Elite School of Optometry

Academia is experiencing massive reforms globally amid lockdown in COVID-19 outbreak. This study is aimed to apprehend the enabling and impeding factors of these reforms, with a focus on optometry education. It brings together how the Indian optometry educational system has responded to COVID-19 disruptions with findings of the 2020 survey, in light of similar survey done in 2018. A cross-sectional survey was designed to find changes in optometry training and adaptations of Indian optometry educators amid COVID 19 lockdown. In the last week of April 2020, on the observation that the majority of optometry institutions have switched their teaching-learning activities on e-learning mode, an online survey was conducted using a validated questionnaire containing a mix of open and close-ended questions. Seventy-three out of 78 optometry educators (93.58%) have switched to e-learning mode in a very short time span with good confidence. Most teaching-learning and assessment activities are carried out using multi-device supporting video conferencing tools, dedicated educational portals and social media apps. The COVID-19 pandemic is proving to be a constructive disruptor, giving an opportunity for restructuring the present conventional, classroom based educational system. The quick transitions to online mode assisted in keeping continuity of optometry education programs, effectively fitting in the purpose of completion of the current academic year. The rapid transition to online education has not only benefited optometry students but also has created a momentum of continued education for practicing optometrist in the country. Propósito: La Academia está experimentando reformas masivas a nivel mundial en medio del bloqueo del brote del COVID-19. Este estudio tiene como objetivo aprehender los factores favorables y desfavorables de estas reformas, con un enfoque en la educación de la optometría. Reúne cómo el sistema educativo de optometría de la India ha respondido a los trastornos del COVID-19 con los resultados de la encuesta de 2020, a la luz de una encuesta similar realizada en 2018. Metodología: Una encuesta transversal fue diseñada para encontrar cambios en la formación de optometría y adaptaciones de los educadores de optometría de la India en medio del cierre del COVID 19. En la última semana de abril de 2020, a partir de la observación de que la mayoría de las instituciones de optometría han cambiado sus actividades de enseñanza-aprendizaje en el modo de aprendizaje electrónico, se realizó una encuesta en línea utilizando un cuestionario validado que contenía una mezcla de preguntas abiertas y cerradas. Resultados: Setenta y tres de 78 educadores de optometría (93,58%) han cambiado a la modalidad de aprendizaje electrónico en un período de tiempo muy corto con buena confianza. La mayoría de las actividades de enseñanza-aprendizaje y evaluación se llevan a cabo utilizando herramientas de videoconferencia de apoyo multidispositivo, portales educativos dedicados y aplicaciones de redes sociales. Conclusión: La pandemia del COVID-19 está demostrando ser un disruptor constructivo, que ofrece la oportunidad de reestructurar el actual sistema educativo convencional basado en el aula. Las rápidas transiciones al modo online ayudaron a mantener la continuidad de los programas educativos de optometría, encajando eficazmente en el propósito de completar el año académico actual. La rápida transición a la educación en línea no sólo ha beneficiado a los estudiantes de optometría, sino que también ha creado un impulso de educación continua para los optometristas en ejercicio en el país.

BACKGROUND: Population-based studies on the prevalence of non-strabismic anomalies of binocular vision in ethnic Indians are more than two decades old. Based on indigenous normative data, the BAND (Binocular Vision Anomalies and Normative Data) study aims to report the prevalence of non-strabismic anomalies of binocular vision among school children in rural and urban Tamil Nadu. METHODS: This population-based, cross-sectional study was designed to estimate the prevalence of non-strabismic anomalies of binocular vision in the rural and urban population of Tamil Nadu. In four schools, two each in rural and urban arms, 920 children in the age range of seven to 17 years were included in the study. Comprehensive binocular vision assessment was done for all children including evaluation of vergence and accommodative systems. In the first phase of the study, normative data of parameters of binocular vision were assessed followed by prevalence estimates of non-strabismic anomalies of binocular vision. RESULTS: The mean and standard deviation of the age of the sample were 12.7 ± 2.7 years. The prevalence of non-strabismic anomalies of binocular vision in the urban and rural arms was found to be 31.5 and 29.6 per cent, respectively. Convergence insufficiency was the most prevalent (16.5 and 17.6 per cent in the urban and rural arms, respectively) among all the types of non-strabismic anomalies of binocular vision. There was no gender predilection and no statistically significant differences were observed between the rural and urban arms in the prevalence of non-strabismic anomalies of binocular vision (Z-test, p > 0.05). The prevalence of non-strabismic anomalies of binocular vision was found to be higher in the 13 to 17 years age group (36.2 per cent) compared to seven to 12 years (25.1 per cent) (Z-test, p < 0.05). CONCLUSION: Non-strabismic binocular vision anomalies are highly prevalent among school children and the prevalence increases with age. With increasing near visual demands in the higher grades, these anomalies could significantly impact the reading efficiency of children. Thus, it is recommended that screening for anomalies of binocular vision should be integrated into the conventional vision screening protocol.

AIM: To investigate the occurrence of neuronal damage, as the earliest change occurring, before the clinical evidence of diabetic retinopathy. METHODS: 70 eyes of subjects with type 2 diabetes mellitus and with no evidence of diabetic retinopathy (cases) and 40 eyes of subjects with no diabetes mellitus (controls) were studied using spectral-domain OCT and microperimetry. The influence of age and gender on the outcome measures was also analyzed. RESULTS: Age- and gender-matched subjects showed a decreased mean retinal nerve fiber layer thickness in cases when compared to the controls (27 vs. 33 μm; p=0.018). Among the cases, subjects between 40 and 45 years of age showed a reduced mean central foveal thickness (175.1 vs. 198.1 μm; p=0.05), mean retinal thickness in the central 6-mm fundus (260.5 vs. 275.3 μm; p=0.006) and mean retinal nerve fiber layer thickness (29 vs. 39 μm; p=0.036) when compared to the controls. However, no differences were noted in the microperimetry outcomes in cases when compared to the controls. The duration of diabetes and the glycemic control did not show any significant changes on the outcome measures in cases, except for a significantly lower mean retinal sensitivity in diabetics with glycosylated hemoglobin values<7% as compared to those with glycosylated hemoglobin≥7% (14.1±2.9 vs. 15.4±1.7 dB; p=0.027). CONCLUSION: The results suggest that there is some evidence of early neuronal damage particularly on spectral-domain OCT, before the clinical evidence of diabetic retinopathy, in subjects with type 2 diabetes mellitus.

Prevention of blindness due to diabetic retinopathy (DR) requires effective screening strategies, for which eye care providers need to know the magnitude of the burden and the risk factors pertinent in their geographical location. It is estimated that around 72 million of the global adult population (around 8.2%) has diabetes and about one-fifth of all adults with diabetes lives in the South-East Asia. In India, around 65 million people have diabetes. As the global prevalence of diabetes increases, so will the number of people with diabetes-related complications, such as DR; nearly one-third of them are likely to develop this complication. This article reviews the present status of diabetes and DR in India, the current situation of DR services and the projections on the load of morbidity associated with retinopathy. The article compiles the Indian studies elucidating the risk factors for DR.

Basic color categories are thought to share a common pattern across linguistic groups, yet the focal colors defining those categories can vary substantially within any single group. We asked whether focal colors can also differ systematically across different groups of individuals living in potentially different color environments, by measuring focal and unique hues for observers in India and the United States. Differences between groups were generally small relative to the within-group variations, consistent with a strong common basis for color naming across diverse contexts. However, for most hues the average settings differed significantly across subpopulations. These differences persisted across testing conditions and thus probably reflect longer-term contextual influences on color appearance judgments. They suggest that while color categories may be qualitatively similar, precisely how the hue spectrum is parsed may differ quantitatively across different populations of observers. Both the between-group and the within-group differences are inconsistent with the differences predicted by common peripheral sources of variation in color vision (e.g., in lens or macular pigment) and may reflect an influence of environmental or cultural differences in focal color choices.

AIM: To determine the morphologic changes in the anterior segment of primary angle closure suspects (PACS) who underwent laser peripheral iridotomy (LPI) for a period of 2 years. METHODS: PACS (n=82 eyes) of Asian Indian origin who attended the Glaucoma clinic of tertiary eye hospital underwent A-scan biometry and ultrasound biomicroscopy. Anterior chamber depth, anterior chamber angle (ACA), axial length, lens thickness, relative lens position, central corneal thickness, angle opening distance 500, trabecular-ciliary process distance, iris-ciliary process distance, and iris thickness were measured before LPI and after LPI at 1 week, 6 months, 1 year, 1.5 years, and 2 years. Variation in the parameters measured over a period of 2 years was analyzed. RESULTS: Fifteen eyes out of 52 eyes developed into primary angle closure (PAC) with synechial changes. Univariate analysis for the predictive factors of PAC showed no significant association for age, sex, narrow angle, ultrasound biomicroscopy parameters, and vertical cup-disc ratio. When analyzed as continuous variables, decreasing ACA was significant risk factor (95% confidence interval: 0.703, 0.989, P=0.037). Iris-ciliary process distance, ACA, lens thickness, and angle opening distance 500 were the parameters that varied significantly (P<0.05) between "before LPI group" and "after LPI groups." None of the subjects developed increased intraocular pressure after laser iridotomy. CONCLUSIONS: In this hospital-based study on the course of PACS subjects after LPI, as many as 28% progressed to PAC. Decreasing ACA was the predictive factor for the progression of PACS to PAC. There was no increase in intraocular pressure, history, or symptoms of acute attack of glaucoma among the study subjects after LPI.

BACKGROUND: To examine the prevalence, patterns and trends of vision impairment and its causes from 1990 to 2010 in Central and South Asia. METHODS: Based on the Global Burden of Diseases Study 2010 and ongoing literature searches, we examined prevalence and causes of moderate and severe vision impairment (MSVI; presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60). RESULTS: In Central Asia, the estimated age-standardised prevalence of blindness decreased from 0.4% (95% CI 0.3% to 0.6%) to 0.2% (95% CI 0.2% to 0.3%) and of MSVI from 3.0% (95% CI 1.9% to 4.7%) to 1.9% (95% CI 1.2% to 3.2%), and in South Asia blindness decreased from 1.7% (95% CI 1.4% to 2.1%) to 1.1% (95% CI 0.9% to 1.3%) and MSVI from 8.9% (95% CI 6.9% to 10.9%) to 6.4% (95% CI 5.2% to 8.2%). In 2010, 135 000 (95% CI 99,000 to 194,000) people were blind in Central Asia and 10,600,000 (95% CI 8,397,000 to 12,500,000) people in South Asia. MSVI was present in 1,178,000 (95% CI 772,000 to 2,243,000) people in the Central Asia, and in 71,600,000 (95% CI 57,600,000 to 92,600,000) people in South Asia. Women were generally more often affected than men. The leading causes of blindness (cataract) and MSVI (undercorrected refractive error) did not change from 1990 to 2010. CONCLUSIONS: The prevalence of blindness and MSVI in South Asia is still three times higher than in Central Asia and globally, with women generally more often affected than women. In both regions, cataract and undercorrected refractive error were major causes of blindness and MSVI.

India has a proud tradition of blindness prevention, being the first country in the world to implement a blindness control programme which focused on a model to address blinding eye disease. However, with 133 million people blind or vision impaired due to the lack of an eye examination and provision of an appropriate pair of spectacles, it is imperative to establish a cadre of eye care professionals to work in conjunction with ophthalmologists to deliver comprehensive eye care. The integration of highly educated four year trained optometrists into primary health services is a practical means of correcting refractive error and detecting ocular disease, enabling co-managed care between ophthalmologists and optometrists. At present, the training of optometrists varies from two year trained ophthalmic assistants/optometrists or refractionists to four year degree trained optometrists. The profession of optometry in India is not regulated, integrated into the health care system or recognised by the majority of people in India as provider of comprehensive eye care services. In the last two years, the profession of optometry in India is beginning to take the necessary steps to gain recognition and regulation to become an independent primary health care profession. The formation of the Indian Optometry Federation as the single peak body of optometry in India and the soon to be established Optometry Council of India are key organisations working towards the development and regulation of optometry.

To report the frequency of binocular vision (BV) anomalies in children with specific learning disorders (SLD) and to assess the efficacy of vision therapy (VT) in children with a non-strabismic binocular vision anomaly (NSBVA). The study was carried out at a centre for learning disability (LD). Comprehensive eye examination and binocular vision assessment was carried out for 94 children (mean (SD) age: 15 (2.2) years) diagnosed with specific learning disorder. BV assessment was done for children with best corrected visual acuity of ≥6/9 – N6, cooperative for examination and free from any ocular pathology. For children with a diagnosis of NSBVA (n = 46), 24 children were randomized to VT and no intervention was provided to the other 22 children who served as experimental controls. At the end of 10 sessions of vision therapy, BV assessment was performed for both the intervention and non-intervention groups. Binocular vision anomalies were found in 59 children (62.8%) among which 22% (n = 13) had strabismic binocular vision anomalies (SBVA) and 78% (n = 46) had a NSBVA. Accommodative infacility (AIF) was the commonest of the NSBVA and found in 67%, followed by convergence insufficiency (CI) in 25%. Post-vision therapy, the intervention group showed significant improvement in all the BV parameters (Wilcoxon signed rank test, p < 0.05) except negative fusional vergence. Children with specific learning disorders have a high frequency of binocular vision disorders and vision therapy plays a significant role in improving the BV parameters. Children with SLD should be screened for BV anomalies as it could potentially be an added hindrance to the reading difficulty in this special population. Reportar la frecuencia de las anomalías en la visión binocular (VB) en niños con trastornos específicos de aprendizaje (SLD), y evaluar la eficacia de la terapia visual (TV) en niños con alteraciones en la visión binocular no estrábicas (NSBVA). El estudio se llevó a cabo en un centro para discapacidades de aprendizaje (LD). Se realizó un amplio examen ocular y una valoración de la visión binocular en 94 niños (Media (DE) edad: 15 (2,2) años) con diagnóstico de trastorno específico de aprendizaje. Se llevó a cabo una valoración de la VB en los niños, con agudeza visual mejor corregida de ≥6/9 – N6, que cooperaron durante el examen, y que carecían de patología ocular. En los niños con diagnóstico de NSBVA (n = 46), se aleatorizaron 24 de ellos para terapia visual, sin realizar intervención alguna en los 22 niños restantes, que sirvieron de controles. Al finalizar las 10 sesiones de terapia visual, se realizó una valoración de VB tanto en el grupo de intervención como en el de no intervención. Se encontraron anomalías en la visión binocular en 59 niños (62,8%), de entre los cuales el 22% (n = 13) tenían alteraciones en la visión binocular estrábica (SBVA), y el 78% (n = 46) reflejaron NSBVA. La inflexibilidad acomodativa (AIF) fue la NSBVA más común, estando presente en el 67% de los casos, seguida de la insuficiencia de convergencia (CI) en 25% de ellos. Tras la terapia visual, el grupo de intervención reflejó una mejora significativa en todos los parámetros de VB (prueba de los rangos con signo de Wilcoxon: p < 0,05) exceptuando la vergencia fusional negativa. Los niños con trastorno específico de aprendizaje tienen una elevada frecuencia de anomalías en la visión binocular, y en ellos la terapia visual juega un papel significativo para la mejora de los parámetros de VB. Deberá supervisarse a los niños con SLD, en relación a las anomalías de VB, que podrían suponer un obstáculo añadido a la dificultad lectora en esta población especial.

PURPOSE: To evaluate the 4-year incidence and progression of and risk factors for diabetic retinopathy (DR) in an Indian population. METHODS: From a cross-sectional study of 1425 subjects with diabetes, 911 (63.9%) returned for 4-year follow-up. After excluding 21 with ungradable retinal images, data from 890 subjects were analyzed. Participants underwent examinations based on a standard protocol, which included grading of retinal photographs. RESULTS: The incidences of DR, diabetic macular edema (DME), and sight-threatening diabetic retinopathy (STDR) were 9.2%, 2.6%, and 5.0%, respectively. In subjects with DR at baseline, the incidence of DME and STDR had increased (11.5% and 22.7%, respectively). 1-step and 2-step progressions of DR were seen in 30.2% and 12.6% of participants, respectively, and 1-step and 2-step regressions were seen in 12.0% and 1.8%, respectively. Incident DR, DME, and STDR were associated with higher systolic blood pressure (odds ratio, OR, 1.21, 2.11 and 1.72, respectively, for every 10 mmHg increase). Incident DR and DME were associated with increasing duration of diabetes (OR 2.29 and 4.77, respectively, for every 10-year increase) and presence of anemia (OR 1.96 and 10.14, respectively). Incident DR was also associated with higher hemoglobin A1c (OR 1.16 for every 1% increase). Variables associated with 1-step progression were every 10 mg/dL increase in serum total cholesterol (OR 15.65) as a risk factor, and 10 mg/dL increase in serum triglyceride (OR 0.52) as a protective factor. CONCLUSIONS: The incidences of STDR and DME were higher in people with pre-existing DR than in those without DR at baseline.

PURPOSE: To report parents' awareness and perception of eye diseases in their children. METHODS: Thirty-five parents and 16 eye care practitioners either participated in in-depth interviews or focus group discussions. Data on parents' awareness and perception were collected using interview guides with unstructured questions. Data were transcribed, familiarized, and coded, and themes were generated. Redundancy was considered as the end point of data collection. RESULTS: The study results conveyed that parents were aware of common eye problems like refractive error, squint, and cataract, except for amblyopia, in their children. The causative factors for ocular diseases were not well understood by parents. The parents' perception was that eye problems can be treated with food, such as eggs or carrots, and exercises. Most of the parents perceived squint as a sign of good luck and spectacle correction as a social stigma. CONCLUSIONS: One of the prerequisites of health-seeking behavior is knowledge of disease and their symptoms, which seems to be lacking in parents of children. The findings of this study suggest that programs to increase awareness of the causative factors, spectacle wearing, and on the harmful effects of squint should be conducted.

Purpose To report the clinical profile and role of perioperative adjunctive measures to reduce the risk of recurrence in Pythium insidiosum keratitis. Methods Retrospective analysis of 10 eyes of 10 patients with P. insidiosum keratitis. Diagnosis was confirmed by PCR DNA sequencing. Results 7out of 10 patients were from urban locales, and none had any obvious history of injury with vegetative matter and were being treated for fungal keratitis. 6 eyes presented with central full thickness infiltrates with subepithelial and superficial stromal infiltrates radiating in a reticular pattern. Corneal scraping in all eyes revealed sparsely septate fungal-like filaments on potassium hydroxide/Calcofluor. All eyes underwent the first therapeutic penetrating keratoplasty (TPK) based on worsening or non-responsiveness of clinical features to the antifungal regimen. Recurrence was noted in 7 out of 10 eyes of which 2 eyes underwent evisceration. Of the six eyes that underwent cryotherapy following confirmation of microbiological diagnosis of Pythium (along with primary TPK-1, with re-TPK-5), only one eye had a recurrence and had to be eviscerated. Of the two eyes that did not undergo cryotherapy during re-TPK, following microbiological diagnosis, one eye had a recurrence and had to be eviscerated. In two eyes with adjoining scleritis, the host bed was swabbed using absolute alcohol of which one eye was salvaged. Conclusion This series highlights the need to be aware of this entity in the management of refractory fungal keratitis. It also brings to fore the adjunctive measures that could have a beneficial role in the management of pythium keratitis.

PURPOSE: Accommodative insufficiency (AI), defined as the inability to stimulate accommodation in pre-presbyopic individuals, has gained much attention over recent years. Despite the enormity of the available information, there is a significant lack of clarity regarding the criteria for definition, methodology adopted for testing and diagnosis, and the varied prevalence across the globe. This review aims to gather evidence that is pertinent to the prevalence, impact and efficacy of available treatment options for AI. METHODS: PubMed, Google Scholar and Cochrane Collaboration search engines were used with the keywords prevalence, accommodative insufficiency, symptoms, plus lens, vision therapy and treatment. Peer-reviewed articles published between 1992 and 2019 were included in the review. After reviewing the studies for study methodology and robustness, 83 articles were chosen for this literature review. RESULTS: The prevalence of AI ranges between <1.00% and 61.6% across studies. The prevalence shows considerable variation across ethnicities and age groups. There is significant variation in the study methodology, diagnostic criteria and number of tests performed to arrive at the diagnosis. Not many studies have explored the prevalence beyond 20 years of age. The prevalence of AI is high among children with special needs. There is no high-quality evidence regarding the standard treatment protocol for AI. Both vision therapy and low plus lenses have shown efficacy in independent studies, and no studies have compared these two treatment options. CONCLUSION: The understanding of AI prevalence is currently limited owing to the lack of a standard set of diagnostic criteria and wide variations in the study methodology. There is a lack of high-quality evidence suggesting the best possible treatment for AI. The current gaps in the literature have been identified and future scope for exploration is elucidated.

BACKGROUND: This population-based, cross-sectional study was designed to determine normative data for binocular vision and accommodative testing in rural and urban populations of Tamil Nadu. METHODS: A sample of 936 was determined, based on a previous pilot study. The epidemiological field work included a comprehensive eye examination and a binocular vision and accommodative assessment carried out in a total of four public schools, two each in the rural and urban arms of Chennai. An overall sample of 3,024 children between seven and 17 years of age was screened in the four schools and 920 children were included in the study. RESULTS: We found significant differences in expected values from the current clinical criteria for near point of convergence (NPC) with penlight, distance and near horizontal phorias, vergence facility, accommodation convergence/accommodation (AC/A) ratio, accommodative amplitudes, monocular and binocular accommodative facility (t-test: p < 0.001). The mean and standard deviation break/recovery values for NPC (in centimetres) with an accommodative target and penlight with red filter was 3 ± 3/4 ± 4 and 7 ± 5/10 ± 7, respectively. The mean accommodative amplitudes for the population could be estimated from the linear regression equation 16 - 0.3 × (age). The vergence facility was 12 ± 4 cycles/minute and 14 ± 4 cycles/minute in the seven to 10 and 11 to 17 age groups, respectively. Monocular accommodative facility was 11 ± 4 cycles/minute and 14 ± 5 cycles/minute and binocular accommodative facility was 10 ± 4 cycles/minute and 14 ± 5 cycles/minute in the seven to 12 and 13 to 17 age groups, respectively. The mean calculated AC/A ratio was 5.4 ± 0.6/1. CONCLUSION: The normative data for vergence and accommodative parameters for the Indian children between seven and 17 years of age are reported. The developmental trend of accommodation and vergence differences and significant differences in cut-off between the current data and available literature are reported. These differences have clinical implications for the interpretation, diagnosis and management of anomalies of binocular vision.

PURPOSE: Acute onset comitant esotropia associated with spasm of accommodation in children and adults is a rare clinical condition. When occurring with pupillary miosis and restricted ocular motility, it is referred to as "spasm of near reflex" (SNR) and may require neurological investigation. The natural history of SNR depends on its etiology. There is little information in the literature regarding the long-term follow-up of SNR and the stability of visual signs and symptoms following cessation of treatment. We report a case of SNR in an otherwise healthy young male, and discuss the presentation, clinical investigations, management, response to treatment, and 1-year follow-up. CASE REPORT: A 23-year-old male patient reported to the clinic with sudden onset of blurred vision, inward deviation of the eyes, and binocular diplopia. On examination, he was diagnosed to have acute onset esotropia resulting from SNR. He was treated with cycloplegic medications and vision therapy. The condition resolved following 1 year and there has been no recurrence. CONCLUSIONS: Acute adult onset esotropia occurring with accommodative spasm responds favorably to cycloplegic medications but may need a longer course of treatment for successful resolution and stability.

AIM: To determine choroidal thickness in healthy Indian subjects using Swept source optical coherence tomography (SS-OCT). METHODS: In this prospective, observational, cross-sectional study; healthy Indian subjects (n = 230) with no history of ocular and/or systemic disorders were enrolled in the study. Choroidal thickness was measured for 230 eyes using SS-OCT. Subjects were divided into six age groups. Main outcome measures were subfoveal choroidal thickness (SFCT) and macular choroidal thickness (MCT) up to 3 mm at 500-micron interval from the fovea was measured in eight different quadrants. RESULTS: The mean SFCT was 307±79 μm and mean MCT was 285±75 μm. No difference in the choroidal thickness was found among genders. Mean SFCT of the different age groups was 327±68 μm (12-18 years), 364±70 μm (18.1-30 years), 321±78 μm (30.1-40 years), 304±79 μm (40.1-50 years), 283±69 μm (50.1-60 years) and 262±72μm (above 60 years; p <0.001; One way ANOVA). Mean macular choroidal thickness was 305±60 μm, 342±61 μm, 306±72 μm, 282±79 μm, 261±66 μm, 238±68μm respectively (p<0.001; one way ANOVA). A significant weak negative correlation was found between age with SFCT (r = -0.368, p<0.001) and MCT (r = -0.40, p<0.001). No significant correlation was found with refractive error, axial length and ocular perfusion pressure. CONCLUSION: This study showed that mean SFCT and MCT was 307±79μm and 285±75 μm, respectively, among healthy Indian subjects. Mean CT was found to decrease with age, although there was no difference in CT between genders.

PURPOSE: To understand the vision-related quality of life (QoL) of schoolchildren with uncorrected refractive error (URE). METHODS: A snapshot qualitative research design and homogeneous sampling strategy was adopted. Thirty-one, 27, and 22 eye care practitioners, children, and teachers participated in four, three, and two focus group discussions, respectively. The participants were recruited from various parts of Chennai, India. The discussions were audio recorded, transcribed, coded, and analyzed. RESULTS: Eight themes emerged: complaints and symptoms of children with URE, vision-related activity limitation, coping strategies, psychological impact, social impact, the perceived difference after first time refractive correction, reasons for refractive error remaining uncorrected, and the significant amount of refractive error. CONCLUSIONS: The study gives a holistic view of the vision-related QoL of children with URE by demonstrating the difficulties and problems that they face in their day-to-day life and also by describing the perceived difference in QoL after wearing refractive correction.

PURPOSE: The aim was to investigate the effect of axial length on full-field electroretinogram (ffERG) and multifocal electroretinogram (mfERG) in young Indian subjects. METHODS: One hundred subjects (44 male) with refractive errors from +0.50 to -18.00 DS and no myopic retinopathy underwent axial length measurement. ffERG was measured, which included scotopic and photopic responses according to International Society for Clinical Electrophysiology of Vision (ISCEV) guidelines. The mfERG was recorded after correcting for refractive error according to ISCEV standards. The dark-adapted and light-adapted parameters of ffERG and N1, P1 parameters of six rings in mfERG were analysed with axial length, controlled for refractive error. The subjects were divided into seven groups based on axial length. The b/a ratio of dark-adapted and light-adapted 3.0 ffERG and P1/N1 ratio of mfERG amplitudes were analysed for seven groups of axial length. RESULTS: The axial length ranged from 21.79 to 30.55 mm. Significant negative correlations were noted for ffERG and mfERG amplitudes, whereas implicit times showed minimal delay with increase in axial length. In ffERG, the scotopic responses were more decreased compared to photopic responses. In mfERG, P1 and N1 amplitudes were significantly decreased in all the rings in all groups and more reduction was noted in the central ring compared to peripheral rings. The P1 amplitudes were more affected as compared to N1 amplitudes. The light-adapted and dark-adapted 3.0 ERG b/a ratio and P1/N1 ratio for seven axial length groups did not show statistically significant difference. The ERG parameters were not significant with refractive error. CONCLUSION: This study quantifies the relationship of axial length with ffERG and mfERG parameters in a young Indian population. Although the amplitudes were reduced significantly, the implicit times were not significantly affected. The ERG parameters were more related to axial length than refractive error. Hence, interpretation of ffERG and mfERG parameters needs careful consideration in subjects with increasing axial length.

Our aim is to study the dynamics of pupillary abnormalities in varying severity of diabetic retinopathy. A non-interventional case-control study with 405 eyes of 244 subjects with diabetes, and 41 eyes of 26 subjects with no history of diabetes was done. Diabetes group was classified according to retinopathy severity: no retinopathy, mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR and proliferative diabetic retinopathy (PDR). After dark adaptation, pupil size and flashlight response were captured with an infrared camera. Baseline Pupil Diameter (BPD), Amplitude of Pupillary Constriction (APC), Velocity of Pupillary Constriction (VPC) and Velocity of Pupillary Dilatation (VPD). Compared to controls, mean BPD decreased with increasing severity of diabetic retinopathy. Mean APC in control group was 1.73 ± 0.37 mm and reduced in mild NPDR (1.57 ± 0.39, p = 1.000), moderate NPDR (1.51 ± 0.44, p = 0.152) and found to be significant reduced in severe NPDR (1.43 ± 0.48, p = 0.001) and PDR (1.29 ± 0.43, p = 0.008). Compared to controls, mean VPC decreased progressively with increasing severity of retinopathy, with a maximal difference in the PDR group. Mean VPD as compared to the control group was significantly reduced in the no DR (p = 0.03), mild NPDR (p = 0.038), moderate NPDR (p = 0.05), PDR group (p = 0.02). We found pupillary dynamics are abnormal in early stages of diabetic retinopathy and progress with increasing retinopathy severity.

PURPOSE: To understand the perceptions of adolescents and their parents about spectacle compliance of adolescents in Southern India. METHODS: Using a qualitative snapshot design, three focus group discussions were conducted each with parents and adolescents studying in schools located in and around Chennai, Tamil Nadu. Purposive sampling technique was used in the selection of participants. Separate focus group guides were developed for parents and adolescents. All focus group discussions were conducted in the school premises and audio recorded. These audio files were then transcribed verbatim and then translated into English. A framework analytical approach was used for data analysis that involved gaining familiarity with the data to identify a thematic framework. RESULTS: Two major themes that emerged were (1) perceptions on barriers to spectacle compliance that was further subdivided into physical, psychological, and societal barriers; and (2) solutions to improve spectacle use. Barriers identified included scars on the nose, unattractive frames contributing to poor appeal, adolescents feeling discriminated and set apart, fears of injury to eyes, lack of parental involvement, and negative attitudes of society toward those wearing spectacles. Solutions given by the stakeholders included provision of lightweight, well-fitting, trendy frames of adolescents' choice, importance and need for periodical eye examinations, including teachers in encouraging spectacle use and preventing bullying and teasing by other adolescents, provision of free spectacles along with periodic replacement, and inclusion of awareness sessions on spectacle use for both parents and adolescents. CONCLUSIONS: The study has identified both barriers and solutions for improving spectacle compliance among school adolescents from the viewpoint of the stakeholders involved. Implementing the solutions suggested by the stakeholders through planned intervention programs could possibly help in ensuring better compliance of spectacle use among school adolescents.