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   2020| February  | Volume 68 | Issue 2  
    Online since January 20, 2020

 
 
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REVIEW ARTICLES
Prevalence and causes of childhood blindness in India: A systematic review
Meenakshi Wadhwani, Praveen Vashist, Suraj Senjam Singh, Vivek Gupta, Noopur Gupta, Rohit Saxena
February 2020, 68(2):311-315
DOI:10.4103/ijo.IJO_2076_18  PMID:31957718
Childhood blindness is one of the priority targets of Vision 2020—Right To Sight due to its impact on the psychological and social growth of the child. An extensive search was performed to locate research papers on childhood blindness prevalence and its causes in the community based and blind schools, respectively, conducted from 1990 onward up to the present. Cross references were also manually searched along with expert consultation to enlarge the reference data. A total of five community-based studies on the prevalence including two refractive error studies conducted all over India in children less than 16 years were found. The causes of childhood blindness from the available blind school studies revealed that causes of childhood blindness have mainly shifted from corneal causes to whole globe abnormalities. This article highlights that though with the availability of proper healthcare facilities, the trend is changing for the causes but still a lot of effort in the form of timely neonatal eye care facilities, pediatric surgical services and proper refraction strategies is required.
  6,668 605 18
CONSENSUS CRITERIA
Primary eye care in India – The vision center model
Rohit C Khanna, Shalinder Sabherwal, Asim Sil, Mohammed Gowth, Kuldeep Dole, Subeesh Kuyyadiyil, Heidi Chase
February 2020, 68(2):333-339
DOI:10.4103/ijo.IJO_118_19  PMID:31957722
The World Health Organization (WHO) Global Action Plan (GAP) 2014-19 emphasize providing Comprehensive Eye Care (CEC) using the health system approach to achieve Universal Eye Health Coverage (UEHC). An important aspect of CEC is Primary Eye Care (PEC). The scope of PEC varies significantly with primary health workers providing PEC in most parts of the developing world, whereas in developed nations PEC is provided by specialized personnel such as optometrists. This article focuses on delivery of PEC models in India, specifically through the vision center (VC) approach. VCs are part of a larger eye care network and provide PEC in remote rural areas of the country. The authors describe the how PEC is delivered in more than 300 VCs operated by six mentor hospitals in India under the Global Sight Initiative (GSI). Key factors compared include: The role of leadership; human resource planning, including recruitment and retention; service delivery; leveraging technology for planning and reaching key populations; financial sustainability; supply chain management; and quality and monitoring. It also discusses issues to be considered to strengthen VCs as we move ahead towards our collective goal of achieving UEHC and eliminating avoidable blindness.
  4,924 563 11
National consensus statement regarding pediatric eye examination, refraction, and amblyopia management
Rohit Saxena, Pradeep Sharma, Pediatric Ophthalmology Expert Group#
February 2020, 68(2):325-332
DOI:10.4103/ijo.IJO_471_19  PMID:31957721
Childhood blindness causes significant social and economic burden. Even though pediatric eye care has gained priority under Vision 2020, it continues to come under the purview of tertiary care centers due to lack of knowhow and facilities at primary and secondary level. Currently, India does not have standard guidelines on pediatric eye examination, refraction, and amblyopia management and therefore these are being managed inadequately or inappropriately. In view of this, an expert group of pediatric ophthalmologists from across the country met under the aegis of All India Ophthalmological Society, and deliberated to reach a consensus on the correct method of pediatric eye examination, treating refractive error in children and managing amblyopia. The purpose of the consensus statement was to enable all ophthalmologists to have a broad set of guidelines, which can form the basic framework for managing common pediatric eye conditions, in most ophthalmic setups. The consensus statement is divided into three broad categories: Pediatric eye examination, pediatric refraction, and amblyopia management. The pediatric eye exam subsection discusses the recommended clinical history, which should be taken and the essential components of an ophthalmic examination including pediatric vision assessment. Additionally, it discusses the role of special tests and investigations such as imaging and electrophysiology. The section on pediatric refraction emphasizes the correct use of cycloplegia and prescribing glasses in the Indian context. The final section on amblyopia management presents the various options of treating amblyopia and provides standard guidelines for the use of occlusion therapy and its weaning over time.
  4,371 561 6
GUEST EDITORIALS
Indian community eye care in 2020: Achievements and challenges
Atul Kumar, Praveen Vashist
February 2020, 68(2):291-293
DOI:10.4103/ijo.IJO_2381_19  PMID:31957710
  4,253 372 20
ORIGINAL ARTICLE
Validation of Deep Convolutional Neural Network-based algorithm for detection of diabetic retinopathy – Artificial intelligence versus clinician for screening
Payal Shah, Divyansh K Mishra, Mahesh P Shanmugam, Bindiya Doshi, Hariprasad Jayaraj, Rajesh Ramanjulu
February 2020, 68(2):398-405
DOI:10.4103/ijo.IJO_966_19  PMID:31957737
Purpose: Deep learning is a newer and advanced subfield in artificial intelligence (AI). The aim of our study is to validate a machine-based algorithm developed based on deep convolutional neural networks as a tool for screening to detect referable diabetic retinopathy (DR). Methods: An AI algorithm to detect DR was validated at our hospital using an internal dataset consisting of 1,533 macula-centered fundus images collected retrospectively and an external validation set using Methods to Evaluate Segmentation and Indexing Techniques in the field of Retinal Ophthalmology (MESSIDOR) dataset. Images were graded by two retina specialists as any DR, prompt referral (moderate nonproliferative diabetic retinopathy (NPDR) or above or presence of macular edema) and sight-threatening DR/STDR (severe NPDR or above) and compared with AI results. Sensitivity, specificity, and area under curve (AUC) for both internal and external validation sets for any DR detection, prompt referral, and STDR were calculated. Interobserver agreement using kappa value was calculated for both the sets and two out of three agreements for DR grading was considered as ground truth to compare with AI results. Results: In the internal validation set, the overall sensitivity and specificity was 99.7% and 98.5% for Any DR detection and 98.9% and 94.84%for Prompt referral respectively. The AUC was 0.991 and 0.969 for any DR detection and prompt referral respectively. The agreement between two observers was 99.5% and 99.2% for any DR detection and prompt referral with a kappa value of 0.94 and 0.96, respectively. In the external validation set (MESSIDOR 1), the overall sensitivity and specificity was 90.4% and 91.0% for any DR detection and 94.7% and 97.4% for prompt referral, respectively. The AUC was. 907 and. 960 for any DR detection and prompt referral, respectively. The agreement between two observers was 98.5% and 97.8% for any DR detection and prompt referral with a kappa value of 0.971 and 0.980, respectively. Conclusion: With increasing diabetic population and growing demand supply gap in trained resources, AI is the future for early identification of DR and reducing blindness. This can revolutionize telescreening in ophthalmology, especially where people do not have access to specialized health care.
  4,049 484 26
REVIEW ARTICLES
Comprehensive eye care - Issues, challenges, and way forward
Maria Vittoria Cicinelli, Srinivas Marmamula, Rohit C Khanna
February 2020, 68(2):316-323
DOI:10.4103/ijo.IJO_17_19  PMID:31957719
As we move from a disease-specific care model toward comprehensive eye care (CEC), there is a need for a more holistic and integrated approach involving the health system. It should encompass not only treatment, but also prevention, promotion, and rehabilitation of incurable blindness. Although a few models already exist, the majority of health systems still face the challenges in the implementation of CEC, mainly due to political, economic, and logistic barriers. Shortage of eye care human resources, lack of educational skills, paucity of funds, limited access to instrumentation and treatment modalities, poor outreach, lack of transportation, and fear of surgery represent the major barriers to its large-scale diffusion. In most low- and middle-income countries, primary eye care services are defective and are inadequately integrated into primary health care and national health systems. Social, economic, and demographic factors such as age, gender, place of residence, personal incomes, ethnicity, political status, and health status also reduce the potential of success of any intervention. This article highlights these issues and demonstrates the way forward to address them by strengthening the health system as well as leveraging technological innovations to facilitate further care.
  3,136 304 11
ORIGINAL ARTICLES
Awareness and knowledge of diabetic retinopathy and associated factors in Goa: A hospital-based cross-sectional study
Dinesh Venugopal, Barsha Lal, Shawnicka Fernandes, Deepali Gavde
February 2020, 68(2):383-390
DOI:10.4103/ijo.IJO_1218_19  PMID:31957734
Purpose: To assess the awareness and knowledge about diabetic retinopathy (DR) and associated factors among patients visiting the tertiary health center in Goa. Methods: A cross-sectional descriptive study was conducted using a standard predesigned and pretested closed-ended structured questionnaire to assess the awareness, knowledge, attitude and practice about DR among patients visiting a tertiary health center. Results: Three hundred and fifty-eight subjects participated in the study. Only 125 (34.9% [95% CI: 30.0–40.1]) subjects were aware of DR and 122 (34.1% [95% CI: 29.2–39.2]) had adequate knowledge about DR. Awareness and knowledge of DR were significantly high among the subjects who completed college level of education (66.7%, OR = 2.78; 95% CI: 1.73–4.48, P < 0.001 and 55.9%, OR = 3.92; 95% CI: 2.41–6.38, P < 0.001) and who spoke English (52.5%, OR = 3.37; 95% CI: 2.14–5.30, P < 0.001 and 50.4%, OR = 3.26; 95% CI: 2.07–5.14, P < 0.001). Christians reported better knowledge about DR compared to other religions (48.8%, OR = 2.27; 95% CI: 1.38–3.75, P = 0.005). Negative association was noted between the knowledge of DR and presence of diabetes (29.4%, OR = 0.64; 95% CI: 0.41–0.99, P = 0.048). The practice pattern was strongly associated (OR = 7.47; 95% CI: 4.51–12.38, P < 0.001) with the knowledge of DR. Attitude was not influenced by any of the factors. Conclusion: We found that awareness and knowledge about DR were unsatisfactory; literacy contributed significantly toward it. These findings also suggest that there is an immediate need to enhance the awareness and knowledge of diabetic eye diseases in order to reduce the burden of visual impairment.
  2,825 283 18
Prevalence and causes of avoidable blindness and visual impairment, including the prevalence of diabetic retinopathy in Siwan district of Bihar, India: A population-based survey
Ajit Kumar Poddar, Tanwir Ahmed Khan, Kumari Sweta, Mritunjay Kumar Tiwary, Rishi R Borah, Rahul Ali, Asim Kumar Sil, Sethu Sheeladevi
February 2020, 68(2):375-380
DOI:10.4103/ijo.IJO_1709_18  PMID:31957732
Purpose: The aim of this study was to estimate the prevalence and causes of visual impairment (VI) and blindness and diabetic retinopathy (DR) in Siwan district, Bihar. Methods: A population-based cross-sectional study was done from January to March 2016 using the Rapid Assessment of Avoidable Blindness 6 (RAAB 6, incorporating DR module) methodology. All individuals aged ≥50 years were examined in 57 randomly selected clusters within the district. Results: A total of 3476 individuals were enumerated and 3189 (92%) completed examination. The overall prevalence of blindness and severe VI was 2.2% (95% confidence interval (CI): 1.6–2.8) and 3.4% (95% CI: 2.6–4.3), respectively. Untreated cataract was the leading cause of blindness (73%) and severe VI (93%). The cataract surgical coverage (CSC) at <3/60 was 71.5% for eyes and 89.3% for persons in this sample and the CSC was similar between the genders. Refractive error (71%) was the primary cause of early VI. The overall prevalence of known and newly diagnosed diabetes was 6.3% (95% CI, 5.4–7.2%). Prevalence of any DR, maculopathy, and sight-threatening DR was 15, 12.4, and 6%, respectively. Conclusion: To conclude, as compared to previous reports, the prevalence of blindness and DR in Siwan district of Bihar was found to be lower and the CSC was higher. However, the problem of avoidable blindness remains a major problem in this region.
  2,671 219 14
Prevalence of ocular morbidities among school children in Raipur district, India
Deepanshu Agrawal, Anupam Sahu, Deepshikha Agrawal
February 2020, 68(2):340-344
DOI:10.4103/ijo.IJO_1454_19  PMID:31957723
Purpose: To estimate the prevalence of various ocular morbidities in school children (5–15 years) utilizing a comprehensive mobile eye unit in Central India. Methods: A prospective, cross-sectional, school-based observational study was carried out in Raipur, Chhattisgarh, India between December 2017 and September 2018. A total of 1557 eligible school-going children in the age group 5–15 years were evaluated. Random sampling was done to allocate schools (n = 29) and children from various urban and rural (836 vs 721) schools. The primary objective was to estimate the prevalence of ocular morbidities in school-going children in Raipur district, India. The secondary objective was to analyze whether geographical location (rural vs urban), age group, and gender led to any differences in ocular morbidity patterns. Results: The mean age of the study population was 10.3 ± 2.4 years. There were 691 (44.4%) boys and 866 (55.6%) girls. Ocular morbidity was present in a total of 331 (21.2%) children. Vitamin A deficiency was the most common cause of ocular morbidity, noted in 156 (10%) children, followed by refractive error (81, 5.2%). Myopia was significantly higher in urban school children (4.3%) compared to rural children (1.9%) (P = 0.002). The older age group had a higher prevalence (7.6%) of refractive error, especially myopia, compared to the younger age group (2.2%) (P < 0.001). Conclusion: Vitamin A deficiency prevalence was much higher indicating missed opportunities for vitamin A supplementation at a younger age. Refractive error was more prevalent in the urban population as well in the older age group (11–15 years), indicating a need for frequent eye screening.
  2,575 305 15
Medios– An offline, smartphone-based artificial intelligence algorithm for the diagnosis of diabetic retinopathy
Bhavana Sosale, Aravind R Sosale, Hemanth Murthy, Sabyasachi Sengupta, Muralidhar Naveenam
February 2020, 68(2):391-395
DOI:10.4103/ijo.IJO_1203_19  PMID:31957735
Purpose: An observational study to assess the sensitivity and specificity of the Medios smartphone-based offline deep learning artificial intelligence (AI) software to detect diabetic retinopathy (DR) compared with the image diagnosis of ophthalmologists. Methods: Patients attending the outpatient services of a tertiary center for diabetes care underwent 3-field dilated retinal imaging using the Remidio NM FOP 10. Two fellowship-trained vitreoretinal specialists separately graded anonymized images and a patient-level diagnosis was reached based on grading of the worse eye. The images were subjected to offline grading using the Medios integrated AI-based software on the same smartphone used to acquire images. The sensitivity and specificity of the AI in detecting referable DR (moderate non-proliferative DR (NPDR) or worse disease) was compared to the gold standard diagnosis of the retina specialists. Results: Results include analysis of images from 297 patients of which 176 (59.2%) had no DR, 35 (11.7%) had mild NPDR, 41 (13.8%) had moderate NPDR, and 33 (11.1%) had severe NPDR. In addition, 12 (4%) patients had PDR and 36 (20.4%) had macular edema. Sensitivity and specificity of the AI in detecting referable DR was 98.84% (95% confidence interval [CI], 97.62–100%) and 86.73% (95% CI, 82.87–90.59%), respectively. The area under the curve was 0.92. The sensitivity for vision-threatening DR (VTDR) was 100%. Conclusion: The AI-based software had high sensitivity and specificity in detecting referable DR. Integration with the smartphone-based fundus camera with offline image grading has the potential for widespread applications in resource-poor settings.
  2,493 313 27
GUEST EDITORIALS
Community based eye care in India – Reconciling quality and quantity – The ACOIN prescription
Swapan Kumar Samanta
February 2020, 68(2):307-308
DOI:10.4103/ijo.IJO_55_20  PMID:31957716
  2,608 159 1
Maintaining quality in community eye care – The Aravind model
P Namperumalsamy
February 2020, 68(2):285-287
DOI:10.4103/ijo.IJO_41_20  PMID:31957708
  2,342 410 6
The Sankara Nethralaya Community model - Technology and evidence based comprehensive quality eye care equally to all
Sengamedu Srinivasa Badrinath, Anuradha Narayanan, Jameel Rizwana Hussaindeen, Thandalam Sundararajan Surendran
February 2020, 68(2):288-290
DOI:10.4103/ijo.IJO_34_20  PMID:31957709
  2,266 309 1
ORIGINAL ARTICLES
Evaluation of a training program on primary eye care for an Accredited Social Health Activist (ASHA) in an urban district
Pallavi Shukla, Praveen Vashist, Suraj Singh Senjam, Vivek Gupta
February 2020, 68(2):356-360
DOI:10.4103/ijo.IJO_1164_19  PMID:31957726
Purpose: An Accredited Social Health Activist (ASHA) available in community could be a potential primary eye care (PEC) worker. Training programme for ASHAs on PEC was undertaken & evaluated in a district of a capital city. Methods: ASHAs selected randomly from a district were imparted one day training on PEC & expected to refer patients to nearby Vision Centres (VC). Their knowledge was assessed before & after training and re-evaluated 1 year later. ASHAs were asked to conduct vision screening of 40+ population in their areas and ASHA referrals were noted by Optometrist in VC. Focus Group Discussions (FGD) of ASHAs were held to find barriers & facilitating factors in engaging ASHAs in PEC. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results. Results: Mean knowledge score increased from 14.96 (±4.34) pre-training to 25.38 (±3.48) post- training and sustained at 21.75 (±4.16) at 1year. Monthly average OPD of vision centres increased by 23.6% after ASHA training. FGDs revealed that ASHAs were willing to work in eye care for awareness generation and patient facilitation but were hesitant in conducting vision screening. Conclusion: ASHAs can be trained as PEC workers provided they have adequate support.
  2,013 188 6
ORIGINAL ARTICLE
Role of teleophthalmology to manage anterior segment conditions in vision centres of south India: EyeSmart study-I
Neha Misra, Rohit C Khanna, Asha L Mettla, Srinivas Marmamula, Varsha M Rathi, Anthony V Das
February 2020, 68(2):362-367
DOI:10.4103/ijo.IJO_991_19  PMID:31957728
Purpose: To study the role of teleophthalmology (TO) in the diagnosis and treatment of anterior segment conditions (including adnexal conditions) in rural areas. Methods: This is a pilot study of 5,604 patients, who visited primary vision centres (VCs) for 1 week from 1-7 September 2018. The patients were examined by a vision technician (VT) to identify those who may need teleconsultation. The centres were located in 16 districts of four Indian states of Andhra Pradesh, Telangana, Odisha, and Karnataka. The demographic profile, along with the role of teleconsultation was reviewed. Results: Teleconsultation was advised in 6.9% of the patients, out of which 59.6% were referred to a higher level of care, and 40.4% were treated directly at the VC. Teleconsultations were higher among males (7.0% as compared to 6.6% in females), though not statistically significant (P = 0.55). Teleconsultation was higher in the older population, that is, 60 years and above (14.5%); those with severe visual impairment (VI) (21%) and blindness (31.1%); and in the states of Telangana (11%) and Andhra Pradesh (6.3%). It was noted that 45% of the patients who underwent teleconsultation had pathologies related to ocular surface, cornea and lid, and adnexa-related conditions. Conclusion: Teleconsultation has a significant role in the management of anterior segment conditions in bridging the gap between the patients and ophthalmologists in rural India. TO can also play an important role in the diagnosis and management of anterior segment, lid, and adnexa-related pathologies.
  1,832 238 14
EDITORIAL
Community ophthalmology - Can excellence, efficiency, and equity co-exist?
Santosh G Honavar
February 2020, 68(2):279-280
DOI:10.4103/ijo.IJO_84_20  PMID:31957706
  1,668 382 -
GUEST EDITORIALS
Diabetic retinopathy: A right time to intervene
Rajiv Raman, Radhika Krishnan, Kim Ramasamy, S Natarajan
February 2020, 68(2):305-306
DOI:10.4103/ijo.IJO_23_20  PMID:31957715
  1,735 307 2
High volume and high quality eye care - Bridging the paradox. A unique rural based approach - The Chitrakoot model
BK Jain, Elesh Jain, Subeesh Kuyyadiyil, Alok Sen, Devindra Sood, Asheesh Bajaj
February 2020, 68(2):294-298
DOI:10.4103/ijo.IJO_61_20  PMID:31957711
  1,696 162 2
ORIGINAL ARTICLES
Causes of vision impairment and blindness among children in schools for the blind in South Indian States of Andhra Pradesh and Telangana
Lapam Panda, Rohit C Khanna, Asha Latha Metla, Srinivas Marmamula, Niranjan K Pehere, Jill E Keeffe
February 2020, 68(2):345-350
DOI:10.4103/ijo.IJO_923_19  PMID:31957724
Purpose: To study the causes of severe vision impairment (SVI) and blindness among children in Andhra Pradesh (AP) and Telangana State (TS) in South India. Methods: A total of 299 children from 10 schools for the blind were examined between January and December 2017. The schools were chosen from 3 districts of AP (Guntur, Krishna and West Godavari) and 2 districts of TS (Adilabad and Mahabubnagar). The World Health Organization Prevention of Blindness' eye examination protocol for children with blindness or visual impairment (VI) was followed. Results: Based on presenting visual acuity (PVA), 248 children (82.9%) were blind, 16 children (5.3%) had SVI, 18 (6%) had moderate VI, and 17 (5.7%) were normal. The most common anatomical cause of blindness or SVI was whole globe anomaly (32%), followed by an abnormality in the retina and vitreous (26.6%). While whole globe anomalies were high both in AP (33.8%) and TS (21.6%), lens-related pathologies were higher in TS (29.7%) and retina-related abnormalities were higher in AP (29.3%). The most common cause was related to heredity (40.5%). Etiology was unknown in 33.5% of cases. Overall, 37.1% of the causes were avoidable. In AP, 33.4% were avoidable whereas in TS nearly 60% were avoidable. Conclusion: Whole globe anomaly constitutes a major cause of SVI and blindness, especially in AP. Lens-related pathologies were higher in TS. Nearly 40% of the causes were avoidable. Hence, robust screening methods and strategies must be established for timely intervention to reduce the burden on VI in children.
  1,626 189 7
GUEST EDITORIALS
Universal health care: Can Indian ophthalmologist community set an example?
Gullapalli N Rao
February 2020, 68(2):281-284
DOI:10.4103/ijo.IJO_83_20  PMID:31957707
  1,421 326 3
ORIGINAL ARTICLES
Open-angle glaucoma in a rural and urban population in Eastern India—the Hooghly river glaucoma study
Chandrima Paul, Subhrangshu Sengupta, Souvik Banerjee, Sumit Choudhury
February 2020, 68(2):371-374
DOI:10.4103/ijo.IJO_836_19  PMID:31957731
Purpose: Glaucoma is the leading cause of irreversible blindness in the world. The current study aims to estimate prevalence, features, and associations of open angle glaucoma (OAG) in a rural and urban East Indian population. Methods: This is a population based cross sectional study with two arms, rural (28 contiguous villages from 13 Gram Panchayats in Balagarh Police Station, Hooghly district) and urban (Kolkata). Individuals residing in the study area aged 40 years and above were included using multistage random cluster sampling. All subjects underwent a detailed ophthalmic examination at our base hospitals including applanation tonometry, ultrasound pachymetry, gonioscopy, and frequency doubling technology perimetry. The primary outcome was the prevalence of POAG (95% CI). Age and gender specific prevalence estimates were calculated. Multiple logistic regressions were used to analyze the risk factors. Results: Data from 7128 and 6964 subjects aged 40 years or older from Kolkata city and Hooghly district, respectively were analyzed. In the urban population, 2.10% (95% CI: 1.99–2.21%) had POAG and 0.15% (95% CI: 0.13–0.17%) had secondary OAG. In the rural population, 1.45% (95% CI: 0.59–2.31%) had POAG and 0.10 ± 0.03% (95% CI: 0.07–0.13%) had secondary OAG. Conclusion: The study concludes that higher age, higher vertical cup disc ratio (VCDR), and lower central corneal thickness (CCT) are important independent predictors of OAG and emphasizes that increased intraocular pressure (IOP) is not POAG. Gonioscopy, disc evaluation, and screening perimetry need to be incorporated in the detection protocol for glaucoma if we intend to lighten the burden of blindness due to glaucoma.
  1,479 179 5
COMMENTARY
Commentary: Rapid assessment of avoidable blindness and diabetic retinopathy in India
Neha Misra, Rohit C Khanna
February 2020, 68(2):381-382
DOI:10.4103/ijo.IJO_1133_19  PMID:31957733
  1,493 148 2
ORIGINAL ARTICLES
Tribal Odisha Eye Disease Study Report # 6. Opportunistic screening of vitamin A deficiency through School Sight Program in tribal Odisha (India)
Lapam Panda, Suryasmita Nayak, Taraprasad Das
February 2020, 68(2):351-355
DOI:10.4103/ijo.IJO_1154_19  PMID:31957725
Purpose: To explore the possibility of vitamin A deficiency (VAD) detection through School Sight Program (SSP) in a tribal district of Odisha, India. Methods: In a cross-sectional observational study, we tracked school children with ocular signs/symptoms of VAD to their villages. The ophthalmologist examined their under-5 siblings and other under-5 children in the village. Information pertaining to family belief and practices of food, water, sanitation, and the socioeconomic status of the family were collected. Results: The ocular features of VAD were detected in 207 of 4801 (4.3%) examined children. This included 70 children (mean age 11 ± 2.6 years) detected in the school, 22 siblings (mean age 3.2 ± 1.2 years) of these children detected at their home, and 115 children (mean age 3 ± 1.5 years) detected in their habitat. The average family size was 5.8 ± 2.02 and the birth order of the child with VAD was 2.3 ± 1.25. Most parents were farmer, living in asbestos-roofed house, depended on public underground water, and practiced open-air defecation. The distribution of VAD in 207 children was conjunctival xerosis (X1A = 207; 100% of VAD and 4.3% of all children), Bitot's spot (X1B = 169; 81.6% of VAD and 3.5% of all children), corneal scar (XS = 3; 1.4% of VAD and 0.06% of all children), and night blindness (XN = 35; 16.9% of VAD and 0.72% of all children). Conclusion: An opportunistic screening for detection of VAD through a SSP could be cost-effective and complement the existing strategy.
  1,443 174 2
COMMENTARIES
Commentary: Teleophthalmology and electronic medical records: Weighing the pros and cons of unavoidable progress
John Davis Akkara, Anju Kuriakose
February 2020, 68(2):367-368
DOI:10.4103/ijo.IJO_2082_19  PMID:31957729
  1,370 174 7
COMMENTARY
Commentary: Artificial intelligence and smartphone fundus photography – Are we at the cusp of revolutionary changes in retinal disease detection?
VG Madanagopalan, Rajiv Raman
February 2020, 68(2):396-397
DOI:10.4103/ijo.IJO_2175_19  PMID:31957736
  1,346 175 3
SPOTLIGHT
Two hundred glorious years of Egmore Eye Hospital, Chennai
Sundaram Natarajan, Akshay Gopinathan Nair, M Ananda Babu, Taraprasad Das
February 2020, 68(2):309-310
DOI:10.4103/ijo.IJO_718_19  PMID:31957717
  1,385 133 -
COMMENTARY
Commentary: Artificial intelligence – A game changer
Ashish Ahuja, Dheeraj Kewlani
February 2020, 68(2):405-406
DOI:10.4103/ijo.IJO_1780_19  PMID:31957738
  1,304 202 4
LETTERS TO THE EDITOR
The Basic Eye Screening Test (BEST) for primary level eye screening by grassroot level workers in India
Srinivas Marmamula
February 2020, 68(2):408-409
DOI:10.4103/ijo.IJO_1554_19  PMID:31957740
  1,298 150 3
GUEST EDITORIALS
Community eye care - The Sitapur model
Madhu Bhadauria
February 2020, 68(2):303-304
DOI:10.4103/ijo.IJO_53_20  PMID:31957714
  1,012 227 4
COMMENTARIES
Commentary: When will “Policy framework” catch up to leverage teleophthalmology to realize the holy grail of Universal Eye Health?
Thulasiraj Ravilla
February 2020, 68(2):369-370
DOI:10.4103/ijo.IJO_2174_19  PMID:31957730
  1,092 137 -
LETTERS TO THE EDITOR
Cost of making a comprehensive ophthalmologist and role of non-government institutes: Our experience
Javed Hussain Farooqui, Umang Mathur, Sima Das, Ashish Saksena
February 2020, 68(2):409-412
DOI:10.4103/ijo.IJO_980_19  PMID:31957741
  1,078 121 -
GUEST EDITORIALS
Taking subspecialty pediatric eye care to the community – The Narayana Nethralaya model
Bhujang Shetty, Rohit Shetty, Chaitra Jayadev, Anand Vinekar
February 2020, 68(2):301-302
DOI:10.4103/ijo.IJO_19_20  PMID:31957713
  935 226 -
COMMENTARY
Commentary: Comprehensive eye care – Issues, challenges, and way forward
Arvind Kumar Morya, Anushree Naidu, Sonalika Gogia, Sujeet Prakash
February 2020, 68(2):323-324
DOI:10.4103/ijo.IJO_1162_19  PMID:31957720
  963 107 1
LETTERS TO THE EDITOR
Commentary: Pediatric eye screening - Reaching the unreached
V Kavitha, Mallikarjun M Heralgi, Sneha Harogoppa, BV Roopasree, Ankit Deokar
February 2020, 68(2):407-408
DOI:10.4103/ijo.IJO_631_19  PMID:31957739
  925 115 -
GUEST EDITORIALS
The MM Joshi model of community eye care - Reaching the unreached
MM Joshi
February 2020, 68(2):299-300
DOI:10.4103/ijo.IJO_62_20  PMID:31957712
  878 124 1
COMMENTARY
Commentary: Evaluation of a training program on primary eye care for accredited social health activists in an urban district
Arvind K Morya
February 2020, 68(2):361-361
DOI:10.4103/ijo.IJO_2095_19  PMID:31957727
  823 153 -