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Vijendran S, Kamath YS, Alok Y, Kuzhuppilly NIR. Determination of Refractive Error Using Direct Ophthalmoscopy in Children. Clin Ophthalmol 2024; 18:989-996. [PMID: 38584720 PMCID: PMC10998502 DOI: 10.2147/opth.s453207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Refractive error is a major cause of visual impairment in children and its early detection can prevent ocular morbidity such as amblyopia and strabismus. Brückner test is a comprehensive test which can be easily administered in children using a direct ophthalmoscope. We aimed to determine refractive error in children by analysis of the red reflex using modified Brückner test. Patients and Methods This prospective observational study was conducted on 683 undilated eyes of 683 children aged four to 10 years. They were evaluated with a direct ophthalmoscope from one meter in a dimly lit room. The characteristics of the red reflex and crescent obtained were compared with photoscreener refraction value and analyzed. Results The presence of superior crescent was associated with hypermetropia (Chi square 37.11, p < 0.001, kappa = 0.15) and inferior crescent with myopia (Chi square 157.29, p < 0.001, kappa = 0.477). Superior crescent was 98.4% sensitive in detecting hypermetropia. Hypermetropia greater than +1.5D, was associated with larger superior crescent crossing horizontal midline of pupil (Chi square = 5.29, p = 0.021). Conclusion The modified Brückner test is useful in detection and quantification of refractive error in children. It is easy, simple, quick and can be employed in the community as a screening test to detect potentially amblyogenic refractive errors.
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Affiliation(s)
- Sruthi Vijendran
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Yogish S Kamath
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Yash Alok
- Department of Community Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Neetha I R Kuzhuppilly
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Reliability of Smart Phone Photographs for School Eye Screening. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101519. [PMID: 36291455 PMCID: PMC9601144 DOI: 10.3390/children9101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/05/2022]
Abstract
Smartphone photographs capturing Bruckner’s reflex have demonstrated reliability in identifying amblyogenic conditions in children. Assessing visual acuity for screening has been the traditional method since the inception of school screening. The present study aims to assess the reliability of smartphone photographs in detecting ocular morbidities in school children and to compare it with traditional vision screening. Two thousand five hundred and twenty school children underwent vision screening and smartphone cameraphotography by a trained research assistant followed by a comprehensive eye examination of all children by an ophthalmologist. Children with unaided visual acuity less than 6/12 in either of the eyes were graded as abnormal. Based upon the characteristics of the Bruckner’s reflex, the photographs were graded as normal or abnormal by two investigators blinded to the clinical findings. Statistical analysis was performed to compare the sensitivity and specificity of traditional vision screening and photograph based screening, considering comprehensive eye examination as the gold standard. The sensitivity and specificity of vision screening was 81.88% and 97.35% whereas for photographs it was 94.69% and 98.85% respectively. When the two methods were compared, the p value was <0.05. We conclude that smartphone photography is better than traditional vision screening for detecting ocular morbidities in school children.
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Kumar PS, Kamath YS. The utility of a direct ophthalmoscope in estimating the magnitude of refractive error using a modification of the Brückner test. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1945924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Praveena S. Kumar
- Department of Ophthalmology, Kasturba Medical College-Manipal, Manipal Academy of Higher Education, MANIPAL, Karnataka, India
| | - Yogish Subraya Kamath
- Department of Ophthalmology, Kasturba Medical College-Manipal, Manipal Academy of Higher Education, MANIPAL, Karnataka, India
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Amitava AK. Commentary: How useful is a deep learning smartphone application for screening for amblyogenic risk factors? Indian J Ophthalmol 2020; 68:1411. [PMID: 32587178 PMCID: PMC7574105 DOI: 10.4103/ijo.ijo_1900_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Abadan K Amitava
- Institute of Ophthalmology, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Gupta R, Agrawal S, Srivastava RM, Singh V, Katiyar V. Smartphone photography for screening amblyogenic conditions in children. Indian J Ophthalmol 2020; 67:1560-1563. [PMID: 31546480 PMCID: PMC6786217 DOI: 10.4103/ijo.ijo_2090_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To validate the smartphone photography as a screening tool for amblyogenic conditions in children. Methods Children between 5 to 8 years attending eye out patient department (OPD) were photographed (by an optometrist) with a smartphone to capture their pupillary red reflexes followed by clinical examination by the principal investigator (PI). The PI on the basis of clinical examination identified children with significant amblyogenic conditions and, subsequently, two ophthalmologists independently categorized the photographs on the basis of color, symmetry, and shape of the pupillary reflex into normal or abnormal. The identification of amblyogenic conditions on clinical examination was compared to that on photography. Refractive errors <3D and anisometropia <2D were excluded. Sensitivity, specificity, positive predictive value, and negative predictive value of smartphone photography screening were determined. Results In all, 250 children were screened. Clinically 23.6% were harboring amblyogenic conditions. The mean sensitivity and specificity of screening by smartphone were 94% and 91%, respectively. Conclusion Smartphone photography is a reliable tool for detection of amblyogenic conditions in children.
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Affiliation(s)
- Richa Gupta
- Department of Ophthalmology, King Georges' Medical University, Lucknow, Uttar Pradesh, India
| | - Siddharth Agrawal
- Department of Ophthalmology, King Georges' Medical University, Lucknow, Uttar Pradesh, India
| | - Rajat M Srivastava
- Department of Ophthalmology, King Georges' Medical University, Lucknow, Uttar Pradesh, India
| | - Vinita Singh
- Department of Ophthalmology, King Georges' Medical University, Lucknow, Uttar Pradesh, India
| | - Vishal Katiyar
- Department of Ophthalmology, King Georges' Medical University, Lucknow, Uttar Pradesh, India
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Staffieri SE, Kearns LS, Sanfilippo PG, Craig JE, Mackey DA, Hewitt AW. Crowd-sourced Ontology for Photoleukocoria: Identifying Common Internet Search Terms for a Potentially Important Pediatric Ophthalmic Sign. Transl Vis Sci Technol 2018; 7:18. [PMID: 29464132 PMCID: PMC5815559 DOI: 10.1167/tvst.7.1.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 12/14/2017] [Indexed: 12/23/2022] Open
Abstract
Purpose Leukocoria is the most common presenting sign for pediatric eye disease including retinoblastoma and cataract, with worse outcomes if diagnosis is delayed. We investigated whether individuals could identify leukocoria in photographs (photoleukocoria) and examined their subsequent Internet search behavior. Methods Using a web-based questionnaire, in this cross-sectional study we invited adults aged over 18 years to view two photographs of a child with photoleukocoria, and then search the Internet to determine a possible diagnosis and action plan. The most commonly used search terms and websites accessed were recorded. Results The questionnaire was completed by 1639 individuals. Facebook advertisement was the most effective recruitment strategy. The mean age of all respondents was 38.95 ± 14.59 years (range, 18-83), 94% were female, and 59.3% had children. An abnormality in the images presented was identified by 1613 (98.4%) participants. The most commonly used search terms were: "white," "pupil," "photo," and "eye" reaching a variety of appropriate websites or links to print or social media articles. Conclusions Different words or phrases were used to describe the same observation of photoleukocoria leading to a range of websites. Variations in the description of observed signs and search words influenced the sites reached, information obtained, and subsequent help-seeking intentions. Translational Relevance Identifying the most commonly used search terms for photoleukocoria is an important step for search engine optimization. Being directed to the most appropriate websites informing of the significance of photoleukocoria and the appropriate actions to take could improve delays in diagnosis of important pediatric eye disease such as retinoblastoma or cataract.
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Affiliation(s)
- Sandra E Staffieri
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia
| | - Lisa S Kearns
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia
| | - Paul G Sanfilippo
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, SA, Australia
| | - David A Mackey
- Menzies Institute for Medical Research, School of Medicine, University of Tasmania, Hobart, TAS, Australia.,Lion's Eye Institute, Centre for Ophthalmology and Visual Sciences, University of Western Australia, Perth, WA, Australia
| | - Alex W Hewitt
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, VIC, Australia.,Menzies Institute for Medical Research, School of Medicine, University of Tasmania, Hobart, TAS, Australia
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Hull S, Tailor V, Balduzzi S, Rahi J, Schmucker C, Virgili G, Dahlmann‐Noor A. Tests for detecting strabismus in children aged 1 to 6 years in the community. Cochrane Database Syst Rev 2017; 11:CD011221. [PMID: 29105728 PMCID: PMC6486041 DOI: 10.1002/14651858.cd011221.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Strabismus (misalignment of the eyes) is a risk factor for impaired visual development both of visual acuity and of stereopsis. Detection of strabismus in the community by non-expert examiners may be performed using a number of different index tests that include direct measures of misalignment (corneal or fundus reflex tests), or indirect measures such as stereopsis and visual acuity. The reference test to detect strabismus by trained professionals is the cover‒uncover test. OBJECTIVES To assess and compare the accuracy of tests, alone or in combination, for detection of strabismus in children aged 1 to 6 years, in a community setting by non-expert screeners or primary care professionals to inform healthcare commissioners setting up childhood screening programmes.Secondary objectives were to investigate sources of heterogeneity of diagnostic accuracy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) (which contains the Cochrane Eyes and Vision Trials Register) in the Cochrane Library, the Health Technology Assessment Database (HTAD) in the Cochrane Library (2016, Issue 4), MEDLINE Ovid (1946 to 5 January 2017), Embase Ovid (1947 to 5 January 2017), CINAHL (January 1937 to 5 January 2017), Web of Science Conference Proceedings Citation Index-Science (CPCI-S) (January 1990 to 5 January 2017), BIOSIS Previews (January 1969 to 5 January 2017), MEDION (to 18 August 2014), the Aggressive Research Intelligence Facility database (ARIF) (to 5 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 5 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 5 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 5 January 2017. We did not use any date or language restrictions in the electronic searches for trials. In addition, orthoptic journals and conference proceedings without electronic listings were searched. SELECTION CRITERIA All prospective or retrospective population-based test accuracy studies of consecutive participants were included. Studies compared a single or combination of index tests with the reference test. Only those studies with sufficient data for analysis were included specifically to calculate sensitivity and specificity and determine diagnostic accuracy.Participants were aged 1 to 6 years. Studies reporting participants outside this range were included if subgroup data were available.Permitted settings included population-based vision screening programmes or opportunistic screening programmes, such as those performed in schools. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. In brief, two review authors independently assessed titles and abstracts for eligibility and extracted the data, with a third senior author resolving any disagreement. We analysed data primarily for specificity and sensitivity. MAIN RESULTS One study from a total of 1236 papers, abstracts and trials was eligible for inclusion with a total number of participants of 335 of which 271 completed both the screening test and the gold standard test. The screening test using an automated photoscreener had a sensitivity of 0.46 (95% confidence interval (CI) 0.19 to 0.75) and specificity of 0.97 (CI 0.94 to 0.99). The overall number affected by strabismus was low at 13 (4.8%). AUTHORS' CONCLUSIONS There is very limited data in the literature to ascertain the accuracy of tests for detecting strabismus in the community as performed by non-expert screeners. A large prospective study to compare methods would be required to determine which tests have the greatest accuracy.
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Affiliation(s)
- Sarah Hull
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Vijay Tailor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Sara Balduzzi
- University of Modena and Reggio EmiliaCochrane Italy, Department of Diagnostic, Clinical and Public Health MedicineVia del Pozzo 71ModenaItaly41124
| | - Jugnoo Rahi
- UCL Institute of Child Health and UCL Institute of OphthalmologyDepartment of EpidemiologyLondonUK
| | - Christine Schmucker
- Medical Center – Univ. of Freiburg, Faculty of Medicine, Univ. of FreiburgCochrane GermanyBreisacher Straße 153FreiburgGermany79110
| | - Gianni Virgili
- University of FlorenceDepartment of Translational Surgery and Medicine, Eye ClinicLargo Brambilla, 3FlorenceItaly50134
| | - Annegret Dahlmann‐Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
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Bani SAO, Amitava AK, Sharma R, Danish A. Beyond photography: evaluation of the consumer digital camera to identify strabismus and anisometropia by analyzing the Bruckner's reflex. Indian J Ophthalmol 2014; 61:608-11. [PMID: 24212318 PMCID: PMC3853466 DOI: 10.4103/0301-4738.121092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Amblyopia screening is often either costly or laborious. We evaluated the Canon Powershot TX1 (CPTX1) digital camera as an efficient screener for amblyogenic risk factors (ARF). We included 138 subjects: 84-amblyopes and 54-normal. With the red-eye-reduction feature off, we obtained Bruckner reflex photographs of different sized crescents which suggested anisometropia, while asymmetrical brightness indicated strabismus; symmetry implied normalcy. Eight sets of randomly arranged 138 photographs were made. After training, 8 personnel, marked each as normal or abnormal. Of the 84 amblyopes, 42 were strabismus alone (SA), 36 had anisometropia alone (AA) while six were mixed amblyopes (MA). Overall mean sensitivity for amblyopes was 0.86 (95% CI: 0.83-0.89) and specificity 0.85 (95% CI: 0.77-0.93). Sub-group analyses on SA, AA and MA returned sensitivities of 0.86, 0.89 and 0.69, while specificities were 0.85 for all three. Overall Cohen's Kappa was 0.66 (95% CI: 0.62-0.71). The CPTX1 appears to be a feasible option to screen for ARF, although results need to be validated on appropriate age groups.
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Affiliation(s)
- Sadat A O Bani
- Institute of Ophthalmology, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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