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Purpose: To evaluate the Canon CP?TX1 camera as a screening tool for ARFs in a pediatric population and estimate the prevalence of ARFs. Methods: In a pediatric outpatient space, largely in the immunization clinic, after obtaining parental consent, we encouraged children to be photographed from a distance of 5 feet in a dim room by using a CP?TX1 camera with the red?eye reduction feature off. Based on the captured red reflex, children were labeled as normal (symmetrical red reflexes in the two eyes, with no visible crescents); all others were considered as abnormal or positive for ARFs. All photographed children were assessed by an optometrist/refractionist for VA by age?appropriate methods. Data were entered into a 2 � 2 contingency table on statpages.org, and diagnostic indices were calculated with 95%CI. Results: With a sample of 262 children, we obtained a sensitivity of 0.82, a specificity of 0.98, a positive predictive value of 0.92, a negative predictive value of 0.94, a positive likelihood ratio of 41.06, a negative likelihood ratio of 0.17, and a prevalence of 0.24 for ARFs. Conclusion: CP?TX1 performed well as a screening tool to identify ARFs in children. Placing such a camera in an immunization clinic offers a chance to identify children with ARFs at a time when amblyopia is eminently reversible.
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We report a case of a 20‑year‑old female having systemic hypertension who presented with right‑sided proptosis, chemosis, and diminished vision, preceded by an acute episode of unilateral throbbing headache. Imaging studies revealed a right‑sided direct, spontaneous carotid‑cavernous fistula (CCF), aneurysm of internal carotid artery, bleed in the parieto‑frontal lobe, and swelling of extraocular muscles. Abdominal ultrasound revealed a small contracted right kidney measuring 64 mm × 27 mm. A direct spontaneous CCF can occur spontaneously following rupture of intracranial aneurysm without any history of trauma or connective tissue disorder. Prompt diagnosis of intravascular malformations at initial presentation can prevent neurological complications and vision loss. A team approach including emergency physicians, neurosurgeons, and ophthalmologists is needed for the proper management of such patients.
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Context: Cost‑effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. Aims: To compare the cost effectiveness of phacoemulsification (PE) versus manual small‑incision cataract surgery (MSICS). Settings and Design: Prospective randomized controlled trial. Tertiary care hospital setting. Subjects and Methods: A total of 52 consenting patients with age‑related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function‑14 (VF‑14) score and their quality‑adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared. Statistical Analysis Used: Two group comparison with Student’s t‑test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate. Results: Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [−0.05−0.11]), VF‑14 score (7.92 [−1.03−16.86]) and QALYs (1.14 [−0.89−3.16]). However, with significantly lower costs (INR 3228 [2700–3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85–14.30]) than PE. Conclusions: MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost‑effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.