Prevalence of ophthalmic disorders among hearing-impaired school children in Guntur district of Andhra Pradesh

Purpose: To estimate the prevalence, causes, and risk factors for visual impairment (VI) among children of school for hearing-impaired (HI) in Guntur district of Andhra Pradesh, India. Methods: Children between 6 and 16 years of age available in all the 12 special schools for HI were examined. Visual acuity (VA) testing, ocular motility, and examination of anterior and posterior segment for all children were done. Those having VA of less than 6/12 in better eye underwent cycloplegic refraction. For definition of VI, as per World Health Organization (WHO), VA of better eye was considered. HI was also classified as mild, moderate, severe, and profound as per WHO definitions. Examination for systemic diseases and other associated disabilities was also done. Results: In all, 402 children underwent examination. Ophthalmic abnormality was seen in 64 children with a prevalence of 15.9% [95% confidence interval (CI) 14.9%–16.8%], and VI was seen in 29 children with a prevalence of 7.2% (95% CI 4.9%–10.2%). Refractive errors [29 (7.2%)], retinitis pigmentosa (RP) [16 (4%)], and squint [8 (2%)] were the major ophthalmic abnormalities. Thirty-five (54.7%) of the abnormalities were either preventable or treatable. The major cause of VI was refractive error (18) followed by RP (5). Twenty of them (69%) with VI in this study group were treatable. Twenty-two (75.9%) children with eye problem were newly diagnosed. The only risk factor for VI was being mentally challenged (odds ratio: 5.63; 95% CI: 1.89–16.8). Conclusion: The prevalence of ophthalmic abnormalities and VI in school for HI was high, and the majority of them were not detected so far. As most of them are easily treatable, it is highly recommended to conduct regular eye examinations in these schools

Person-item map for the Rasch-revised 8-item ‘psychosocial’ subscale of the AS-20 questionnaire.

<p>Participants are located on the left of the dashed line (represented by ‘x’) and participants with worse health-related quality of life are located at the top of the map. Items are on the right of the dashed line with those considered to be less difficult to endorse are located toward the top of the map. Each ‘x’ and “.” represent four and one participants respectively. Alongside each item is also indicated its original item number as in the AS-20 questionnaire. The complete description of items can be found in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127064#pone.0127064.t001" target="_blank">Table 1</a> in the text. M, mean; S, 1 SD from the mean; T, 2 SD from the mean.</p

Person-item map for the Rasch-revised 9-item ‘function’ subscale of the AS-20 questionnaire.

<p>Participants are located on the left of the dashed line (represented by ‘x’) and participants with worse health-related quality of life are located at the top of the map. Items are on the right of the dashed line with those considered to be less difficult to endorse are located toward the top of the map. Each ‘x’ and “.” represent six and one participants respectively. Alongside each item is also indicated its original item number as in the AS-20 questionnaire. The complete description of items can be found in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127064#pone.0127064.t001" target="_blank">Table 1</a> in the text. M, mean; S, 1 SD from the mean; T, 2 SD from the mean.</p

Measuring Health-Related Quality of Life in Strabismus: A Modification of the Adult Strabismus-20 (AS-20) Questionnaire Using Rasch Analysis

<div><p>Purpose</p><p>To evaluate the psychometric properties of the Adult Strabismus-20 (AS-20)- a health-related quality of life (HRQoL) questionnaire in adults with strabismus, and if flawed, to revise the AS-20 and its subscales creating valid measurement scales.</p><p>Methods</p><p>584 adults (meanage, 27.5 years) with strabismus were recruited from an outpatient clinic at a South Indian tertiary eye care centre and were administered the AS-20 questionnaire.The AS-20 was translated and back translated into two Indian languages. The AS-20 and its two 10-item subscales – ‘psychosocial’ and ‘function’were assessed separately for fit to the Rasch model, including an assessment of the rating scale, unidimensionality (by principal components analysis), measurement precision by person separation reliability, PSR, targeting, and differential item functioning (DIF; notable > 1.0 logits).</p><p>Results</p><p>Response categories were not used as intended, thereby, required re-organization and reducing their number from 5 to 3. The AS-20 had adequate measurement precision (PSR = 0.87) but lacked unidimensionality; however, deletion of the six multi-dimensionality causing items and an additional three misfitting items resulted in 11-item unidimensional questionnaire (AS-11). Two items failed to satisfy the model expectations in the ‘psychosocial’ subscale and were deleted – resulting in an 8-item unidimensional scale with adequate PSR (0.81) and targeting (0.23 logits). One item misfit in the ‘function’ subscale and was deleted—resulting in a 9 item Rasch-revised unidimensional subscale with acceptable PSR (0.80) and targeting (0.97 logits).None of the items displayed notable DIF by age, gender and level of education.</p><p>Conclusions</p><p>The AS-11 and its two Rasch-revised subscales – 8-item psychosocial and 9-item function subscale may be more appropriate than the original AS-20 and its two 10-item subscales for use as unidimensional measures of HRQoL in adults with strabismus in India. Further work is required to establish the validity of the revised rating scale.</p></div

Item content of the Adult Strabismus Questionnaire-20^*.

<p>Response categories of items 1–20 include: never, rarely, sometimes, often, always</p><p>*Formatted questionnaire available for download at <a href="http://www.pedig.net/" target="_blank">www.pedig.net</a></p><p>Item content of the Adult Strabismus Questionnaire-20^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127064#t001fn002" target="_blank">*</a>}.</p

Adult Strabismus-20 questionnaire (AS-20) before (left, 5 categories) and after (centre, 4 categories, and right, 3 categories) the collapsing procedure.

<p>Cat. label—Category label; Obs. Count: Observed count—number of times each response category was used across items and participants in percentage; Avg. measure: Average measure—mean ability of the participants getting a given score; Step calib.—Step calibrations or Rasch/Andrich thresholds correspond to the ability level at which adjacent scores are equally likely</p><p>^ϮNo threshold presented for category 0 because it is the lowest category.</p><p>Adult Strabismus-20 questionnaire (AS-20) before (left, 5 categories) and after (centre, 4 categories, and right, 3 categories) the collapsing procedure.</p

Overall performance of the AS-20 and its two subscales in adults with strabismus.

<p>AS-20—Adult strabismus-20 questionnaire</p><p>*Misfitting items were deleted iteratively and final revised versions are shown here. See text for details.</p><p>^ϮDifferential item functioning analyses was performed and tested across age, gender, location of residence and educational level.</p><p>Overall performance of the AS-20 and its two subscales in adults with strabismus.</p

Characteristics of the 584 participants who completed the Adult Strabismus-20 Questionnaire.

<p>^Ϯ Data not available for 15 patients</p><p>Characteristics of the 584 participants who completed the Adult Strabismus-20 Questionnaire.</p

Grand Challenges in global eye health: a global prioritisation process using Delphi method

Background: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods: Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings: Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation: This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding: The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations: For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.</p