Characteristics of 'sawtooth shunt' following anti-vascular endothelial growth factor for aggressive posterior retinopathy of prematurity.

OBJECTIVE: To explore the characteristics of 'sawtooth shunts (STS)' following intravitreal anti-vascular endothelial growth factors (anti-VEGF) for aggressive posterior retinopathy of prematurity (AP-ROP). DESIGN: Prospective observational study. METHODS: In a prospective observational study, 45 eyes of 24 babies receiving intravitreal anti-VEGF for AP-ROP or hybrid ROP were analyzed. Anti-VEGF molecule and doses: bevacizumab (0.62 mg or ½ IVB, n = 30 eyes; 0.25 mg or 1/5IVB, n = 9 eyes; 0.12 mg or 1/10 IVB, n = 1 eye); or ranibizumab (0.25 mg or ½IVR, n = 3 eyes; 0.1 mg or 1/5IVR, n = 2 eyes). They were followed every 1-2 week till disease regression with or without laser treatment. Development of STS, its variants, characteristics, timeline, and final outcomes was analyzed. RESULTS: STS occurred in 26 (57.7%) eyes at 1-6 weeks following anti-VEGF injections and persisted for 1-14 weeks. While the shunt regressed spontaneously in half of the treated eyes (n = 13) with anti-VEGF alone, the other half (n = 13) required additional laser because of either non-compliance (n = 9) or recurrence (n = 4). CONCLUSION: The STS was observed to be an important retinal vascular change seen in infants treated with intravitreal anti-VEGF at half adult doses. It warrants further studies to explore the association between STS and its association with disease recurrence or regression.

Knowledge, attitude, and practice of childhood myopia among Indian optometrists: A questionnaire-based study.

Purpose: To investigate the knowledge of myopia and its natural history including complications and clinical approaches for management adopted by optometrists across India. Methods: An online survey was distributed to Indian optometrists. A pre-validated questionnaire was adopted from previous literature. Respondents provided information about their demographics (gender, age, practice location, and modality), myopia knowledge, self-reported practice behaviors relating to childhood myopia, the information and evidence base used to guide their practice, and perceived extent of adult caregiver engagement in making management decisions for myopic children. Results: A total of 302 responses were collected from different regions of the country. Most respondents demonstrated knowledge of the association between high myopia and retinal breaks, retinal detachment and primary open-angle glaucoma. Optometrists used a range of techniques to diagnose childhood myopia, with a preference for non-cycloplegic refractive measures. The most common approaches to management were single-vision distance despite most optometrists identifying orthokeratology and low-dose (0.01%) topical atropine as two potentially more effective therapeutic interventions for controlling childhood myopia progression. Almost 90% of respondents considered increasing the time spent outdoors to be beneficial for reducing the rate of myopia progression. The main sources of information used to guide clinical practice were continuing education conferences, seminars, research articles, and workshops. Conclusion: : Indian optometrists appear to be aware of emerging evidence and practices, but are not routinely adopting measures. Clinical guidelines, regulatory approval, and sufficient consultation time may be of value for assisting practitioners in making clinical decisions based on the current available research evidence.

Non-pathologic components are associated with reduced visual acuity in myopes after spectacle correction.

Purpose: To find the association between reduced best-corrected visual acuity and non-pathologic components after optical correction in individuals with low to high myopia. Methods: Myopic children under 16 years of age were reviewed using electronic medical records and the following data were extracted and recorded: participant's age, gender, uncorrected visual acuity (UCVA), manifest refraction, and best corrected visual acuity (BCVA). Spherical equivalent and cylinder were classified into low, moderate, and high categories based on the magnitude range. Similarly, astigmatism was defined into with-the-rule, against-the-rule, and oblique based on the location of the steepest meridian. Reduced BCVA was defined when the decimal visual acuity was less than 0.66 (equivalent to Snellen's acuity of 6/9 or 20/30). Logistic regression was performed to test the factors associated with reduced visual acuity after optical correction in the absence of myopic pathologic changes. Statistical significance was considered if P < 0.05. Results: Overall 44.9% (N = 242/538) of myopes had reduced best-corrected visual acuity (BCVA) and none of the patients had pathologic myopic lesions. Using logistic regression, we found that high spherical refraction (OR 27.98, 95% CI 14.43-54.25, P < 0.001) and moderate spherical refraction (OR 5.52, 95% CI 2.56-11.91, P < 0.001) were significantly associated with reduced best corrected visual acuity despite any pathological lesions. Additionally, oblique and ATR astigmatism were associated with reduced visual acuity in myopic children with (OR 2.05, 95% CI 0.77-5.42) and (OR 1.59, 95% CI 0.82-3.08). Conclusion: Higher magnitude of refractive error components causes reduced visual acuity in the absence of pathologic changes.

A pilot non-randomized trial of smartphone-based anaglyph system for treatment of adult amblyopia through VR (Virtual Reality).

Purpose: To evaluate the effectiveness of amblyopia treatment through a smartphone-based anaglyph system by virtual reality (VR) in adult patients. Methods: A total of 10 subjects diagnosed with anisometropic amblyopia were enrolled during the study period. Best Corrected Visual Acuity (BCVA), stereoacuity, and contrast acuity were evaluated during three visits (at presentation, 3 months and 6 months) of smartphone-based anaglyph video run in the VR mode. All the amblyogenic factors including stereopsis, color vision, and contrast acuity were compared using Friedman two-way analysis of variance. Statistical significance was considered if P < 0.05. Results: Mean BCVA in amblyopic eye improved significantly from a logMAR value of 0.73 ± 0.64 before Virtual reality vision therapy (VRVT) to a post-training VRVT value of 0.48 ± 0.44 (P < 0.01). Mean stereoacuity changed from a value of 560.00 ± 301.58 before VRVT to a value of 263.00 ± 143.58 seconds of arc after training (VRVT) (P < 0.01). Mean accommodation changes from a value of 15.00 ± 7.40 before training or VRVT to value of 12.60 ± 6.10 cm after training (P < 0.01). Mean contrast acuity changes from a value of 1.21 ± 0.72 at presentation to a value of 1.52 ± 0.49 log unit after VRVT. Conclusion: A smartphone-based anaglyph system using VR vision therapy appears to be an effective treatment option for amblyopia in adults.

Role of 0.01% atropine in high myopic children of Moradabad, India (RAMCOM Study).

Purpose: Low-concentration atropine is an emerging therapy for myopia progression, but its efficacy remains uncertain among high myopic children. This study aimed to evaluate the efficacy and safety of low-concentration atropine eye drop (0.01%) in high myopic children. Methods: A non-randomized, parallel-group, longitudinal interventional cohort study. Myopic children were divided into two groups: (1) the intervention arm of children who received one drop of topical 0.01% atropine once a day at bedtime and (2) the control arm, in which enrolled children who were on observation only. Repeated measurements of spherical equivalent refractive errors (SERs) were performed at baseline and 1 and 2 years after treatment. Results: A total of 37 eyes were enrolled in the intervention arm (allocated to 0.01% atropine at year 1 follow-up) and 23 eyes in the control arm. After 1 year of 0.01% atropine therapy, the myopia progression was 0.15 ± 0.9 D in the intervention group versus 1.1 ± 1 D in the control group (P = 0.001). Similarly, after 2 years of treatment, the myopia progression was 0.3 ± 1.1 D in the intervention group versus 1.4 ± 1.1 D in the control group (P ≤ 0.001). Conclusion: Compared to no treatment, 0.01% atropine treatment had shown better effect on myopia progression in high myopic children.

Retinopathy of prematurity care in peripheral districts in Odisha, India: Pilot for a sustainable model.

The outcome of a retinopathy of prematurity (ROP) program initiated in five districts of Odisha over 3 years with partnerships between the government and non-government organizations was prospectively analyzed. The mentoring partners trained the district ophthalmologists and neonatal care providers; the program was handed over when the trainees were considered competent enough to diagnose and treat babies with ROP. During the project period (July 2016-June 2019), 3058 babies were examined; ROP was detected in 33.81% (n = 1034) and 5.06% (n = 159) babies required treatment. At the end of the project, ROP screening was possible in all five districts, and treatment was possible in three districts. ROP care nodal centers were built in one government medical college. To strengthen the initial gain, we recommend creating an Odisha Retinopathy of Prematurity (OD-ROP) steering committee with private-public partnerships to support the program and monitor its progress in other districts of Odisha.

Barriers to timely presentation for appropriate care of retinopathy of prematurity in Odisha, Eastern India.

Purpose: To analyze the causes for late presentation in a series of patients with advanced retinopathy of prematurity (ROP) in a tertiary eye care institute in Eastern India. Methods: We analyzed our medical records and ROP database retrospectively from 2007 to 2015 and prospectively thereafter till 2017 to identify the factors for late presentation in babies with advanced ROP (stages 4 and 5). Results: A total of 71 eligible subjects were analyzed. The mean chronological age was 15.1 months (2 months to 14 years). The three important barriers were: (1) the system and neonatal care policy failure (n = 45; 63.3%), (2) parental negligence and ignorance (n = 19; 26.7%), and (3) ophthalmologist's misdiagnosis or unavailability (n = 7; 10%). Majority of the babies (63.3%) were admitted in the neonatal care unit when they were due for ROP screening with an average duration of stay of 35.5 days. Conclusion: The main barriers to early screening for ROP were related to availability of trained human resources, ignorance of "parents and health care personnel," and distance from the point of care. This calls for training of ophthalmologists, advocacy with neonatologists and parents, and create systems for better coordination and compliance of the care providers.

Spontaneous Attachment of Rhegmatogenous Retinal Detachment Following Vitrectomy for Stage 4B Retinopathy of Prematurity and Atypical Retinal Changes Post-Resolution.

A prematurely born baby underwent lens-sparing vitrectomy for Stage 4B retinopathy of prematurity (ROP) in the left eye. This child had a stormy neonatal course, referred late, and was treated with intravitreal anti-vascular endothelial growth factor and laser in both eyes in the past. The surgery was uneventful, and the retina was attached until a month after surgery. Later, there was development of a break that led to the occurrence of rhegmatogenous retinal detachment in the operated eye. The retinal detachment increased with time during the course of 6 weeks. Surprisingly, the hole disappeared with spontaneous attachment of retina in the following weeks, with multiple depigmented spots over the posterior pole. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:544-547.].