Quality of life and vision assessment with scleral lenses in keratoconus.

PURPOSE: The purpose of the study is to evaluate the visual outcomes and improvement in quality of life (QOL) of patients with keratoconus with scleral lenses. METHODS: In this prospective study, 14 patients (28 eyes) with bilateral keratoconus were fitted with scleral lenses (McAsfeer 16.00 mm) in Pune city, Maharashtra, India. Uncorrected visual acuity (VA), best spectacle-corrected VA, and VA with scleral lenses were evaluated. The patients were given the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) for judging the QOL, before and after using scleral lenses for 3 months. RESULTS: The mean uncorrected VA of the 14 patients with a mean age of 28.64 ± 6.57 years was 1.18 ± 0.19 logMAR. Best spectacle-corrected high-contrast VA improved from 0.47 ± 0.25 logMAR to 0.03 ± 0.07 logMAR with scleral lenses (P < 0.001). Best spectacle-corrected low-contrast VA improved from 0.68 ± 0.22 logMAR to 00.47 ± 0.10 logMAR with scleral lenses (P < 0.001). Along with the increase in overall median scores on the NEI VFQ-25 from 1735 to 2930 points (P < 0.001), the distance and near activities (P < 0.001), vision-specific mental health (P < 0.002), social functioning (P < 0.004), and driving (P < 0.005) improved after using scleral lenses for 3 months. CONCLUSION: Scleral lenses can be an effective and safe management option for patients with keratoconus leading to an improved vision and QOL.

Why are we not doing retinoscopy in the school eye screening? Is distant visual acuity a sensitive tool for making referrals?

PURPOSE: School eye screening program is an integrated part of SarvaShikshyaAbhiyan. Distance visual acuity was the only tool used in such school eye screening for making referrals. We aim to evaluate the referral rate when only distance visual acuity was used as the screening tool versus using retinoscopy. METHODS: School children were earlier screened using distant visual acuity as the sole criteria. They were again examined as per the guidelines recommended by State of Alaska and American Academy of Pediatrics, and the results of the two examinations were compared. Microsoft Excel 2007 was used for the statistical analysis. RESULTS: Earlier 384 school children of class first to fourth (aged 6-10 years) had been screened using distant visual acuity. Of them, 87 (22.6%) were referred. The rest 297 (male 183 61.6%) students with a mean age of 7.8 years (standard deviation ± 1.23) were again examined and 42/384 (11%) were detected as having visual anomaly that were false negative/or missed during the initial screening. Refractive errors were detected in 33/42 (78.6%) students by retinoscopy. Retinoscopy showed the highest sensitivity (78.6%) and negative predictive value (96.6%) to detect all types of refractive error among all types of tests. Of 42 pair of eyes, 36 right eyes and 39 left eyes had refractive errors, mostly astigmatic, or hyperopic, which were missed earlier. CONCLUSION: Only distance visual acuity failed to detect hyperopia and astigmatism properly. Introduction of retinoscopy would increase the validity of school eye screening.

Impact of correcting visual impairment and low vision in deaf-mute students in Pune, India.

AIM: The aim of this study was to evaluate visual acuity and vision function before and after providing spectacles and low vision devices (LVDs) in deaf-mute students. SETTINGS: Schools for deaf-mute in West Maharashtra. METHODS: Hearing-impaired children in all special schools in Pune district underwent detailed visual acuity testing (with teachers' help), refraction, external ocular examination, and fundoscopy. Students with refractive errors and low vision were provided with spectacles and LVD. The LV Prasad-Functional Vision Questionnaire consisting of twenty items was administered to each subject before and after providing spectacles, LVDs. STATISTICAL ANALYSIS: Wilcoxon matched-pairs signed-ranks test. RESULTS: 252/929 (27.1%) students had a refractive error. 794 (85.5%) were profound deaf. Two-hundred and fifty students were dispensed spectacles and LVDs. Mean LogMAR visual acuity before introduction of spectacles and LVDs were 0.33 ± 0.36 which improved to 0.058 (P < 0.0001) after intervention. It was found that difference in functional vision pre- and post-intervention was statistically significant (P < 0.0001) for questions 1-19. The most commonly reported difficulties were for performing distance task like reading the bus destination (58.7%), making out the bus number (51.1%), copying from blackboard (47.7%), and seeing whether somebody is waving hand from across the road (45.5%). In response to question number 20, 57.4% of students felt that their vision was much worse than their friend's vision, which was reduced to 17.6% after dispensing spectacles and LVDs. CONCLUSION: Spectacle and LVD reduced visual impairment and improved vision function in deaf-mute students, augmenting their ability to negotiate in and out of school.

Spectacle compliance amongst rural secondary school children in Pune district, India.

BACKGROUND: Refractive errors (RE) are the most common cause of avoidable visual impairment in children. But benefits of visual aids, which are means for correcting RE, depend on the compliance of visual aids by end users. AIM: To study the compliance of spectacle wear among rural school children in Pune district as part of the sarva siksha abhiyan (education for all scheme) after 6 - 12 months of providing free spectacles. SETTINGS AND DESIGN: Cross-sectional follow-up study of rural secondary school children in western India. MATERIALS AND METHODS: The students were examined by a team of optometrists who collected the demographic details, observed if the child was wearing the spectacles, and performed an ocular examination. The students were asked to give reasons for non-wear in a closed-ended questionnaire. STATISTICAL ANALYSIS: Chi-square test and multiple logistic regression used for data analysis. RESULTS: Of the 2312 students who were dispensed spectacles in 2009, 1018 were re-examined in 2010. 523 students (51.4%) were female, the mean age was 12.1 years 300 (29.5%) were wearing their spectacles, 492 (68.5%) students claimed to have them at home while 211 (29.4%) reported not having them at all. Compliance of spectacle wear was positively associated to the magnitude of refractive error (P < 0.001), father's education (P = 0.016), female sex (P = 0.029) and negatively associated to the visual acuity of the better eye (P < 0.001) and area of residence (P < 0.0001). Of those that were examined and found to be myopic (N = 499), 220 (44%) wore their spectacles to examination. Factors associated with compliance to spectacle usage in the myopic population included increasing refractive error (P < 0.001), worsening visual acuity (P < 0.001), and higher academic performance (P < 0.001). The causes for not wearing spectacles were 'lost spectacles' 67(9.3%), 'broken spectacles' 125 (17.4%), 'forgot spectacles at home' 117 (16.3%), 'uses spectacles sometimes' 109 (15.2%), 'teased about spectacles' 142 (19.8%) and 'do not like the spectacles' 86 (12%). CONCLUSION: Spectacle compliance was poor amongst school children in rural Pune; many having significant vision loss as a result.

Impact of nutrient components on production of the phytoestrogens daidzein and genistein by hairy roots of Psoralea corylifolia.

Transformed hairy roots of Psoralea corylifolia were established by infection with Agrobacterium rhizogenes LBA 9402. The aim of this work was to elucidate the effects of media constituents on production of the phytoestrogenic isoflavones daidzein and genistein. A. rhizogenes strain LBA 9402 harboring Ri plasmid was used to transform stem segments of in vitro seedlings. The resultant hairy roots were confirmed by polymerase chain reaction (PCR) and exhibited Ri T-DNA. Transformed hairy root clones were cultured in Murashige and Skoog's (MS) medium altered with different concentrations of NH(4) (+) and NO(3) (-) and their growth and production of isoflavones were assessed. Biomass and productivity increased when MS medium was supplemented with NH(4) (+) and NO(3) (-) at a ratio of 20:10. Increased yield of daidzein was obtained when sucrose level in the culture medium increased, whereas decreased level of sucrose favored genistein production. The hairy roots produced the highest levels of daidzein (2.06% dry wt.) and genistein (0.37% dry wt.) in the presence of low concentrations of PO(4) (3-). Hairy roots secreted trace amounts of daidzein and genistein into the culture medium. The present results demonstrated that the productivity of daidzein was 2.2-fold more than that of untransformed roots.

Studied enhancement strategies for phytoestrogens production in shake flasks by suspension culture of Psoralea corylifolia.

This study proposed secondary metabolites incremental yield due to manipulation of nutrient components into the culture medium. To validate this, the effects of nutrients such as carbon, phosphate and nitrogen on growth and production of phytoestrogens daidzein and genistein by suspension cultures of Psoralea corylifolia was investigated for the first time. The maximum production of daidzein and genistein was achieved when sucrose and maltose used as a sole source of carbon. Suspension cell cultures enriched with sucrose (3%) stimulated accumulation of isoflavones daidzein (1.76% dry wt) and genistein (0.25% dry wt) compared to glucose, fructose and maltose. Sucrose feeding strategy significantly stimulated biomass growth and isoflavones (2.79% dry wt of daidzein and 0.32% dry wt of genistein) production rate. Reduced concentrations of phosphate (0.625 mM) promoted daidzein (1.89% dry wt) and genistein (0.26% dry wt) production by suspension cell cultures, whereas high amount (5mM) in medium was inhibited isoflavones production. It was observed that medium fortified with NH(4)(+) and NO(3)(-) alone inhibited production of isoflavones. The maximum production obtained of daidzein (2.20% dry wt) and genistein (0.29% dry wt) when medium comprised with NH(4)(+)/NO(3)(-) at ratio 20:40 mM as a nitrogen source. Similar nutrient components ratio when altered NH(4)(+)/NO(3)(-); 40:20mM) resulted in approximately 3-fold decrease in production. HPLC analysis revealed that suspension cells cultures leached out trace amount of daidzein and genistein into the culture medium.