The impact of COVID-19 on compliance to amblyopia treatment in a tertiary eye care center.

Purpose: To investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on compliance to amblyopia therapy from the perspective of parents of amblyopic children. Methods: The participants for the qualitative study were enrolled from the medical records of a tertiary eye care center during the COVID-19 pandemic. The trained researcher conducted telephonic interviews consisting of validated 15 open-ended questions for 15 min. The questions were related to patients' compliance toward amblyopia treatment and the date of follow-up with their practitioners. The data collected were entered on Excel sheets in the participant's own words and later converted to a transcript for analysis. Results: A total of 217 parents of children with amblyopia who were due for follow-up were contacted through telephone. The response rate for willingness to participate was only 36% (n = 78). Of these, 76% (n = 59) of parents reported that their child was compliant toward the treatment during the therapy period and 69% reported that their child was currently not on treatment for amblyopia. Conclusion: In the current study, we have observed that although reported compliance by parents during the therapy period was good, around 69% of patients had discontinued amblyopia therapy. The main reason for the discontinuation of therapy was the failure to visit the hospital during the scheduled follow-up with the eye care practitioner.

TFOS Lifestyle: Impact of contact lenses on the ocular surface.

Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviors (e.g., when using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.

Prevalence and Patterns of Refractive Errors in Children and Young Adults in an Urban Region in South India: the Hyderabad Eye Study.

PURPOSE: To determine the prevalence of refractive error (RE) and associated risk factors for myopic refractive errors in children and young adults from the urban region of Hyderabad, South India. METHODS: Four thousand sixty-five (4,065) participants aged 6-22 years were enrolled and examined in this cross-sectional study conducted from October 2013 to January 2015. Participants were enrolled from a random sample of schools and universities in regions representative of urban Hyderabad. RE was determined using cycloplegic autorefraction. The association of demographic factors such as age, gender, and socio-economic category (SEC) (low/mid/high) with myopia was explored with logistic regression with robust standard error. RESULTS: Of the total participants, 2,259 were children aged 6-15 years and 1,806 were adolescents and young adults aged 16-22 years. Overall prevalence of myopia, high myopia (≤ -5.00D and ≤ -6.00 D), hyperopia, emmetropia, and astigmatism was 29.8% (95% CI: 26.0% to 33.6%, n = 1,216), 2.9% (95% CI: 1.9% to 3.9%, n = 120), 1.1% (95%CI: 0.7% to 1.5%, n = 46), 14.7% (95% CI: 12.4% to 17.0%, n = 599), 46.9% (95% CI: 43.7% to 50.1%, n = 1913) and 8.6% (95% CI: 7.4% to 9.9%, n = 352) respectively. A strong correlation existed between age and prevalence of myopia (R2 = 0.88, p < .001) and high myopia (R2 = 0.71, p < .001). Children from schools of low SEC (34.7%) had higher prevalence of myopia compared to the mid SEC (16.8%) (p = .043). CONCLUSION: Myopia was the most prevalent refractive error and increased with age in this urban population. More myopia was observed in schools of low SEC.

Visual Examination Standard for Forklift and Crane Operators: A Report for 66 Operators of a Factory in Mumbai.

CONTEXT: Forklift and crane industry in India is progressing at a rapid pace and the visual integrity of the operators is crucial for occupational safety. Hence, we performed a vision screening at a factory based in Mumbai. AIMS: To evaluate the current visual status of forklift and crane operators working at a factory in Mumbai. SETTINGS AND DESIGN: Prospective observational cross-sectional. METHODS AND MATERIALS: All forklift and crane operators were invited to undertake visual examination that included visual acuity (VA) assessment, refraction, slit-lamp examination, color vision assessment, visual field assessment, and stereopsis. Referrals were made for participants who needed further assessment. STATISTICAL ANALYSIS USED: Mean and standard deviation were calculated and presented. RESULTS: A total of 66 forklift operators with an average age of 48 years that ranged from 26-60 years completed the study. The average distance VA in LogMAR with current spectacles was 0.1 ± 0.14. The near VA with usual spectacles averaged at 0.63 M ± 0.2 M. The best-corrected VA (BCVA) of 0 LogMAR was not achieved by 12% subjects; however, all participants except one met the 0.3 LogMAR visual acuity criteria. The average stereopsis was 55.8 ± 47.8 with 8% operators had lower than acceptable levels of stereopsis while 7% could not meet the set criteria. One operator had 400 s of an arc and 4 had 100 s of arc stereopsis. CONCLUSIONS: The study demonstrates an urgent need to set up standards for vision assessment at the time of employment and frequency of eye examination for forklift and other powered industrial vehicles.

Impact of COVID-19 on Indian optometrists: A student, educator, and practitioner's perspective.

PURPOSE: The optometry profession has experienced massive changes amid lockdown in COVID 19 pandemic. This study gauges the impact of COVID-19 on optometry education and practices in India. METHODS: The impact of COVID-19 among key stakeholders of Indian optometry that included educators, students, and practitioners was surveyed. The content validity of the survey tool was achieved through a focused group discussion with experts. RESULTS: Of the 1408 responses, 118 were educators, 845 were students and 445 were practitioners. Post COVID-19 lock-down, a high percentage of students (96%) and educators (94%) were now using online mode of education to learn and teach. The blended learning methods were reported to be used by 81% of educators. Practical skills were the most difficult to teach by educators and to learn by students. Almost a third of the students were concerned about their internships and job opportunities amid the pandemic. Practitioners felt confident in performing routine eye examinations with personal protective equipment (PPE). Telemedicine was found to be adopted by 55% of the private practitioners and 49% of the eye hospitals. CONCLUSION: The COVID-19 pandemic has provided an opportunity to reform Indian optometry education through blended learning methods. Optometry practices changed and adapted instantly to the new hygiene norms that have raised the standard of care provided to patients. Telemedicine emerged as a mode of providing care by optometrists. Overall, all key stakeholders of optometry in India were found to have adapted well to the sudden changes due to COVID 19 pandemic.

Fluorescein staining and physiological state of corneal epithelial cells.

PURPOSE: To evaluate the physiological status of corneal epithelial cells exhibiting fluorescein staining. METHODS: Fluorescein staining properties of corneal epithelial cells under normal and stressed conditions were studied using cell-culture (human corneal limbal epithelial cells - HCLE) and organ-culture (rabbit) models. Stress stimuli comprised exposure to hypotonicity, hypertonicity, preservatives, scratch, and alkaline wounding. In addition to fluorescein, cells were stained with Hoechst-33342 (HO), Propidium-iodide (PI), and Annexin-V (AN-V) to identify live, dead and apoptotic cells. Clinical-slit-lamp and fluorescence confocal-microscopic (FCM) observations were performed. FCM images were quantified for fluorescence intensity using Image-J software. RESULTS: Healthy HCLE cells uniformly took up fluorescein to a moderate degree with a mean grey value of 62 ± 24 (mean ± SD) on a scale of 0-256 (no unit). Fluorescence levels similar to those observed prior to stress were associated with healthy cells. Apoptotic cells showed the highest fluorescence (138 ± 38). Dead cells showed minimal fluorescence (23 ± 7) that was similar to the background (20 ± 11, p>0.05). Observations in whole rabbit eyes were in general agreement with these cell culture findings. CONCLUSIONS: The clinical observation of corneal staining with fluorescein suggests the presence of epithelial cells that are undergoing apoptosis but does not indicate dead cells. Under in vitro or ex vivo conditions, healthy cells took up fluorescein at levels that were lower than those of apoptotic cells and thus, are not likely to be perceived as exhibiting staining during clinical observation. Sodium fluorescein may be considered as a probe for apoptotic epithelial cells.

Mechanisms of superficial micropunctate corneal staining with sodium fluorescein: the contribution of pooling.

PURPOSE: To establish if sodium fluorescein (SFL) dye accumulation within intercellular spaces on the ocular surface contributes to the appearance of superficial punctate corneal staining. METHODS: Thirteen subjects bilaterally wore PureVision™ lenses that had been pre-soaked in ReNu MultiPlus® multipurpose solution. After 1h of lens wear, corneal staining with SFL was assessed using a standard slit-lamp technique. Participants who presented with bilateral, corneal staining were selected for further evaluation. A randomly selected eye was rinsed with saline three times. Fellow eyes (control) received no rinsing. After each rinse, the appearance of SFL staining was recorded without any further instillation of the dye. To eliminate any confounding effects of staining due to residual fluorescein in the tear menisci, corneal staining was induced in freshly excised, isolated, rabbit eyes by topical administration of 0.001% PHMB and staining, rinsing and grading were performed as above. RESULTS: Nine out of 13 subjects presented with bilateral diffuse corneal staining (mean grade±SD: 2.4±0.7). The mean staining grades in test and control eyes respectively after each of the three rinses were (1) 2.41±0.41, 2.25±0.69 (p=0.9); (2) 2.34±0.79, 2.1±0.83 (p=0.8); and (3) 1.71±0.65, 1.60±0.79 (p=0.6) there was no significant reduction in staining with rinsing (p>0.05) and no difference was observed between test and control eyes at any sampling-point. Similar observations made in ex vivo rabbit eyes replicated these results. CONCLUSIONS: Pooling or accumulation of SFL solution within intercellular spaces does not appear to contribute to the appearance of superficial micropunctate corneal staining.

Onset time course of solution induced corneal staining.

PURPOSE: To evaluate the early phase time course of solution induced corneal staining. METHODS AND MATERIALS: A double masked, single centred, prospective clinical trial was conducted. Twenty-five participants, either experienced or new contact lens wearers, participated in the study. Corneal staining response to short term use of ReNu MultiPlus Multipurpose Solution and PureVision silicon hydrogel contact lens with fluorescein was observed using standard techniques after 15, 30, 45, 60 and 120 min of lens wear and graded according to the IER scale. Measurements were carried out on separate days for each time point, in random order. RESULTS: Mean extent of staining was greater in test than in control eyes at all time points except baseline. In test eyes, the degree of staining increased successively at each time point after insertion, up to, but not beyond, 60 min. For those participants presenting with staining, maximum severity and frequency were both observed at 60 min and were significantly greater (p < 0.05) than at 15, 30, and 45 min. CONCLUSION: Solution induced corneal staining gradually increased after lens insertion to a maximum at 1h. This level was maintained until at least 2h post-insertion.