Pinhole Visual Acuity Research Articles

Save sight keratoconus registry study: Transepithelial versus epithelium-off corneal crosslinking

PurposeCorneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus and can be performed with the epithelium on or off. Evidence is needed to guide clinicians and patients on whether they should have transepithelial or epithelium-off CXL. The aim of this study was to determine the safety and efficacy of transepithelial and epithelium-off CXL. DesignAn observational prospective study was conducted using real-world data from patients in the Save Sight Keratoconus Registry. MethodsPatients with no previous intervention before CXL were included. The primary outcomes were adverse events, change in Kmax, habitual visual acuity and minimum corneal thickness from baseline to 12 months follow up. Mixed effects regression models evaluated changes in outcomes adjusted for age, sex, eye laterality, practices, and baseline outcomes. ResultsThere were 46 eyes (37 patients) and 1203 eyes (976 patients) included treated with transepithelial and epithelium-off CXL, respectively. At 12 months follow up, the habitual visual acuity, pinhole visual acuity, Kmax, K2 and minimum corneal thickness were not significantly different between epithelium-off and transepithelial CXL. There were fewer adverse events recorded in transepithelial compared to epithelium-off CXL. ConclusionEpithelium-off and transepithelial CXL were similarly effective, measured by visual acuity and corneal curvature, to stabilise and prevent progression between baseline and 12 months follow-up in keratoconus. Transepithelial CXL had fewer adverse events compared to epithelium-off CXL.

INFERIOR RETINAL DETACHMENT REPAIR USING VITRECTOMY WITH OR WITHOUT SCLERAL BUCKLING.

To compare outcomes in inferior rhegmatogenous retinal detachment (RRD) repair using pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB). Patients who underwent surgery for inferior RRD at a tertiary care center between 2014 and 2018 were included. Inferior RRD was defined as RD with tears between 4:00 and 8:00 clock hours in a detached retina. Non-RRD etiologies (e.g., traumatic, tractional), proliferative vitreoretinopathy grade ≥C2, and silicone oil use were excluded. Single-surgery anatomic success was defined as the absence of reoperation for recurrent RRD during follow-up. There were 366 patients included of which 260 (71%) were operated using PPV-SB. Single-surgery anatomic success was achieved in 96 (91%) of patients with pars plana vitrectomy and 227 (87%) of patients with PPV-SB ( P = 0.38) over a median follow-up of 15 months. At the final follow-up, pinhole visual acuity was 0.18 (0.10-0.30) among patients with pars plana vitrectomy and 0.18 (0.10-0.40) among patients with PPV-SB (Snellen equivalent: 20/30; P = 0.03). After adjusting for demographic (i.e., age and sex) and preoperative characteristics (i.e., macula on status, baseline pinhole visual acuity, and grade C1 proliferative vitreoretinopathy), PPV-SB did not alter single-surgery anatomic success ( P = 0.210). Following inferior RRD repair, there were no significant differences in single-surgery anatomic success between patients undergoing pars plana vitrectomy and PPV-SB in this large, retrospective cohort.

Chronic myeloid leukemia presenting with disc edema: A case report

The aim is to report a case of chronic myeloid leukemia (CML) in a 20-year-old female who initially presented with bilateral optic disc edema and headaches, and to raise awareness of uncommon causes of disc edema that could potentially be life-threatening. The patient first presented in June 2022 with blurry vision in the left eye, headache, and neck pain of 6 months duration. Initial examination revealed a young woman in no acute distress, with a blood pressure of 100/60 mm Hg and a body mass index of 26.98. Her pinhole visual acuity was 6/9 in both eyes, extraocular motility was full bilaterally, and both pupils were briskly reactive. However, she had bilateral optic disc edema. Both brain and orbital magnetic resonance imaging (MRI) revealed normal findings. Serological tests for syphilis and human immunodeficiency virus were negative. Based on these and the clinical features, an initial diagnosis of idiopathic intracranial hypertension was made, and the patient was started on acetazolamide tablets. She was followed up for approximately 1 year without resolution of symptoms. At a follow-up visit in December 2023, she was found to have developed dilated tortuous vessels with discrete retinal lesions. A peripheral blood film result showed that the patient had CML. In conclusion, a high index of suspicion should be entertained when managing a patient with unexplained bilateral disc swelling with normal brain MRI study. A complete blood workup, including a peripheral blood film, should be included as a part of the routine investigation of these patients so that diagnosis and treatment could be instituted early.

Comparison of pupil dilation in manual small incision cataract surgery using topical versus intracameral mydriatic agents – A randomised controlled trial

Objectives: The purpose of this research is to assess and compare the efficacy of an intracameral mydriatic solution with conventional topical agents in the completion of manual small incision cataract surgery (MSICS) in a black population. Materials and Methods: This randomised controlled trial was conducted among 102 patients undergoing MSICS under sub-tenon’s block. Mydriasis in the topical group was achieved with a pre-operative topical dilating combination of tropicamide 0.8% and phenylephrine 5% while surgery was commenced in patients in the intracameral group without dilation, and mydriasis was achieved intraoperatively with an intracameral solution of lidocaine 0.5% and adrenaline 0.001%. Pupil sizes were measured serially, before, and at four different junctures during surgery. The proportion of patients needing supplementary mydriasis in either group was noted, as well as post-operative pinhole visual acuity (VA). Data analysis was carried out using the Statistical Package for the Social Sciences Statistical Product and Service Solutions(SPSS) version 25.0 (IBM, Chicago, Illinois). The level of statistical significance was set at P < 0.05 at a 95% confidence interval. Results: Mean pupil diameter before dilating and blocking was 2.5 ± 0.6 mm in the topical group and 2.5 ± 0.7 mm in the intracameral group (P = 0.752). This increased to 7.7 ± 1.1 mm and 7.4 ± 0.8 mm, respectively (P = 0.134), after administering either mydriatic agents. After that, mean pupil diameter progressively reduced in both groups but was significantly higher in the intracameral group at each point of measurement (P < 0.05). Postoperatively, there was no significant difference in the VA between the two groups (P < 0.05). Conclusion: Using an intracameral mixture of lidocaine and adrenaline gives adequate mydriasis for the successful completion of MSICS without pre-operative dilation.

The Rapid Assessment of Avoidable Blindness survey: Review of the methodology and protocol for the seventh version (RAAB7).

The Rapid Assessment of Avoidable Blindness (RAAB) is a population-based cross-sectional survey methodology used to collect data on the prevalence of vision impairment and its causes and eye care service indicators among the population 50 years and older. RAAB has been used for over 20 years with modifications to the protocol over time reflected in changing version numbers; this paper describes the latest version of the methodology-RAAB7. RAAB7 is a collaborative project between the International Centre for Eye Health and Peek Vision with guidance from a steering group of global eye health stakeholders. We have fully digitised RAAB, allowing for fast, accurate and secure data collection. A bespoke Android mobile application automatically synchronises data to a secure Amazon Web Services virtual private cloud when devices are online so users can monitor data collection in real-time. Vision is screened using Peek Vision's digital visual acuity test for mobile devices and uncorrected, corrected and pinhole visual acuity are collected. An optional module on Disability is available. We have rebuilt the RAAB data repository as the end point of RAAB7's digital data workflow, including a front-end website to access the past 20 years of RAAB surveys worldwide. This website ( https://www.raab.world) hosts open access RAAB data to support the advocacy and research efforts of the global eye health community. Active research sub-projects are finalising three new components in 2024-2025: 1) Near vision screening to address data gaps on near vision impairment and effective refractive error coverage; 2) an optional Health Economics module to assess the affordability of eye care services and productivity losses associated with vision impairment; 3) an optional Health Systems data collection module to support RAAB's primary aim to inform eye health service planning by supporting users to integrate eye care facility data with population data.

Resident operative time as an independent predictor of early post-operative cataract surgery outcomes and supervising attending surgeon impact: a retrospective case series

BackgroundThe authors sought to determine if resident operative time in cataract extraction and intraocular lens insertion (CE/IOL) affects early visual outcomes and post-operative recovery. They further sought to investigate if attending surgeons can reduce resident operative time.MethodsThis retrospective, chart-review, case series at single Veterans Affairs Hospital (VA Tennessee Valley Healthcare System) studied resident cataract surgeries between March 1, 2018 and March 31, 2020. Following power analysis, 420 eyes of 400 patients from all resident cataract surgeries were included. Eyes with attending as primary surgeon, laser-assisted cataract surgery, or concurrent secondary procedures were excluded. Linear mixed effect models were used to study the association between operative time and visual outcomes while adjusting for covariates including cumulative dissipated energy, preoperative factors, and intraoperative complications.ResultsLonger operative time was statistically associated with worse post-operative-day 1 (POD1) pinhole visual acuity (PH-VA) adjusting for cumulative dissipated energy and other operative factors (p = 0.049). Although resident physicians were the primary surgeons, the operative times were different between the ten supervising attending surgeons in the study (p < 0.001).ConclusionThe results suggest that increased resident operative time is a significant, independent risk factor for decreased POD1 PH-VA. Increased resident operative time is not associated with worsened long term visual outcomes. Attending surgeons may be able to reduce resident operative time, which is associated with improved early visual outcomes.

REtinal Detachment Outcomes Study (REDOS): study protocol for a factorial, randomized controlled trial

BackgroundFew large randomized controlled trials provide strong evidence to guide surgical repair of primary rhegmatogenous retinal detachment (RRD) repair. The purpose of this factorial, single-blind, randomized controlled trial is to analyze and compare the surgical outcomes, functional visual outcomes, complications, and quality of life associated with RRD repair using (A) pars plana vitrectomy only (PPV) or PPV with scleral buckle (PPV-SB) and (B) sulfur hexafluoride gas (SF6) or perfluoropropane gas (C3F8) tamponade.MethodsEligible patients with moderately complex RRD will be randomized 1:1 to PPV or PPV-SB and 1:1 to SF6 or C3F8 gas tamponade. Approximately 560 patients will be recruited to be able to detect a difference of around 10% in SSAS rate between the groups. Patients will be followed using multimodal imaging and quality of life questionnaires after the surgical repair until 1 year postoperative. The primary outcome will be a single-surgery anatomic success (SSAS), defined as the absence of reoperation for recurrent RRD in the operating room. Secondary outcomes will be pinhole visual acuity (PHVA) at 8–10 weeks and 6 months, final best-corrected visual acuity (BCVA), final retina status (i.e., attached or detached), time to onset of RRD recurrence, severity and number of complications, and questionnaire results.DiscussionThis will be the first 2 × 2 factorial RCT examining repair techniques in primary RRD. It will also be the first RCT to compare gas tamponade between the two most common agents. Notably, it will be adequately powered to detect a clinically significant effect size. The use of multimodal imaging will also be a novel aspect of this study, allowing us to compare head-to-head the impact of adding an SB to the retina’s recovery after RRD repair and of differing gas tamponades. Until now, the treatment of RRD has been largely guided by pragmatic retrospective cohort studies. There is a lack of strong evidence guiding therapeutic decisions and this trial will address (1) whether supplemental SB is justified and (2) whether longer duration gas tamponade with C3F8 is necessary.Trial registrationClinicalTrials.gov NCT05863312. Registered on 18 May 2023.

Visual Outcomes of Cataract Surgery at the Eye Foundation Community Hospital in Nigeria

Aims: To determine the visual outcome of cataract surgeries postoperatively at first day, one and three months. &#x0D; Study Design: Retrospective, case series study.&#x0D; Place and Duration of Study: Eye Foundation Community Hospital, Ilese-Ijebu-Imushin, Ogun state of Nigeria. 3-month duration from June 1st 2019 to August 31st 2019.&#x0D; Methodology: All patients 18 years and above operated for cataract surgery without comorbidity were included in the study. Type of surgery done were manual small incision cataract surgery (MSICS) and phacoemulsification. Patient data were entered into excel spread sheet created for the study. From where it was cleaned up and exported in to statistical package for social sciences 20. Visual outcome was assessed on the first day, first month and at third month post operatively. Snellen visual acuity was converted to log MAR. P value = 0.05 is determined as statistically significant. &#x0D; Results: Two hundred and fifty (250) patients or eyes were analysed in this study. Two hundred and twenty patients (88%) had MSICS, 30 (12%) had phacoemulsification. Preoperatively, majority (150, 60%) presented with visual acuity less than 3/60 followed by patients with visual acuity between 6/18 to 6/60 (76, 30.4%). Nineteen patients (7.6%) had visual acuity of 6/18 or better. Mean preoperative log MAR was 1.6 ± 0.8 (equivalent to count finger). 3-month post op, two hundred and fourteen (85.6%) had uncorrected visual acuity of 6/18 or better while 231 patients (92.4%) had best corrected (with pinhole) visual acuity of 6/18 or better. (P=0.004 and 0.038 respectively). &#x0D; Conclusion: There is an appreciable improvement in the visual outcome following cataract surgery.

Visual impairment associated with diabetic retinopathy and macular edema: a hospital-based study.

Data on visual impairment (VI) in patients with diabetes are necessary in order to guide economic and human resources for reducing its prevalence. To estimate the prevalence of diabetic retinopathy-related VI in patients with type 2 diabetes in a hospital-based setting. Cross-sectional study carried out from 2014 to 2019 in an ophthalmology outpatient clinic. Any VI was defined as corrected pin-hole visual acuity in the better eye of ≥ 0.24 logMAR. The presence of diabetic retinopathy (DR), diabetic macular edema (DME) and cataract was evaluated. A total of 840 patients were included; median diabetes duration was 15 years. The prevalence of VI was 30%. DR was found in 62% of patients (30% had sight-threatening DR [STDR]), 17% had referable DME, and 3%, cataracts. The odds ratio for moderate or worse VI was 9.02 for STDR (p < 0.001), 5.89 for referable DME (p = 0.001), and 2.51 for cataract (p = 0.006). Thirty percent of participants had some degree of VI. Moderate or worse VI showed a strong association with STDR and referable DME.

Bilateral sequential and simultaneous rhegmatogenous retinal detachments: anatomic and functional outcomes

ObjectifAnalyser les résultats anatomiques et fonctionnels de la réparation chirurgicale des décollements de rétine rhegmatogènes bilatéraux (DRRB) séquentiels et simultanés. NatureÉtude de cohorte rétrospective. ParticipantsUn total de 218 yeux de 109 patients. MéthodesLes dossiers des patients qui ont reçu un diagnostic de DRRB entre 2014 et 2020 au Centre universitaire d'ophtalmologie du CHU de Québec–Université Laval ont été passés en revue. Les principaux paramètres de mesure étaient la réussite anatomique d'une seule chirurgie (SSAS, pour single-surgery anatomic success) et l'acuité visuelle (AV) au trou sténopéïque (TS) finale en logMAR. RésultatsSur les 109 patients, 86 (79 %) étaient de sexe masculin, et l’âge médian (Q1, Q3) lors de la visite initiale pour le premier œil était de 60 ans (fourchette : 54–66 ans). Dans 92 % des cas (n = 100), il s'agissait d'un DRRB séquentiel et dans 8 % des cas (n = 9), d'un DRRB simultané. La durée médiane (Q1, Q3) des symptômes était plus courte dans le cas du deuxième œil (premier œil : 7 jours [fourchette : 3–15 jours] vs deuxième œil : 4 jours [fourchette : 2–10 jours]; p = 0,028). Il y avait moins de déchirures rétiniennes dans le deuxième œil (premier œil : 2,94 ± 2,76 déchirures vs deuxième œil : 2,38 ± 1,79 déchirures; p = 0,031), et l'AV au TS médiane préopératoire était meilleure (premier œil : 0,46 logMAR [fourchette : 0,14–2,30 logMAR] vs deuxième œil : 0,24 logMAR [fourchette : 0,06–0,95 logMAR]; p = 0,012). La SSAS a été obtenue dans 100 (92 %) des premiers yeux et dans 101 (93 %) des deuxièmes yeux, respectivement (p = 1,00). L'AV au TS finale était meilleure dans le premier œil (premier œil : 0,14 logMAR [fourchette : 0,04–0,30 logMAR] vs deuxième œil : 0,20 logMAR [fourchette : 0,04–0,43 logMAR]; p = 0,010), mais comparable dans les deux yeux après 3 mois (premier œil : 0,30 logMAR [fourchette : 0,14–0,48 logMAR] vs deuxième œil : 0,34 logMAR [fourchette : 0,13–0,70 logMAR]; p = 0,36). ConclusionsLa SSAS était semblable dans les deux yeux. Le deuxième œil était plus susceptible d’être traité plus rapidement et de présenter des lésions moins avancées. Cela dit, l'AV au TS à 3 mois ne différait pas significativement entre les deux yeux. La différence au chapitre de l'AV au TS finale pourrait être attribuable à un suivi de plus longue durée dans le premier œil.

Nationwide Rapid Assessment of Avoidable Blindness (RAAB) in Armenia

ABSTRACT Purpose This study aimed to estimate the prevalence and main causes of blindness and visual impairment in population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. Methods The study team randomly selected 50 clusters (each consisting of 50 people) from all 11 regions of Armenia. Data on participants’ demographics, presenting visual acuity, pinhole visual acuity, principal cause of presenting visual acuity, spectacle coverage, uncorrected refractive error (URE), and presbyopia were collected using the RAAB survey form. Four teams of trained eye care professionals completed data collection in 2019. Results Overall, 2,258 people of 50 years and older participated in the study. The age- and gender- adjusted prevalence of bilateral blindness, severe and moderate visual impairment were 1.5% (95% CI: 1.0–2.1), 1.6% (95% CI: 1.0–2.2) and 6.6% (95% CI: 5.5–7.7), respectively. The main causes of blindness were cataract (43.9%) and glaucoma (17.1%). About 54.6% and 35.3% of participants had URE and uncorrected presbyopia, respectively. The prevalence of bilateral blindness and functional low vision increased with age and was the highest in participants 80 years and older. Conclusion The rate of bilateral blindness was comparable with findings from countries that share similar background and confirmed that untreated cataract was the main cause of blindness. Given that cataract blindness is avoidable, strategies should be developed aiming to further increase the volume and quality of cataract care in Armenia.

Blindness and visual impairment and their causes in India: Results of a nationally representative survey.

IntroductionAvoidable blindness is a significant public health problem in India. Nationally representative RAAB surveys (Rapid Assessment of Avoidable Blindness) are being conducted periodically in the country to know the current status of blindness in the country. The current study describes the findings from the RAAB survey conducted during 2015–19 in India.MethodologyA cross-sectional, population-based survey was conducted across the entire country among persons aged 50 years and above using RAAB version 6 methodology. Presenting and pinhole visual acuity was recorded followed by lens examination using a torchlight. In order to estimate the prevalence of blindness and visual impairment in overall population in India, district weights were assigned to each of the 31 surveyed districts and the prevalence was standardized using the RAAB software.ResultsThe overall weighted, age-gender standardized, prevalence of blindness (presenting visual acuity <3/60 in better eye) in population aged ≥50 years was 1.99% (95% CI 1.94%, 2.13%) and of visual impairment (VI) (presenting visual acuity <6/12 in better eye) was 26.68% (95% CI 26.57–27.17%). On multivariate analysis, adjusted odds ratio showed that blindness was associated with age ≥ 80 years (OR = 20.3, 95% CI: 15.6–26.4) and being illiterate (OR = 5.6, 95% CI: 3.6–8.9). Blindness was not found to be significantly associated with either gender or locality.ConclusionThe results of the survey demonstrate that currently more than one fourth of persons aged 50 years and above are visually impaired (PVA<6/12 in better eye) in India. The prevalence of blindness among them is 1.99%, and older age and illiteracy are significantly associated with blindness. Major causes of blindness included cataract (66.2%), corneal opacity (CO) (8.2%), cataract surgical complications (7.2%), posterior segment disorders (5.9%) and glaucoma (5.5%). The proportion of blindness and visual impairment that is due to avoidable causes include 92.9% and 97.4% respectively.

Results of the Pinhole Test Correlate with Hybrid Contact Lens Visual Acuity in Patients with Visual Impairment due to Corneal Diseases.

Introduction Trial rigid lens fitting is considered the best approach to determine whether the correction of residual defocus and irregular astigmatism might improve the visual acuity in patients with corneal disorders including keratoconus. This study aimed to analyze the correlation between hybrid lenses and pinhole visual acuity (VA). Methods Patients undergoing hybrid contact lens fitting at the Hygeia Clinic, Poland, were included. The VA of each patient was assessed as decimal Snellen fractions under the following conditions: (i) uncorrected VA, (ii) VA with spherocylindrical correction (i.e., corrected distance VA), (iii) VA with a single 1.2 mm pinhole occluder, and (iv) VA with the best-fitted hybrid contact lens. Pearson's correlation coefficient r was used to assess correlations among variables. Results This study involved 29 eyes of 19 patients, mainly with advanced keratoconus. The uncorrected VA was 0.11 ± 0.10. The pinhole test provided significantly improved VA over corrected distance VA (0.51 ± 0.29 vs. 0.31 ± 0.20, respectively; p < 0.0001). Similarly, the fitted hybrid contact lenses provided improved VA over corrected distance VA (0.66 ± 0.26 vs. 0.31 ± 0.20, respectively; p < 0.0001). The pinhole VA was strongly correlated with the hybrid contact lens VA (r = 0.8135; 95% CI: 0.61–0.92; p < 0.0001). The improvement in the pinhole test over corrected distance VA was moderately correlated with the improvement with the fitted lens over corrected distance VA (r = 0.6269; 95% confidence interval (CI): 0.32–0.80; p=0.0005). Conclusions A significant improvement in VA with the pinhole test is a simple predictor of general improvement with hybrid contact lenses. The pinhole test should be used in patients with corneal diseases such as keratoconus to determine whether optical aberrations associated with the disease cause their visual impairment.

OUTCOMES IN PRIMARY UNCOMPLICATED RHEGMATOGENOUS RETINAL DETACHMENT REPAIR USING PARS PLANA VITRECTOMY WITH OR WITHOUT SCLERAL BUCKLE.

To compare outcomes after primary uncomplicated rhegmatogenous retinal detachment repair using pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB). This is a retrospective cohort study with propensity score analysis in a single tertiary care center between 2014 and 2018 comparing patients with primary uncomplicated rhegmatogenous retinal detachment repaired using PPV only or PPV-SB (full cohort: n = 1,516, propensity-matched cohort: n = 908). The primary outcome was single surgery anatomic success, whereas secondary outcomes were 3-month and final pinhole visual acuity in logarithm of the minimum angle of resolution and final retina status. In the full cohort, single surgery anatomic success was achieved in 745 (91%) PPV patients versus 623 (89%) PPV-SB patients (P = 0.13). This was 390 (92%) versus 314 (88%) in phakic patients (P = 0.06) compared with 353 (91%) versus 301 (90%) in pseudophakic patients (P = 0.79), respectively. After matching, single surgery anatomic success was achieved in 424 (93%) PPV patients versus 412 (91%) PPV-SB patients (P = 0.14). Median pinhole visual acuity after PPV was better at 3 months (PPV: 20/40 vs. PPV-SB: 20/50; both cohorts: P < 0.001) and final follow-up (PPV: 20/29 vs. PPV-SB: 20/38; full cohort: P < 0.001 and PPV: 20/29 vs. PPV-SB: 20/36; matched cohort: P < 0.001). Addition of scleral buckle does not significantly change the rate of single surgery anatomic success compared with PPV only in primary uncomplicated rhegmatogenous retinal detachment. It is also associated with worse pinhole visual acuity at follow-up.

Frequency of Hyperopia in Children between 5 to 15 Years of Age

Aim: To determine the frequency of hyperopia in children between 5 and 15 years of age. Study Design: Cross sectional study Setting and Duration of Study: Al-Shifa Trust Eye Hospital Rawalpindi between March 2015 to September 2015 Methodology: 150 children between the ages of 5-15 years were included in the study. All children with eye disorders like corneal opacity, retinoblastoma, cataracts, amblyopia, chronic metabolic disorders, and hemoglobinopathies were excluded from the study. The participants were assessed for visual acuity was checked through a LogMAR visual acuity assessment chart for each eye. Those who found to have decreased visual acuity their pin-hole visual acuity was determined and then they got thorough examination by slit lamp biomicroscopy and fundoscopy to rule out causes of decreased vision other than refractive errors. Results: A mean (SD) age of 8.57 (2.52) years with 106 (70.76%) children between 5-10 years and 44 (29.33%) were between 11-15 years of age. Males were predominant in our study with 90/150 (60%) male patients and 60 (40%) female population. The frequency of hyperopia I our study was 93 (62%). Out of 60 female patients, 35 (58.33%) had hyperopia whereas, out of the 90 male patients, 58 (64.4%) patients had hyperopia. Conclusion: We reported that hyperopia is a very frequent refractive disorder found in children. Male are more frequently diagnosed with the disorder between the ages of 5-10 years. Further large-scale cohorts should be conducted to determine the correlating factors that increase the risk of hyperopia and prognosis. Keywords: hyperopia, refractive disorders, strabismus, emmetropia, ocular examination, visual acuity

IDF21-0347 Treatment response in the first Emirati patient with diabetes associated with the A3243G mitochondrial point mutation

Background: Maternally inherited diabetes and deafness (MIDD) is estimated as the cause of 1% of cases of diabetes. Due to the small patient population, it is not clear which diabetes treatments are most effective in MIDD. Aim: We discuss the response to different classes of hypoglycaemic agents in the first Emirati patient reported with mitochondrial diabetes. Method: A 23-year old male presented with hyperglycaemia and features atypical for Type 1 Diabetes including retinal changes at diagnosis. MIDD was confirmed by presence of an A to G point mutation in the tRNALeu(UUR) gene at base pair 3243 (A3243G) of the mitochondrial genome using targeted next generation sequencing. We report his management and his clinical features at 3.8 years of follow-up. Results: At diagnosis, anti-GAD and anti-IA2 antibody titres were not elevated and insulin secretory reserve was maintained, with C-peptide of 0.631nmol/L and simultaneous plasma glucose of 11.6mmol/L. No objective hearing loss was detected at presentation. Microvascular disease was detected at 39 days after onset of diabetes with background retinopathy (R1) and maculopathy (M1), and elevated albumin-creatinine ratio (ACR) (3.7 mg/mmoL, with subsequent microalbuminuria of 3.1, 4.1, 3.1, and 5.6 mg/mmoL at 12, 14, 17, and 19 months, respectively). Pinhole visual acuity (VA) was 0.8 (left) and 0.7 (right). BMI, HbA1c, and triglycerides were 27.3 kg/m2, 8.5%, and 1.34mmol/L, respectively. MIDD was confirmed by genetic analysis in the patient’s mother, who had an established diagnosis of diabetes mellitus; his brother declined screening. He was initially managed with insulin and metformin (HbA1c from 8.5% to 6.9%). He was switched to sulphonylurea (gliclazide) after diagnosis of MIDD (HbA1c from 6.9% to 7.7%), with canagliflozin added at 12 weeks (HbA1c from 7.7% to 6.2%, subsequently to 9%) and sitagliptin combined at 48 weeks (HbA1c from 9% to 8.7%). Dulaglutide was added at 73 weeks, leading to a dramatic improvement in his HbA1c from 8.7% to 6.9% and BMI from 28.4 to 25.4kg/m2 within 4 months and cessation of insulin, canagliflozin and sulphonylurea treatment. Dulaglutide was discontinued due to intolerance with subsequent deterioration of glycaemic control (HbA1c 9.5%). At 3.8 years of follow-up, he progressed to pre-proliferative retinopathy (R2, M1); his ACR was 7.0mg/mmoL. Pinhole VA reduced to 0.4 (left) and 0.3 (right). He remained overweight (BMI, 27.6kg/m2). LDL was elevated at 3.5mmol/L, and triglycerides were 1.3mmol/L while taking atorvastatin 20 mg. Discussion: The use of glucagon-like peptide-1 (GLP-1) analogues in patients with MIDD has been shown to effectively improve HbA1c within 6 months in three recent case reports. In this case, a GLP-1 induced a dramatic improvement in HbA1c within 4 months with cessation of several concomitant medications, sustained until the GLP-1 was discontinued due to lack of tolerability, with subsequent deterioration in glycaemic control. Although a full case series is lacking, accumulating evidence from case reports suggests that GLP-1 treatment may be particularly effective in people with MIDD.

Prevalence and causes of visual impairment and blindness in Lao People’s Democratic Republic: the Vientiane Eye Study

AimsTo determine the prevalence and causes of visual impairment and blindness in Vientiane Province, the Lao People’s Democratic Republic (Lao PDR).MethodsWe conducted a population-based, cross-sectional study of 1264 participants aged...

Pinhole does not increase screening accuracy of detecting decreased best corrected visual acuity in schoolchildren

BackgroundDecreased best corrected visual acuity among children should be treated early in life, and vision screening in schoolchildren is an efficient and feasible selection for developing countries. Thus, the screening accuracy of different visual acuity tests is the key point for making vision screening strategies. The present study aims to explore the screening accuracy of uncorrected visual acuity (UCVA) and pin-hole corrected visual acuity (PCVA) using different vision chart in the detection of decreased best-corrected visual acuity (BCVA) among schoolchildren.MethodsGrade one primary schoolchildren in urban Lhasa with data of UCVA using tumbling E chart (UCVAE), PCVA using tumbling E chart (PCVAE), UCVA using Lea Symbols chart (UCVAL), PCVA using Lea Symbols chart (PCVAL) and BCVA using Lea Symbols chart were reviewed. Decreased BCVA was defined as BCVA≤20/32(≥0.2 logMAR). Difference, reliability, and diagnostic parameters in the detection of decreased BCVA of different visual acuity results were analyzed.ResultsOverall, 1672 children aged 6.58 ± 0.44 years fulfilling the criteria. The prevalence of decreased BCVA was 6.8%. Although no significant differences were found between UCVAE vs UCVAL (p = .84, paired t-test) as well as PCVAE vs PCVAL (p = .24), the ICC between them was low (0.68 and 0.57, respectively). The average difference between BCVA and UCVAE, UCVAL, PCVAE, PCVAL was logMAR -0.08 (− 0.37, 0.21), − 0.08 (− 0.29, 0.17), − 0.05 (− 0.30, 0.19), − 0.06 (− 0.23, 0.12) using Bland–Altman method. The area under the receiver operating characteristic curve of UCVAE, PCVAE, UCVAL, PCVAL for the detection of decreased BCVA was 0.78 (0.73, 0.84), 0.76 (0.71, 0.82), 0.95 (0.94, 0.96), 0.93 (0.91, 0.95), respectively.ConclusionPinhole does not increase the screening accuracy of detecting decreased BCVA in grade one primary schoolchildren. Visual acuity test using Lea Symbols is more efficient than Tumbling E in the screening of that age.Trial registrationData were maily from the Lhasa Childhood Eye Study which has finished the clinical registration on (ChiCTR1900026693).

Rapid assessment of prevalence of blindness and cataract surgery in Kabul province, Afghanistan

ObjectiveTo estimate prevalence and causes of blindness and vision impairment and assess cataract surgical coverage and quality of cataract surgery in Kabul.Methods and analysisA total of 3751 adults aged 50...

Visual Acuity Outcomes after Phacoemulsification in Eyes with Good Visual Acuity before Cataract Surgery

Objective: to analyse cataract surgery outcomes and related factors in eyes presenting with good visual acuity. Subject and Methods: A retrospective longitudinal study of patients undergoing phacoemulsification between 2014 and 2018 in Moorfields Eye Hospital was conducted. Pre- and post-operative visual acuities were analysed. Inclusion criteria were age ≥40 years and pinhole visual acuity ≥6/9 pre-operatively. Exclusion criteria were no post-operative visual acuity data. The visual acuity change variable was also defined according to post-operative visual acuity being above or below the Snellen 6/9 threshold. Results: 2,720 eyes were included. The unaided logMAR visual acuity improved from 0.54 to 0.20 (p < 0.001), the logMAR visual acuity with glasses improved from 0.35 to 0.05 (p < 0.001), and the logMAR pinhole visual acuity improved from 0.17 to 0.13 (p < 0.001); 8.1% of patients had Snellen visual acuity <6/9 post-operatively. Mean follow-up period was 23.6 ± 9.9 days. In multivariate analysis, factors associated with visual acuity <6/9 post-operatively were age (OR = 0.96, 95% confidence interval [CI] [0.95, 0.98], p < 0.001), vitreous loss (OR = 0.21, 95% CI [0.08, 0.56], p = 0.002), and iris trauma (OR = 0.28, 95% CI [0.10, 0.82] p = 0.02). Conclusions: Visual acuity improved significantly, although at least 8.1% of them did not reach their pinhole preoperative visual acuity. Worse visual acuity outcomes were associated with increasing age, vitreous loss, and iris trauma. The 6/9 vision threshold may not be able to accurately differentiate those who may benefit from cataract surgery and those who may not.