Myopia prevalence in a population-based childhood visual impairment study in North India - CHVI-2

Purpose:The aim of the study was to determine the prevalence of myopia at the community level.Methods:A population-based, cross-sectional study was planned in 40 clusters among children identified with subnormal vision in the urban community of Delhi. House-to-house visits were conducted for visual acuity screening of 20,000 children aged 0–15 years using age appropriate visual acuity charts. All the children with visual acuity of < 6/12 in any eye in the age group between 3 and 15 years and inability to follow light in age group 0–3 years were referred for detailed ophthalmic examination.Results:A total of 13,572 (64.7%) children belonged to the age group of 6–15 years. Of these, a total of 507 (3.7%) were found to be having myopia (spherical equivalent of -0.50 DS or worse in one or both eyes) with positive association with higher age groups.Conclusion:The estimated prevalence of myopia is 3.7%; the proportion of uncorrected myopia was 45%, which reflects that refractive error services need to be improved further.     

Cataract surgery in retinitis pigmentosa

Purpose:The aim of this study was to evaluate visual outcomes of cataract surgery in patients with retinitis pigmentosa.Methods:This retrospective case series includes a review of the medical records of all patients with retinitis pigmentosa undergoing cataract surgery between 2005 and 2018. The primary outcome measure was corrected distant visual acuity and change in vision impairment after surgery.Results:Of the 103 (132) patients, 60 (58.3%) were men and 43 (41.7%) were women. The mean age of the study population was 51.3 ± 11.3 (22–74) years. The mean symptom duration was 35.4 ± 44.5 (1–300) months. The most common morphology of cataracts was a combination of nuclear sclerosis, posterior subcapsular, and cortical cataract (n = 65 eyes, 49.3%). Phacoemulsification (87 eyes, 65.9%) was the preferred surgical technique. The mean preoperative corrected distant visual acuity of 1.21 ± 0.87 log MAR units improved significantly (P < 0.001) to 0.60 ± 0.56 log MAR units after surgery. The number of blind patients reduced from 27 (26.2%) to 8 (7.8%) patients. Zonular dialysis and posterior capsule tear were seen in six (4.5%) eyes each. Good preoperative vision (odds ratio: 6.1 [95% confidence interval: 2.9–13.0], P < 0.0001) was associated with better outcome, wheras reduced central macular thickness (odds ratio: 3.5 [95% confidence interval: 1.3–9.2], P = 0.011) was associated with poor outcome.Conclusion:A considerable number of patients presented with advanced cataracts and severe vision impairment. Significant improvement in visual acuity and alleviation of vision impairment was seen after surgery, with few complications. Good preoperative visual acuity predicted a good outcome, whereas macular thinning predicted a poor outcome.     

A population-based study on the prevalence and causes of childhood blindness and visual impairment in North India

Purpose:This was a population-based study to determine the prevalence and causes of visual impairment in children less than 16 years in Urban North India.Methods:This cross-sectional study was conducted in 40 clusters of urban Delhi. 20,955 children aged less than 16 years underwent visual acuity screening using age-appropriate visual acuity charts. Unaided visual acuity of enumerated children aged over 2 years was assessed by using Lea symbols chart in 3-5 years age group and logMAR tumbling E charts for the 6-15 years age group. For children aged 0-2 years, fixation and following to torch light was assessed. All the children with unaided visual acuity of <6/12 in any eye in age group 3–15 years and inability to follow the light in age <3 years were referred for detailed ophthalmic examination.Results:Amongst 20,955 children examined for visual acuity a total of 789 children were referred to the central clinic for detailed ophthalmic examination. Of these referred children, a total of 124 had presenting visual acuity <6/18 in the better eye. The prevalence of visual impairment (VI) was 5.92 per thousand (95% CI: 4.96-7.05). The prevalence of moderate to severe visual impairment was maximum in the age group of 11 to 15 years. The main cause of avoidable VI in these children was a refractive error (75.7%). The prevalence of blindness was 0.42 per thousand.Conclusion:Optic nerve abnormalities were the most important cause of blindness in children. Refractive error is the most important cause of visual impairment amongst children and needs to be addressed.     

Visual functioning and quality of life outcomes among cataract operated and unoperated blind populations in Nepal

BACKGROUND—Visual acuity and vision related quality of life outcomes in cataract surgery were evaluated in a population based survey in two geographic zones in Nepal.
METHODS—Case finding was based on random sampling using a stratified cluster design with door to door enumeration of people aged 45 years followed by eye examinations at village sites. All aphakics/pseudophakics, those with visual acuity less than 6/60 in either eye, and a sample of those with normal visual acuity were administered visual functioning (VF) and quality of life (QOL) questionnaires.
RESULTS—15% of the 159 cataract operated cases had presenting visual acuity 6/18 in both eyes, 38% with best corrected visual acuity. 21% were still blind with presenting visual acuity <6/60 in both eyes, 7% with best correction. On a 0-100 scale, mean VF and QOL scores were 87.2 and 93.9 respectively in normally sighted unoperated individuals, dropping to 15.6 and 29.5 for those severely blind (<3/60). Among the cataract operated, mean VF and QOL scores were 47.5 and 55.4, respectively. VF and QOL scores correlated with vision status at statistically significant levels (p <0.0001)
CONCLUSION—Cataract surgery outcomes, whether measured by traditional visual acuity or by patient reported VF/QOL, are at levels many would consider unacceptably low. It is apparent that in the quest to reduce cataract blindness much more attention must be given to improving surgery outcomes.

Keywords: cataract surgery; visual acuity; visual functioning; quality of life     

Vision centre helps reduce blindness and vision impairment. Proof of concept in a four-year longitudinal study in an urban area in India

Purpose:To estimate the prevalence of blindness and severe visual impairment (SVI) by using a door-to-door screening and vision center (VC) examination strategy in an urban area in western Maharashtra (Pune), India and repeat the exercise after 4 years to study its impact.Methods:Four trained community health workers measured the visual acuity and performed an external ocular examination in patients’ homes. People with vision <6/18 were requested to visit the VC for a comprehensive eye examination by an optometrist. An ophthalmologist examined people whose vision did not improve to 6/12. A home examination was done for people who did not visit the VC despite two requests. The same population was examined twice in an interval of 4 years.Results:In the study, 44,535 people in 2015–16 and 98.14% (n = 43,708) of them in 2018–19 were examined. Blindness (vision < 3/60 in better eye), and moderate-to-severe visual impairment (MSVI, vision 6/18–6/60 in better eye) were 0.26% and 1.3%, respectively, in the first cohort, and 0.16% and 1.1%, respectively, in the second cohort (P < 0.001). When the worse eye was considered, the prevalence of blindness reduced from 0.72% to 0.44%, SVI reduced from 0.1% to 0.07%, and MVI decreased from 1.7% to 1.49% between 2015 and 2019 (P < 0.001). Females (P < 0.001) and older individuals (P < 0.001) were more likely to have blindness or SVI. In the VC, 8211 people were examined in 4 years.Conclusion:The reduction of blindness and MSVI in the urban area of Pune can be partly ascribed to the presence of a VC and attendant screening in this locality.     

Correlation between visual acuity at discharge and on final follow-up in patients undergoing manual small incision cataract surgery

Purpose:The aim of this study was to determine the correlation between visual acuity on discharge and at final follow-up in patients undergoing manual small incision cataract surgery (MSICS) through outreach services of a tertiary care training center.Methods:A prospective observational study was done to determine the correlation between visual acuity on postoperative day 1 and final follow-up (4–8 weeks) among various categories of surgeons and surgical complications in patients who underwent MSICS between January 2018 and March 2018. Proportions of patients benefitting from refractive correction were also analyzed.Results:Of the 924 patients who underwent MSICS through outreach services during the study period 841 were eligible for the study. Follow-up rate at 4–8 weeks was 91%. Mean age was 61.6 (SD 9.2) years, 63% were females and 55% were operated by trainees. There was a positive correlation between visual acuity at day one and final follow-up with a Spearman''s correlation coefficient of 0.375 and 0.403 for uncorrected (UCVA) and best corrected visual acuity (BCVA) respectively (P < 0.001). The correlation coefficient, while still positive, was lower for trainees (0.287), as compared to consultants (0.492). At least two lines of improvement in visual acuity on refractive correction were found in 77% of patients.Conclusion:Visual acuity on the day of discharge may be a useful quality indicator of visual outcome for monitoring cataract surgical programs. However, a follow-up at 4–8 weeks is recommended for individual patient benefit and monitoring surgical quality especially in training hospitals.     

Outcome of superior manual small-incision cataract surgery in pediatric age group - A five year retrospective study at a tertiary eye hospital in Karnataka

Purpose:To analyze intraoperative difficulties and visual and surgical outcomes following pediatric cataract surgery.Methods:This five-year retrospective study (2014–2019) included 138 eyes (85 children) with cataract aged between 12 months and 18 years (either sex). All children had undergone best-corrected visual acuity (BCVA), anterior and posterior segment evaluation, intraocular lens (IOL) power calculation, superior manual-small-incision cataract surgery (MSICS) with or without posterior capsulotomy/anterior vitrectomy and IOL implantation under general or local anesthesia, visual rehabilitation, and had been followed up for a minimum period of 12 months.Results:The mean age was 111.27 ± 4.84 months. Preoperative BCVA distance: 113 (81.88%)eyes had BCVA < 6/60; near BCVA: 114 (82.6%) eyes had ≤N36. At last postoperative follow-up (mean: 20.98 ± 13.08 months): distant BCVA- ≥6/60 had been recorded in 120 (86.96%) eyes; near BCVA- >N36 in 123 (89.13%) eyes. Improvement in BCVA was statistically significant. Intraoperative scleral tunnel difficulties were seen in three eyes (thin flap in two, and buttonhole in one eye); in the majority of the eyes 113 (81.88%), IOL was placed in the bag. Twenty eyes had early postoperative inflammation. At last follow-up: posterior capsular opacity was recorded in six eyes, IOL decenteration in two eyes, secondary glaucoma in six eyes, and severe amblyopia in 36 (26.09%) eyes. The mean myopic shift was − 1.11 ± 0.89 D and was statistically significant.Conclusion:Superior MSICS as a treatment for pediatric cataract has minimal intraoperative complications and satisfactory visual and surgical outcomes.     

Predicting postoperative visual outcomes in cataract patients with maculopathy

Purpose:

To assess the accuracy of the potential acuity meter (PAM) in predicting postcataract surgery visual acuity outcome in patients with healed inactive maculopathies.

Study Design:

Prospective interventional clinical trial.

Patients and Methods:

Patients scheduled for phacoemulsification had preoperative and 1 month postoperative best-corrected visual acuity (BCVA), PAM test, fluorescein angiography, and macular optical coherence tomography. Patients were grouped to following preoperative BCVA: PRE1: 0.29 and better, PRE2: 0.25–0.13, and PRE3: 0.1 or worse; age: G1 <60, G2 = 60–70, and G3 >70 years. PAM accuracy was divided into: Grade 1: Postoperative BCVA ≤1 or less line error of the PAM score, Grade 2: Between 1 and 2 lines error, and Grade 3: ≥3 lines or more error.

Results:

This study enrolled 57 patients with a mean age of 71.05 ± 6.78 years where 34 were females. There were 21 (36.84%) patients with diabetic maculopathy and 36 (63.16%) with age-related macular degeneration. The mean preoperative BCVA was 0.198 ± 0.12 (0.1–0.5). The mean PAM score was 0.442 ± 0.24 (0.1–1.3). The mean postoperative BCVA was 0.4352 ± 0.19 (0.17–1.00). The PAM score was in Grade 1, 2, and 3 in 46 (80.7%), 54 (94.7%), and 56 (98.2), respectively. There was a highly significant correlation between the PAM score and the postoperative BCVA (P < 0.001, Chi-square test). There was no correlation between the PAM test accuracy and age, gender, diagnosis, and preoperative BCVA (P = 0.661, 0.667, 0. 0.991, 0.833, Chi-square test; respectively).

Conclusion:

The PAM is an accurate method of predicting postoperative visual acuity for eyes with nuclear cataracts Grade I and II and inactive maculopathies.     

A Novel Computerized Visual Acuity Test for Children

Purpose

To investigate the efficacy of a computerized visual acuity test, the SNU visual acuity test for children.

Methods

Fifty-six children, ranging from 1 to 5 years of age, were included. In a dark room, children gazed at and followed a circular dot with 50% contrast moving at a fixed velocity of 10 pixels/sec on a computer monitor. Eye movement was captured using a charge coupled device camera and was expressed as coordinates on a graph. Movements of the eye and dot were superimposed on a graph and analyzed. Minimum visualized dot diameters were compared to the Teller visual acuity.

Results

Ten eyes (8.9%) of six children failed to perform the Teller visual acuity test, and two eyes (1.8%) of one patient failed to perform the SNU visual acuity test. The observed Teller visual acuity and SNU visual acuity were significantly correlated (p < 0.001). Visual angle degrees converted from the Teller visual acuity and SNU visual acuity were also significantly correlated (p < 0.001).

Conclusion

The SNU visual acuity using moving targets correlated well with Teller visual acuity and was more applicable than the Teller acuity test. Therefore, the SNU visual acuity test has potential clinical applications for children.     

Post laser-assisted in-situ keratomileusis dry eye disease and temporary punctal plugs

Purpose:The aim of this study was to compare the incidence of post laser in situ keratomileusis (LASIK) dry eye with and without intraoperative extended duration temporary punctal plug placement.Methods:This retrospective study included myopicastigmatic eyes without a preoperative diagnosis of dry eye disease that underwent LASIK surgery between January 2017, and March 2018. Patients who received punctal plugs during surgery in addition to usual postoperative care were compared to a control group who received usual postoperative care alone. Visual acuity, safety and efficacy indices, as well as predictability and presence of dry eye disease were assessed 3–6 months after surgery.Results:A total of 345 eyes of 345 patients were included, 172 eyes received punctal plugs and 173 did not. The mean age was 30.4 ± 10 years (range: 17–60 years) and 46.1% (N = 159) were female. Both groups were similar in terms of preoperative parameters, including age, gender, spherical equivalent, pachymetry or contact lens use. Patients treated with punctal plugs had significantly less postoperative dry eye complaints (N = 37 vs. 58, 21.5% vs. 34.1% respectively, P = 0.001). Patients treated with plugs that did develop dry eye disease did so later (51.2 ± 77.64 days'' vs. 20.78 ± 26.9 days, P = 0.009). Postoperative visual acuities were similar between groups (P > 0.05) at all postoperative follow-up visits as were safety (0.95 ± 0.16 vs. 0.99 ± 0.09, P = 0.30) and efficacy (1.01 ± 0.13 vs. 1.00 ± 0.11, P = 0.52) indices.Conclusion:Preventative temporary punctal plug placement during LASIK appears to reduce dry eye disease in the short term, without affecting visual acuity outcomes.     

Outcome of ranibizumab treatment in neovascular age related macula degeneration in eyes with baseline visual acuity better than 6/12

Background

The beneficial effect of intravitreal ranibizumab in the treatment of neovascular age-related macula degeneration (nAMD) is well known. Outcome data for eyes presenting with visual acuity better than 6/12 is limited.

Aims

To assess the effect of baseline vision on outcome in ranibizumab-treated nAMD eyes, including a subgroup with baseline vision ≥6/12 (<0.30 logmar).

Design

Prospective, consecutive and interventional case series.

Methods

A consecutive cohort of patients treated with intravitreal ranibizumab for nAMD with 52-week follow-up were studied. Patients who had received previous treatment for nAMD were excluded. Eyes were stratified according to baseline logmar visual acuity into four groups: <0.30 (>6/12), 0.30–0.59 (6/12–6/24), 0.60–0.99 (6/24–6/60) and 1.00–1.20 (6/60–6/96). Intravitreal ranibizumab (0.5 mg in 0.05 ml) was administered in three loading monthly doses followed by PRN dosing according to optical coherence tomography (OCT) findings.

Results

A total of 615 eyes were studied including 88 eyes with baseline vision <0.30. The mean change in logmar letters at 52 weeks was +5.5 (entire study group), −0.5 (<0.30 subgroup), +2.2 (0.30–0.59 subgroup), +6.5 (0.60–0.99 subgroup) and +15.3 (1.00–1.20 subgroup). In the <0.30 subgroup, 60 of 88 eyes (68%) had best-corrected visual acuity (BCVA) equal to or better than baseline and 82 of 88 eyes (93%) lost <15 letters at 52 weeks. Within this subgroup 56 of 67 eyes (84%) maintained UK driving standard BCVA visual acuity over the study period.

Conclusions

This study provides evidence that intravitreal ranibizumab treatment stabilises good vision in nAMD presenting with vision better than 6/12 over 52 weeks follow-up.     

Visual outcome after manual small-incision cataract surgery by viscoexpression technique

Purpose:Globally, cataracts have remained the major cause of blindness. Cataract accounts for 62.6% of blindness affecting 9–12 million people. The only treatment for cataracts is surgical removal of cataracts. The surgical procedures include phacoemulsification and extracapsular cataract extraction (ECCE). In India, there is a huge backlog of cataract patients. Phacoemulsification is preferred nowadays for early visual rehabilitation, but in developing countries like ours, where facilities are not widely available, small-incision cataract surgery (SICS) is a cost-effective alternative as no machine is required. Also, it provides early visual rehabilitation as it is sutureless when compared to ECCE. So, manual SICS has emerged as a substitute for phacoemulsification and ECCE. The aim of the study was to evaluate the visual acuity and surgically induced astigmatism in patients more than 40 years of age, undergoing manual SICS with nucleus management by viscoexpression technique.Methods:This was a prospective study that included 50 patients over the age of 40 years undergoing manual SICS at a tertiary health-care center in North India by viscoexpression technique. Only those patients whose functional visual disability could be attributed to cataracts were included in the study. Preoperative and postoperative astigmatism were analyzed in the first, fourth, and sixth weeks.Results:Fifty patients who were undergoing manual SICS were analyzed. Preoperative best-corrected visual acuity (BCVA) and astigmatism were compared to postoperative BCVA and astigmatism. Of 50 patients, 48 (96%) patients were able to gain good vision after 6 weeks.Conclusion:This study showed early visual rehabilitation with less surgically induced astigmatism following manual SICS by viscoexpression technique.     

Development of Pocket Vision Screener and its effectiveness at screening visual acuity deficits

Aim:The aim was to construct a visual acuity chart and find its effectiveness at screening visual acuity deficits.Results:The mean age of the subjects was 43 ± 17 years. Subjects were classified as normal or deficient based on the logMAR visual acuity measurement. The screener was found to have 81% sensitivity, 94% specificity. The positive and negative predictive values were found to be 91% and 87%, respectively. A significant difference (P < 0.001) was found in the time taken to record visual acuity using both the charts.Conclusion:The Pocket Vision Screener can be used as a quick and accurate tool to screen subjects for visual acuity deficits, being highly sensitive, specific, and cost-effective.     

Longer term visual outcome of eyes with retinopathy of prematurity treated with cryotherapy or diode laser

AIMS—Visual outcome of 66 eyes in 37 patients who had undergone treatment with either cryotherapy or diode laser for threshold retinopathy of prematurity was assessed.
METHODS—17 patients, representing 30 eyes treated with cryotherapy, were examined at between 56 and 98 months corrected age (median 68 months). 20 patients representing 36 eyes treated with diode laser, were examined at between 30 and 66 months corrected age (median 51 months). Structural outcome was categorised as: optimal—flat posterior pole; suboptimal—macular ectopia, optic nerve hypoplasia, retinal fold involving the macula, and retinal detachment involving the macula.
RESULTS—Optimal structural outcome was, in the absence of amblyopia, associated with optimal visual acuity (of 6/12 or better) in all cases, with most eyes achieving a visual acuity of 6/9 or 6/6. Suboptimal structural outcome was invariably associated with suboptimal visual acuity. Amblyopia was present in eight out of 20 cryotherapy treated eyes and in five out of 26 laser treated eyes with an optimal structural outcome. Refractive errors were significantly less in laser treated eyes as was the incidence of anisometropic amblyopia.
CONCLUSION—Eyes treated with either cryotherapy or diode laser for threshold retinopathy of prematurity with optimal structural outcome are associated with development of optimal visual acuity—that is, 6/12 or better. Treatment with either cryotherapy or laser does not in itself reduce the visual potential of these eyes.

Keywords: retinopathy of prematurity; cryotherapy; laser; visual acuity     

Near vision impairment among the elderly in residential care—the Hyderabad Ocular Morbidity in Elderly Study (HOMES)

Background/objectiveTo report on the prevalence and risk factors for near vision impairment (NVI) among the elderly in residential care in Telangana State in India.MethodsIndividuals aged ≥60 years were recruited from 41 ‘home for the aged’ centres in Hyderabad, India. All participants had complete eye examinations including presenting and best-corrected visual acuity assessment for distance and near. NVI was defined as binocular presenting near vision worse than N8 (6/15) among those who had a normal presenting distance visual acuity of 6/18 in the better eye.ResultsOf the 826 participants, the mean age was 74.4 years (standard deviation—8.4 years), 525 (63.6%) were women, 715 (86.6%) had at least school education. The prevalence of NVI was 51.2% (95% CI: 47.7–54.7) based on presenting vision. On applying multiple logistic regression analysis, the odds of NVI were higher in 80 years and older age (OR: 2.17; 95% CI: 3.44–13.6). Those with school education (OR: 0.58: 95% CI: 0.36–0.94) and higher education (OR: 0.38; 95% CI: 0.21–0.69) had lower odds for NVI. Similarly, those with self-reported diabetes (OR: 0.69; 95% CI: 0.49–0.97), those using spectacles (OR: 0.09; 95% CI: 0.05–0.16), and those who had undergone cataract surgery (OR: 0.51; 95% CI: 0.36–0.74) had lower odds for NVI.ConclusionsNVI was common among the elderly in residential care in homes for the aged in Hyderabad, India. As most of this NVI is correctable, a routine screening programme and dispensing of spectacles can be undertaken to address this vision loss.Subject terms: Geriatrics, Epidemiology     

Visual impairment and ten-year mortality: the Liwan Eye Study

ObjectivesTo explore associations between visual impairment (VI) and mortality in an adult population in urban China.MethodsThe Liwan Eye Study was a population-based prevalence survey conducted in Guangzhou, Southern China. The baseline examination was carried out in 2003. All baseline participants were invited for the 10-year follow-up visit. VI was defined as the visual acuity of 20/40 or worse in the better-seeing eye with habitual correction if worn. Correctable VI was defined as the VI correctable to 20/40 or better by subjective refraction, and non-correctable VI was defined as the VI correctable to worse than 20/40. Mortality rates were compared using the log-rank test and Cox proportional hazards regression models.ResultsOf the 1399 participants (mean age: 65.3 ± 9.93 years; 56.4% female) with available baseline visual acuity measurement, 320 participants (22.9%) had VI. After 10 years, 314 (22.4%) participants died. Visually impaired participants had a significantly increased 10-year mortality compared with those without VI (40.0% vs. 17.2%, P < 0.05). After adjusting for age, gender, income, educational attainment, BMI, history of diabetes and hypertension, both VI (HR, 1.55; 95% CI, 1.14–2.11) and non-correctable VI (HR, 2.72; 95% CI, 1.86–3.98) were significantly associated with poorer survival, while correctable VI (HR, 0.99; 95% CI, 0.66–1.49) was not an independent risk factor for 10-year mortality.ConclusionsOur findings that VI, particularly non-correctable VI, predicting poorer survival may imply the underlying mechanism behind VI-mortality association and reinforce the importance of preventing and treating disabling ocular diseases to prevent premature mortality in the elderly.Subject terms: Vision disorders, Risk factors     

Changes in corneal curvature and visual acuity in North Indian adults after pterygium excision with modified sutureless,glueless limbal-conjunctival autograft

Purpose:To identify the exact time point during after following pterygium excision with a modified technique of sutureless, glueless limbal-conjunctival autograft, when stabilization of the change in corneal curvature is achieved; correlate size of pterygium with uncorrected visual acuity and astigmatism at baseline, and assess changes in these parameters postoperatively over time.Methods:This prospective study longitudinally assessed 30 eyes of 30 north Indian adults with primary pterygium encroaching upon ≥1 mm of the cornea pre- and postoperatively at 1 week and then monthly for 4 months, recording uncorrected (UCVA) and best-corrected logMAR visual acuity, astigmatism and keratometry. Results were analyzed using ANOVA, Mauchly’s test of sphericity with Greenhouse–Geisser correction, and post-hoc test using Bonferroni correction. Pearson’s correlation coefficient r > 0.5 was considered clinically significant, and P < 0.05 statistically significant.Results:Pterygium size was well correlated with pre-operative astigmatism (r = 0.867, P < 0.001) and pre-operative UCVA (r = 0.856, P < 0.001). There was mean improvement of 0.43 logMAR units of visual acuity (P < 0.00001), a mean increase of 0.79D of keratometric value for the flatter meridian (P < 0.00001) and a mean reduction of 2.00D of astigmatism (P < 0.00001). At 2-month follow-up, the keratometric value for the flatter meridian approached the final keratometric reading at 4 months such that the difference was not significant (t = 1.185, P = 0.245). There were no significant complications or recurrence during the follow-up period.Conclusion:Pterygium excision with modified autograft reduced corneal astigmatism and improved visual acuity comparable to classical technique. Alteration in corneal curvature stabilizes 2 months after surgery, when spectacle correction can be given to patients.     

Prognostic factors for open globe injuries and correlation of Ocular Trauma Score at a tertiary referral eye care centre in Singapore

Objective:

To evaluate the factors influencing final vision outcome after surgical repair of open globe injuries and to correlate the Ocular trauma score.

Materials and Methods:

Retrospective case analysis of patients with open globe injuries at a tertiary referral eye care centre in Singapore was performed. Pre-operative factors affecting final vision outcome in patients with open globe injury and correlation of ocular trauma score in our study with international ocular trauma scoring system was performed.

Results:

Case records of 172 eyes with open globe injury were analyzed. Mean age was 36. 67 years. Mean follow up was 12.26 m. Males were pre-dominantly affected. Initial visual acuity was ≥20/40, 20/50 < 20/200, 20/200- CF, HM– PL and NLP in 24 (14%), 39 (22.7%), 16 (9.3%), 66 (38.4%) and 27 (15.7%) eyes respectively. Final visual acuity was ≤20/40, 20/50 < 20/200, 20/200- 1/200, HM– PL and NLP in 76 (44.2%), 28 (16.3%), 11 (6.4%), 30 (17.4%) and 27 (15.7%) eyes respectively. Ocular trauma score in our study correlates with international ocular trauma scoring system.

Conclusion:

The present study showed pre-operative variables such as mode of injury, pre-operative visual acuity, traumatic cataract, hyphaema, relative afferent papillary defect, vitreous lossand vitreous hemorrhage to be adversely affecting the final vision outcome. Our study showed a good synchrony with international ocular trauma score (OTS) and based on this study we were able to validate application of OTS in Singapore population. Recognizing these factors can help the surgeon in evidence based counseling.     

Comparison of the effectiveness of amblyopia treatment with eye-patch and binocular Occlu-tab for the same treatment duration

Purpose:This study aimed to compare the conventional eye patch with Occlu-tab—a binocular open-type amblyopia training device—and evaluate their effectiveness in amblyopia treatment.Methods:In this prospective, multi-center study, 40 patients between ages 3 to 12 years, diagnosed with anisometropic amblyopia (refraction difference of both eyes ≥ 2 D, best-corrected visual acuity [BCVA] of the amblyopic eye ≤ 0.1 [logMAR]) were treated with Occlu-tab or conventional eye patch for 1 h per day thrice a week. We compared the visual acuity of both groups before and after 6, 7, and 8 weeks of amblyopia treatment. One-way repeated-measures analysis of variance and Tukey’s test were used to compare the visual acuity of both groups pre- and post-treatment.Results:Both groups had significantly improved visual acuity at 6, 7, and 8 weeks compared to that before treatment (all P < 0.001). The improvement in BCVA of the Occlu-tab group (0.33 ± 0.25) was significantly greater than that of the eye patch group (0.16 ± 0.17) after 8 weeks of treatment (P = 0.02).Conclusion:Amblyopia treatment using binocular open game training with Occlu-tab led to greater improvement in visual acuity than that with a conventional eye patch for the same treatment duration.     

Visual acuity outcomes following surgery for idiopathic epiretinal membrane: an analysis of data from 2001 to 2011

Purpose

Pars plana vitrectomy (PPV) is commonly used to remove the epiretinal membrane (ERM), but the timing of surgical intervention guided by visual acuity (VA) performance at presentation is uncertain.

Patients and methods

Prospectively entered clinical data of 237 patients on an electronic patient record from 2001 to 2011 were analysed to determine visual outcomes, in particular in relation to pre-operative VA.

Results

The mean age of the patients was 68.8 years and 54.4% were female. Median follow-up was 0.55 years. The median pre-operative logMAR VA was 0.60 (SD 0.48–0.78, Snellen equivalent 6/36) and post-operative VA was 0.30 (SD 0.18–0.60, 6/12, P<0.005). Pre-operative VA correlated with post-operative VA (linear R²=0.22, P<0.0001). In all, 69.6% of patients showed an improvement in VA, 15.2% showed no change, and the condition of 15.2% worsened. The number of patients with an improvement in logMAR VA of more than 0.3 was greatest in those who had a pre-operative VA of 1.0 (6/60) or worse, followed by those in the range of 0.6–0.9 and then those with pre-operative VA of 0.5 or better (P<0.001). The proportion of patients with visual improvement of logMAR VA of more than 0.3 increased statistically with progressing years (P=0.019).

Conclusion

In conclusion, this study shows improvement in VA after PPV and ERM removal. Patients with better initial VA achieve higher levels of visual outcome but those with poorer pre-operative VA show a greater change in VA following ERM surgery. Results of surgery improved over the time period of the study.