PurposeTo evaluate effectiveness of Welch Allyn Spot Vision Screener in detecting refractive error in all age groups and amblyopia risk factors in children in a tribal district of India.MethodsAll participants received dry retinoscopy and photorefraction; children also received cycloplegic retinoscopy. Statistical analysis included Bland-Altman and coefficient of determination (R2).ResultsPhotoscreener could not elicit a response in 113 adults and 5 children of 580 recruited participants. In Bland-Altman analysis mean difference of Spot screener spherical equivalent (SSSE) and dry retinoscopy spherical equivalent (DRSE) was 0.32 diopters (D) in adults and 0.18 D in children; this was an overestimation of hyperopia and underestimation of myopia. In Bland-Altman analysis of SSSE and cycloplegic retinoscopy spherical equivalent (CRSE) the mean difference was −0.30 D in children; this was an overestimation of myopia and underestimation of hyperopia. In regression analysis the relationship between SSSE and DRSE was poor in adults (R2 = 0.50) and good in children (R2 = 0.92). Cubic regression model for Spot versus cycloretinoscopy in children was: CRSE = 0.34 + 0.85 SSSE − 0.01 SSSE2 + 0.006 SSSE3. It was 87% accurate. Sensitivity and specificity of Spot in detecting amblyopia risk factors (2013 American Association for Pediatric Ophthalmology and Strabismus [AAPOS] criteria) was 93.3% and 96.9% respectively. Sensitivity of Spot screener in detection of amblyopia was 72%.ConclusionsPhotoscreener has 87% accuracy in refraction in children. Its value could be used for subjective correction tests.Translational RelevancePhotoscreening could complement traditional retinoscopy to address refractive error in children in a resource-limited facility region.
PurposeTo describe program planning and effectiveness of multistage school eye screening and assess accuracy of teachers in vision screening and detection of other ocular anomalies in Rayagada District School Sight Program, Odisha, India.MethodsThis multistage screening of students included as follows: stage I: screening for vision and other ocular anomalies by school teachers in the school; stage II: photorefraction, subjective correction and other ocular anomaly confirmation by optometrists in the school; stage III: comprehensive ophthalmologist examination in secondary eye center; and stage IV: pediatric ophthalmologist examination in tertiary eye center. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of teachers for vision screening and other ocular anomaly detection were calculated vis-à-vis optometrist (gold standard).ResultsIn the study, 216 teachers examined 153,107 (95.7% of enrolled) students aged 5–15 years. Teachers referred 8,363 (5.4% of examined) students and 5,990 (71.6% of referred) were examined in stage II. After prescribing spectacles to 443, optometrists referred 883 students to stage III. The sensitivity (80.51%) and PPV (93.05%) of teachers for vision screening were high, but specificity (53.29%) and NPV (26.02%) were low. The specificity and NPV, in general, were higher in ocular anomaly detection but varied from disease to disease.ConclusionMultistage school screening is rapid and comprehensive in a resource-limited community. Regular training and periodic reinforcement of teachers for vision assessment and other ocular anomaly identification are required for further success of the strategy.
ObjectiveTo report the role of intralesional bleomycin as sole or adjunct therapy in the management of superficial ocular adnexal lymphatic malformations.DesignRetrospective study.ParticipantsThree patients/three eyes.MethodsRetrospective chart analysis of patients receiving intralesional bleomycin sclerotherapy as sole or adjunctive treatment for superficial ocular adnexal lymphatic malformations at a single tertiary level eye care institution.ResultsDegree of clinical regression of the lesions (graded by percentage) and resolution of symptoms and signs associated with the lesions.ConclusionsUse of intralesional bleomycin sclerotherapy appears to be an effective sole or adjunct treatment in the management of superficial ocular adnexal lymphatic malformations.
India has done well in eye care delivery by recognizing visual impairment and blindness as a major medical challenge. Major contributions have come from ophthalmologists (mass cataract surgery in the early 1900s; major participation of non-government organizations), policy makers (National Program for Control of Blindness and Visual Impairment 1976; systematic development under the World Bank assisted India Cataract Project, 1995–2002), and the industry (manufacturing of affordable surgical instruments and medicines). Although the country could boast of higher cataract surgical coverage and near-total elimination of trachoma, there is increasing prevalence of diabetic retinopathy and undetected glaucoma. India is in the crossroad of adherence to old successful models of service delivery and adoption of new innovative methods of teaching and training, manpower development and skill-based training, relevant medical research and product development. In the absence of these new approaches, the initial gains in eye care could not be furthered in India. A new approach, that will combine the best of the “old” tradition of empathy and the “new” technology of analytics, is required to imagine the future of eye care in India.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.