Guidelines for setting up low-vision and rehabilitation services in India.

ABSTRACT: Low vision and blindness are increasing public health issues impacting individuals' quality of life. During clinical low-vision services, vision rehabilitation is crucial for enhancing daily living skills and improving life quality. Low-vision and rehabilitation (LVR) services encompass comprehensive measures that aid visually disabled individuals in restoring function, autonomy, and social participation. Such holistic management requires a multidisciplinary approach, facilitating adaptation to environmental and sociocultural changes. However, the lack of awareness about the principles and practices of LVR services poses a major hindrance to setting up such a special clinic in the eye hospital. This article is about a consensus statement on the guidelines for establishing LVR services focusing on basic requirements, especially in low-resource countries. The present recommendation to set up an LVR clinic was made after group discussions and debates among various experts and stakeholders during the National Workshop on Strengthening Low-Vision and Rehabilitation Services organized at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. The event was participated by many ophthalmologists and optometrists coming from across the country. The recommendations required at the tertiary level are outlined under the four headings: Human resources and training: two ophthalmologists, that is, a low vision specialist or a well-experienced in low vision and one who has received one-week orientation and training, one optometrist, one rehabilitation supervisor, and two rehabilitation assistants; Assessment equipment: basic screening and diagnostic; Assistive devices for low vision, including, digital and non-digital; Assistive devices for rehabilitation, and methods for records maintenance. The institution may not follow strictly the present guidelines but will provide an idea on LVR services initiation.

Identifying causes of vision loss and assistive technology needs among patients attending rehabilitation clinic of a tertiary care center in North India.

PURPOSE: Investigating the causes of visual loss and the best corrected visual acuity (BCVA) is crucial for identifying avoidable eye problems and planning appropriate rehabilitation and assistive technology (AT) services. The study aimed to identify various causes of vision loss and determine AT required for vision rehabilitation (VR). METHODS: The electronic records of patients who attended the VR clinic at a tertiary eyecare for the past 2 years were reviewed. Information such as demographics, BCVA, and causes of visual impairment were retrieved from the records. BCVA was categorized into better than or equal to 1/60 and less than <1/60 for AT services. RESULTS: In total, 1723 patients, mostly male (71.2%), visited the rehabilitation clinic from 2018 to 2019. Around 58.6% of patients belonged to the age group 16-49 years, whereas 25.6% were less than 15 years old. The most frequent eye problems were retinal disorders (63.5%), followed by retinitis pigmentosa (15.2%) and rod-cone dystrophy (4.7%). In contrast, congenital disorders were the most common cause of vision loss among younger groups. Approximately 36.0% of patients had <1/60 blindness and 16.6% had ≥1/60. Around 17.1% of patients would benefit from large prints (near vision acuity N18-N12). CONCLUSION: Early detection and timely management will prevent a significant proportion of patients from developing irreversible vision loss. Around one-third of patients would benefit from visual substitution AT.

A large-scale volumetric correlated light and electron microscopy study localizes Alzheimer's disease-related molecules in the hippocampus.

Connectomics is a nascent neuroscience field to map and analyze neuronal networks. It provides a new way to investigate abnormalities in brain tissue, including in models of Alzheimer's disease (AD). This age-related disease is associated with alterations in amyloid-ß (Aß) and phosphorylated tau (pTau). These alterations correlate with AD's clinical manifestations, but causal links remain unclear. Therefore, studying these molecular alterations within the context of the local neuronal and glial milieu may provide insight into disease mechanisms. Volume electron microscopy (vEM) is an ideal tool for performing connectomics studies at the ultrastructural level, but localizing specific biomolecules within large-volume vEM data has been challenging. Here we report a volumetric correlated light and electron microscopy (vCLEM) approach using fluorescent nanobodies as immuno-probes to localize Alzheimer's disease-related molecules in a large vEM volume. Three molecules (pTau, Aß, and a marker for activated microglia (CD11b)) were labeled without the need for detergents by three nanobody probes in a sample of the hippocampus of the 3xTg Alzheimer's disease model mouse. Confocal microscopy followed by vEM imaging of the same sample allowed for registration of the location of the molecules within the volume. This dataset revealed several ultrastructural abnormalities regarding the localizations of Aß and pTau in novel locations. For example, two pTau-positive post-synaptic spine-like protrusions innervated by axon terminals were found projecting from the axon initial segment of a pyramidal cell. Three pyramidal neurons with intracellular Aß or pTau were 3D reconstructed. Automatic synapse detection, which is necessary for connectomics analysis, revealed the changes in density and volume of synapses at different distances from an Aß plaque. This vCLEM approach is useful to uncover molecular alterations within large-scale volume electron microscopy data, opening a new connectomics pathway to study Alzheimer's disease and other types of dementia.

Burden of Ocular Motility Disorders at a Tertiary Care Institution: A Case to Enhance Secondary Level Eye Care.

AIM: To evaluate the profile of strabismus and amblyopia in patients presenting to a tertiary care institution in order to understand the disease burden. MATERIALS AND METHODS: A retrospective, prospective hospital-based observational study was conducted at a tertiary level eye care hospital in India. All patients with strabismus or amblyopia who presented over a 1-year period were identified and referred to the squint clinic, where they were evaluated with a detailed clinical history and examination. RESULTS: A total of 24475 patients were evaluated, of which 1950 had strabismus or amblyopia. The overall magnitude of amblyopia and strabismus was 2.0% [95% confidence interval (CI), 1.8-2.2)] and 6.9% (95% CI, 6.6-7.2), respectively. About 20% of those seeking an ophthalmic consultation were children and they constituted over half of the population referred to the squint clinic. Among younger children, the burden of amblyopia and strabismus was 84.4% and 26.6%, respectively. Among the referred patients, strabismus was noted in 84.6% (N = 1649), most of the cases of which was of the comitant subtype (78.1%, N = 1288) with an equal distribution of exotropia and esotropia. Paralytic [12.9% (N = 251)] and restrictive [4.7% (N = 85)] squint constituted the remaining burden of strabismus. CONCLUSION: Strabismus and amblyopia affect a sizeable proportion of patients presenting to a tertiary care ophthalmology setup. A significantly higher burden is present in the pediatric population. The majority of the cases of strabismus are of a comitant variety, which do not merit tertiary level eye care. There is a need to improve pediatric eye care at a secondary level to reduce the immense burden on tertiary referral centers.

S-layer homology motif is an immunogen and confers protection to mouse model against anthrax.

SLH proteins bear an S-layer homology motif comprised of three S-layer homology (SLH) domains. Several SLH proteins in Bacillus anthracis have been recognized as immunogenic in recent past. We hypothesized that the SLH motif, the most common moiety amongst all the SLH proteins could be responsible for their immunogenicity. To test this hypothesis, we checked the immunogenic capacity of recombinant SLH motif. The rSLH fragment on immunization in mice led to the development of a potent humoral and T Helper immune response as compared to the only adjuvant immunized group. Antibodies raised against rSLH could identify the surface of B. anthracis Ames strain vegetative forms. rSLH immunization protected 50% mice challenged with B. anthracis compared to 0% survival in group of mice immunized with only adjuvant. But when rSLH immunization was synergized with a single sub-optimal dose of rPA (Protective Antigen), 80% immunized mice survived the lethal challenge of B. anthracis. Taken together, for the first time we demonstrate the immunogenic and protective potential of SLH motif of the SLH proteins of B. anthracis.