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.

Cerebral visual impairment in children: Multicentric study determining the causes, associated neurological and ocular findings, and risk factors for severe vision impairment.

Purpose: To evaluate the causes, associated neurological and ocular findings in children with cerebral visual impairment (CVI), and to identify risk factors for severe vision impairment. Methods: A multicenter, retrospective, cross-sectional analysis was carried out from January 2017 to December 2019 on patients less than 16 years of age with a diagnosis of CVI. Results: A total of 405 patients were included of which 61.2% were male and 38.8% were female. The median age at presentation was 4 years (range 3 months to 16 years). Antenatal risk factors were present in 14% of the cases. The most common cause of CVI was hypoxic-ischemic encephalopathy (35.1%), followed by seizure associated with brain damage (31.3%). The most common neurological finding was seizure (50.4%), followed by cerebral palsy (13.6%). Associated ophthalmological findings were significant refractive error (63.2%), esotropia (22.2%), exotropia, (38%), nystagmus (33.3%), and optic nerve atrophy (25.9%). Severe visual impairment (<20/200) was associated with optic atrophy (odds ratio: 2.9, 95% confidence interval: 1.4-6.0; P = 0.003) and seizure disorder (odds ratio: 1.9, 95% confidence interval: 1.2-3.3; P = 0.012). Conclusion: The various ophthalmic, neurological manifestations and etiologies could guide the multidisciplinary team treating the child with CVI in understanding the visual impairment that affects the neuro development of the child and in planning rehabilitation strategies.

Suture Selection for Incision Closure in Pediatric Cataract Surgery: A Dilemma for Pediatric Ophthalmologists.

PURPOSE: To measure and compare suture-related complications in children undergoing cataract surgery with a surgical incision closure performed by either a 10-0 nylon suture followed by suture removal within 1 to 2 weeks after surgery or a 10-0 polyglactin suture left in situ. METHODS: This was a prospective, non-randomized cohort study. All children with bilateral cataracts who underwent cataract surgery with a surgical incision closure by non-absorbable 10-0 nylon sutures followed by suture removal within 1 to 2 weeks after surgery in their first eye and incision closure by absorbable 10-0 polyglactin sutures left in situ after their second eye surgery. The frequency of suture-related complications (vascularization near to suture, loosening of suture, mucus accumulation, early rupture, and infective keratitis) was noted for 10-0 nylon and 10-0 polyglactin sutures. RESULTS: Eighty-two eyes of 41 children were enrolled in the study. All children were observed until 3 months after surgery. Of the 10-0 nylon sutures, 2 (4.9%) were loose and 2 (4.9%) had underlying corneal edema. The remaining sutures (n = 37, 90.2%) were removed within 1 to 2 weeks after surgery. Of the 10-0 polyglactin sutures, 5 (12.2%) were loose, 2 (4.9%) were vascularized, and 3 (7.3%) had mucus infiltration. These sutures (n = 10, 24.3%) were removed 2 to 5 weeks after the second eye surgery. The remaining polyglactin sutures (n = 31, 75.6%) were left in situ. CONCLUSIONS: A higher frequency of suture-related complications was observed with the 10-0 polyglactin sutures than the 10-0 nylon sutures. The authors recommend using 10-0 nylon sutures with suture removal within 1 to 2 weeks after surgery over using 10-0 polyglactin sutures for incision closure in pediatric cataract surgeries. [J Pediatr Ophthalmol Strabismus. 2022;59(4):243-247.].

Clinical profile of childhood blindness and inappropriate enrolment of children in schools for visually impaired in Uttar Pradesh, India.

PURPOSE: To assess major causes of severe visual impairment (SVI)/blindness (BL) in children studying in schools for the blind in western Uttar Pradesh, India and the extent of inappropriate enrolment of children in blind schools. METHODS: Students of five schools for the blind were examined in a tertiary care eye hospital. The anatomical sites and etiology for SVI/BL were recorded using the World Health Organization/Prevention of Blindness standard reporting form. Categorical variable were summarized using frequencies and percentages. RESULTS: A total of 93 students were examined. Male/Female ratio was 3.4:1. The most common anatomical sites of SVI/BL were the whole globe (40.3%) and the cornea (26.4%). Postnatal or childhood causes were noted in 13.8% cases. Forty-one (56.9%) students had hereditary diseases which was most likely caused by chromosomal abnormalities. Three students were having an associated disability, one was deaf and mute, one was physically handicapped, and one was intellectually challenged. Fifty-four (58%) children were blind and 21 (22.6%) children had no visual impairment but were studying in schools for the blind. CONCLUSION: Schools for the blind should be screened routinely to reduce the incidence of misdiagnosed visual impairment. This will prevent inappropriate enrolment and will definitely help in reducing the social and economic burden of society and of the schools of blind too.