and a beneficial triage tool. Physicians acknowledged telemedicine's convenience for follow-up assessment and its ability to expand the capacity for emergency cases. However, both patients and physicians voiced concerns about the absence of ancillary examination and technological challenges. Our review highlights the positive impact of telemedicine in eye care during the pandemic. Nonetheless, most studies were limited in sample size. They did not delve into potential disparities based on race/ethnicity, socioeconomic status, and geographic location, factors that could influence patient attitudes toward telemedicine. Further research is warranted to validate the findings from our selected studies and explore factors that influence the implementation of telemedicine, particularly across various eye care subspecialties.

Effective prism diopter for strabismus measurement: Conversion from anterior Prentice position to posterior parallel position and from glass prism to acrylic prism.

In clinical ophthalmology, prisms, commonly made of glass, are labeled based on the prism diopter (PD) value measured in the anterior Prentice position. However, they are often used in the posterior parallel position for practicality, causing a discrepancy between labeled and effective PD. This study proposes a conversion tool to address this issue. Geometric optical analysis was employed to calculate the effective PD of glass prisms in the posterior parallel position. A lookup table was created to convert the labeled PD of the anterior Prentice position to the effective PD when the prism is used in the posterior parallel position. Clinical data from 162 patients with horizontal strabismus were collected to validate the method. Glass prism measurements, converted to effective PD, were compared with acrylic prism results. The variations were significant in glass prism PD with rotation in the anterior Prentice position but stability in the posterior parallel position. Clinical deviations were larger with glass prisms, especially exceeding 30 PD, compared with acrylic prisms. Converted PD from glass prisms correlated well with acrylic prisms (R2 = 0.94, P = 0.002). The half-width of the 95% limit of agreement was ±12.32 PD. The proposed conversion table is valid, facilitating consistency between clinical and literature-based prism use in different positions and materials.

Racial/ethnic disparities in cost-related barriers to care among near-poor beneficiaries in Medicare Advantage vs traditional Medicare.

To compare racial and ethnic disparities in cost-related medical care and dental care barriers and use of vision care among near-poor Medicare beneficiaries in Medicare Advantage (MA) vs traditional Medicare (TM) overall and stratified by supplemental insurance enrollment. Cross-sectional analysis of 2015-2019 data from the nationally representative Medicare Current Beneficiary Survey. Propensity score-weighted difference-in-disparities analyses comparing Black-White and Hispanic-White disparities in MA vs TM among near-poor Medicare beneficiaries with incomes between 101% and 250% of the federal poverty level. We assessed differences in cost-related medical care barriers and cost-related dental care barriers as well as receipt of annual eye exams in MA vs TM. For cost-related barriers to medical care, Hispanic-White disparities were narrower by 8.8 (95% CI, -14.0 to -3.6) percentage points in MA relative to TM but differences in Black-White disparities were not statistically significant. MA was not associated with narrower differences in Hispanic-White or Black-White disparities in dental care access. Higher proportions of Black and Hispanic beneficiaries in MA received an annual eye exam vs White beneficiaries in both MA and TM. MA was associated with narrower racial disparities primarily compared with TM without supplemental insurance. Among near-poor Black and Hispanic Medicare beneficiaries, MA was associated with greater use of vision care and narrowing of some disparities in cost-related access barriers vs TM. However, MA did not uniformly narrow racial/ethnic disparities in access and use. These findings highlight the importance of maintaining and enhancing features of Medicare coverage that may promote equitable access to care, including additional benefits and lower cost sharing.

Vision Care as A Strategy to Prevent Falls Among People with Moderate or Severe Intellectual Disability in the Hostel Setting in Hong Kong

Background: Factors contributing to the higher fall risk among people with intellectual disabilities (PIDs) are complex due to their discrete patterns of multimorbidity. Visual impairment, such as cataract, was common at old age and could be a crucial risk factor. Given the insufficient evidence regarding this relationship, the present study aimed at investigating this issue in a hostel setting in Hong Kong. Methods: This study was conducted in four hostels which served people with moderate to severe intellectual disability. Health data of residents collected in the year of 2022-23 was utilized for the current analysis. Data included fall risk, assessed by Morse Fall Scale, as well as other health conditions (osteoporosis, osteoarthritis, cataract) and demographics (age and gender) among residents. Results: The sample consisted of 199 residents (85 were males and 114 females), with an age range of 22 to 76 years. Around 40% (85; 42.7%) of them aged above 45 years old. Among the whole sample, cataract was the most common health condition and its prevalence reached 27.14%. Those who aged 45-year or above were 4.61 times (95%CI 2.09-11.07) more likely to have cataract. Bivariate analysis results showed that presence of fall risk was associated with older age (above 45 years old; OR 2.38; 95%CI 1.28-4.49), diagnosis of cataract (OR 3.3; 95%CI 1.71-6.33) and osteoarthritis (OR 12.68; 95%CI 1.70-564.75). Logistic regression analysis further illustrated that cataract (p = 0.04) remained as a significant predictor of fall risk after controlling age, gender, osteoarthritis and osteoporosis in the model. Conclusion: Our data showed that presence of cataract diagnosis was significantly associated with higher fall risk among PIDs in hostel setting. Given cataract was a prevalent condition especially among aging PIDs, early screening and intervention could be crucial components of fall prevention strategy in a hostel setting.

Dmitry S. Gorbachev – the path of a military doctor

The name of Dmitry S. Gorbachev has a worthy place in the list of teachers and ophthalmic surgeons of the Department of Ophthalmology of the Kirov Military Medical Academy and military ophthalmology in general.D.S. Gorbachev dedicated his life to military medicine, training and education of future military doctors. He is a student of Professor V.V. Volkov, and was deeply immersed in the complex problem of orbital surgery. At the Department, D.S. Gorbachev, due to his deep scientific immersion in the problem, brought the field of orbital surgery to a modern multidisciplinary level. He constantly passed on his knowledge and skills to his students, who are currently continuing his work.

Deprivation and NHS General Ophthalmic Service sight testing activity in England in 2022-2023.

Socioeconomic deprivation is associated with an increased incidence of sight-loss. To inform potential developments in eyecare, General Ophthalmic Service (GOS) sight-testing activity was explored in relation to deprivation for GOS contractors submitting National Health Service (NHS) claims in England. Data on NHS sight-test claims for the financial year 2022-2023 were sought from NHS England (NHSE), including number of sight-tests by GOS contractors, their unique Organisation Data Service codes and postcodes and age-bands of patients accessing sight-testing. Deprivation scores were assigned to contractor practices using the Index of Multiple Deprivation (IMD) and the average number of sight-tests for all contractors within each IMD decile calculated, allowing rate of sight-testing per 1000 population per decile of deprivation to be estimated using Office of National Statistics (ONS) Lower Layer Super Output Area mid-year population estimates. Inequality was examined using the Odds Ratio (OR) and slope and relative index of inequality measures (SSI and RII). Overall, 12.94 million NHS sight-tests were provided by 5622 GOS contractors in England in 2022-2023. Most affluent decile GOS contractors undertook an average ~2200 NHS sight-tests, while in the most deprived decile, average NHS sight-tests per contractor was ~1100. Rate of sight-testing per 1000 population in the most deprived decile was one quarter of that in the most affluent, with an OR of 5.29 (95% CI 5.27-5.30), indicating those in the most affluent areas were ~five times more likely to access NHS sight-tests. Overall, SII and RII were 333.5 (95% CI 333.52-333.53) and 6.4 (95% CI 6.39-6.40), respectively, findings reflective of substantial inequality in uptake. There remains substantial unwarranted variation in uptake of NHS sight-testing, with those in more affluent areas accessing sight-testing substantially more than those in more deprived areas. Strategies are required to facilitate primary care optometry to provide more equitable access to eyecare.

Global Health Security in Vision Care: Health Systems Strengthening During Ebola Virus Disease Outbreak Responses.

During the last decade, global health security has been threatened by major Ebola virus disease outbreaks in Western Africa (2014 to 2016) and in eastern Democratic Republic of the Congo (2018 to 2020). Particularly in Western Africa, the outbreak initially overwhelmed health care capacity in already fragile health systems. Thousands of survivors were at risk of newly recognized postacute ocular complications, and their need for urgent ophthalmic care challenged national vision health systems with scarce eye care services. In these unprecedently large outbreaks with implications for global health security, agile eye care responses were challenging, including in regard to decision coordination and requisite logistical needs. In this report, we detail vision care initiatives implemented in response to these outbreaks and highlight the need to include vision care as a critical component of the response to infectious disease outbreaks with eye health implications.

Preface: Global Health Security in Vision Care: Addressing Disparities, Outbreaks, and Conflict.

Preface: Global Health Security in Vision Care: Addressing Disparities, Outbreaks, and Conflict.

Development, Validity, and Reliability of the Primary Eye Care Questionnaire (PECQ) Among Optometrists in Malaysia.

Visual impairment and vision loss are preventable or treatable if there is access to eyecare services for early detection and if proper interventions are given.Optometristsplay a vital role in the early detection of eye and visual-related issues.As healthcare professionals, optometrists are trained to provide comprehensive eye and vision care encompassing dispensing and refraction, detection of abnormalities in the vision and eye, and the rehabilitation of conditions of the visual system, as suggested by the World Council of Optometry.In the current practice of primary eye care, optometrists are not fully utilized and are mostly restricted to refractive correction. Therefore, the optometrists' practice level, scope, and challenges to practice primary eye care must be identified before strengthening optometrists' role in the community. The present study aimed to develop and validate a questionnaireto determine the contributing factors and challenges to the practice of primary eye care by optometrists in Malaysia. The Primary Eye Care Questionnaire (PECQ) was developed through an extensive literature search to identify the domains and to construct the items. The items were then scrutinized further through focus group discussions with experts (n = 10) from various sectors of eye care. Content validation was conducted with ophthalmologists and optometrists as panels (n = 10), followed by face validation (n = 10) by optometrists from the public and private sectors. Construct validation was performed with exploratory factor analysis and reliability was evaluated by using Cronbach's alpha coefficient and the test-retest reliability. In total, the PECQ questionnaire was constructed with 123 itemsunder three main domains: contributing factors, challenges, and continuous education. The content validity index (CVI) for each item (I-CVI) score ranged from 0.9 to 1.0 for each item and the CVI for average scale (S-CVI/Ave) was above 0.8 for each domain, with internal consistency of 0.948 and Cronbach's alpha coefficient of 0.971. The PECQ is a valid and reliable tool for assessing the optometrists' scope of practice, challenges, and contributing factors to the practice of primary eye care.

Ocular Manifestations in Children with Special Needs Presenting in a Tertiary Eye Hospital of Central Nepal

Background Children with special needs are at a substantially higher risk of visual impairment (VI) (10.5% compared with 0.16%) but also of ocular disorders of all types, including refractive errors and strabismus. VI and other potentially correctable ocular disorders are frequently unidentified in children with complex needs. Although assessment may be more challenging, identifying these potential additional barriers to learning and development may be critical.MethodsDetailed ophthalmic examination was carried out in all children with special needs presenting to the Pediatric OPD of Bharatpur Eye Hospital over 6 months (January to June 2023). Ophthalmic examination included case history, presenting distance visual acuity, cycloplegic refraction, binocular vision examination, anterior and posterior segment evaluation.ResultsOut of the total of 55 participants, mean age was 9.74 ± 5.07 years, majority were male 32 (58.18%). Quantitative visual acuity could be assessed only in 19 (34.55%) children, using picture chart 9 (16.36%) and Snellen chart 10 (18.18%). Strabismus 21 (38.18%) and refractive error 14 (25.45%) were the commonest visual disorders in our study children.Conclusions With patience, suitably adapted methods, visual assessment is feasible in the majority of children with special needs. It is hoped that the formulation of proper vision care guidelines at a national level may help in early detection and management of visual disorders in this special population and enhance their quality of life.

Importance of Grading Cataracts in Predicting Recovery Time and Final Visual Outcomes After Cataract Surgery.

Cataracts have been considered as one of the major causes for reducing the vision-related quality of life and increasing the risk of comorbidities and mortality among the general population. This study aimed to assess the importance of grading cataracts in predicting recovery time and final visual outcomes after cataract surgery. A retrospective consecutive case review of elective cataract surgeries performed in a tertiary care hospital during a three-year period from 2019 to 2021 was studied. The postoperative visual status was correlated with grading. The reports of this study implicate the fact that 16.4% of the patients had grade 1 anterior segment cataracts. Visual acuity of perfect vision (6/6P) was obtained in 24% of patients, and 41.2% of patients had grade 1 anterior segment cataract surgery on day 1 (p<0.005). Perfect vision at 6/6 visual acuity was obtained in 24% of patients, and 27.5% of patients had grade 2 anterior segment cataract surgery in week 1 (p<0.05). The study shows that patients with grade 1 anterior segment cataract surgery had a better visual recovery time and visual outcome. The grading system of cataracts has further shown improvement in the vision care of the patients, along with showing reliability and monitoring of cataract formation.