Traditional eye medicine associated keratitis- Current trends and practices

To study the prevalence, types and demographic profile of traditional eye medicine (TEM) use among corneal ulcer patients presenting to a tertiary eye care centre in South India.A cross-sectional study conducted on 432 new corneal ulcer patients at a tertiary eye care centre in South India from September 2018 to July 2019. Data collected included demographic profile such as name, age, sex, occupation, income, rural/urban residence, type of TEM use. Of the 432 new corneal ulcer cases, 32 used TEM. Most TEM users belonged to the age group 40- 60 years (n= 20; 62.5%). There was no difference in sex distribution. Majority of TEM users in our study resided in rural areas (n= 30; 93.75%), were involved in agriculture as occupation (n=28, 87.5%) and belonged to the lower socioeconomic status n=31(96.88%) as per Kuppuswamy classification. Profile of TEM used ranged from plant extract (n= 14; 43.75%), tongue cleaning (n= 5; 15.63%), oil (n= 7; 21.87%), breast milk (n= 4; 12.5%) and ash (n= 2; 6.25%). Use of traditional medicine is a prevalent practice in the study population. These findings offer a better understanding of health seeking behaviour of the study population which will lead to better planning, implementation and targeting of preventive and promotive eye services and awareness programmes.

Assessment of knowledge, attitude and practice of diabetic eye care among non-ophthalmic speciality doctors at a tertiary institute in India

Aim of this study was to assess the knowledge, attitude and practices (KAP) in eye care of diabetics by non-ophthalmic doctors of different specialization. The was a cross-sectional questionnaire based KAP survey among 108 non-ophthalmic diabetes mellitus treating faculties of various departments at our institute. The level of Knowledge was considered excellent if the overall average score was > 75%, similarly questionnaire focusing on attitude was considered positive if the average score was > 50% and excellent practice constituted an average score > 75%. The findings will be noted in percentages with 95% confidence interval limit. Out of the 108 subjects, 75.57% {95%CI(61%-78%)} of participants had excellent knowledge, while >87.6% {95%CI(73%-88%)} of participants had a positive attitude towards diabetic eye care, whereas there were glaring deficits in diabetic eye care practices accounting to only 45.5%{95%CI(32.8%-51.4%)} which was considered poor. Knowledge and attitude regarding diabetic eye care was excellent, there was glaring deficits in the practice of diabetic eye care by non-ophthalmic treating doctors. The deficit was probably due to busy schedule of some doctors, due to lack of uniform eye care protocols of diabetic patients, and lack of updated timely education of eye care practices among non-ophthalmic medical professionals. Hence based on the findings of our study we aim to train and educate our non-ophthalmic medical faculty regularly for adequate and better management of spectrum of diabetic eye disease.

Comparison of visual acuity measured by ETDRS based smart phone applications I sight pro and Peek acuity versus traditional Snellen\\\'s chart visual acuity in children 6-14 years in a tertiary care institute in India

Covid-19 pandemic has led to children missing schools due to which eye care screening activities at schools have taken a backseat. To mitigate this home based visual acuity estimation smartphone applications are increasingly being used for the purpose of tele-ophthalmology purposes, although with no validation of the same. We aim to fulfil this lacunae. Current study was a cross sectional analysis on 286 eyes of 148 children aged between 6years to 14years attending our OPD from April 2021 to June 2021, with non-acute ocular symptomatology. Snellen’s distant visual acuity was compared against the visual acuity recorded by smart phone based Isight pro app and Peek acuity smart phone app. Statistical analysis was performed by Bland Altmann analysis by using SPSS version 21 and p<0.05 was taken as the level of significance. The mean differences between the smartphone-based test Isight pro and the Snellen’s chart and the smartphone-based test Peek acuity and Snellen’s acuity data were 0.06 (95%CI, 0.04–0.08) and 0.07 (95%CI,0.05–0.09) logMAR, respectively. Time taken to test visual acuity by Snellen’s chart was approximately 118.2±21.38 seconds, whereas with Isight pro and Peek acuity smart phone apps the time for testing was approximately 92±15.88 seconds and 94.03±19.73 seconds respectively. P<0.05.The mean visual acuity was comparable with Snellen’s chart and ETDRS based smart phone apps like Isight pro and Peek acuity. The mean time to assess visual acuity was slightly more in Snellen’s acuity than with smart phone based apps. Inability to access eye care services through screening activities in schools has been mitigated effectively by using these smart phone apps. Hence these smart phone apps can be effectively used in tele-ophthalmologic practice and screening activities in these COVID-19 pandemic times.

Authorship Correction: Effect of Door-to-Door Screening and Awareness Generation Activities in the Catchment Areas of Vision Centers on Service Use: Protocol for a Randomized Experimental Study (Preprint)

UNSTRUCTURED A vision center (VC) is a significant eye care service model to strengthen primary eye care services. VCs have been set up at the block level, covering a population of 150,000-250,000 in rural areas in North India. Inadequate use by rural communities is a major challenge to sustainability of these VCs. This not only reduces the community’s vision improvement potential but also impacts self-sustainability and limits expansion of services in rural areas. The current literature reports a lack of awareness regarding eye diseases and the need for care, social stigmas, low priority being given to eye problems, prevailing gender discrimination, cost, and dependence on caregivers as factors preventing the use of primary eye care. Our organization is planning an awareness-cum-engagement intervention—door-to-door basic eye checkup and visual acuity screening in VCs coverage areas—to connect with the community and improve the rational use of VCs. In this randomized, parallel-group experimental study, we will select 2 VCs each for the intervention arm and the control arm from among poor, low-performing VCs (ie, walk-in of ≤10 patients/day) in our 2 operational regions (Vrindavan, Mathura District, and Mohammadi, Kheri District) of Uttar Pradesh. Intervention will include door-to-door screening and awareness generation in 8-12 villages surrounding the VCs, and control VCs will follow existing practices of awareness generation through community activities and health talks. Data will be collected from each VC for 4 months of intervention. Primary outcomes will be an increase in the number of walk-in patients, spectacle advise and uptake, referral and uptake for cataract and specialty surgery, and operational expenses. Secondary outcomes will be uptake of refraction correction and referrals for cataract and other eye conditions. Differences in the number of walk-in patients, referrals, uptake of services, and cost involved will be analyzed. Background work involved planning of interventions and selection of VCs has been completed. Participant recruitment has begun and is currently in progress. Through this study, we will analyze whether our door-to-door intervention is effective in increasing the number of visits to a VC and, thus, overall sustainability. We will also study the cost-effectiveness of this intervention to recommend its scalability. ClinicalTrials.gov NCT04800718; https://clinicaltrials.gov/ct2/show/NCT04800718

Fundus Examination in Pediatric Patients Using Indirect Ophthalmoscopy

The goal of this chapter is to provide the clinician with an understanding of binocular indirect ophthalmoscopy (BIO) and helpful clinical techniques for success in examining the fundus of the pediatric patient, including scleral depression. The challenging technique to examine the premature infant at risk for retinopathy of prematurity will be explained in detail, including the standard classification of the disease with photos depicting the different location and stages of disease. BIO with the addition of scleral indentation helps the clinician diagnose and locate lesions that may otherwise go undetected, such as retinal holes, tears, or vitreoretinal adhesions. Complete examination of the fundus of a child is no less important than of any other patient who seeks eye care but often requires efficiency and precision (as well as many human arms). Time is a rate limiting aspect when examining children so preparation and experience will lead to success.