Acuity Status Research Articles

Characteristics and outcomes of patients with an unscheduled return visit within 72 hours to the Paediatric Emergency Centre at a Private Tertiary Referral Hospital in Kenya.

IntroductionPatients’ unscheduled return visits (URVs) to the paediatric emergency Centre (PEC) contribute to overcrowding and affect health service delivery and overall quality of care. This study assessed the characteristics and outcomes of paediatric patients with URVs (within 72 hours) to the PEC at a private tertiary hospital in Kenya.MethodsWe conducted a retrospective chart review of all URVs within 72 hours among paediatric patients aged ≤15 years between 1 July and 31 December 2018 at the tertiary hospital in Nairobi, Kenya.ResultsDuring the study period, 1.6% (n=172) of patients who visited the PEC returned within 72 hours, with 4.7% revisiting the PEC more than once. Patients’ median age was 36 months (interquartile range: 42 months); over half were male (51.7%), 55.8% were ambulatory and 84.3% were insured. In addition, 21% (n=36) had chronic diseases and 7% (n=12) had drug allergies. Respiratory (59.5%) and gastrointestinal (21.5%) tract infections were the most common diagnoses. Compared with the first visit, more patients with URVs were classified as urgent (1.7% vs. 5.2%) and were non-ambulatory (44.2% vs. 49.5%, p=<0.001); 18% of these patients were admitted. Of these 58% were male, 83.9% were aged 0–5 years, 12.9% were classified as urgent, 64.5% had respiratory tract infections and 16.1% had gastrointestinal tract infections. Being admitted was associated with patient acuity (p=0.004), laboratory tests (p=<0.001) and ambulatory status (p=0.041).ConclusionThe URV rate is low in our setting. Patients who returned to the PEC within 72 hours tended to be male, under 5 years old and insured. Many were non-urgent cases with diagnoses of respiratory and gastrointestinal tract infections. The findings suggest that some URVs were necessary and may have contributed to better care and improved outcomes while others highlight a need for effective patient education and comprehensive initial assessment.

Comparison of Post-Heart Transplant Survival between Status 1A versus Status 1-3 Recipients before and after the UNOS Allocation Policy Change

Purpose The October 2018 UNOS heart allocation policy change was implemented in an effort to better prioritize heart transplants for the most critically ill patients. We compare six-month post-transplant survival of HT patients listed at status 1A one year before (PRE) vs. status 1-3 one year after (POST) the allocation policy change. Methods We identified patients (N = 2926) listed at the highest status levels (status 1A vs. status 1-3) that underwent HT between 10/18/2017 to 10/17/2019. There were 1242 status 1A patients in the PRE group and 1684 status 1-3 patients in the POST group. Baseline clinical characteristics were compared using Mann-Whitney U test and Chi-Square test as appropriate. Survival analysis was performed using Kaplan-Meier analysis. Univariate and Multivariate Cox Proportional Hazards (PH) regression analysis was adjusted for policy change, recipient age, donor age, bilirubin, creatinine, dialysis use, ischemic time, ventilator use, and ECMO use. Results There was no significant change in six-month survival in the POST vs. PRE groups (92% vs 93%, p=0.13). Furthermore, the policy change was not a significant predictor of mortality on both univariate Cox PH (HR: 1.24 [0.94-1.63, p=0.13]) and multivariate (HR: 1.13 [0.85-1.50, p=0.40]) analyses. Ischemic time (median and interquartile range: 3.5h [2.9, 4.1] vs. 3.1h [2.4, 3.7], p Conclusion Among patients in the highest acuity status groups, there was no difference in six-month post-HT survival following implementation of the policy change. This outcome was seen despite longer ischemic times, greater distance from donor recipient hospitals, and shorter total waitlist times. Further investigation is warranted to assess longer term outcomes.

Imaging the pediatric retina: An overview.

Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.

Inner Retinal Morphology and Visual Outcomes in Idiopathic Epiretinal Membrane Surgery: A Retrospective Optical Coherence Tomography Study.

Epiretinal membrane (ERM) is a common retinal finding for patients older than 50 years. Disorganization of the retinal inner layers (DRIL) has emerged as a novel predictor of poor visual acuity (VA) in eyes with inner retinal pathology. The aim of our study is to correlate preoperative DRIL with visual outcomes after ERM surgery. Medical records and optical coherence tomography (OCT) images of 81 pseudophakic patients who underwent treatment of idiopathic ERM were reviewed. Preoperative DRIL on OCT was correlated with VA at baseline and at 3 and 6 months after ERM surgery. DRIL was defined as the loss of distinction between the ganglion cell-inner plexiform layer complex, inner nuclear layer, and outer plexiform layer. DRIL severity was based on its extent within the central 2-mm region of a transfoveal B-scan (absent/mild: <one-third, severe: >one-third horizontal width). Review of preoperative OCT showed severe DRIL in 41% and absent/mild DRIL in 59%. Severe DRIL was associated with worse baseline VA (P < .001). Preoperative VA and DRIL status at baseline were both predictors of postoperative VA at follow-up time points (P < .001). Severe DRIL was associated with significantly less improvement in VA at 6 months (-0.23 logMAR for absent/mild vs-0.14 for severe DRIL). Presence of severe preoperative DRIL correlates with worse baseline VA in patients with ERM and reduced VA improvement at 6 months. DRIL can be a strong predictor of long-term poor visual outcomes in ERM surgery.

Gaze shift dynamic visual acuity: A functional test of gaze stability that distinguishes unilateral vestibular hypofunction.

BACKGROUND:Embedded within most rapid head rotations are gaze shifts, which is an initial eye rotation to a target of interest, followed by a head rotation towards the same target. Gaze shifts are used to acquire an image that initially is outside of the participant’s current field of vision. Currently, there are no tools available that evaluate the functional relevance of a gaze shift.OBJECTIVE:The purpose of our study was to measure dynamic visual acuity (DVA) while performing a gaze shift.METHODS:Seventy-one healthy participants (42.79±16.89 years) and 34 participants with unilateral vestibular hypofunction (UVH) (54.59±20.14 years) were tested while wearing an inertial measurement unit (IMU) sensor on the head and walking on a treadmill surrounded by three monitors. We measured visual acuity during three subcomponent tests: standing (static visual acuity), while performing an active head rotation gaze shift, and an active head rotation gaze shift while walking (gsDVAw).RESULTS:While doing gsDVAw, patients with Left UVH (n = 21) had scores worse (p = 0.023) for leftward (0.0446±0.0943 LogMAR) head rotation compared with the healthy controls (–0.0075±0.0410 LogMAR). Similarly, patients with right UVH (N = 13) had worse (p = 0.025) gsDVAw for rightward head motion (0.0307±0.0481 LogMAR) compared with healthy controls (–0.0047±0.0433 LogMAR). As a whole, gsDVAw scores were worse in UVH compared to the healthy controls when we included the ipsilesional head rotation on both sides gsDVAw (0.0061±0.0421 LogMAR healthy vs. 0.03926±0.0822 LogMAR UVH, p = 0.003). Controlling for age had no effect, the gsDVAw scores of the patients were always worse (p < 0.01).CONCLUSION:The gaze shift DVA test can distinguish gaze stability in patients with UVH from healthy controls. This test may be a useful measure of compensation for patients undergoing various therapies for their vestibular hypofunction.

Effects of cannabis on visual function and self-perceived visual quality

Cannabis is one of the most used drugs of abuse in the world. The objective of this study was to analyze the effects of smoking cannabis on vision and to relate these to those perceived by the user. Thirty-one cannabis users participated in this study. Visual function assessment was carried out in a baseline session as well as after smoking cannabis. We evaluated static visual acuity, contrast sensitivity, stereoacuity, accommodative response, straylight, night-vision disturbances (halos) and pupil size. The participants were also divided into two groups depending on whether they perceived their vision to have worsened after smoking cannabis. A logistic regression analysis was employed to identify which visual test could best predict self-perceived visual effects. The study found that smoking cannabis has significant adverse effects on all the visual parameters analyzed (p < 0.05). Self-perceived visual quality results revealed that about two thirds of the sample think that smoking cannabis impairs their vision. Contrast sensitivity, specifically for the spatial frequency 18 cpd, was identified as the only visual parameter significantly associated with self-perceived visual quality (Odds Ratio: 1.135; p = 0.040). Smoking cannabis is associated with negative effects on visual function. Self-perceived visual quality after smoking cannabis could be related to impaired contrast sensitivity.

Optimal methods for estimating sports vision in kendo athletes

This study investigated whether the eight standard tests of sports vision used in Japan appropriately reflect sports vision; whether all eight tests are necessary; and if not, which combination yields the optimal model. Participants were kendo practitioners (exercise group, n = 41) and those with no exercise habits (non-exercise group, n = 65). The performance of the two groups on all eight tests were compared. The groups differed in static visual acuity, kinetic visual acuity, and eye/hand coordination. A high correlation (r = 0.75) was observed between static visual acuity and kinetic visual acuity, while contrast sensitivity was moderately correlated with static visual acuity and kinetic visual acuity (r = 0.6), and dynamic visual acuity was moderately correlated with eye/hand coordination (r = − 0.66). Logistic regression analysis indicated that it is not necessary to conduct all eight tests; the optimal model included static visual acuity, visual reaction time, and eye/hand coordination. Our results suggest that static visual acuity, visual reaction time, and eye/hand coordination are sufficient for assessing visual function in kendo practitioners. For other sports, it may be possible to construct discriminative models using the same method and determine which aspects of visual function and which training methods to emphasise in a given sport.

Impact of Acceleration on Human Visual Acuity and Stereopsis

Purpose: To assess the impact of horizontal acceleration on human visual acuity and stereopsis. Methods: The written consent of 60 subjects (36 females and 24 males) aged between 18-24 years was taken after proper explanations. History taking followed by VA measurement, refraction, slit lamp examination, Ophthalmoscopy was performed to rule out the exclusion criteria. Measurements of near visual acuity and stereopsis was done in 3 speeds, slow, moderate and high speed of tread mill for all subjects. Static and dynamic VA measurements was noted. Dynamic VA was measured in tread mill with examiner holding the VA chart. After completing the near visual acuity examination, participant was subjected to stereopsis test using the stereo-test circles with both eyes. Duration of each test was noted. Results: The ANNOVA test analysis revealed no significant difference in visual acuity and stereopsis measured in slow and moderate speed in comparison with static visual acuity and stereopsis (p>0.05). However, a highly significant difference was found in visual acuity and stereopsis measured during high speed (p<0.01). Also, it was observed that time taken to read visual acuity and stereopsis chart increased with increasing speed (p<0.01). It was also found that majority of subjects experienced different level of dizziness, headache, ocular discomfort during acceleration. Conclusion: High acceleration had a highly significant effect on visual acuity and stereopsis.

Changing trend in the morphology of cataracts at a tertiary eye care centre in South India due to COVID-19-pandemic related national lockdown.

Purpose:To study the changing trends in the morphology of cataracts at a tertiary eye care center in South India due to COVID-19 pandemic-related national lockdown.Methods:A retrospective study conducted at a tertiary eye care center in Andhra Pradesh state of South India, which included 1724 patients (1753 eyes) who underwent cataract surgery at our center during April 2019–July 2019 (1298 eyes of 1271 patients) and April 2020–July 2020 (455 eyes of 453 patients). Factors studied included preoperative lens status, associated phacodonesis or subluxation, pupil size, other eye lens status, associated retinal problems, glaucoma, and complications during surgery. Postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal clarity, intraocular pressure (IOP), and disc status at postoperative day 1, 1 week, and 1-month visits were compared.Results:A significantly lower proportion of nuclear sclerosis (decreased from 83.2% in last year before lockdown to 55.2% during lockdown) and significantly higher proportions of mature, brown, or black cataract and phacomorphic, phacolytic, or Morgagnian cataract (increased from 15.5% in last year before lockdown to 43.8% during lockdown) were observed. The proportion of small-incision cataract surgery decreased significantly (from 63.2% to 57.4%), whereas the proportion of phacoemulsification increased significantly (from 35.9% to 41.5%) during lockdown as compared to last year. A significantly higher proportion of eyes with small pupils and association with retinal pathology were also observed during the lockdown.Conclusion:During the national lockdown, there was a shift from nuclear sclerosis grade toward mature, brown, black grade of cataracts. In addition, the proportion of small-incision cataract surgery decreased significantly whereas the proportion of phacoemulsification increased significantly during the lockdown. More number of cataracts with small pupils and associated retinal pathology were observed during the lockdown.

Changes in the Optical Corneal Densitometry, Visual Acuity, and Refractive Error after the Annular Intracorneal Inlay Implantation.

Purpose:To investigate the changes in the optical corneal densitometry as an objective method in assessing the corneal light back-scattering before and 1 year after the annular intracorneal inlay (AICI) implantation into the keratoconic corneas.Methods:Changes in the optical corneal densitometry, visual acuity, refractive, and tomographical status were assessed before and 1 year after the AICI implantation into the corneas with different stages of keratoconus. Optical corneal densitometry was evaluated using the Pentacam-HR in 0–2, 2–6, 6–10, and 10–12 mm rings in the anterior 120 μ, central layers, posterior 60 μ and also the total value were measured for cornea in the Grey Scale Unit criterion.Results:Totally, 34 patients with keratoconus were studied; the uncorrected and best corrected visual acuity were increased after the surgery (0.98 ± 0.25 to 0.53 ± 0.30 logMAR, P < 0.001 and 0.26 ± 0.18 to 0.19 ± 0.14, P = 0.007 logMAR, respectively); the spherical equivalent was decreased from −4.45 ± 2.25 to − 2.06 ± 2.01 D (P = 0.004). AICI implantation led to an increase in the amount of optical corneal densitometry in 0–2 mm central, 2–6 mm central, 6–10 mm central, total central, 2–6 mm posterior, and 2–6 mm total rings (all, P < 0.05); however, a decrease was observed in 0–2 mm anterior ring (P = 0.049). Results of statistical analysis showed that the total optical corneal densitometry, anterior total, and posterior total back-scattering did not change after the AICI implantation (all, P > 0.05).Conclusions:Our results revealed a significant improvement in the visual function, including refractive error and visual acuity following the AICI implantation. Changes in the optical corneal densitometry were different in distinct regions and layers however, the total amount did not change after the AICI implantation.

Neurocognitive measures and self-reported symptoms following a short intensive multimodal neurorehabilitation program in individuals with post-concussion syndrome: Retrospective case-series study

This case-series study investigates the effect of a condensed multi-modal neurorehabilitation program on neurocognitive measures and self-reported symptoms using the C3Logix assessment tool on 137 individuals with diagnosed Post-Concussion Syndrome (PCS). In PCS, neurocognitive dysfunction is typically accompanied by symptoms of the physical, affective, and sleep domains. While most individuals recover within weeks of sustaining a head injury, evidence shows that those who do not recover in 3 months, may never. Recovery methods are usually prescribed with varying success, but the pathophysiologic complexity of concussion may require additional rehabilitation strategies that address the impaired neural networks to accelerate recovery. 137 individuals (M: 81, F: 56; mean (SD) age: 32.0 (14.0)) with a diagnosed PCS were treated at an outpatient rehabilitation center specializing in functional neurology. Using the C3Logix platform, individuals were evaluated at the intake and discharge of a 5-day program. Interventions included neuromuscular re-education, vestibular rehabilitation, orthoptics and cognitive training. Neurocognitive components and symptoms were exported and analyzed in Graphpad PRISM v. 8.4.3 using an rmANOVA. Results are reported as difference-of-means (95% CI). An alpha level of 0.05 was considered statistically significant. The C3Logix modified Graded Symptom Checklist score (0-150) decreased by 19.45 (15.16-23.75) (p < 0.0001), Trails A and B decreased 3.9 s (2.2-5.5) and 4.8 s (2.1-7.5) (p < 0.0001), respectively. Simple- and Choice Reaction Time decreased 31.3 ms (21.5-41.1) and 50.7 ms (37.9-63.6) (p < 0.0001), respectively. Static and Dynamic Visual Acuity decreased 0.03 LogMAR (0.0085-0.059) (p = 0.0021) and 0.05 LogMAR (0.021-0.073), respectively. Standardized Assessment of Concussion score (0-30) increased 0.8 (0.3-1.3) (p = 0.001) and digit-symbol coding increased 4.6 symbols (3.0-6.2) (p < 0.0001). The results of the present case-series study suggest clinically relevant improvements in neurocognitive measures and subjective symptoms in individuals with PCS following a multi-modal 5-day rehabilitation program.

Association of sports vision with age, gender, and static visual acuity among nonathletic population.

PURPOSE:Excellent vision is essential to performing well in sports. Sports vision includes visual, perceptual, cognitive, and oculomotor tasks that enable athletes to process and respond to what is seen. We aimed to examined how sports vision parameters – dynamic visual acuity (DVA), eye movement (EM), peripheral vision (PV), and momentary vision (MV) – varied with age and sex and assessed how static visual acuity (SVA) affect sports vision performance.MATERIALS AND METHODS:Sports vision was assessed at 45 cm distance at best-corrected SVA in 310 nonathletic participants (age, 6–60 years). Among these 310 participants, 108 university students underwent their sports vision test at 45 cm and 2.5 m distance, with and without glasses. The 4 sports vision parameters were measured by Athlevision software package installed to a laptop. Two-way analysis of variance (ANOVA) was used to compare sports vision performance in relation to age group and sex. Repeated-measures ANOVA with 1 within-factor (4 conditions) were used to analyze how sports vision varied among the near/far distance with/without glasses conditions.RESULTS:DVA increased during childhood, peaked during the 20s or 30s, and gradually decreased during middle age (P < 0.0001). DVA was significantly better in males than in females (P = 0.0001). The other 3 sport vision parameters – EM, PV, and MV – exhibited similar age trends (P < 0.001) but did not differ between two sexes. The university students with mild myopia had similar DVA, EM, and PV at both near and far distances, with and without correction; but moderate or severe myopic students with uncorrected vision had worse DVA, EM, and PV at 2.5 m than at 45 cm.CONCLUSION:Low SVA in uncorrected myopia significantly interferes the performance in sport vision tests applied in this study, especially in far distance. Improve static vision, such as myopic correction, may significantly improve sports vision, which is important in athletic performance and safety.

Factors influence bullous keratopathy post cataract surgery at National Eye Center of Cicendo Eye Hospital (PMN RSMC), West Java, Indonesia

Background: Bullous keratopathy is one of the leading causes of vision loss following cataract surgery. Several factors have been elucidated regarding the influence of bulosa keratopathy post cataract surgery. This study aims to evaluate pre-, intra-, and postoperative predisposition factors for bullous keratopathy following cataract surgery.Methods: A retrospective descriptive study was done using data extracted from medical records. Patients diagnosed with bullous keratopathy after cataract surgery who underwent further examination procedures for at least 3 months were included. Patients with a history of glaucoma, Fuch's dystrophy, or other intraocular procedures were excluded. Data were analyzed by SPSS version 20 for Windows.Results: Fourteen cases were included in this study. Most cases were female (78.57%) aged ≥60 years old (64.29%). There were postoperative changes in visual acuity and corneal status in most patients without any change in intraocular pressure. The majority of patients underwent manual small incision cataract surgery with posterior chamber intraocular lens implantation. Intraoperative complications were vitreous prolapse and Descemet membrane stripping, while postoperative complications were uveitis and lens adhesion.Conclusion: Bullous keratopathy after cataract surgery was more common in elderly females. There were notable changes in visual acuity and corneal status postoperatively. Further large-scale analytic study is warranted to confirm the predictive factors and causality.

Bilateral vestibulopathy and age: experimental considerations for testing dynamic visual acuity on a treadmill

IntroductionBilateral vestibulopathy (BVP) can affect visual acuity in dynamic conditions, like walking. This can be assessed by testing Dynamic Visual Acuity (DVA) on a treadmill at different walking speeds. Apart from BVP, age itself might influence DVA and the ability to complete the test. The objective of this study was to investigate whether DVA tested while walking, and the drop-out rate (the inability to complete all walking speeds of the test) are significantly influenced by age in BVP-patients and healthy subjects.MethodsForty-four BVP-patients (20 male, mean age 59 years) and 63 healthy subjects (27 male, mean age 46 years) performed the DVA test on a treadmill at 0 (static condition), 2, 4 and 6 km/h (dynamic conditions). The dynamic visual acuity loss was calculated as the difference between visual acuity in the static condition and visual acuity in each walking condition. The dependency of the drop-out rate and dynamic visual acuity loss on BVP and age was investigated at all walking speeds, as well as the dependency of dynamic visual acuity loss on speed.ResultsAge and BVP significantly increased the drop-out rate (p ≤ 0.038). A significantly higher dynamic visual acuity loss was found at all speeds in BVP-patients compared to healthy subjects (p < 0.001). Age showed no effect on dynamic visual acuity loss in both groups. In BVP-patients, increasing walking speeds resulted in higher dynamic visual acuity loss (p ≤ 0.036).ConclusionDVA tested while walking on a treadmill, is one of the few “close to reality” functional outcome measures of vestibular function in the vertical plane. It is able to demonstrate significant loss of DVA in bilateral vestibulopathy patients. However, since bilateral vestibulopathy and age significantly increase the drop-out rate at faster walking speeds, it is recommended to use age-matched controls. Furthermore, it could be considered to use an individual “preferred” walking speed and to limit maximum walking speed in older subjects when testing DVA on a treadmill.

Vision function of pseudophakic eyes with posterior capsular opacification under different speed and spatial frequency.

To investigate the characteristics of dynamic visual acuity (DVA) and contrast sensitivity (CS) in pseudophakic patients with posterior capsular opacification (PCO). Fifty-four eyes (36 patients) with PCO planned for laser capsulotomy were recruited. They underwent examinations of static visual acuity (SVA), DVA, CS and optical quality analysis (OQAS) before and one week after the laser treatment. Improvements in each index after laser treatment were analyzed. The visual quality of patients with good initial vision was studied separately. SVA, DVA and CS all significantly increased after capsulotomy (P < 0.05). Postoperative improvements in DVA were higher than in SVA, but they decreased when the speed increased. DVA at 15 dps gained the most improvement after capsulotomy. DVA at all analyzed speeds was significantly lower than SVA (P = 0.000). There was a significant speed-dependent decrease in DVA at lower speeds compared with higher speeds. The postoperative improvements in CS decreased when the spatial frequency was increased. The CS at the lower frequencies of 3cpd and 6cpd was the most improved after capsulotomy. CS was much lower at high frequencies (p < 0.05). There was a significant decrease in CS at higher spatial frequencies compared with lower frequencies. DVA improvements were correlated with CS improvements at medium spatial frequencies and with objective scattering index and Strehl ratio. The CS at all frequencies significantly improved for patients with good initial vision. PCO could impair dynamic vision function, but CS was a more sensitive indication of visual complaints in patients with slight PCO.

Effect of Toric Intraocular Lens Implantation on Visual Acuity and Astigmatism Status in Eyes Treated With Microhook Ab Interno Trabeculotomy

Use of toric intraocular lenses is a reasonable option for better visual outcomes when a combined minimally invasive glaucoma surgery (MIGS) and cataract surgery is performed in eyes with corneal astigmatism. To assess the efficacy of toric intraocular lenses (IOLs) in combined cataract and MIGS, visual and refractive outcomes were compared between eyes implanted with nontoric and toric IOLs during microhook ab interno trabeculotomy triple procedures. Glaucomatous eyes with preexisting corneal astigmatism exceeding -1.5 D implanted with nontoric (n=10) or toric (n=10) IOLs were evaluated retrospectively. The uncorrected visual acuity (UCVA) and refractive astigmatism preoperatively and 3 months postoperatively were compared. Preoperatively, the groups had similar logarithm of the minimum angle of resolution (logMAR) UCVAs and refractive astigmatism. Postoperatively, the logMAR UCVA (toric, 0.07±0.07; nontoric, 0.33±0.30; P=0.0020) was significantly better and the refractive astigmatism (toric, -0.63±0.56 D; nontoric, -1.53±0.74 D; P=0.0110) significantly less in the toric group. The toric group had postoperative improvements in the logMAR UCVA (-0.58, P=0.0039) and refractive astigmatism (+1.45 D, P=0.0195). Vector analyses showed the postoperative centroid magnitude of refractive astigmatism was less in the toric group (0.23 D at 83 degrees) than the nontoric group (1.03 D at 178 degrees). Postoperatively, 70% of eyes in the toric group had 1.0 D or less refractive astigmatism compared with 10% in the nontoric group. Surgically induced astigmatism (nontoric group, 0.62 D at 10 degrees; toric group, 0.50 D at 113 degrees) and intraocular pressure reduction (22% in both groups) did not differ between groups. Better visual outcomes may be achieved with toric IOLs when a combined MIGS/cataract surgery is performed in eyes with corneal astigmatism.

Donor Quality by UNOS Status After the 2018 Cardiac Transplantation Allocation System Change

Introduction The allocation system for heart transplantation changed in the United States on October 18, 2018. In this analysis, we report donor quality metrics by UNOS status for patients transplanted under the new allocation system. We suspect higher quality (male, younger, less under-sized) donors will be allocated to patients with the highest acuity UNOS status recipients. Methods Adults (18 years and older) who underwent first-time heart transplantation were identified from the United Network for Organ Sharing (UNOS) registry after October 18, 2018. Donor characteristics by UNOS recipient status then were compared with one-way ANOVA and chi-squared tests, where appropriate. To determine the percent of donors that were under-sized, predicted total ventricular mass for each donors and recipient pair was calculated utilizing previously published models based on age, sex, height, and weight. Under-sizing was defined as a calculated donor mass of more than 10% under the recipient cardiac mass, based on previously reported ideal ranges. Results The analysis included 1,817 patients (Status 1: 141, Status 2: 807, Status 3: 478, Status 4: 319, Status 5: 72). Statistically significant differences were observed across the UNOS status groups, with higher acuity status recipients receiving younger donors with less donor hypertension (Table). Higher acuity status recipients were less likely to receive female donors into male recipients or to be under-sized (Status 1 & 2: 18.7% under-sized vs. Status 3, 4, & 5: 23.8% under-sized, p=0.007). Ischemic times were longer for Status 1 and 2 recipients. Donor alcohol and cocaine use were similar across UNOS statuses. Conclusions Initial analysis reveals that heart transplant recipients with the highest acuity UNOS status are receiving donor hearts with more favorable donor characteristics although with longer ischemic times. More detailed analysis of the donor characteristics and longer follow-up time will be need to further quantify and assess the impact of this measurable variation in donor quality on post-transplant outcomes.

DIFFERENCES IN VISUAL ACUITY, NUTRITIONAL STATUS AND MOTOR FUNCTION IN NEW ELEMENTARY STUDENTS IN RURAL AND URBAN AREA

School children in rural and urban areas need attention in terms of education and health. This study was aimed to analyze diff erences in visual acuity, nutritional status and motor function among school-age children in rural and urban areas. This was an analytic observational with cross-sectional design. As much as 57 students at SD Sokanegara and Kedungbanteng elementary school was recruited by purposive sampling method with inclusion criterias including fi rst grade of elementary school student in healthy condition. Visual acuity data was examined by using Snellen Chart, nutritional status data by anthropometric measurements of body weight and height was calculated using the BMI for age index, while motor function was obtained by Carpenter Motor Ability Test measurements. Data was analyze using the Mann Whitney test. The results showed there were diff erences in visual acuity (p= 0.001) and nutritional status (p= 0.027) in rural and urban school children, while motor function did not show any signifi cant diff erence (p= 0.783). It is recommended to increase outdoor activities as a protection against visual acuity

Surgical Outcomes of Combined Phacoemulsification and Silicone oil Removal in Post Retinal Detachment Surgery Patients

Purpose: To evaluate the surgical outcomes of Combined Phacoemulsification with IOL implantation and Silicone oil removal in patients with previous retinal surgery.&#x0D; Study Design: Interventional case series.&#x0D; Place and Duration of Study: Al-Ibrahim eye Hospital Karachi from January 2019 to December 2019.&#x0D; Methods: Total 30 eyes of 30 patients between ages of 25 to 65 years, who had retinal detachment surgery with silicone oil used as internal tamponade and later on developed cataract were re-operated once confirming that retinal was attached. The time interval between two surgeries was 8 to 10 months. Phacoemulsification with IOL implantationwas done followed by silicone oil removal by 23-gauge pars plana method. Postoperative follow-ups were done at day 1, 1 month and at 6 months to record visual acuity and retinal status.&#x0D; Results: Best corrected Visual acuity was recorded pre and post-operatively using Snellen chart. Preoperatively 12 patients had visual acuity of 6/60, 12 with vision 6/95 and 6 with 6/120. There was improvement of 2 lines of visual acuity post operatively as recorded by Snellen chart. Retina was attached in 28 (93.33%) patients and 2 (6.66%) had re-detached retina at the end of 6 months.&#x0D; Conclusion: Visual outcomes were found to be better with low rate of retinal re-detachment after 6 months follow-up of combined phacoemulsification with IOL implantation and silicone oil removal. Hence, Combined Phacoemulsification with Silicone oil removal is a method that is associated with better visual and anatomical outcomes as well as decrease the chances of patients undergoing third surgery for cataract extraction.&#x0D; Key Words: Retinal Detachment, Phacoemulsification, Silicon Oil.

Vestibulo ocular reflex in multiple sclerosis patients without any optic neuritis

PurposeTo investigate vestibulo ocular reflex (VOR) in MS patients without any history of optic neuritis. Methods26 MS patients without any previous history of optic neuritis and 13 age- matched control subjects were included in this study. Their age ranged from 22 to 50 years old. We evaluated monocular visual evoked potential (VEP), monocular and binocular best corrected static and dynamic visual acuity, near and distance phoria and VOR gain. ResultsMean spherical equivalent (SE) was – 0.40 ± 0.93 D and – 0.04 ± 0.14 D for study and control group, respectively (P = 0.060). There was a significant difference in dynamic visual acuity (DVA) between two groups (P = 0.029). VOR gain was not significantly different in both groups through vHIT measurements (P = 0.338). Duration of MS had a mean of 78.38 ± 75.94 months (ranged from 6 to 336 months). We found no significant correlation between disease duration and VOR (Rho 0.277, P = 0.171) or DVA (Rho 0.782, P = 0.057). ConclusionOur study showed that although vHIT results decreased in MS patients, there was no significant differences between two groups.