Effectiveness of a novel mobile health (Peek) and education intervention on spectacle wear amongst children in India: Results from a randomized superiority trial in India.

BACKGROUND: Uncorrected refractive errors can be corrected by spectacles which improve visual functioning, academic performance and quality of life. However, spectacle wear can be low due to teasing/bullying, parental disapproval and no perceived benefit.Hypothesis: higher proportion of children with uncorrected refractive errors in the schools allocated to the intervention will wear their spectacles 3-4 months after they are dispensed. METHODS: A superiority, cluster-randomised controlled trial was undertaken in 50 government schools in Hyderabad, India using a superiority margin of 20%. Schools were the unit of randomization. Schools were randomized to intervention or a standard school programme. The same clinical procedures were followed in both arms and free spectacles were delivered to schools. Children 11-15 years with a presenting Snellen visual acuity of <6/9.5 in one or both eyes whose binocular acuity improved by ≥2 lines were recruited.In the intervention arm, classroom health education was delivered before vision screening using printed images which mimic the visual blur of uncorrected refractive error (PeekSim). Children requiring spectacles selected one image to give their parents who were also sent automated voice messages in the local language through Peek. The primary outcome was spectacle wear at 3-4 months, assessed by masked field workers at unannounced school visits. www.controlled-trials.com ISRCTN78134921 Registered on 29 June 2016. FINDINGS: 701 children were prescribed spectacles (intervention arm: 376, control arm: 325). 535/701 (80%) were assessed at 3-4 months: intervention arm: 291/352 (82.7%); standard arm: 244/314 (77.7%). Spectacle wear was 156/291 (53.6%) in the intervention arm and 129/244 (52.9%) in the standard arm, a difference of 0.7% (95% confidence interval (CI), -0.08, 0.09). amongst the 291 (78%) parents contacted, only 13.9% had received the child delivered PeekSim image, 70.3% received the voice messages and 97.2% understood them. INTERPRETATION: Spectacle wear was similar in both arms of the trial, one explanation being that health education for parents was not fully received. Health education messages to create behaviour change need to be targeted at the recipient and influencers in an appropriate, acceptable and accessible medium. FUNDING: USAID (Childhood Blindness Programme), Seeing is Believing Innovation Fund and the Vision Impact Institute

Quantification of retinal nerve fiber layer thickness using spectral domain optical coherence tomography in normal Indian population

The purpose of this study was to measure peripapillary retinal nerve fiber layer thickness (RNFLT) using spectral domain optical coherence tomography (SD-OCT) in normal Indian eyes, for which, 210 normal volunteers were recruited. One eye of each subject underwent RNFL scanning at 3.4 mm circle diameter around optic nerve using SD OCT. The data were analyzed to determine RNFLT in the sample population and its variation with age and gender. The average peripapillary RNFLT was 114.03 ± 9.59 μm. There was no effect of gender on RNFLT parameters. Age had significant negative correlation with average (P = 0.005), superior (P = 0.04), temporal (P = 0.049), and nasal quadrants (P = 0.01) RNFLT. Inferior quadrant RNFLT also had a negative correlation with age, but it was not statistically significant (P = 0.15)

Ability of spectral domain optical coherence tomography peripapillary retinal nerve fiber layer thickness measurements to identify early glaucoma

Purpose : To evaluate the ability of spectral domain optical coherence tomography (OCT) peripapillary retinal nerve fiber layer thickness (RNFLT) parameters to distinguish normal eyes from those with early glaucoma in Asian Indian eyes. Design : Observational cross-sectional study. Materials and Methods : One hundred and seventy eight eyes (83 glaucoma patients and 95 age matched healthy subjects) of subjects more than 40 years of age were included in the study. All subjects underwent RNFLT measurement with spectral OCT/ scanning laser ophthalmoscope (SLO) after dilatation. Sensitivity, specificity and area under the receiving operating characteristic curve (AROC) were calculated for various OCT peripapillary RNFL parameters. Results: The mean RNFLT in healthy subjects and patients with early glaucoma were 105.7 ± 5.1 μm and 90.7 ± 7.5 μm, respectively. The largest AROC was found for 12 o′clock- hour (0.98), average (0.96) and superior quadrant RNFLT (0.9). When target specificity was set at ≥ 90% and ≥ 80%, the parameters with highest sensitivity were 12 o′clock -hour (91.6%), average RNFLT (85.3%) and 12 o′ clock- hour (96.8 %), average RNFLT (94.7%) respectively. Conclusion : Our study showed good ability of spectral OCT/ SLO to differentiate normal eyes from patients with early glaucoma and hence it may serve as an useful adjunct for early diagnosis of glaucoma

Optic disc topography in normal Indian eyes using spectral domain optical coherence tomography

<b>Purpose:</b> The aim was to study optic nerve head (ONH) parameters in normal Indian eyes using spectral domain optical coherence tomography (OCT)/scanning laser ophthamoscope (SLO). <b>Materials and Methods:</b> One hundred and fifty-seven eyes of 157 normal subjects of various age groups underwent ONH imaging with spectral OCT/SLO and the parameters obtained were correlated with disc size. The effect of age, gender, and refractive error on various ONH parameters were also studied. <b>Results:</b> The mean optic disc area was 3.36 &#177; 0.64 mm ² (range, 2.13-5.08 mm ² ), mean rim area was 2.49 &#177; 0.58 mm ² (range, 1.20-3.62 mm ² ), and mean cup area was 1.10 &#177; 0.75 mm ² (range, 0-3.07 mm ² ). The disc area showed significant positive correlation with the rim area, cup area, horizontal cup disc ratio, vertical cup disc ratio, cup disc area ratio, mean cup depth, and maximum cup depth (<i>P</i> &lt; 0.001). Neither gender nor refractive error showed any significant difference in various ONH parameters. ONH parameters did not show significant change with age except for rim area which declined with the advancing age (<i>r</i> = -0.25, <i>P</i> &lt; 0.001). <b>Conclusions:</b> The quantitative measurement of ONH topography obtained with this study provides a normative database for an Indian population with spectral OCT/SLO. As optic disc area influences ONH topography, disc size should to be considered when evaluating optic disc for progressive optic neuropathies such as glaucoma