Blinding Retinopathy of Prematurity in Western India: Characteristics of Children, Reasons for Late Presentation and Impact on Families.

OBJECTIVE: To ascertain why children with end-stage retinopathy of prematurity (ROP) become blind, and to explore the impact of blindness on families. DESIGN: Mixed quantitative and qualitative methods. SETTING: Tertiary-care eye hospital in India. PARTICIPANTS: Children with end-stage ROP and their carers. INTERVENTION: Cases presenting between June 2009 and July 2016 were identified from medical records and data extracted. Carers were contacted for missing information, if required. Data were analyzed to explore where failure had occurred in the process of screening and treatment. A subset of carers were selected for in-depth interviews to explore the impact of having a blind child. Interviews were recorded, transcribed and analyzed using a thematic framework. MAIN OUTCOME MEASURES: Parental perceptions. RESULTS: 66 children were included: median age 4.3 y (range 3 mo- 6 y), 58% boys. 74% were blind due to 'screening failure', which was associated with lower maternal education (P=0.03). Of the 17 case of treatment failure (24.6%), majority (12, 70%) had aggressive posterior ROP. A subset of carers of 18 children (50% boys) were interviewed, mostly mothers. Most reported impoverishment as a result of having a blind child, and many reported lack of access to special education, negative attitudes of others and concerns about the future. CONCLUSIONS: Screening for retinopathy of prematurity needs to be expanded and counselling improved. Access to special education and rehabilitation need to be improved.

Mobile unit for retinopathy of prematurity screening and management at urban Neonatal Intensive Care Units: Outcomes and impact assessment.

PURPOSE: To study the outcomes and impact of a mobile unit for retinopathy of prematurity (ROP) screening and management at urban Neonatal Intensive Care Units (NICUs). STUDY DESIGN: Public health intervention study. METHODS: This study was conducted in 2012. Staff of a mobile unit assessed all infants aged 32 weeks or less and/or weight 1250 g or less admitted in five NICUs between 2009 and 2011. An ophthalmologist performed bedside ROP screening through dilated pupils using indirect ophthalmoscopy. ROP was graded and managed as per the International Classification of ROP treatment guidelines. Counseling and laser treatment were the interventions. The incidence, grade, and determinants of ROP were estimated. Direct and indirect costs were calculated to estimate the unit cost of screening and managing a child with ROP using the mobile unit. RESULT: The study sample included 104 preterm/underweight infants. The prevalence of ROP of different grades in either eye was 32.7% (95% confidence intervals: 23.7-41.7). ROP Stage I was present in 75% of these eyes. The mobile unit could help in preventing/reducing visual disability in 5 infants with advanced stages of ROP. The unit cost of ROP screening, identifying one child with ROP, and addressing visual disability due to ROP was US $310, 950, and 6500, respectively. CONCLUSION: A mobile screening is likely feasible and cost-effective method to detect ROP and offer timely intervention in urban areas with limited resources.

Outcomes of Asymmetric Primary Inferior Oblique Muscle Overaction Managed by Bilateral Myectomy and Tucking of Proximal Muscle End: A Cohort Study.

BACKGROUND: We present the outcomes of bilateral myectomy and tucking of the proximal end of the muscle for the treatment of asymmetric primary inferior oblique (IO) overaction. METHODS: This was a one-armed prospective cohort study. An ophthalmologist and orthoptist evaluated cases of primary IO muscle overaction presenting between January 2010 and December 2013. All eyes underwent bilateral myectomy and tucking of the proximal end of the IO muscle. Data were collected on ocular motility, the angle of deviation, postoperative complications, and status of hypertropia at 6 months postoperatively. The 95% confidence intervals (CI) were calculated. The statistical significance was indicated by P < 0.05. RESULTS: The patient cohort was comprised of 51 patients with primary IO muscle overaction. Preoperatively, all eyes had +2 or greater overaction of the IO muscle except one patient with +1 and +3 overaction in the right and left eyes, respectively. At 6 months postoperatively, the reduction in the angle of deviation for distance and near was 32.6 prism diopters (PD) ([95% CI 30.3-34.9], P < 0.001) and 32.6 PD ([95% CI: 29.8-35.3], P < 0.001), respectively. There was no significant difference in the postoperative variation of the reduction in the angle of deviation based on gender, right or left eye, and type of horizontal strabismus. There were no cases of "A" or "V" patterns, clinically a significant IO underaction or "adherence syndrome" postoperatively. CONCLUSION: Bilateral myectomy and tucking of the proximal end of the muscle is likely an effective method of treating asymmetric primary IO muscle overaction.