Elimination of avoidable blindness due to cataract: where do we prioritize and how should we monitor this decade?

BACKGROUND: In the final push toward the elimination of avoidable blindness, cataract occupies a position of eminence for the success of the Right to Sight initiative. AIMS: Review existing situation and assess what monitoring indicators may be useful to chart progress towards attaining the goals of Vision 2020. SETTINGS AND DESIGN: Review of published papers from low and middle income countries since 2000. MATERIALS AND METHODS: Published population-based data on prevalence of cataract blindness/visual impairment were accessed and prevalence of cataract blindness/visual impairment computed, where not reported. Data on prevalence of cataract blindness, cataract surgical coverage at different visual acuity cut offs, surgical outcomes, and prevalence of cataract surgery were analyzed. Scatter plots were used to look at relationships of some variables, with Human Development Index (HDI) rank. Available data on Cataract Surgical Rate (CSR) was plotted against prevalence of cataract surgery reported from surveys. RESULTS: Worse HDI Ranks were associated with higher prevalence of cataract blindness. Most studies showed that a significant proportion of the blind were covered by surgery, while a fifth showed that a significant proportion, were operated before they went blind. A good visual outcome after surgery was positively correlated with higher surgical coverage. CSR was positively correlated with cataract surgical coverage. CONCLUSIONS: Cataract surgical coverage is increasing in most countries at vision <3/60 and visual outcomes after cataract surgery are improving. Establishing population-based surveillance of cataract surgical need and performance is a strong monitoring tool and will help program planners immensely

Statistical analysis plan for the family-led rehabilitation after stroke in India (ATTEND) trial: A multicenter randomized controlled trial of a new model of stroke rehabilitation compared to usual care

Background In low- and middle-income countries, few patients receive organized rehabilitation after stroke, yet the burden of chronic diseases such as stroke is increasing in these countries. Affordable models of effective rehabilitation could have a major impact. The ATTEND trial is evaluating a family-led caregiver delivered rehabilitation program after stroke. Objective To publish the detailed statistical analysis plan for the ATTEND trial prior to trial unblinding. Methods Based upon the published registration and protocol, the blinded steering committee and management team, led by the trial statistician, have developed a statistical analysis plan. The plan has been informed by the chosen outcome measures, the data collection forms and knowledge of key baseline data. Results The resulting statistical analysis plan is consistent with best practice and will allow open and transparent reporting. Conclusions Publication of the trial statistical analysis plan reduces potential bias in trial reporting, and clearly outlines pre-specified analyses

Color vision devices for color vision deficiency patients:A systematic review and meta-analysis

Abstract Background and Aims There is insufficient evidence to support that using electronic or optical color vision devices improve color perception with current advanced technology. The purpose of this study is to compare and analyze the different color vision devices available for patients with color vision deficiency (CVD) and evaluate whether these devices improved their color perception. Methods This review included randomized, experimental, comparative studies, as well as narrative reviews, prototype and innovation studies, and translational studies, followed by case‐control and clinical trials with nonsurgical interventions studies, that is, electronic color vision devices, optical devices, and contact lens‐based studies, with standardized inclusion and exclusion criteria. Results The primary outcome studied was the performance of color vision devices, both objective and subjective. Secondary outcomes included the ease of use and accessibility of color vision devices and technology. The grading of recommendation, assessment, development, and evaluation framework was used to develop a systematic approach for consideration and clinical practice recommendation for CVD devices for color‐deficient populations. We incorporated meta‐analysis reports from a total of n = 16 studies that met the criteria which consisted of case‐control studies, prototype and innovation studies, comparative studies, pre‐ and post‐clinical trial studies, case studies, and narrative reviews. Proportion and standard errors, as well as correlations, were calculated from the meta‐analysis for various available color vision devices. Conclusion This review concludes that commercially available color vision devices, such as EnChroma Glasses, Chromagen filters, and EnChroma Cx‐14 do not provide clinically significant evidence that subjective color perception has improved. As a result, recommending these color vision devices to the CVD population may not prove high beneficial/be counterproductive. However, only a few color shades can be perceived differently. This systematic review and analysis will aid future research and development in color vision devices

Consanguinity and eye diseases with a potential genetic etiology. Data from a prevalence study in Andhra Pradesh, India

Purpose: To determine the prevalence of consanguinity and its potential associations with eye diseases in Andhra Pradesh state of south India. Methods: As part of a demographic interview schedule, prior to clinical examinations, trained investigators collected information regarding consanguinity of the parents from subjects randomly chosen for a population-based cross-sectional epidemiological study. Each subject underwent a detailed ocular examination including visual acuity measurements, anterior segment examinations with slit-lamp biomicroscopy, and posterior segment examinations. Adjusted odds ratios (OR), attributable risks (AR) and population attributable risks (PAR) were estimated. Results: We obtained details regarding consanguinity of the parents from 10,290 of the 10,293 subjects who were enumerated and examined in the study. Parental consanguinity was reported by 1822 (24.7%) rural subjects and 782 (32.9%) urban subjects. Eighty (0.008%, 95% CI: 0.006, 0.010) of the 9757 subjects had an ocular disease with a potential genetic basis. We found microcornea to be significantly associated with both an uncle-niece relationship (adjusted OR: 7.32, 95% CI: 1.73, 30.97, AR = 86.34%, PAR = 42.11%) and a first-cousin relationship between the parents (adjusted OR 4.51, 95% CI: 1.05, 19.40, AR = 77.83%, PAR = 29.02%). Retinitis pigmentosa was significantly associated with a first-cousin relationship between the parents (adjusted OR: 5.31, 95% CI: 1.00, 28.25, AR = 81.17%, PAR = 33.43%). Conclusions: The high prevalence of consanguinity in this population does not appear to translate into a high prevalence of ocular malformations; however, studies with larger sample sizes are required to further explore the strength of these associations