Media's influence on suicide: Building a safer online world for all.

In 1999, World Health Organization (WHO) initiated a global campaign focused on suicide prevention. In collaboration with International Association for Suicide Prevention, WHO compiled recommendations and resources intended to educate various societal and groups with the potential to impact suicide prevention, and this included the media. In order to combat the alarmingly high incidence of suicides (Tandon and Nathani, 2018), it is imperative to institute guidelines outlining how the social media forums ought to disseminate altruistic, essential educational content while. This work is a step toward achieving the same by laying down guidelines that could potentially reduce the suicide rate.

Association of sunlight exposure with visual impairment in an Indian fishing community.

Purpose: Indian fishermen belong to a marginalized population and are continuously exposed to extreme occupational hazards and sunlight. A high prevalence of visual impairment (VI) is reported in the coastal fishing community. We aimed to investigate the association between VI and sunlight exposure measurement (SEM). Methods: In this cross-sectional observational study, 270 eyes of 135 participants were enrolled from a coastal fishing village. Participants underwent a comprehensive ophthalmic examination, which included best-corrected visual acuity (BCVA), and anterior and posterior segment examination. Ocular Surface Disease Index (OSDI) and SEM questionnaire were administered to estimate the level of dry eye and ultraviolet-B (UV-B) exposure, respectively. VI was defined as presenting visual acuity worse than 6/12 (logarithm of the minimum angle of resolution [logMAR] > 0.3). Results: The mean age and spherical equivalent were 50.56 ± 11.72 years (range: 18-80 years) and 0.36 ± 1.68 diopters (D) (range: -7.0 to +3.0 D), respectively. Age, SEM, OSDI, fishing as an occupation, and cataract were significantly associated with higher odds of VI in univariate analysis. Refraction, gender, education level, smoking status, amblyopia, systematic, and other ocular diseases were not significantly associated with VI. In the multivariate analysis, age, SEM, and presence of cataract remained significantly associated with a higher risk for VI. The area under the receiver operating characteristic curve values for age and SEM scores demonstrate a fair index of discrimination for the detection of VI. Conclusion: SEM level is directly associated with a higher risk of VI among fishermen. The fishing community might benefit from regular eye examinations and awareness about the harmful effects of sunlight exposure and preventive measures.

Comparison between Plusoptix A09 and gold standard cycloplegic refraction in preschool children and agreement to detect refractive amblyogenic risk factors.

BACKGROUND: The preschool children hardly complain about their vision problems. It is of paramount importance to screen them with an objective tool and compare with the gold standard technique. AIM: To compare the values obtained with Plusoptix A09 and cycloplegic refraction in 3-6 years children and agreement to detect refractive amblyogenic risk factors. SUBJECTS AND METHODS: A cross-sectional study was conducted in the Outpatient Department of Ophthalmology in a tertiary care hospital. Informed consent from parents and verbal assent from children were obtained. Each subject had monocular vision assessment with Lea symbol chart, stereo acuity measurement with Frisby, refractive screening with Plusoptix A09, squint assessment, and anterior segment evaluation before administering Homatropine hydrobromide (homide) 2% eye drops. Cycloplegic refraction and posterior segment evaluation were performed for final diagnosis. STATISTICAL ANALYSIS: Descriptive statistics were used to summarize the data. Spearman correlation coefficient and kappa statistics were also employed. RESULTS: In total, data of 94 children were analyzed. The correlation values obtained between plusoptix and cyclorefraction values for spherical, cylindrical, spherical equivalent were 0.508 (P < 0.0001), 0.779 (P < 0.0001), and 0.407 (P < 0.0001), respectively. Refractive errors were seen in 32% and amblyopia in 17% of eyes. Kappa value was κ = 0.974 in detecting refractive amblyogenic risk factors. CONCLUSION: Good correlation was found between the plusoptix and cyclorefraction values. Cylindrical values showed a better correlation. Refractive errors and amblyopia were the major ocular disorders observed. There was significant agreement between the refractive techniques in detecting amblyogenic risk factors.

Performance of Plusoptix A09 Photo Screener in Refractive Error Screening in School Children Aged between 5 and 15 Years in the Southern Part of India.

PURPOSE: To evaluate the performance of Plusoptix A09 in detecting ametropia, warranted against frequently-used technique of retinoscopy in children attending school (5-15 years) and its probability as a screening tool. METHODS: This study was the subset of a larger epidemiological study visual acuity refractive error squint conducted in schools to determine the prevalence of ocular morbidity among the 5-15 years' school children population. Every 7th student in the class (each school had mean value of 100 students) was randomly selected for this study after ascertaining their eligibility as per the inclusion criteria. A cohort of a total of 150 children within the age group of 5-15 (mean, 10.21 ± 2.83) years were recruited from 11 schools of Udupi district. Students with best corrected visual acuity of 20/20, refractive error within ±5.00 diopter (D), without any eccentric fixation, and no history of ocular pathology or seizures were recruited. Refractive error was tested by Plusoptix photorefractor followed by non-cycloplegic and cycloplegic retinoscopic techniques. The examiners performing these tests were masked and unware of the findings. Bland Altman plotted the agreement between the techniques, followed by the receiver operating characteristic curve (ROC), and sensitivity of Plusoptix. RESULTS: One-way analysis of variance calculated statistical differences among Plusoptix, objective retinoscopy, and cycloplegic retinoscopy for mean spherical value (1.12 ± 1.16 D, 0.65 ± 0.69 D, and 0.8 ± 0.82 D), cylindrical value (-0.83 D ± 1.27, -0.32 D ± 0.86, and -0.34 D ± -0.93), and spherical equivalent value (0.71 D ± 1.06, 0.45 D ± 0.7, and 0.61 D ± 0.81), with P = 0.0001, 0.0001, and 0.097, respectively. Bland Altman plots showed good agreement for spherical equivalent values of Plusoptix and objective retinoscopy. However, the area under the ROC curve (0.386) suggests that lower diagnostic ability of this device in this age group population in comparison to retinoscopy (0.575) with the sensitivity and specificity of Plusoptix was 69.2% and 84.8%. CONCLUSIONS: This study fails to report ideal sensitivity mandated for a screening tool, although good specificity and agreement are observed. Along with retinoscopy, this tool will be effective in screening a children's population aged between the age group of 5 and 15 years.

Diagnostic accuracy and agreement between visual acuity charts for detecting significant refractive errors in preschoolers.

BACKGROUND: Preschool vision screenings are considered to be cost-effective methods to identify children with vision disorders. The children of this age group are poor at communicating their symptoms and hence screening is mandated. This study is aimed at estimating the diagnostic accuracy and agreement of Lea, HOTV and E visual acuity charts for detecting significant refractive errors. METHODS: A cross-sectional study was conducted, in which monocular unaided vision assessment of each study participant was performed with Lea, HOTV and E charts. Stereo acuity was measured with the Randot Preschool Test and a comprehensive eye examination including dilatation was performed. Significant refractive error was defined as hyperopia > 3.25 D, myopia > 2.00 D, astigmatism > 1.50 D, anisometropia if interocular difference > 1.00 D for hyperopia, > 3.00 D for myopia or > 1.50 D for astigmatism. Sensitivity, specificity, positive and negative predictive values were estimated. Bland-Altmann plots were generated to help identify the level of agreement between the vision charts. RESULTS: A total of 256 eyes were analysed. Lea, HOTV and E had sensitivities of 87.8 per cent, 90.2 per cent and 90.2 per cent, respectively. Specificity and positive predictive values were better for HOTV (77.3 per cent, 65.5 per cent) and Lea (75 per cent, 62.6 per cent), compared to E chart (69.8 per cent, 58.7 per cent). Negative predictive values for Lea, HOTV and E charts were 92.8 per cent, 93.8 per cent and 93.8 per cent, respectively. Bland-Altmann analysis showed good agreement between Lea and HOTV, Lea and E, and HOTV and E visual acuity charts. The acuity difference was least between Lea and HOTV charts (0.1 logMAR). Eighty-five (33.2 per cent) eyes had significant refractive errors. Eighty (94.1 per cent) eyes were astigmatic. CONCLUSION: The diagnostic accuracy of the visual acuity charts was high for the identification of significant refractive errors in preschool children. There was very good agreement between the visual acuity charts.

Awareness, knowledge, and barriers to low vision services among eye care practitioners.

BACKGROUND: Eyesight plays an important role in our day today life. When the vision gets hampered, daily activities of an individual will be affected. The prevalence of visual impairment is increasing across the globe, with more burdens on the developing world. The uptake of low vision services remains to be low in developing countries like India. METHODS: A newly constructed questionnaire using information from previously conducted telephonic interviews and article search was administered among 50 eye care practitioners from Kerala, India for the pilot study. Modifications were made in the questionnaire, based on the responses obtained from the pilot study. From their responses, awareness, knowledge, and barriers for the low vision services among eye care practitioners were assessed. RESULTS: (1) Pilot study - the Cronbach's alpha values obtained for knowledge, awareness and barrier questions were 0.814, 0.297, and 0.810, respectively, and content validity index was found to be 0.64. (2) Main study - 211 eye care practitioners from 12 states of India took part in the study that accounted for a response rate of 16.7%. The participants included were 95 (45%) men and 116 (55%) women with a mean age of 28.18 ± 7.04 years. The lack of awareness was found to be the major barrier in the provision and uptake of low vision services from the practitioner's perspective. CONCLUSION: The study results showed that there is a lack of awareness among eye care practitioners about low vision services, which acts as a major barrier in the effective delivery of these services.

Test Re-Test Reliability and Validity of Different Visual Acuity and Stereoacuity Charts Used in Preschool Children.

BACKGROUND: Preschool vision screenings are cost effective ways to detect children with vision impairments. The use of any vision tests in children must be age appropriate, testable, repeatable and valid. AIM: To compare the test re-test reliability, sensitivity and specificity of different visual acuity and stereo acuity charts used in preschool children. MATERIALS AND METHODS: Monocular visual acuity of 90 subjects (180 eyes) of age 36 to 71 months was assessed with HOTV, Lea and E-chart in a preschool located in a semi urban area, Manipal, Karnataka. After the vision assessment, stereo acuity was recorded using Frisby and Titmus stereo charts followed by comprehensive eye examination. Repeated measurements of visual acuity and stereo acuity were done one week after the initial assessment. RESULTS: Mean age of children was 53± 10 months with equal gender distribution. Intra class correlation (ICC) of Lea, HOTV, E-chart, Frisby and Titmus charts were 0.96, 0.99, 0.92, 1.0 and 1.0 respectively. The area under receiver operating curve (ROC) for Lea and E-chart was 0.892 and 0.776. HOTV was considered as the gold standard as it showed the least difference on repeated measurements. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of E-chart was 99, 15, 45, 94 and 21.8 percent, and Lea was 93, 56, 59 and 92 percent. The sensitivity, specificity, PPV and NPV of Frisby was 75, 27, 9, 92 percent were as of Titmus was 75, 13, 8 and 85 percent respectively. CONCLUSION: HOTV chart can be used as the gold standard for measuring visual acuity of pre-schoolers in a semi urban area. Lea chart can be used in the absence of HOTV chart. Frisby and Titmus charts are good screening tools, but with poor diagnostic criteria.

Normative data for near point of convergence, accommodation, and phoria.

BACKGROUND: Measurement of for near point of convergence (NPC), amplitude of accommodation (AA) and phoria are important components of diagnosing nonstrabismic binocular vision anomalies. There is a huge variation in the normative data established for orthoptic parameters because of the variation in measurement technique. There are only limited studies for normative data based on nonclinical population in Indian population. Therefore, we aim estimate the normative values for NPC, AA, and phoria measurement in Indian population using techniques, which has good repeatability and reliability. MATERIALS AND METHODS: Subjects between the age group 10-35 years participated in this prospective cross-sectional study. A self-administered symptom questionnaire was used to exclude patients with asthenopic symptoms. Clinical techniques which have good repeatability and reliability were used. NPC was measured using pen light red, green glass test. AA was measured using minus lens technique. Horizontal and vertical phoria at distance and near was measured using modified Thorington method. RESULTS: One hundred and fifty subjects participated in the study. We found that NPC receded with age, which could because of the increase in horizontal phoria at near with age. The mean normative value for objective NPC, break and recovery of subjective NPC, monocular and binocular AA, horizontal and vertical phoria at distance and near for the three age groups are reported in the study. CONCLUSION: The data presented in this study can be used as a cut-off by eye care practitioners while diagnosing convergence, accommodation related anomalies in Indian population.

Contact lens compliance among a group of young, university-based lens users in South India.

PURPOSE: To investigate the rate of compliance with the soft contact lens care and maintenance procedures with a focus on contact lens wearing habits, cleaning and disinfecting procedures, and maintenance of lens care accessories in a group of young, university-based contact lens wearers METHODS: Two hundred and sixteen young soft contact lens wearers with an age range of 18-22 years were selected conveniently from the student population of Manipal University, Manipal, India. After receiving informed consent from the participants, their level of compliance with contact lenses was assessed using a questionnaire. RESULTS: The mean (±SD) age of the participants was 21.86±2.35 years. Out of 216 subjects, only 34% of the lens users were identified to be compliant with the least level of compliance observed in the maintenance of lens care accessories. Conventional users showed significantly (p=0.001) better level of compliance compared to disposable wearers and so did the users who acquired their lenses from clinicians (p=0.001) compared to over-the-counter lens receipt. The gender (p=0.496) and years of experience in contact lens use (p=0.142) did not show any statistically significant difference in the level of compliance. CONCLUSION: This study demonstrated that non-compliance with lens care procedures among a group of young, university-based soft contact lens wearers is common. The results indicated that all subjects had some degree of non-compliance and the least level of compliance observed in the care of lens accessories.

Reliability of a modified logMAR distant visual acuity chart for routine clinical use.

BACKGROUND/AIM: Acuity charts that follow the principle of logarithmic size progression (logMAR charts) are considered to be the gold standard for the assessment of distant vision. But it is not well accepted for routine eye examinations due to increased testing time and the complexity of scoring. This study was designed to check whether a modified logMAR chart with three optotypes would provide a reliable acuity assessment compared to standard logMAR charts for routine eye examination. MATERIALS AND METHODS: Two versions of modified and standard logMAR charts were designed, constructed, and used to assess the visual acuity of 50 individuals drawn from a typical out-patient population. Timed test-retest variability and limit of agreement (95% confidence limit of agreement) of the modified chart are compared to the standard logMAR chart using Bland-Altman method. A comparison of the testing time was carried out using paired t-test. RESULTS: The test-retest variability of the charts was comparable, with 95% confidence limit of the mean difference being ±0.08 for standard logMAR and ±0.10 for modified logMAR. Both the versions of modified logMAR charts produced the results which agreed well with those of the standard logMAR charts. The mean testing time required to complete the acuity measurements with the modified chart was significantly lesser compared to the standard chart (P < 0.001). CONCLUSION: The outcomes of the current study demonstrates that the modified logMAR chart with three optotypes offers a comparable result to the standard logMAR charts for assessing distant visual acuity in routine clinical examination set up with a much lesser testing time.

The effect of smoking on the ocular surface and the precorneal tear film.

BACKGROUND: Smoking, both active and passive, creates a plethora of health-related problems, which primarily affect the cardiovascular and respiratory systems. There is very little evidence on the effects of tobacco smoke on the eye, especially regarding anterior ocular surface related pathology. This study was undertaken to determine the effects of smoking on the ocular surface and the tear film in smokers. METHODS: A total of 51 (102 eyes) smokers and 50 (100 eyes) age-and gender-matched healthy non-smokers were included in this study. The ocular surface was evaluated by measuring tear film break-up time, surface staining with fluorescein, and corneal and conjunctival sensitivities, and by completing the Schirmer's II test. Data was analysed using Statistical Package for Social Sciences (SPSS) version 11.5. A p value less than 0.05 was considered statistically significant. RESULTS: The smoker group had significantly lower tear film break-up time, and corneal and conjunctival sensitivity than the nonsmoker group. Punctate staining was significantly higher in the smoker group than the non-smoker group. There was no statistically significant difference in Schirmer's II test results between the smoker and non-smoker group. CONCLUSION: Smoking caused adverse effects on the precorneal tear film and there was strong association between smoking and tear film instability. Although a causative relationship could not be determined, there is a need for further longitudinal studies.