Ocular Morbidity among Street Children in Kathmandu Valley

Purpose: Prevalence of ocular morbidity among street children is largely unknown. The present study was carried out to determine the prevalence of ocular morbidity among street children in the Kathmandu Valley.

Methods: A cross-sectional study consisting of an eye examination program among 569 street children aged younger than 18 years was conducted from March 2013 to February 2014. Children were included from 11 safe houses of 6 non-governmental organizations and an independent eye camp. Eye examination included visual acuity testing, anterior segment and posterior segment examination, retinoscopy and refraction, cover test, convergence, accommodation and color vision tests. Chi-square test was used to analyze the association of ocular morbidity with age, sex and living conditions.

Results: The majority of children (43.8%) were in the age group of 12–15 years, and the male to female ratio was 3.9:1. Uncorrected and best-corrected visual acuity ≥6/9 in at least one eye was found in 89.8% and 98.4% of children, respectively. Total ocular morbidity was observed at 31.6%. The most common types of ocular morbidity were conjunctivitis (11.0%) and refractive error (11.6%). Ocular morbidity was more common in children over 15 years of age (40.9%; p?<?0.01; odds ratio 1.8).

Conclusions: Ocular infection and refractive error represent the most common ocular morbidities in street children in the Kathmandu Valley.     

Ocular morbidity in Palestine]

Examinations of 1427 subjects (2848 eyes) on the Western Bank of the Jordan and in the Ghaza sector have revealed a high incidence of ophthalmic diseases, particularly of conjunctivitis, cataracts (nuclear among other ones), corneal opacities, pigmented retinal dystrophies, diabetic retinopathies, congenital conditions. Blindness resulted mostly from corneal opacities, most often developing after trachoma, and from congenital diseases of the eyes. Marriages between relatives appear to play an essential role in the development of congenital diseases of the eyes, as well as of pigmented abiotrophy of the retina.     

Ocular morbidity in patients with active systemic tuberculosis

The ocular morbidity pattern in 2010 eyes of 1005 patients with active pulmonary and extrapulmonary tuberculosis was studied prospectively. A complete clinical (ocular and systemic) examination, radiologic evaluation, Mantoux test and sputum analysis for acid-fast bacilli were carried out in all patients. The ocular morbidity in patients in this study with active tuberculosis was 1.39%. The most common ocular finding was bilateral healed focal choroiditis (50%). No case of Eales' disease was found in this series. There was no statistically significant correlation between the ocular lesions and Mantoux positivity.Presented in part at the International Uveitis Study Group Meeting at the National Institute of Health, Bethesda, Maryland U.S.A. on June 25th, 1994. Supported by Sankara Nethralaya, Vision Research Foundation, 18, College Road, Madras 600 006, India.     

Ocular morbidity associated with intravitreal triamcinolone acetonide

AIM: To report on the complications associated with the use of intravitreal triamcinolone acetonide (IVTA) in a tertiary referral hospital setting. MATERIALS AND METHODS: A retrospective case series review of all IVTA injections carried out over a period of 30 months. RESULTS: One hundred and thirty IVTA injections were performed; nine with limited local follow-up were excluded. Thus, 121 injections (108 patients, 114 eyes) were included in the study. Triamcinolone (4 mg) was used in all cases. Indications were diabetic macular oedema (n=41 eyes), retinal vein occlusions (n=27), postoperative cystoid macular oedema (n=24), exudative age-related macular degeneration (n=16), and others (n=6). No intraoperative complications were recorded. Postoperative intraocular pressure (IOP) readings of 22, 28, 35, and 40 mmHg or higher were recorded in 46.5, 29.8, 12.3, and 7.9% of eyes, respectively. IOP elevation was treated with antiglaucoma medication in all but one eye (0.9%) that required trabeculectomy and one (0.9%) that required vitrectomy with cataract extraction for suspected phacoanaphylactic glaucoma. Two eyes (1.8%) developed retinal detachment; both had previously been treated for retinal breaks. One eye (0.9%) developed culture-positive endophthalmitis. Conclusions: Significant morbidity is associated with IVTA injection; clinicians should be aware when considering treatment options.     

Ocular dominance, reading, and spelling ability in schoolchildren.

The association of reading disability with perceptuomotor problems has had a chequered history. This study examines the relationship between a new test of ocular dominance and reading and spelling ability in a group of 298 schoolchildren. Similar rates for unstable ocular dominance were found for poor readers as in comparable studies. The rates of unstable ocular dominance did not differ between the 'dyslexics' and the controls. These findings in a blind study question the role of this test as a diagnosis of 'dyslexia.'     

Ocular morbidity in infants of very low birth weight.

In the years 1977-8,258 infants weighing less than 1500 g were born at, or transferred to, the Royal Women's Hospital, Melbourne; 177 (68.5%) survived, and 111 of these attended for an ophthalmic examination. Significant ocular lesions were found in 37 (33%): 21 (19%) children had squint, 19 (17%) had a significant refractive error, 11 (10%) had cicatricial retrolental fibroplasia (RLF), and 3 (2.7%) had very poor vision due to optic atrophy associated with cerebral palsy. No children were blind owing to RLF, indicating that the recent increase in survival rate of infants of very low birth weight has not been accompanied by an increase in the prevalence of severe RLF. In those children with neither cerebral palsy nor RLF the prevalence of squint was 11% and of refractive errors 13%. Myopia was found mainly in children who had shown RLF changes in the neonatal period. It is recommended that infants of very low birth weight continue to be screened in the premature nursery for RLF, and also at the age of 2, for the detection of refractive errors and squint.     

Ocular morbidity among school-going children in the Union Territory of Chandigarh

Schoolchildren in India are susceptible to various types of ocular morbidities. Early detection through regular surveys helps in prompt treatment and prevention of blindness. The aim of this study was to estimate the prevalence of ocular morbidity among schoolchildren aged 6–16 years and to determine their socio-demographic risk factors. This cross-sectional study includes government and private schools in Chandigarh. The study was conducted during August 2010 to December 2010. The World Health Organization 30-cluster sampling technique was used to cover an optimum sample size of 9,067 students in 30 schools from 169 schools in Chandigarh with proportional allocation in different classes. Statistical analysis was done using SPSS version 15.0. Qualitative data was analysed using the Chi squared test. Logistic regression analysis was performed to identify risk factors. Prevalence rates of refractive error, colour-blindness, squint, and vitamin A deficiency were found to be 29.3, 1.2, 0.8 and 0.05 %, respectively, with an overall prevalence of ocular morbidity of 30.4 %. The prevalence of ocular morbidity was significantly higher among female students and among those studying in private schools. The prevalence rate increased significantly with age. A high prevalence of treatable or preventable ocular morbidity was observed among school-going children, and refractive error was the most common problem.     

Ocular component data in schoolchildren as a function of age and gender.

PURPOSE: To describe the refractive error and ocular components of a large group of school-aged children as a function of age and gender. METHODS: In this report, we describe the refractive error and ocular components of 2583 school-aged children (49.3% girls, overall mean [+/-SD] age 10.0 +/- 2.3). Measurement methods included cycloplegic autorefraction, autokeratometry, videophakometry, and A-scan ultrasonography. For statistical comparisons across gender and age, a critical point of alpha = 0.005 was used to assess significance because of the large sample size and the large number of comparisons made. RESULTS: Of these 2583 children, 10.1% were myopic (-0.75 D or more myopia in both meridians), and 8.6% were hyperopic (+1.25 D or more hyperopia in both meridians). As would be expected, there was a significant effect of age on refractive error (spherical equivalent, p < 0.0001), toward less hyperopia/more myopia. There was no significant difference in the average refractive error between girls and boys (p = 0.0192). Girls had steeper corneas than boys (0.74 D steeper in the vertical meridian and 0.63 D steeper in the horizontal meridian, p < 0.0001). There were no significant differences in corneal power with age (p = 0.16). Both older age and male gender were significantly associated with deeper anterior chambers (p < 0.0001 for both). The crystalline lens showed significant thinning with age (p < 0.0001), however, there was no significant difference in the lens thickness between girls and boys (p = 0.66). Both Gullstrand lens power and calculated lens power showed significant effects of age and gender (p < 0.0001 for both). Girls, on average, had Gullstrand lens powers that were 0.28 D steeper and calculated lens powers that were 0.80 D more powerful than boys. Axial length also showed significant effects of age and gender (p < 0.0001 for both). Girls' eyes were, on average, 0.32 mm shorter than those of boys. CONCLUSIONS: These cross-sectional data show a general pattern of ocular growth, no change in corneal power, and crystalline lens thinning and flattening between the ages of 6 and 14 years. Girls tended to have steeper corneas, stronger crystalline lenses, and shorter eyes compared with boys.     

Ocular growth and morbidity in preterm children without retinopathy of prematurity

Purpose  

To investigate ocular growth and morbidity in both preschool and school-aged children born prematurely without retinopathy of prematurity (ROP).     

孟加拉吉大港区学龄前儿童眼病发生率研究

目的:研究吉大港区学龄前儿童的眼病发生率情况.方法:随机横断面抽样调查,研究孟加拉吉大港区学龄前儿童的眼病发生率.对60所托儿所4～6岁学龄前儿童进行记录,走访且检查眼睛.根据性别、年龄、视力障碍和眼部疾病的诱因,分析所获得的数据.结果:对60所托儿所共计900例学龄前儿童进行检查,其中男性儿童占52.6％,女性儿童占47.4％.年龄范围为4～6岁不等.平均年龄为5.47 ±0.64.在学龄前儿童中,眼病发生率为16.89％,通常疾病为7.66％儿童存在屈光不正,其次3.66％患结膜炎,2.77％患睑缘炎,1.66％患鼻泪管阻塞(NDO),0.88％患感染性结膜炎,0.33％患麦粒肿,0.44％患睑板腺囊肿.其中1.11％患弱视,0.77％患斜视,0.11％患发育性白内障,0.33％患角膜混浊,是一个值得关注的问题.结论:研究学龄前儿童的眼病发生率可以很容易地确定可持续视力筛查方案,如果及时采取治疗能够有效降低眼部疾病的患病率和视力障碍.目前的研究表明,未对屈光不正进行矫正是学龄前儿童视力障碍的主要原因.     

Ocular morbidity prevalence among school children in Shimla, Himachal, North India

Background

Data on eye diseases among school children is not readily available. Considering the fact that one-third of India''s blind lose their eyesight before the age of 20 years and many of them are under five when they become blind, early detection and treatment of ocular morbidity among children is important.

Aim

To estimate the prevalence of ocular morbidity among school children of age 6-16 years.

Settings

Government and private coeducational schools in urban area of Shimla.

Design

Cross-sectional

Materials and Methods

Government and private coeducational schools selected by stratified random sampling. About 1561 school children, studying in elementary through secondary class in these schools were examined from August 2001 to January 2002 in Shimla. A doctor did visual acuity and detailed ophthalmic examination.

Statistical analysis

The Chi-square test was used to test differences in proportions. Differences were considered to be statistically significant at the 5% level.

Results

Prevalence of ocular morbidity was 31.6% (CI=29.9-32.1%), refractive errors 22% (CI=21.1-22.8%), squint 2.5% (CI=2.4-2.6%), color blindness 2.3% (CI=2.2-2.4%), vitamin A deficiency 1.8 % (CI=1.7-1.9%), conjunctivitis 0.8% (CI=0.79-0.81%). Overall prevalence of ocular morbidity in government and private schools did not show any statistical significant difference. Prevalence of conjunctivitis was significantly (P<0.5) more in government schools.

Conclusion

A high prevalence of ocular morbidity among high-school children was observed. Refractive errors were the most common ocular disorders.     

Willingness to pay for cataract surgery in Kathmandu valley

AIM: A cross sectional study was carried out on 78 screened cataract patients of two screening camps in Kathmandu valley, Nepal, to assess the willingness to pay for cataract surgery. METHODS: A non-probability sampling technique with open ended and close ended questionnaires was used. RESULTS: The average age of patients was 68.8 years. The ratio of men and women was 0.9:1. 42.3% (33) of patients were willing to pay for cataract surgery. Among them 48.5% (16) of people were willing to pay less than dollars 13 and 51.5% (17) were willing to pay more than dollars 13. The mean was dollars 2.3 (SD dollars 15.5) per case. Patients with bilateral cataract were more willing to pay than unilateral cases. Poverty (44.4%, 20) was the main barrier for unwillingness to pay for cataract surgery. Other reasons were the lack of family support (28.9%, 13), lack of knowledge of surgery and belief that it was an unnecessary procedure (15.6%, seven), and waiting for a free surgical service (11.1%, five). CONCLUSION: This study clearly indicates that although there was awareness of the availability of treatment and services provided within the reach, people are not willing to pay for the surgery and use the facility primarily because of poverty. Hence, to change patients' attitudes, a more holistic approach is needed, keeping in view the cultural, social, and economic background of the society.     

Dynamic refraction in schoolchildren

A technique for dynamic refraction measurement in natural conditions is proposed using open-field refractometer. Dynamic refractometry was studied in 101 schoolchildren with emmetropia and different degree ametropia. Based on the data obtained accommodation input for 5, 2.5, 1, 0.5 and 0.33 m was countered. It was found that as the object becomes closer spheric power and astigmatism degree increase and axis changes. Accommodation input in patients with hyperopia was close to calculated values, in emmetropia decrease of input by mean 49% was found and in myopia--by 74% compared to calculated values.     

Ocular morbidity associated with airbag deployment: a report of seven cases and a review of the literature

PURPOSE: To review ocular injuries secondary to airbag deployment that were seen in our institution and were reported in the literature. METHODS: Patients examined at our institution between 1997 and 2000 were evaluated for ocular injuries caused by airbags. A review of the medical literature using Medline was performed. All reports involving ocular injuries secondary to airbags were included in this study. RESULTS: Seven cases from our medical center were identified to involve airbag-related eye injuries. The ages of the patients ranged from 4 to 73 years. Ocular injuries included corneal abrasion, corneal decompensation, corneal alkali injury, hyphema, iris sphincter tears, vitreous hemorrhage, macular retinal pigment epithelium disruption, dislocated posterior chamber intraocular lens, and commotio retinae. A review of the medical literature showed 74 cases involving 80 eyes. The ages of the patients ranged from 2 to 81 years. Males slightly outnumbered females by a ratio of 1.1 to 1.0. The speed of the vehicles ranged from 0 to 65 miles per hour, with an average reported speed of 31 miles per hour. Reported injuries ranged from mild corneal abrasions to open globes. CONCLUSIONS: Ocular morbidity secondary to airbag deployment must be recognized as a significant risk for motor vehicle drivers and passengers. Improvements in airbag safety will include increased consumer awareness and manufacturer design modification.     

Ophthalmic findings in dyslexic schoolchildren.

The ophthalmic findings of 55 dyslexic 12 to 13-year-old Finnish schoolchildren and 50 age, sex, and social class-matched control children were evaluated. On a neuropsychological basis the children could be divided into six subgroups: general deficiency, general language, visuomotor, naming, mixed, and normal. The two groups did not differ significantly from each other in visual acuity, cycloplegic refraction, the amount of phorias and tropias, stereo acuity, fusion, or accommodation. Convergence near point > or = 8 cm was, however, statistically more frequent in the dyslexic group. This finding was also significant in the general deficiency subgroup compared with the other subgroups. The most conspicuous common denominator in those with dyslexia was revealed to be the convergence insufficiency type of exodeviation, occurring in 38% of the general deficiency dyslexic subgroup and in 36% of the visuomotor dyslexic subgroup. This finding suggests a low accommodative convergence/accommodation ratio in these children.     

Environmental factors associated with ocular morbidity among children in three ecological regions of Nepal: a phase II Nepal Pediatric Ocular Diseases Study

Purpose

The Nepal Pediatric Ocular Diseases Study (NPODS) was a 3-year (January 2012–December 2014) longitudinal study carried out in three ecological regions of Nepal to understand the magnitude of the problems of childhood ocular morbidity and blindness. Based on the results of this study, a second phase of NPODS was undertaken to understand the risk factors associated with childhood ocular diseases. This paper analyzes environmental factors.

Method

This was a nested case–control study with study population selected from the same cohort of children included in the baseline survey of NPODS. The study areas were the same (three districts from three ecological regions: Sindhupalchowk from mountain, Makawanpur from hills, and Sarlahi from terai). After sample size calculation, cases and controls were taken in 1:4 ratio and matched for age, sex, and location.

Results

A total of 830 children (166 cases, 664 controls) were selected with 5.4 % of cases and 2.7 % of control participants nonresponders. Among environmental factors, children who stayed with their mother during cooking, who had with fewer windows in their kitchen, and who used dusty roads to school had significant association with ocular morbidities. Similarly, children with cable TV in their house had higher chance of having refractive error.

Conclusions

Many of the environmental factors associated with ocular diseases in children are modifiable. Improving the household environment is likely to effectively decrease the burden of eye diseases. The association of refractive error with increased indoor and near activities is an important finding, reported herein for the first time in Nepalese children.

     

Ocular Features in Neurosarcoidosis

Background/aims: To determine the type of ocular involvement in patients with neurosarcoidosis, and evaluate whether the type of eye involvement may help in the diagnosis of neurosarcoidosis. Methods: Retrospective, case history study. We reviewed the medical records of 46 patients who attended the sarcoidosis clinics at the Royal Brompton and Moorfields Eye Hospital over a 4-year period with a diagnosis of definite and probable neurosarcoidosis supported by laboratory investigations and exclusion of other causes for the neurological symptoms. Results: Cranial nerve involvement was the most common neurological manifestation in this series. Among the 27 patients with cranial neuropathy, lower motor neurone facial palsy was the most frequently seen in 19 patients (70.4%). Diplopia was seen in four patients (14.9%). In three patients, this was because of common oculomotor nerve paresis. Uveitis was the most common intraocular manifestation in patients with neurosarcoidosis. The majority of these patients (9, 64.3%) suffered from anterior uveitis, but in 35.7% of them the inflammatory process involved the posterior segment. Conclusions: We found a higher incidence of ocular manifestations, including intraocular inflammation in neurosarcoidosis compared to that in systemic sarcoidosis elsewhere. The most common ocular complication seen in our series was anterior uveitis; however there were no associated clinical features of the uveitis in these series that could contribute to the differential diagnosis between neurosarcoidosis and other autoimmune disorders with neuro-ophthalmic features such as multiple sclerosis. Patients with neurological symptoms and associated intraocular inflammation should have a routine work-up for sarcoidosis. Investigations should include MRI scan of the brain and orbits and lumbar puncture in selected cases. Tissue biopsy should be attempted when clinically accessible lesions are available i.e., conjunctiva or lacrimal gland.