Too much sugar does not just make us fat; it can also make us sick.

The post-COVID-19 care era is likely to see a burgeoning of metabolic dysfunction and chronic kidney disease. Attention to self-care, including nutrition, will underpin the management of those affected. The damaging effects of sugar-sweetened beverages are well documented and profound and counter many accepted medical treatments. Government leadership is urgently required with explicit and strong messaging to avoid sugar-sweetened beverages.

A survey of visual impairment and blindness in children attending eight schools for the blind in Myanmar: An update.

Purpose: To determine the causes of visual impairment (VI) and blindness among children in schools for the blind in Myanmar; to identify the avoidable causes of VI and blindness; to provide spectacles, low-vision aids, and ophthalmic treatment where indicated; to provide an update of the 2007 survey performed and identify any major epidemiological changes. Methods: Two hundred and ninety children under 16 years of age from all eight schools for the blind in Myanmar were examined and the data entered into the World Health Organization Prevention of Blindness Examination Record for Childhood Blindness. Results: In total, 271 children (93.4%) were blind (visual acuity [VA] <3/60 in the better eye) and 15 (5.17%) had severe visual impairment (SVI = VA <6/60 to 3/60 in the better eye). Most children had whole globe as the major anatomical site of SVI or blindness (105, 36.6%). The cause was unknown in the majority of these (155, 54.0%). One hundred and twelve children had avoidable causes of blindness and SVI (39.0%). Forty children (13.9%) required an optical device and 10.1% required surgical or medical attention, with a potential for visual improvement through intervention in 3.48%. Conclusion: In all, 39.0% of children had potentially avoidable causes of SVI and blindness with cataracts and measles being the commonest causes. This follow-up survey performed after the first one completed in Myanmar in 2007 demonstrates a change in the major site of abnormality from the cornea to whole globe and a reduction in avoidable blindness but highlights the ongoing burden of measles.

AUSTRALIAN AND NEW ZEALAND STUDY OF PHOTODYNAMIC THERAPY IN CHOROIDAL AMELANOTIC MELANOMA.

PURPOSE: To evaluate the safety and efficacy of primary photodynamic therapy (PDT) for posterior choroidal amelanotic melanomas. METHODS: Patients with posterior choroidal amelanotic melanomas up to 6 mm in height were treated with PDT using verteporfin as the photosensitizing agent. Treatment was repeated every 3 months until the tumor was flat up to a maximum of 6 treatments. Tumor response and recurrence was assessed by clinical examination, photography, and ultrasonography. Patients were monitored 3 monthly for a minimum of 3 years. RESULTS: Thirty-six of 41 (88%) patients had complete regression after an initial course of PDT. Of them, 20 (56%) had no recurrence, 3 (8%) had recurrences that were successfully treated with further PDT, and 13 (36%) had recurrences that failed or were not amenable to further PDT. None of the measured baseline characteristics predicted treatment outcomes. There was no reduction in visual acuity due to PDT. The mean follow-up time was 3.5 years. CONCLUSION: In this large series, primary PDT was highly effective in achieving initial regression of posterior choroidal amelanotic melanomas. Photodynamic therapy is a vision-preserving treatment option for these tumors; however, patients need to be followed up closely because there is a significant rate of recurrence.

PAX6 molecular analysis and genotype-phenotype correlations in families with aniridia from Australasia and Southeast Asia.

Purpose: Aniridia is a congenital disorder caused by variants in the PAX6 gene. In this study, we assessed the involvement of PAX6 in patients with aniridia from Australasia and Southeast Asia. Methods: Twenty-nine individuals with aniridia from 18 families originating from Australia, New Caledonia, Cambodia, Sri Lanka, and Bhutan were included. The PAX6 gene was investigated for sequence variants and analyzed for deletions with multiplex ligation-dependent probe amplification. Results: We identified 11 sequence variants and six chromosomal deletions, including one in mosaic. Four deleterious sequence variants were novel: p.(Pro81HisfsTer12), p.(Gln274Ter), p.(Ile29Thr), and p.(Met1?). Ocular complications were associated with a progressive loss of visual function as shown by a visual acuity ≤ 1.00 logMAR reported in 65% of eyes. The prevalence of keratopathy was statistically significantly higher in the Australasian cohort (78.6%) compared with the Southeast Asian cohort (9.1%, p=0.002). Variants resulting in protein truncating codons displayed limited genotype-phenotype correlations compared with other variants. Conclusions: PAX6 variants and deletions were identified in 94% of patients with aniridia from Australasia and Southeast Asia. This study is the first report of aniridia and variations in PAX6 in individuals from Cambodia, Sri Lanka, Bhutan, and New Caledonia, and the largest cohort from Australia.

Aqueous Chlorhexidine for Intravitreal Injection Antisepsis: A Case Series and Review of the Literature.

PURPOSE: To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety. DESIGN: Multicenter retrospective case series. PARTICIPANTS: All patients receiving intravitreal injections from 7 retinal specialists. METHODS: An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine. MAIN OUTCOME MEASURES: Incidence of endophthalmitis after intravitreal injections. RESULTS: A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used. CONCLUSIONS: Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.

Intravitreal aflibercept treatment in eyes with exudative age-related macular degeneration following prior treatment with intravitreal ranibizumab.

BACKGROUND: To investigate visual and anatomical outcomes in eyes with exudative age-related macular degeneration treated with intravitreal aflibercept following prior treatment with intravitreal ranibizumab. MATERIALS AND METHODS: Retrospective, single-center study of 192 eyes treated with 0.5 mg intravitreal ranibizumab every 4 weeks for three consecutive doses followed by a variable dose schedule. After more than 12 months of ranibizumab treatment, eyes that required ranibizumab injections at 4-week or 6-week intervals were switched to aflibercept therapy. RESULTS: After 12-69 months (42 months ± 18 months, mean ± standard deviation [SD]) of treatment with intravitreal ranibizumab, 80 eyes were changed to 2 mg intravitreal aflibercept treatment with follow-up after 12-18 months (16 months ± 1 month, mean ± SD). Thirty-nine eyes had persistent macular fluid after treatment with ranibizumab. Mean logMAR visual acuity (VA) in eyes treated with ranibizumab changed by - 0.089 ± 0.310 (mean ± SD; P = 0.0003), which correlates to an approximate gain of 4.5 letters. The number of eyes with macular fluid decreased from 39 to 23 after aflibercept treatment. Mean logMAR VA in eyes with intraretinal macular fluid treated with aflibercept changed by -0.079 ± 0.134 (mean ± SD; P = 0.006), which correlates to an approximate gain of 4 letters. Mean logMAR VA in eyes with submacular fluid was not significantly different after aflibercept treatment. CONCLUSION: Eyes with persistent intraretinal macular fluid had visual and anatomic response after changing from ranibizumab to aflibercept treatment.

Causes of Severe Visual Impairment and Blindness: Comparative Data From Bhutanese and Laotian Schools for the Blind.

PURPOSE: To determine and compare the major causes of childhood blindness and severe visual impairment in Bhutan and Laos. DESIGN: Independent cross-sectional surveys. METHODS: This survey consists of 2 cross-sectional observational studies. The Bhutanese component was undertaken at the National Institute for Vision Impairment, the only dedicated school for the blind in Bhutan. The Laotian study was conducted at the National Ophthalmology Centre and Vientiane School for the Blind. Children younger than age 16 were invited to participate. A detailed history and examination were performed consistent with the World Health Organization Prevention of Blindness Eye Examination Record. RESULTS: Of the 53 children examined in both studies, 30 were from Bhutan and 23 were from Laos. Forty percent of Bhutanese and 87.1% of Laotian children assessed were blind, with 26.7% and 4.3%, respectively, being severely visually impaired. Congenital causes of blindness were the most common, representing 45% and 43.5% of the Bhutanese and Laotian children, respectively. Anatomically, the primary site of blinding pathology differed between the cohorts. In Bhutan, the lens comprised 25%, with whole globe at 20% and retina at 15%, but in Laos, whole globe and cornea equally contributed at 30.4%, followed by retina at 17.4%. There was an observable difference in the rates of blindness/severe visual impairment due to measles, with no cases observed in the Bhutanese children but 20.7% of the total pathologies in the Laotian children attributable to congenital measles infection. CONCLUSIONS: Consistent with other studies, there is a high rate of blinding disease, which may be prevented, treated, or ameliorated.

Intermediate-Term Cataract Surgery Outcomes from Rural Provinces in Lao People's Democratic Republic.

PURPOSE: Limited data are available about cataract surgery outcomes from developing regions in South-East Asia, but are necessary to monitor the impact of ongoing program delivery as outlined in the World Health Organization Vision 2020 directives. METHODS: We conducted a retrospective cohort study of 488 eyes of 449 patients who had undergone cataract surgery in 2011 in Luang Prabang and Xayaboury provinces of northwestern Lao People's Democratic Republic (Lao PDR). The study included 400 eyes of 361 subjects (80.4% of the target population). The main outcomes were presenting and pinhole visual acuity (VA). RESULTS: Subjects' mean age was 68 years (standard deviation 12.1 years); 52.6% were women. Preoperative presenting VA in the operated eye was <6/60 in all patients where presenting VA data was available (76.4%). Presenting VA in the operated eye was >6/18 in 185/400 eyes (46.3%, 95% confidence interval, CI, 41.4-51.2%), <6/18-6/60 in 177/400 (44.3%, 95% CI 39.4-49.2%) and <6/60 in 38/400 (9.5%, 95% CI 6.6-12.4%). VA improved two or more lines in 61/400 eyes (15.3%, 95% CI 11.7-18.8%) with pinhole. Relative afferent pupillary defect was present in 13/400 eyes (3.3%, 95% CI 1.5-5.0%). CONCLUSION: Presenting postoperative VA did not meet the World Health Organization criteria for good outcomes. Further study is required to determine specific factors contributing to adverse outcomes in this population.

Management of diffuse ocular surface squamous neoplasia: efficacy and complications of topical chemotherapy.

BACKGROUND: Ocular surface squamous neoplasia (OSSN) characterized by diffuse conjunctival or corneal spread is much less common than localized conjunctival disease. However, it is an important subcategory of the disease because of the difficulty it poses to treatment. It is rarely amenable to simple excision, and a purely surgical approach usually necessitates ocular surface reconstruction. Primary treatment with topical chemotherapy is an alternative, but its efficacy for these lesions is not well understood. DESIGN: Retrospective case series. PARTICIPANTS: Thirty-eight eyes treated for diffuse OSSN, defined as a lesion extending over five or more limbal clock hours or by extensive central or paracentral corneal spread. METHODS: Treatment utilized either topical 5-FU 1% or mitomycin-C (MMC) 0.04%. MAIN OUTCOME MEASURES: (i) Disease remission; (ii) complications. RESULTS: Thirty-two patients were treated for a primary diffuse OSSN. Ten patients (31%) required further treatment for disease persistence or recurrence. Thirteen patients had previously undergone a single unsuccessful treatment course for diffuse OSSN. Administration of a second treatment course (whether MMC or 5FU) was successful in 46% (six) of patients. 5-FU 1% resulted in drug-related complications in seven of 12 cases, and included a single case of focal paracentral corneal stromal melt. MMC 0.04% resulted in transient drug related complications in 23 of 39 cases. CONCLUSION: Diffuse OSSN is often recalcitrant to initial treatment with either 5-FU 1% or MMC 0.04%, and a pragmatic and vigilant approach to this heterogenous disease is required. Compared to localized disease, diffuse disease often requires multiple treatment efforts.

Long-term outcomes after adjunctive topical 5-flurouracil or mitomycin C for the treatment of surgically excised, localized ocular surface squamous neoplasia.

BACKGROUND: To report rates of recurrence and complications of localized ocular surface squamous neoplasia treated with 5-fluorouracil or mitomycin C as adjunctive treatment to surgical excision. DESIGN: Long-term follow up of two prospective, non-comparative interventional case series. PARTICIPANTS: One hundred fifty-three eyes with histologically confirmed localized, non-invasive ocular surface squamous neoplasia. 89 eyes were treated with adjuvant 5-fluorouracil and 64 eyes were treated with adjuvant mitomycin C. METHODS: Following surgical excision±cryotherapy patients received topical 5-fluorouracil 1% four times daily for two weeks or topical mitomycin C 0.04% four times daily for two to three 1-week cycles. MAIN OUTCOME MEASURES: Ocular surface squamous neoplasia recurrence, complications of therapy and compliance. RESULTS: Median follow up was 33.6 (range 12-84) months and 57.9 (range 12-160) months in 5-fluorouracil and mitomycin C groups, respectively. There was one recurrence in the 5-fluorouracil group and no recurrences in the mitomycin C group. Side-effects occurred in 69% of 5-fluorouracil patients and 41% of mitomycin C patients. Five patients (6%) required intervention for treatment-related side-effects in the 5-fluorouracil group versus 11 (17%) in the mitomycin C group. No vision-threatening complications were noted. CONCLUSIONS: Long-term recurrence of localised ocular surface squamous neoplasia is rare when topical 5-fluorouracil or mitomycin C are used as adjunctive treatment to surgical excision. While side-effects are common, the majority are transient and rarely limit compliance.

Perspective on ophthalmic support in countries of the developing world.

There are over 300 million people living in the world today who are visually impaired and a further 45 million who are blind. The large majority (90%) of these people live in developing countries, and up to 75% of blindness are avoidable. With cataracts being the major cause of blindness and visual impairment, many ophthalmic aid programmes are aimed at alleviating the enormous burden caused by this readily treatable disease. Having said that, caution should be exercised that short surgical visits to remote rural areas that are not coordinated with local national eye care managers should be discouraged because they do little for the development of sustainable eye care programmes. With this in view, it has become imperative to design blindness prevention and ophthalmic support programmes that are workable, comprehensive, economical and sustainable.

Exceptionally low prevalence of refractive error and visual impairment in schoolchildren from Lao People's Democratic Republic.

OBJECTIVE: Vientiane Province is an urbanizing region in Southeast Asia. We aimed to determine the prevalence of refractive error and visual impairment in primary school-aged children in this region. DESIGN: Prospective, cross-sectional survey. PARTICIPANTS: A total of 2899 schoolchildren from Vientiane Province, Lao People's Democratic Republic (Lao PDR). METHODS: Ten districts from Vientiane were randomly selected and 2 primary schools were randomly selected from each district. All children aged 6 to 11 years at selected schools were eligible to participate. The examination included visual acuity (VA) testing, cycloplegic retinoscopy with subjective refinement if indicated, ocular motility testing, and anterior segment and fundus examinations in visually impaired children. MAIN OUTCOME MEASURES: Cycloplegic refraction and VA. RESULTS: There was an estimated total of 3330 children who were eligible to participate, and data were recorded from 2899 (87%) of these children. Complete refractive data were available on 2842 children (85% of eligible population). The mean spherical equivalent (SE) in the right eyes was +0.60 diopter (D) (95% confidence interval [CI], 0.49-0.72), and the mean SE in the left eyes was +0.59 (95% CI, 0.50-0.68). The prevalence of hyperopia was 2.8% (95% CI, 1.9-3.7; 88 subjects), and the prevalence of myopia was 0.8% (95% CI, 0.3-1.4; 24 subjects). The majority of children (98%; 95% CI, 97.0-99.0) had normal unaided binocular VA (at least 20/32 in their better eye). The overall prevalence of any visual impairment (presenting VA <20/32 in the better eye) was 1.9% (95% CI, 1.0-2.9; 55 subjects). In multivariate logistic regression analysis, age (P = 0.001) was a significant predictor, and female gender (P = 0.08) and Yao ethnicity (P = 0.09) were borderline significant predictors of the presence of any visual impairment. CONCLUSIONS: Visual impairment is not a public health concern in this primary school-aged population; however, visually impaired children in the community were not studied. From this baseline, future surveys could determine the effect of increasing urbanization on myopia prevalence in this population.

Refractive error in school children in an urban and rural setting in Cambodia.

PURPOSE: To assess the prevalence of refractive error in schoolchildren aged 12-14 years in urban and rural settings in Cambodia's Phnom Penh and Kandal provinces. METHODS: Ten schools from Phnom Penh Province and 26 schools from Kandal Province were randomly selected and surveyed in October 2010. Children were examined by teams of Australian and Cambodian optometrists, ophthalmic nurses and ophthalmologists who performed visual acuity (VA) testing and cycloplegic refraction. RESULTS: A total of 5527 children were included in the study. The prevalence of uncorrected, presenting and best-corrected VA ≤ 6/12 in the better eye were 2.48% (95% confidence interval [CI] 2.02-2.83%), 1.90% (95% CI 1.52-2.24%) and 0.36% (95% CI 0.20-0.52%), respectively; 43 children presented with glasses whilst a total of 315 glasses were dispensed. The total prevalence of refractive error was 6.57% (95% CI 5.91-7.22%), but there was a significant difference between urban (13.7%, 95% CI 12.2-15.2%) and rural (2.5%, 95% CI 2.03-3.07%) schools (P < 0.0001). Refractive error accounted for 91.2% of visually impaired eyes, cataract for 1.7%, and other causes for 7.1%. Myopia (spherical equivalent ≤ -0.50 diopters [D] in either eye) was associated with increased age, female gender and urban schooling. CONCLUSIONS: The prevalence of refractive error was significantly higher in urban Phnom Penh schools than rural schools in Kandal Province. The prevalence of refractive error, particularly myopia was relatively low compared to previous reports in Asia. The majority of children did not have appropriate correction with spectacles, highlighting the need for more effective screening and optical intervention.

Killing two birds with one stone: the potential effect of cataract surgery on the incidence of primary angle-closure glaucoma in a high-risk population.

BACKGROUND: To estimate the proportion of cataract surgery performed at various visual acuity and lens opacity thresholds that would coincidentally treat early angle-closure disease, and to estimate the effect of this surgery on the incidence of primary angle-closure glaucoma. DESIGN: Cross-sectional, population-based survey in Meiktila, Myanmar. PARTICIPANTS: Total of 2076 inhabitants, 40 years of age and over were included. METHODS: Eyes with cataract-induced visual impairment, and primary angle-closure disease were identified. Analyses were stratified by various pinhole-corrected visual acuity and Lens Opacity Classification System III scores thresholds. MAIN OUTCOME MEASURES: The dual role of cataract surgery in primary cataract treatment and primary angle-closure glaucoma prevention was estimated. RESULTS: Of 4153 eyes available for analysis, 261 eyes were either primary angle-closure suspect or primary angle closure; 975 eyes had a visual acuity of <6/18 and Lens Opacity Classification System III score ≥ 3 on the nuclear or cortical scales. Of these, 86 eyes had either primary angle-closure suspect or primary angle closure. If cataract surgery were performed on all 975 eyes, this would potentially prevent up to 86 cases of primary angle-closure glaucoma in this population; 8.82% (95% confidence interval 7.12-10.78%) of the cataract surgery would address the cataract and prevent primary angle-closure glaucoma. This would achieve a 38.46% (95% confidence interval 20.23-59.43%) relative reduction in the incidence of primary angle-closure glaucoma in the adult population. CONCLUSION: In populations with a high prevalence of both visually significant cataract and angle-closure disease, quality cataract extraction can serve a dual role of visual restoration and reducing the incidence of angle-closure disease in the population: killing two birds with one stone.

Homozygous mutations in PXDN cause congenital cataract, corneal opacity, and developmental glaucoma.

Anterior segment dysgenesis describes a group of heterogeneous developmental disorders that affect the anterior chamber of the eye and are associated with an increased risk of glaucoma. Here, we report homozygous mutations in peroxidasin (PXDN) in two consanguineous Pakistani families with congenital cataract-microcornea with mild to moderate corneal opacity and in a consanguineous Cambodian family with developmental glaucoma and severe corneal opacification. These results highlight the diverse ocular phenotypes caused by PXDN mutations, which are likely due to differences in genetic background and environmental factors. Peroxidasin is an extracellular matrix-associated protein with peroxidase catalytic activity, and we confirmed localization of the protein to the cornea and lens epithelial layers. Our findings imply that peroxidasin is essential for normal development of the anterior chamber of the eye, where it may have a structural role in supporting cornea and lens architecture as well as an enzymatic role as an antioxidant enzyme in protecting the lens, trabecular meshwork, and cornea against oxidative damage.

A survey of severe visual impairment and blindness in children attending thirteen schools for the blind in sri lanka.

PURPOSE: To identify the causes of blindness and severe visual impairment (BL/SVI) in children attending schools for the blind in Sri Lanka, and to provide optical devices and ophthalmic treatment where indicated. METHODS: Two hundred and six children under 16 years from 13 schools for the blind in Sri Lanka were examined by a team of ophthalmologists and optometrists. Data were entered in the World Health Organization Prevention of Blindness Eye Examination Record for Childhood Blindness (WHO/PBL ERCB). RESULTS: Of the 206 children, 83.5% were blind (BL = Visual acuity [VA] <3/60), and 9.2% had severe visual impairment (SVI = VA <6/60 to 3/60 in the better eye). The major anatomical site of BL/SVI was the retina in 35.9% of cases, followed by the whole globe in 22.4% of cases. The major underlying aetiologies of BL/SVI were unknown in 43.8% of cases and hereditary in 37.5%. Avoidable causes of BL/SVI accounted for 34.9% of cases; retinopathy of prematurity made up the largest proportion of this subgroup. One third of the children required an optical device to improve their vision. CONCLUSION: Just over one third of the children in schools for the blind in Sri Lanka had potentially avoidable causes of BL/SVI. Vision could also be improved in a third of children. The data support the need to develop specialized pediatric ophthalmic services, particularly in the face of advancing neonatal life support in Sri Lanka, and the need for increased provision of optical support.

Adjuvant 5-fluorouracil in the treatment of localised ocular surface squamous neoplasia.

AIM: To report the outcome of treatment of localised non-invasive ocular surface squamous neoplasia (OSSN) where topical 5-fluorouracil (5-FU 1%) is used as an adjuvant to surgical excision. METHODS: The study was a prospective non-comparative interventional case series. 55 cases of primary localised OSSN and 10 cases of recurrent localised OSSN were treated with excision, cryotherapy and adjuvant 5-FU 1%. In all cases, irrespective of the involvement of surgical margins, a single cycle of 5-FU 1% was administered, four times a day for 2 weeks continuously. The main outcome measures were (1) recurrence and (2) complications related to adjuvant topical chemotherapy. Individuals were reviewed for a minimum of 12 months. RESULTS: There was a single case of recurrence (1.5%). 57% of patients had short-term complications secondary to 5-FU 1%, most frequently lid toxicity (49%), followed by superficial keratitis, epiphora and corneal epithelial defects. Four patients were unable to complete the course of 5-FU 1% because of local toxicity. CONCLUSIONS: The management of localised non-invasive OSSN with adjuvant 5-FU 1% was associated with a low rate of local recurrence. Although 5-FU 1% frequently results in short-term complications, most commonly lid toxicity, a full course is usually tolerated. Serious complications appear uncommon in the treatment of localised disease.

The differential diagnosis of localised amelanotic limbal lesions: a review of 162 consecutive excisions.

AIMS: To report the distribution of histopathological diagnoses in patients who underwent excision of localised limbal lesions that were clinically suspected to be squamous neoplasia (intra-epithelial neoplasia or squamous cell carcinoma). METHODS: 162 consecutive patients of a single ocular oncologist underwent an excisional biopsy between 1998 and 2009 for suspected squamous neoplasia. Histopathological reports were retrospectively reviewed. RESULTS: The population comprised 122 males and 40 females. The mean age was 63.4±15.8 (range: 27-90). 138 (85.2%) lesions were identified as intraepithelial neoplasia (CIN), of which 34 (21.0%) were CIN I, 32 (19.8%) were CIN II and 72 (44.4%) were CIN III or squamous cell carcinoma in situ. In seven (4.3%) cases, the lesion was invasive squamous cell carcinoma. In two (1.2%) cases, the lesion was amelanotic malignant melanoma. In 16 (9.9%) cases, histopathology revealed a benign entity including lesions described as squamous papilloma, solar elastosis and epithelial hyperplasia, keratosis or reactive atypia. CONCLUSIONS: In this population, for an experienced ocular oncologist, the misdiagnosis of localised limbal squamous neoplasia occurred in 10.5% of cases, with 5.5% of cases being malignant. This study highlights the importance of acquiring a clinical diagnosis before administering a topical chemotherapeutic agent.

A survey of visual impairment and blindness in children attending four schools for the blind in Cambodia.

PURPOSE: To identify the causes of blindness and severe visual impairment (BL/SVI) in children attending four schools for the blind in Cambodia and to provide spectacles, low vision aids, orientation and mobility training and ophthalmic treatment. METHODS: Children < 16 years of age were recruited from all 4 schools for the blind in Cambodia. Causes of visual impairment and blindness were determined and categorized using World Health Organization methods. RESULTS: Of the 95 children examined, 54.7% were blind (BL) and 10.5% were severely visually impaired (SVI). The major anatomical site of BL/SVI was the lens in 27.4%, cornea in 25.8%, retina in 21% and whole globe in 17.7%. The major underlying etiologies of BL/SVI were hereditary factors (mainly cataract and retinal dystrophies) in 45.2%, undetermined/unknown (mainly microphthalmia and anterior segment dysgenesis) in 38.7% and childhood factors in 11.3%. Avoidable causes of BL/SVI accounted for 50% of the cases; 12.9% of the total were preventable with measles being the commonest cause (8.1% of the total); 37.1% were treatable with cataracts and glaucoma being the commonest causes (22.6% and 4.8% respectively). More than 35% of children required an optical device and 27.4% had potential for visual improvement with intervention. CONCLUSION: Half of the BL/SVI causes were potentially avoidable. The data support the need for increased coverage of measles immunization. There is also a need to develop specialized pediatric ophthalmic services for the management of surgically remediable conditions, to provide optometric, low vision and orientation and mobility services. Genetic risk counseling services also may be considered.