Ocular morbidity and co-morbidities in children attending a nodal district early intervention center in Uttar Pradesh.

Purpose: To obtain epidemiological data on children with ocular morbidity attending a nodal district early intervention center (DEIC). Methods: : After parental consent, we recruited children with ocular morbidity. After detailed history and clinical evaluation, along with pediatric consultation and relevant neuro-radiological and ancillary investigation, information was entered in a pretested proforma: especially looking for perinatal morbidity, including developmental delay (DD). Visual acuity (VA) was assessed by age-appropriate means by an ophthalmic assistant trained to work with children with special needs. We diligently looked for strabismus and performed dilated ophthalmoscopy. Using JASP, we summarized data as means and proportions and reported 95% CIs. We explored the association of disability percentage with possible predictor variables using regression. Results: We enrolled 320 children, with a mean age of 34.43 ± 31.35 months; two-thirds were male; one-third belonged to lower socioeconomic status (36%), with most parents being illiterate. The mean presenting VA was 1.8 logMAR for both eyes, range: 0 to 3. Sixty-one percent were hyperopic and 27% were myopic. High refractive error, (>±6D) occurred in nine; anisometropia in one; strabismus in 149, mostly esotropia; congenital cataract in 25, whereas 63 had abnormal fundus. Seventy-six received a diagnosis of cerebral visual impairment (CVI). On multivariate linear regression (MLR), younger age, presence of DD, and CVI significantly predicted a higher disability percentage. Logistic regression revealed that statutory disability is likely associated with DD (odds ratio [OR]:13.43); whereas older age was protective (OR: 0.977). Conclusion: Our study suggests that in DEIC children with ocular morbidity, younger children, and the presence of DD significantly predict both greater disability and the likelihood of statutory levels.

Single-snip paralimbal incision: A quick approach to rectus muscles.

INTRODUCTION: Less invasive and quicker surgeries have become common. We compared two conjunctival incisional approaches in strabismus, namely Follow standard paralimbal approach for (SPLA) and single-snip paralimbal (SSPLA). MATERIALS AND METHODS: Forty-four patients with horizontal strabismus qualifying for uniocular recession-resection surgeries were randomized to SPLA and SSPLA. SSPLA involved a single v-shaped incision, with the apex of the V near the limbus, and the limbs facing away: by pinching up the conjunctiva with a forceps and delivering the single snip with a spring scissors. We compared the postoperative grades of redness, congestion, chemosis, foreign body sensation, and drop intolerance at day 1, 2 weeks, and 6-8 weeks; scar visibility, as yes or no, at 6-8 weeks; success rates, considered to be within 10 prism diopters of orthophoria, at 6-8 weeks; and operation duration in minutes. STATISTICAL ANALYSIS: Statistical analysis was done using Mann-Whitney U-test, for inflammatory grades, Chi-square for proportions, and t-test for parametric measures. Statistical significance was set at P < 0.05. RESULTS: On postoperative day 1, congestion (P = 0.02), foreign-body sensation (P = 0.04), and total inflammatory score (P = 0.003) were statistically significantly favoring the SSPLA group. While at 2 weeks, only congestion (P = 0.02) was found to be significantly less in the SSPLA group. There were no significant differences in the proportions of scar visibility (5/22 in the SPLA vs. 3/22 in the SSPLA) and success rate: 20/22 vs. 18/22. The SSPLA was quicker on an average by 6 min (P < 0.001, 95% confidence interval: 3.2-8.7). CONCLUSION: Compared to the SPLA, the SSPLA is quicker and results in lesser inflammation in the immediate postoperative period.

Economizing strabismus surgery: Using half the double-armed suture for horizontal muscles.

In a developing country like India, both availability and affordability of medical care are obstacles, leading to delay in seeking timely treatment. To reduce the cost incurred to the patients for strabismus surgery, we used half of a 6-0 polyglactin suture for performing common muscle weakening and strengthening procedures: a fixed and hang back recessions with plication and resection. We cut the 45-cm-long double-armed 6-0 polyglactin sutures in two halves, and with a modified approach, used one-half in each of two patients planned for monocular two horizontal muscles surgeries: fixed recession-plication and hang back recession-resection. By devising an intuitive manner of threading a single armed 22.5 cm suture we successfully carried out horizontal extraocular muscle surgeries on each of two patients of exotropia. We believe in the long run, this will reduce the cost to individual patients and sponsoring groups, and suggest that strabismus surgeons consider adopting this option.

Saving space: Comparing mini - logMAR with standard logMAR visual acuity.

Purpose: Assessing visual acuity (VA) is the cornerstone of an ophthalmic workup and needs VA charts in a four or six meters space. The objective of this study was to compare the performance of distant VA (DVA) on one meter mini-logMAR (MLM) with a standard six meter logMAR (SLM) chart. Methods: We developed a MLM chart to be used at 1 m with +1.0 D spectacles, by reducing the SLM chart designed for 6 meters, to 1/6th its size, using AutoCAD version 2014. On an initial cohort, we obtained DVA on the two charts by optometrist trainees, masked to the outcomes on the different tests. We performed regression and checked agreement between the two measurements. Subsequently, on a new cohort, we validated the performance of the MLM. Results: Of the 56 initial subjects, mean DVA with SLM was 0.44 ± 0.13 and with MLM was 0.45 ± 0.13; mean difference of -0.01 ± 0.02, 95%CI: 0.007 to 0.018; P < 0.0001 on paired t-test. There was a significant correlation: r = 0.99; r2 = 0.98, P < 0.0001. On an average, DVA with MLM was less than a letter worse than with SLM. The regression formula obtained: SLM DVA = -0.1312 + 1.0014 x (MLM DVA). The validation study revealed no significant difference (P = 0.29) between the predicted standard DVA calculated by the regression formula and the actual standard. Conclusion: We suggest that we can deduce distance logMAR VA from a mini-logMAR chart as devised and used by us. This will take less space, be portable and allow congenial interaction with patients.

Do all children need a cycloplegic refraction? A comparison of Mohindra's versus cycloplegic refraction.

PURPOSE: In 1-12 years old children, we assessed correlation, regression, and agreement between spherical equivalents (SE) obtained on Mohindra's near retinoscopy (MNR) and the post cycloplegic refraction (PCRef), performed 72 h after a cycloplegic refraction (CRef) using cyclopentolate 1% drops. METHODS: In this prospective comparative study, Mohindra's near retinoscopy (MNR) was performed on 202 eyes of 101 children, from 50 cm with a streak retinoscope, in a dimly lit room, subtracting 1.25 from the trial lens used for neutralization, to obtain the final refraction. Subsequently we undertook CRef, half-hour after instilling 1% cyclopentolate, with a PCRef 72 h later. All refractive data were converted to SE for evaluation. We compared the SEs using correlation, linear regression, and agreement (Bland-Altman graphic analysis) and paired t-test. Significance was set at P ≤ 0.05. RESULTS: The mean SE on MNR was 1.71 ± 2.49 D compared to 1.43 ± 2.42 D on PCRef. A significant correlation with r = 0.97 (r2= 0.94, P < 0.001) existed. Agreement analysis suggested that MNR overestimates hypermetropia and underestimates myopia each by 0.3 D than the standard procedure of CRef-PCRef. The regression analysis suggested that SE on PCRef is 95% of that on MNR, less 0.20. CONCLUSION: Our study suggests that MNR offers single point refraction very similar to CRef-PCRef, and may be considered as a viable option more often.