Profile of contact lens prescribing in GCC countries.

PURPOSE: This study aimed to report the pattern of contact lens prescribing from the Gulf Cooperation Council (GCC) countries. METHODS: Optometrists in the GCC region were contacted to participate in a web-based survey hosted on Qualtrics XM (Provo, Utah, USA). The survey methodology was adapted from the International Contact Lens Prescribing Consortium, and participants were asked to report their last five lens fits. It collected information on practitioner demographics (age, gender, nationality, qualification, country of practice, and number of years of experience), CL user demographics (age and gender) and on lens specific details such as lens type, lens design, lens material, replacement plan, and modality of lens wear. Descriptive statistics were used to analyse and report the data. RESULTS: This study reports 739 contact lens fits by 174 practitioners from six GCC countries. The average age of the patients was 29.72 ± 9.07 (Mean ± SD) years and 64 % of them were females. The majority (80.2 %) were fitted with soft contact lenses, with 59 % preferring silicone hydrogels, 20 % wearing them for cosmetic purposes and nearly half of them disposed of their lenses daily (55 %). Among the RGP lenses, 41 % were scleral lenses. This survey demonstrated a greater proportion of new lens fits (55 % vs. 37 %), disposable hydrogel lens use (21 % vs. 13 %), and a preference for cosmetic contact lenses (20 % vs. 4 %) compared to the international data. CONCLUSION: The pattern of CL prescriptions in the GCC region closely resembled the global trend. The survey observed a higher preference towards frequent replacement soft lenses, a greater proportion of silicone hydrogel lenses, a higher percentage of rigid lens fits, a greater affinity for cosmetic contact lenses, and a higher percentage of new fits. These trends suggest that contact lens prescription habits in the region are likely to continue evolving in the future.

Efficacy of Neuro-Optometric visual rehabilitation in Homonymous Hemianopia.

OBJECTIVES: To assess oculomotor dysfunction and the effectiveness of neuro-optometric visual rehabilitation in improving oculomotor parameters in participants with homonymous hemianopia. MATERIALS AND METHODS: Fifty subjects diagnosed with homonymous hemianopia (HH), referred through the neuro-ophthalmology department, were recruited for the study. All the subjects underwent a detailed neuro-optometric evaluation that included testing for sensory, visuo-motor and oculomotor functions. Subjects with homonymous hemianopia were then prescribed with yoked prisms and were randomized to two treatments at one month, namely group 1: yoked prisms (n = 15) and group 2: yoked prisms with in-office visual search training (n = 15). RESULTS: The mean ± SD age of the subjects was 46 ± 12 years. Subjects with HH exhibited a significant delay in the completion time, response and accuracy of tasks on proactive, saccadic and visual search parameters using the SVI compared to age-matched controls (Independent t-test, p < 0.05). A significant improvement in the reading speed and visual search parameters (RM ANOVA, p < 0.001) was seen post neuro-optometric visual rehabilitation with both yoked prisms and SVI. Statistically significant differences were observed in the reaction time of the visual search paradigms between the two rehabilitative modalities yoked (group1), yoked and SVI (group2) (Mann-Whitney U test, p < 0.001), with the group 2 showing better visual search performance outcomes compared to group 1 (yoked). CONCLUSION: Visual search parameters among participants with homonymous hemianopia improved following combined rehabilitation (yoked prisms and visual search trainng).

Impact of Covid-19 on Pediatric Ophthalmology Care: Lessons Learned.

The COVID-19 pandemic came with many new challenges that forced personal and professional lifestyle modifications. Medical facilities were in scarcity against this new unknown enemy and were challenged with the overloaded patient flow, scarcity of healthcare staff, and evolving treatment modalities with a better understanding of the virus each day. Ophthalmology as a "branch of medicine" suffered challenges initially because of a lack of guidelines for patient management, close working distance during routine examinations, and halt of major surgeries, including cataracts. Pediatric ophthalmology had major implications, as reduced outpatient visits would mean deeper amblyopia, and changed lifestyles, including online classes and home refinement, predisposing children to myopia, digital eye strain, and worsening of strabismus. COVID-19 also unveiled underlying accommodation and convergence anomalies that predisposed pediatric and adolescent patients to an increased prevalence of headache and acute onset esotropia. Teleophthalmology and other innovative solutions, including the use of prism glasses, safe slit-lamp shields, alternative ways of school screening with the use of photoscreeners, performing retinoscopy only when needed, and using autorefractors were among the few guidelines or modifications adopted which helped in the efficient and safe management of pediatric patients. Many pediatric ophthalmologists also suffered in terms of financial constraints due to loss of salary or even closure of private practices. School screening and retinopathy of prematurity screening suffered a great setback and costed a lot of vision years, data of which remains under-reported. Important implications and learnings from the pandemic to mitigate future similar situations include using teleophthalmology and virtual platforms for the triage of patients, managing non-emergency conditions without physical consultations, and utilizing home-based vision assessment techniques customized for different age groups. Though this pandemic had a lot of negative implications, the innovations, modifications, and other important learnings helped pediatric ophthalmologists in navigating safely.

Discrimination of paediatric acuity test optotypes by 6-year-old children.

PURPOSE: To compare the discrimination performance of 6-year-old children for optotypes from six paediatric visual acuity tests and to fit Luce's Biased Choice Model to the data to estimate the relative similarities and bias for each optotype. METHODS: Full data sets were collected from 20 typically developing 6-year-olds who had passed a vision screening. They were presented with single optotypes labelled 6/12 at a distance of 9 m and were asked to identify the optotype using a matching task containing all optotypes from the relevant test. The data were combined to form a confusion matrix for each test and a biased choice model was fitted to the data. RESULTS: Median correct performance varied from 40% to 100% across optotypes, with the HOTV test having the highest values. Estimates of the similarity of each pair of optotypes indicated equal values for all pairs in the Landolt C, HOTV, Lea numbers and Tumbling E tests. The values differed for the picture tests, that is Lea Symbols and Allen figures. The estimates of bias for each individual optotype also indicated different values with the picture tests. CONCLUSIONS: Previous studies of the threshold acuity of young children and adults have indicated differences in acuity estimates across paediatric tests. A recognition acuity task typically requires resolving the difference information between optotypes. The performance of the 6-year-olds here reveals variance in similarity and bias values for picture tests, particularly for the Allen figures when compared with the Lea Symbols. Ideally, this analysis should be performed when designing new tests, and these results motivate progression from the use of current picture tests to well calibrated letter or number tests at the earliest possible age.

Parental perception of facilitators and barriers to activity and participation in an integrated tele-rehabilitation model for children with cerebral visual impairment in South India - A virtual focus group discussion study.

Purpose: This study utilized virtual focus group discussions to document the facilitators and barriers reported by the parents as part of the tele-rehabilitation service delivery model in India. Methods: This study included 17 participants who were enrolled into the Tele-rehabilitation program (16 mothers, 1 father) and the virtual focus group discussion (V-FGD) were conducted through a WhatsApp video call. Three V-FGDs were conducted involving two moderators and a note taker. The V-FGD, focused at extracting the perceptions of parents pertaining to facilitators, barriers and coping mechanisms to barriers related to the tele-rehabilitation model. Results: Thematic analysis resulted in four themes for barriers that included: family and support, time, parent and care taker, child and place of living related; facilitators reported included: continuous monitoring, accessibility to professional services, provision of resource materials and parental empowerment. Themes "family and support" and "child" were most reported by parents with children >3 years and ≤3 years respectively. Finally, the barriers and facilitators were aligned with the chapters and codes of International Classification of Functioning, children and youth version (ICF-CY) environment and personal factors. Conclusion: This V-FGD highlights the importance of parental-centred and structured Tele-rehabilitation among children with CVI in India. The outcome of this study opens avenues for creating effective intervention.

Myopia and Its Association with Near Work, Outdoor Time, and Housing Type among Schoolchildren in South India.

SIGNIFICANCE: In this comprehensive assessment of environmental associations with refractive status among schoolchildren in India, outdoor time was the key modifiable risk factor associated with myopia rather than time spent on near work. PURPOSE: This study aimed to investigate the environmental risk factors associated with myopia among adolescent schoolchildren in South India. METHODS: Children in grades 8 to 10 from 11 schools in Tamil Nadu, South India, underwent eye examination and risk factor assessments through a modified version of the Sydney myopia questionnaire. Time spent on near work and outdoors was analyzed after division into three groups based on tertiles. Mixed-effects logistic regression was performed to assess the factors associated with myopia. RESULTS: A total of 3429 children (response rate, 78.4%) provided both questionnaire and refraction data. The mean (standard deviation) age was 14 (0.93) years with an equal distribution of sexes. Myopia was present among 867 children (noncycloplegic spherical equivalent refraction, ≤-0.75 D). Refraction was not associated with near work tertiles ( P = .22), whereas less time outdoors was associated with higher myopic refractions ( P = .01). Refraction shifted toward increased myopia with an increase in the near-work/outdoor time ratio ( P = .005). Children living in apartment housing had a higher prevalence of myopia compared with other types of housing ( P < .001). In multivariate analysis, increased time outdoors was a protective factor against myopia (odds ratio, 0.79; 95% confidence interval, 0.63 to 0.99; P = .04), whereas living in apartment housing (odds ratio, 1.27; 95% confidence interval, 1.04 to 1.55; P = .02) was a significant risk factor. CONCLUSIONS: In this cohort of Indian children, outdoor time, increased near-work/outdoor time ratio, and type of housing were the factors associated with myopia. Policies should target implementing a balance between near-work and outdoor time among children.

Reading Difficulty Due to Oculomotor Dysfunction following Mild Traumatic Brain Injury: A Case Report.

Reading involves adequate coordination of the oculomotor system. As interlink consists of neuronal control, an insult to the brain might affect the signal processing and lead to oculomotor dysfunction that can affect reading performance. Appropriate training to enhance the oculomotor coordination is effective in such scenarios. The purpose of this case report is to highlight the role of neuro-optometric vision therapy as a management option in oculomotor-based reading difficulty.

Results of the School Children Ocular Biometry and Refractive Error Study in South India.

Objectives: Axial length (AL) is an important contributor to refraction, and growth curves are gaining importance in the prediction of myopia. This study aimed to profile the distribution of ocular biometry parameters and to identify correlates of spherical equivalent refraction (SE) among school children in South India. Materials and Methods: The School Children Ocular Biometry and Refractive Error study was conducted as part of a school screening program in southern India. The enrolled children underwent tests that included vison check, refraction, binocular vision assessment, and biometry measurements. Results: The study included 1382 children whose mean (standard deviation [SD]) age was 10.18 (2.88) years (range: 5-16 years). The sample was divided into 4 groups (grades 1-2, grades 3-5, grades 6-9, and grade 10) based on significant differences in right AL (p<0.001). The mean (SD) AL (range: 20.33-27.27 mm) among the four groups was 22.50 (0.64) mm, 22.88 (0.69) mm, 23.30 (0.82) mm, and 23.58 (0.87) mm, respectively. The mean SE (range: +1.86 to -6.56 D) was 0.08 (0.65 D) in class 1 and decreased with increasing grade to -0.39 (1.20 D) in grade 10. There was a significant difference in all biometry parameters between boys and girls (p<0.001). Age, AL, and mean corneal curvature were the main predictors of SE. Conclusion: This study provides a profile of ocular biometry parameters among school children in South India for comparison against profiles from other regions across the country. The study data will form a reference for future studies assessing myopia in this ethnicity.

Diagnostic accuracy of indigenously developed computer-based binocular vision assessment.

CONTEXT: The increased prevalence of nonstrabismic binocular vision anomalies (NSBVA) has given rise to the need for cost-effective screening and diagnostic tools. AIMS: The aim of the study is to assess the efficacy of an indigenously developed computer-based binocular vision assessment software (Train Your Eyes®) in screening NSBVA. SUBJECTS AND METHODS: Subjects who visited the binocular vision clinic of a tertiary eye care center with asthenopic symptoms between January 2019 and January 2020 were included in the study. Patients with other ocular comorbidities and stereopsis poorer than 500 arc seconds were excluded. All subjects underwent a comprehensive eye examination followed by binocular vision assessment using both the manual and computer-based methods. STATISTICAL ANALYSIS USED: Receiver operating characteristic (ROC) curves were utilized to choose the cut-off points that maximize the sensitivity and specificity. RESULTS: The mean (standard deviation) age of 88 subjects was 22 (4.5) years with 34 males. Based on the conventional manual assessment, 71 (81%) were diagnosed to have NSBVA and 17 (19%) had normal binocular vision. Based on the ROC analysis, the following cut-off points are proposed: 14 prism diopter (PD) for near positive fusional vergence amplitudes, 4.5 PD for near negative fusional vergence amplitudes, 4.5 cycles per minute (cpm) for binocular accommodative facility, and 3.5 cpm for monocular accommodative facility. All the binocular vision parameters demonstrated statistical significance in the ROC analysis (P < 0.05). CONCLUSIONS: The software-based screening tool was found to be highly sensitive in identifying NSBVA and thus could be used as a potential screening tool in the clinic and community.

Digital Eye Strain- A Comprehensive Review.

Digital eye strain (DES) is an entity encompassing visual and ocular symptoms arising due to the prolonged use of digital electronic devices. It is characterized by dry eyes, itching, foreign body sensation, watering, blurring of vision, and headache. Non-ocular symptoms associated with eye strain include stiff neck, general fatigue, headache, and backache. A variable prevalence ranging from 5 to 65% has been reported in the pre-COVID-19 era. With lockdown restrictions during the pandemic, outdoor activities were restricted for all age groups, and digital learning became the norm for almost 2 years. While the DES prevalence amongst children alone rose to 50-60%, the symptoms expanded to include recent onset esotropia and vergence abnormalities as part of the DES spectrum. New-onset myopia and increased progression of existing myopia became one of the most significant ocular health complications. Management options for DES include following correct ergonomics like reducing average daily screen time, frequent blinking, improving lighting, minimizing glare, taking regular breaks from the screen, changing focus to distance object intermittently, and following the 20-20-20 rule to reduce eye strain. Innovations in this field include high-resolution screens, inbuilt antireflective coating, matte-finished glass, edge-to-edge displays, and image smoothening graphic effects. Further explorations should focus on recommendations for digital screen optimization, novel spectacle lens technologies, and inbuilt filters to optimize visual comfort. A paradigm shift is required in our understanding of looking at DES from an etiological perspective, so that customized solutions can be explored accordingly. The aim of this review article is to understand the pathophysiology of varied manifestations, predisposing risk factors, varied management options, along with changing patterns of DES prevalence post COVID-19.

Diagnosis and Management of Post Traumatic Recurrent Unilateral Accommodative Spasm-A Case Report.

Spasm of accommodation refers to constant contraction of the ciliary muscles of the eye, which fail to relax. Neurological issues, head injury, and psychogenic factors can lead to spasm of accommodation, which is generally bilateral. This case report describes the clinical presentation of traumatic, unilateral accommodative spasm in an army person. A 26-year-old male presented with complaints of diminution of near vision in the left eye noticed accidentally. History revealed a blunt injury in the eyebrow region of the left eye two months back. His best corrected visual acuity was 6/6, 0.8 M (N6) in the right eye and 6/9, 2.5 M (N18) in the left eye. Accommodative response was documented using an open-field autorefractometer that showed asymmetry in the accommodation response and pupillary diameter between the two eyes. One percent Atropine sulfate eye ointment - twice a day for 3 days - was prescribed. On the fourth day, the spasm was resolved in the left eye. Pre- and post-Atropine administration, lens thickness measurements were documented, which showed significant changes. Accommodative facility exercise was initiated after the pharmacological management. Unilateral accommodative spasm is rare and needs careful investigations. Objective assessment of accommodative response and lens thickness measurement play a vital role in confirming the diagnosis.

Ocular features of patients with Parkinson's disease examined at a Neuro-Optometry Clinic in a tertiary eye care center.

PURPOSE: To report the ocular features of patients with PD who presented with visual complaints to a tertiary eye care center. METHODS: This was a retrospective study carried out between January 2015 and March 2020 at the Neuro-Optometry clinic of a tertiary eye care center in Southern India. All PD patients with ocular complaints examined by the neuro- ophthalmologists were referred to Neuro-Optometry Clinic for detailed evaluation. Patients with other neurodegenerative disorders, brain injury, and other causes of vision loss or extraocular motility disorders were excluded. RESULTS: A total of 43 patients (7 females, 36 males) between 50 and 86 years of age (mean: 70 ± 8.9 years) with a mean duration of PD of 4.5 ± 4.5 years were studied. Decreased vision associated with reading difficulty (40%) was common in PD patients. In terms of gaze restriction, vertical gaze involvement (35%) was more than horizontal involvement (7%). Convergence insufficiency (CI) was the most common binocular vision dysfunction (30%), followed by CI with oculomotor dysfunction (14%) and vertical gaze palsy (18%). Ground prisms were recommended for 26 patients (61%) and home vision therapy for 5 patients (12%) as corrective measures. CONCLUSION: Binocular vision dysfunction is highly prevalent among PD patients. This could potentially contribute to the reading difficulties and double vision encountered by these patients. Assessment of binocular vision and oculomotor parameters thus becomes important to understand and manage the reading difficulties in patients with PD.

Prevalence of myopia among urban and suburban school children in Tamil Nadu, South India: findings from the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) Study.

PURPOSE: To report the baseline prevalence of myopia among school children in Tamil Nadu, South India from a prospective cohort study. METHODS: Children between the ages of 5 and 16 years from 11 schools in two districts of Tamil Nadu underwent vision screening. All children underwent visual acuity assessment using a Pocket Vision Screener followed by non-cycloplegic open-field autorefraction (Grand Seiko WAM-5500). Myopia was defined as a spherical equivalent (SE) refraction of ≤-0.75 D and high myopia was defined as SE ≤ -6.00 D. Distribution of refraction, biometry and factors associated with prevalence of myopia were the outcome measures. RESULTS: A total of 14,699 children completed vision screening, with 2% (357) of them having ocular abnormalities other than refractive errors or poor vision despite spectacle correction. The remaining 14,342 children (7557 boys; 52.69%) had a mean age of 10.2 (Standard Deviation [SD] 2.8) years. A total of 2502 had myopia in at least one eye, a prevalence of 17.5% (95% CI: 14.7-20.5%), and 74 (0.5%; 95% CI: 0.3-0.9%) had high myopia. Myopia prevalence increased with age (p < 0.001), but sex was not associated with myopia prevalence (p = 0.24). Mean axial length (AL; 23.08 (SD = 0.91) mm) and mean anterior chamber depth (ACD; 3.45 (SD = 0.27) mm) positively correlated with age (p < 0.001). The mean flat (K1; 43.37 (SD = 1.49) D) and steep (K2; 44.50 (SD = 1.58) D) corneal curvatures showed negative correlation with age (p = 0.02 and p < 0.001, respectively). In the multivariable logistic regression, older age and urban school location had higher odds for prevalence of myopia. CONCLUSION: The baseline prevalence of myopia among 5- to 16-year-old children in South India is larger than that found in previous studies, indicating that myopia is becoming a major public health problem in this country.

Does non-strabismic amblyopia affect the quality of life of adults? Findings from a qualitative study.

PURPOSE: While much is known about the psychosocial impacts of strabismus, little is known about the effects of non-strabismic amblyopia on quality of life (QoL). The aim of this study was to explore the long-term impacts of anisometropic amblyopia. METHODS: A phenomenological qualitative investigation was carried out on a sample of adults with anisometropic amblyopia. Subjects participated in in-depth telephone interviews and described how their eye condition affected different aspects of their life. The interviews were audio-recorded, transcribed verbatim and analysed iteratively to form emergent themes. RESULTS: Sixteen participants took part in the study (median age: 21.5 years; range: 18-36 years; 11 male and 5 female). Six themes emerged: (1) symptoms experienced by participants, (2) concerns and apprehensions, (3) emotional impacts, (4) activity limitations, (5) hassle and inconveniences and (6) economic and career implications. Symptoms reported by participants ranged from glare to difficulty concentrating. They were extremely concerned about the safety of their better eye and lived with several doubts and anxieties. Negative emotions such as grief and disappointment due to eye care negligence in childhood was apparent. Guilt and regretful feelings were present in those who did not comply with past treatment. Participants expressed several limitations in driving, reading, mobility (e.g., using stairs) and tasks requiring high resolution. Reported inconveniences associated with coping with their eye condition included having to travel across the country in search of a cure for their amblyopia. Economic impacts ranged from costs associated with accessing eye care and management to career choices being compromised. CONCLUSION: Lived experiences of people with anisometropic amblyopia indicate that the QoL impacts are multifaceted and substantial, even in the absence of strabismus. The results have the potential to influence patient-practitioner relationship by opening newer horizons to communication and care while managing adult amblyopes.

Comparison of Binocular Vision Parameters Pre- and Post-EPILASIK Laser Vision Correction Surgery for Myopia in a Pilot Study - Can Vision Therapy Augment Refractive Results?

PURPOSE: To analyze the changes in the binocular vision parameters after bilateral Epilasik laser vision correction surgery (LVCS). SETTING: Medical Research Foundation, Tamil Nadu, India. STUDY DESIGN: Prospective cohort study. METHODS: Subjects with a best corrected visual acuity of ≤ 0.0 Log MAR scale and refractive error: < 6.00DS of myopia, < 0.75D of astigmatism, and < 1D of anisometropia were included in the study. All subjects underwent a comprehensive eye examination, LVCS workup which included corneal topography, tomography, aberrometry, and dry eye assessment prior to binocular vision assessment. Complete Binocular vision assessment which included stereopsis, fusion for distance and near, near point of convergence, phoria measurement, vergence amplitudes and facility, accommodative amplitudes, response, and facility was performed with the best corrected vision prior to LVCS, one month and six months after the surgery. RESULTS: Twenty-five subjects of age 23.8 ± 2.9 years were included. Age ranged from 20 to 32 years. Ten were female and 15 were male. The median spherical power was -2.00DS with an inter quartile range (IQR) of -1.50DS to -3.00DS for both eyes. The median cylindrical power was plano with IQR -0.50DC to -1.00DC for both eyes. There was a statistically significant decrease in monocular and binocular accommodative amplitudes (accounting for age-related changes) as well as positive fusional vergence recovery for near between baseline and one month after surgery (p < 0.05). CONCLUSION: Though subjects were asymptomatic post LVCS, still there is an indication that myopic LVCS could precipitate or aggravate an existing non-strabismic binocular vision anomaly. Comprehensive binocular vision assessment and appropriate management is recommended before and after LVCS.