Retrospective analysis of low vision assistive products - A 6-year review.

PURPOSE: The purpose of the study was to analyze the demographics, visual acuity (VA), etiologies, recommended low vision assistive products (LVAP), and the acceptance rates of LVAP in various age groups. METHODS: This was a long-term retrospective review of all the patients presenting to the low vision clinic of our tertiary eye care hospital from January 2011 to December 2016. Data obtained included age, gender, VA, visual fields, ocular pathology causing the low vision, and types of LVAP advised. The primary outcome was to analyze the type of LVAP prescribed in different age groups, and the secondary outcome was the acceptance rate of LVAP. RESULTS: We analyzed the results of 8309 patients, out of which 2844 (34%. 2) were <15 years of age, 2425 (29.5%) were between 16-40 years, and 3013 (36.3%) were above 40 years. A total of 5522 (66.4%) had best-corrected visual acuity (BCVA) ranging from 6/18-3/60, and 2796 (33.6%) had BCVA from 3/60-No PL. Approximately 38% improved with LVAPs. The most common etiology was retinitis pigmentosa in 1545 (18.6%) patients, followed by congenital nystagmus in 1482 (17.8%), and the least was albinism 383 (4.6%). Maximum prescribed and accepted LVAP were hand and stand magnifiers among 1017 (44.3%) and 512 (52.6%) patients, respectively. CONCLUSION: Products that are easy to use, require lesser adaptability, are cheap, and require lower maintenance have maximum acceptance rates. We suggest that great emphasis should be laid on training, education, and guidance for low vision rehabilitation centers.

Microplastic contamination in commercial fish species in southern coastal region of India.

Due to its potential impact on food safety and human health, commercial species that have been contaminated with microplastics (MPs) are drawing more attention on a global scale. This study investigated the possibility of MPs contamination in different marine fish species with substantial commercial value that was captured off the south coast of India, from Adyar and Ennore regions. Over the course of six months, from October 2019 to March 2020, 220 fish were examined. It was discovered that the gills and guts had accumulated more numbers of MPs (1115 MPs) of which 68% were fibres and fragments. The commercial fish samples contained an average of 3.2-7.6 MPs per fish. Greater MPs pollution is seen in the Ennore regions. The prevalence of MPs was observed in carnivorous and planktivorous fish collected from both the sites. Fish guts contained the most MPs, according to the data. Pelagic fish accounted for the least amount of MPs, followed by mid- and demersal fish. Four different types of polymers were also identified in the present study: polyethylene, polypropylene, polystyrene, and polyamide. These results clearly showed the degree of microplastic contamination in fish tissues from the south Indian coastal regions of Adyar and Ennore. These results we hope will create a baseline data for MPs contamination in commercial fish species. The presence of MPs in the fish could have detrimental effects both on the environment and human health and thus comprehensive steps are required to prevent plastic pollution of the environment in south India's coastal region.

Comparison of a New Head Mount Virtual Reality Perimeter (C3 Field Analyzer) With Automated Field Analyzer in Neuro-Ophthalmic Disorders.

BACKGROUND: Automated perimetry in neurologically disabled patients is a challenge. We have devised a patient-friendly virtual reality perimeter, the C3 field analyzer (CFA). We aim to assess the utility of this as a visual field-testing device in neuro-ophthalmic patients for screening and monitoring. METHODS: Neuro-ophthalmic patients and controls were selected to participate in the study between September and December 2018. They randomly underwent either the CFA or automated field analyzer (HFA) first followed by the other in an undilated state. The CFA results were compared with the HFA, and the correlation of the pattern of the field defect was assessed by an independent masked physician. RESULTS: In total, 59 eyes of 33 neuro-ophthalmic patients (cases) and another 95 normal individuals (controls) were enrolled. CFA was found to have greater proportion of reliable fields (81.4%) than HFA (59.3%) ( P = 0.009). There were less false negatives ( P < 0.001) and more false positives in CFA ( P < 0.001) among neuro-ophthalmic patients compared with controls. Among neuro-ophthalmology patients, the number of fixation losses was greater with CFA ( P < 0.001), whereas false negatives were greater in HFA ( P < 0.001). On assessing the pattern of the field defects, we found that there was almost 70% correlation of CFA with HFA. Moreover, in classical neurological fields such as hemianopia, the correlation was 87.5%. CONCLUSIONS: The CFA seems to correlate well with HFA in classic neurological fields such as hemianopias and may serve as an alternative in patients unable to perform a standard automated perimetry. Further developments are currently underway to incorporate threshold testing.

Diagnostic accuracy and clinical utility of bed side tests versus laboratory tests in the diagnosis of ocular myasthenia.

Purpose: To assess the diagnostic accuracy of forced eyelid closure test (FECT), ice pack test (IPT), repetitive nerve stimulation test (RNS), and acetylcholine receptor (AchR) antibody test in patients with suspected ocular myasthenia. To assess the clinical utility of AchR antibody test in predicting disease progression. Methods: Retrospective cohort study of patients diagnosed with ocular myasthenia at a South-Indian neuro-ophthalmology tertiary eye clinic. Baseline characteristics; ocular myasthenia symptoms; results of FECT, IPT, RNS, and AchR antibody test; and progression time to generalized myasthenia (GM) over 36 months from the time of diagnosis were recorded and analyzed using receiver operator curve analysis, multiple logistic regression, and Kaplan-Meier survival analysis. Results: FECT had a sensitivity of 96.7% (95% CI: 88.5-99.6) and a specificity of 75% (95% CI: 34.9-96.8). Combination of FECT and IPT, using the positivity of at least one test, increased the sensitivity to 98.3% (95% CI: 91-100), reducing the specificity to 50% (95% CI: 15.7-84.3), whereas using the positivity of both tests, we obtained a sensitivity of 71.7% (95% CI: 58.6-82.5) and a specificity of 100% (95% CI: 63.1-100). In the subset of patients with double negative RNS and AchR antibodies, the positive predictive value of combined FECT and IPT (double positive) was 100%. Patients who developed GM were more likely to have a positive AchR antibody test result (P = 0.001). Conclusion: Combined FECT and IPT (double positive) has high diagnostic accuracy even among patients with normal RNS and negative AchR antibodies. Despite low sensitivity, AchR-antibody test has a significant predictive value in disease progression.

Elevated episcleral venous pressure and its implications: A case of Radius-Maumenee syndrome.

We report a rare case of dilated episcleral veins with unilateral secondary open-angle glaucoma. Our case highlights the possible differentials to be considered and the systematic investigations to be done while ruling out the etiologies. Radius-Maumenee syndrome is a diagnosis of exclusion. Raised IOP can remain refractory to the medical therapy and conventional trabeculectomy carries higher risk of complications. Here, we discuss the choice of surgical treatment and its implications on management of this secondary open-angle glaucoma.

Diagnostic challenges in a case of an isolated third nerve palsy.

PURPOSE: Neuro-ophthalmic manifestations may be the first and sole presenting feature of a nasopharyngeal carcinoma. Peri-neural spread is an emerging phenomenon that explains the distant spread of tumour cells well beyond the local extent of invasion. This under recognized route of tumour spread often results in delayed diagnosis and reduced life expectancy. The authors report a case of an isolated third nerve palsy as the only initial manifestation of nasopharyngeal carcinoma and emphasize the need for a high index of suspicion. OBSERVATION: The patient presented with left painful pupil involving complete third nerve palsy. Contrast enhanced imaging was initially deferred due to renal impairment. Plain MRI with MRA brain was normal. Hematology was suggestive of giant cell arteritis which is a rare but well documented cause of painful nerve palsies in the elderly. Unresponsiveness to steroids prompted contrast imaging with a reduced gadolinium dosing and hemodialysis backup which finally revealed a nasopharyngeal carcinoma. CONCLUSION AND IMPORTANCE: This report is the journey of a third nerve palsy from a clinical diagnosis of an aneurysm (pupil involving palsy) to a probable diagnosis of giant cell arteritis (based on hematology) and to a final diagnosis of nasopharyngeal carcinoma (based on contrast imaging and immunohistochemistry)Nasopharyngeal carcinoma can be successfully cured if detected early. This report highlights the various manifestations of nasopharyngeal carcinoma and challenges faced in diagnosing this elusive tumor.

Barriers in utilisation of low vision assistive products.

AIM: To understand the barriers in utilisation of low vision assistive products (LVAPs) from the perspective of patients with low vision. METHODS: Patients referred to low vision clinic in a tertiary eye care hospital in India who were prescribed LVAPs but were un-willing to accept the products were interviewed using questionnaires. Data pertaining to the age, diagnosis, gender, occupation, preferred LVAPs, patient's perception of vision loss and the primary reason for non-acceptance of LVAPs were analysed. RESULTS: A total of 235 among the 413 patients who noticed improvement in visual performance with LVAPs were unwilling to utilise these products. The questionnaire revealed that 53% of the patients who felt they were not candidates for LVAPs were experiencing severe visual impairment (p < 0.02). Non-acceptance was highest (68.6%) in patients < 15 years of age. The most common causes of non-acceptance were social stigma in patients < 40 years (41.3%; p < 0.0001), fear of loss of employment in patients 41-60 years (26.6%; p < 0.01) and low necessity in patients > 60 years (25%; p < 0.001). Denial of the magnitude of their illness was more common in patients above 60 years (16.5%). Non-acceptance rate was lowest for macular disorders (39.6%) and highest for retinitis pigmentosa (81%). Among devices, hand and stand magnifiers had the lowest non-acceptance rate (41%). Telescopes and electronic devices had the highest rate of non-acceptance (92% and 89%, respectively). CONCLUSION: Reasons for poor utilisation of LVAPs are multifactorial extending beyond affordability or accessibility. Knowledge of these barriers can help in creating content for awareness campaigns among patients, healthcare professionals and general society. Further research is necessary on the psychological and psycho social contributors to this process.